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. 2025 Sep 10.
doi: 10.1097/JPN.0000000000000865. Online ahead of print.

Factors Influencing Awareness and Attitude Regarding Do-Not-Resuscitation Orders Among Nurses Working in Neonatal Intensive Care Unit: A Mixed-Method Study

Jessie Shaji Paul  1 , Anu P, Surya Kant Tiwari, Shanty Charlin, Meena Joshi, Ankit Verma, Poonam Joshi
Affiliations

Factors Influencing Awareness and Attitude Regarding Do-Not-Resuscitation Orders Among Nurses Working in Neonatal Intensive Care Unit: A Mixed-Method Study

Jessie Shaji Paul et al. J Perinat Neonatal Nurs. .

Abstract

Purpose: This sequential mixed-method study explores neonatal intensive care unit (NICU) nurses' awareness, attitudes, and perceptions regarding do-not-resuscitate (DNR) orders.

Methods: Quantitative surveys were conducted among 50 neonatal nurses, supplemented by qualitative focused group discussions involving 10 participants. Data collection included structured questionnaires assessing awareness and attitudes toward DNR orders, alongside qualitative interviews to capture their perceptions.

Results: The mean age of the participants was 33.88 ± 8.60 years, predominantly females (98.0%), young adults (44.0%), and holding degree in nursing (68.0%). Findings indicated that over half of the neonatal nurses had poor awareness (52%) and negative attitudes (50%) toward DNR orders. Factors such as being unmarried (adjusted odds ratio [AOR] = 0.01, confidence interval [CI] = 0.01-0.27), <5 years of NICU experience (AOR = 0.04, CI = 0.00-0.53), and not attending refresher course on End of Life Care (AOR = 0.87, CI = 0.00-0.99) significantly reduced odds of good awareness. Additionally, being Christian (AOR = 0.01, CI = 0.00-0.40), unmarried (AOR = 0.05, CI = 0.00-0.51), and <5 years of NICU experience (AOR = 0.03, CI = 0.00-0.38) were associated with significantly lower odds of positive attitude toward DNR orders. Qualitative insights highlight emotional challenges and feelings of inadequacy among nurses during DNR order discussions with parents.

Conclusion: The study highlights a need for comprehensive training and support for NICU nurses in navigating DNR order discussions effectively.

Practical implications: Hospitals must prioritize regular nurse training on DNR orders. NICU settings need counseling support. Nurses' training should emphasize empathy and effective communication for sensitive DNR discussions.

Precise: Most neonatal nurses lacked awareness and positive attitudes toward DNR orders, influenced by factors like marital status and NICU experience. Qualitative insights revealed emotional challenges in discussing DNR with parents.

Keywords: attitude; awareness; cardiopulmonary resuscitations; neonatal intensive care units; neonatal nurses; resuscitation orders.

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References

    1. Sawyer T, McBride ME, Ades A, Kapadia VS, Leone TA, Lakshminrusimha S, et al. Considerations on the use of neonatal and pediatric resuscitation guidelines for hospitalized neonates and infants: on behalf of the American Heart Association emergency cardiovascular care committee and the American Academy of Pediatrics. Pediatrics. 2024;153(1):e2023064681. doi:10.1542/peds.2023-064681. - DOI
    1. Mishra S, Mukhopadhyay K, Tiwari S, Bangal R, Yadav BS, Sachdeva A, et al. End-of-life care: Consensus statement by Indian Academy of Pediatrics. Indian Pediatr. 2017;54(10):851–859. doi:10.1007/s13312-017-1149-4. - DOI
    1. Joshi P, Verma A, Kapoor A, Paul JS, Joshi M. Assisting parents in making “do not resuscitate” decisions for their neonates in a neonatal intensive care unit of a tertiary care facility of a developing country. J Neonatal Nurs. 2023;29(1):217–218. doi:10.1016/j.jnn.2022.08.003. - DOI
    1. Definition of do not resuscitate order—NCI Dictionary of Cancer Terms–NCI. Published February 2, 2011. Accessed March 3, 2024. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/do-not...
    1. Kaneetah AH, Baowaidan FO, Abulaban BA, Sabban MF, Alshehri AS, Kaneetah AH, et al. The perspectives of the general population and relatives of cancer patients with respect to the do-not-resuscitate order. Cureus. 2019;11(1):e3968. doi:10.7759/cureus.3968. - DOI

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