Nurses’ perceptions of medical procedures and nursing practices for older patients with non-cancer long-term illness and do-not-attempt-resuscitation orders: A vignette study

Aim: To elucidate influence of a do-not-attempt-resuscitation (DNAR) order on nurses’ perceptions of the medical procedures and nursing practices for non-cancer older patients. Design: A vignette-based questionnaire study. Methods: A questionnaire survey asking nurses their perceptions of clinical practices for the following three vignettes was performed in a community hospital in Japan (N = 120): the control vignettes with an older patient with repeated heart failure who was living alone and the other two with either an absence of relatives or a diagnosis of dementia. We also prepared additions to each vignette describing a DNAR order. Results: Nurses’ perception on cardiopulmonary resuscitation, defibrillation, blood tests and intravenous nutrition showed statistically significant and minimally important declines after the DNAR order compared with before for all three vignettes (p <.001). DNAR orders can influence nurses’ perceptions of clinical practices for non-cancer older patients with chronic heart failure.