Date of Award

12-5-2021

Degree Type

Thesis

Degree Name

Master of Science in Nursing (MScN)

First Advisor

Dr. Salma Rattani

Second Advisor

Dr. Atif Waqar

Third Advisor

Ms. Zohra Kurji

Department

School of Nursing and Midwifery, Pakistan

Abstract

Background: A Do-not resuscitate (DNR) order implies that the decision has been made not to perform advanced coronary pulmonary rescue in case of cardiac or pulmonary arrest, where cardiopulmonary resuscitation (CPR) might jeopardize the quality of life, yet, not to forgo any other aspect of clinical care. Health care providers (HCPs) play a vital role in caring for all the patients, including the DNR patients; they make a multidisciplinary team that works together to treat a patient, and doctors and nurses are important members of this team. Perspectives of nurses and physicians about the quality of care strongly influence their attitudes and practices towards the care. Therefore, it was considered important to explore the perspectives of physicians and nurses, working in an inpatient setting, about their aspects of care delivery to DNR patients. In addition, perspectives about the care of DNR patients have not being explored in Pakistan before, as per the researcher’s knowledge.
Purpose: The purpose of the study was to explore the experiences of health care providers regarding the care of DNR patients, in a tertiary care hospital in Pakistan. The study also aimed to identify the challenges faced by the HCPs, and their proposed recommendations to improve the quality of care for DNR patients.
Methodology: This study was conducted using a descriptive exploratory design. It was conducted in the non-critical adult patient care areas of a private tertiary care hospital in Karachi, Pakistan. The participants were attending physicians/consultants, registered nurses, residents, and nursing technicians working in the non-critical medical units. The study sample consisted of 15 participants. Semi-structured interviews were conducted for data collection. Analysis was performed manually, by using the content analysis approach, to generate the themes and categories.
Results: Three major themes were identified from the data analysis: (i) Describing the DNR order (ii) Challenges in dealing with the DNR patients (iii) Strategies to improve care. Categories and sub-categories were also extracted through analysis. The findings revealed that a significant population of patients comprises DNR patients, towards whom various health care providers have different perspectives. Continuous education and training, staff sensitization, and awareness about patients’ autonomy are required to improve the quality of care being provided to the DNR patients.
Conclusion: The study explored health care providers’ perceptions about the care of DNR patients in the inpatient general units. The findings of the study generated health care providers’ understanding of care for DNR patients, and proposed various strategies to improve the standard of care for DNR patients.

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1

Last Page

112

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