Absence of relatives impairs the approach of nurses to cardiopulmonary resuscitation in non-cancer elderly patients without a do-not-attempt-resuscitation order: A vignette-based questionnaire study

Asaka Higuchi, Morihito Takita, Azusa Yoshii, Tomoko Akiyama, Tsuyoshi Nemoto, Ritsuko Nakahira, Toshihiro Nakajima, Hiroki Fukahori, Masaharu Tsubokura, Rika Igarashi

Research output: Contribution to journalArticle


A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient’s personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses’ perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. A vignette-based questionnaire was used to evaluate nurses’ beliefs both before and after issuance of a DNAR order. Three vignettes were developed: the control vignette described an 85-year-old woman with repeated heart failure, the second and third incorporated a lack of relatives and a dementia diagnosis, respectively. The survey assessed the approach of nurses to 10 routine medical procedures, including CPR, clinical laboratory testing and nursing care, using a 5-base Likert-scale, for six vignette scenarios. A questionnaire was completed by 186 nurses (64% response). The pre-DNAR non-relative vignette showed significantly lower scores for CPR, indicating a deterioration in willingness to perform CPR, compared to the pre-DNAR control (median [interquartile]; 3 [2-4] and 4 [3-4] in the non-relative and control vignettes, respectively, p < 0.001). No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.

Original languageEnglish
Pages (from-to)71-78
Number of pages8
JournalTohoku Journal of Experimental Medicine
Issue number1
Publication statusPublished - 2020 Jan 1



  • Chronic disease
  • Dementia
  • Do-not-attempt-resuscitation order
  • Family relationship
  • Patient autonomy

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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