Clinicians’ perceptions and experiences regarding adult end of life decision making process within an inpatient setting

Abstract

Aim: To explore and describe medical doctors and nurses’ current knowledge, perceptions, attitudes and clinical practices regarding ‘Cardiopulmonary Resuscitation’ (CPR) and or ‘Not for Resuscitation’ (NFR) decisions for the adult end of life or dying patients. Additionally, this study sought to identify whether the clinicians’ knowledge, perceptions and practice differences were based on the clinicians’ years or practice or experience, strength of religious beliefs, professional position and ethnicity. Design: A descriptive design involving mixed method approach was utilised and the study was conducted in two phases. Setting: Five acute medical wards of a general district hospital which is located in South Auckland, New Zealand. Participants: All the clinicians were employed in one of the five study wards and had some experience with direct care of end life patients and or NFR decisions. The clinicians had a diverse range of clinical experiences, ethnic background, strength of religious beliefs and professional positions. Methods: In phase one, a total of 55/80 (response rate 69%) nurses and 16/40 (response rate 40%) doctors completed a self-administered questionnaire. This was followed by phase two in which eleven nurses participated in two separate focus group discussions. There were three participants in the doctors’ focus group discussion. The questionnaire data was analysed quantitatively via SPSS (Statistical Package for the Social Sciences) and generated descriptive statistics. The focus group discussion data was analysed qualitatively resulting in a number of themes. Results: A variety of stimulating results were revealed from both, questionnaire and focus group data. Data from the questionnaire and the focus group discussions were consistent with a few mixed results. The majority (91%) of clinicians reported that they had not received any training pertaining to NFR decisions and or end of life patients. There was evidence of uncertainty and lack of knowledge amongst clinicians regarding the legal interpretation of NFR decision. A wide range of clinicians’ perceptions, attitudes and clinical practices regarding NFR decisions was reported. Additionally, a number of clinicians’ attitudes, perceptions and clinical practices reached statistical significance and appeared to be influenced by clinicians’ years of practice, professional position, strength of religious beliefs and ethnicity. Furthermore, the findings of the focus group discussions revealed numerous difficulties that clinicians faced when making CPR/NFR decisions for the end of life patients. Conclusion: Clinicians need education, training and support both in undergraduate training programmes and clinical practice regarding end of life patient care and decisions. Enhanced training and support will not only reduce the complexities of DNR decisions but also reduce pain and suffering. Hence, better patient outcome can be achieved.