Nurses’ Opinions on Do-Not-Resuscitate Orders

2020 ◽  
pp. 003022282096931
Author(s):  
Şenay Gül ◽  
Gülcan Bağcivan ◽  
Miray Aksu
Keyword(s):  
Healthcare Professionals ◽  
Decision Makers ◽  
Do Not Resuscitate ◽  
Future Studies ◽  
Ethical Competence ◽  
Positive Attitudes ◽  
Bachelor's Degrees ◽  
Decision Making Processes ◽  
The Mean ◽  
Dnr Orders

The aim of this study was to determine nurses’ opinions on Do Not Resuscitate (DNR) orders. This is a descriptive study. A total of 1250 nurses participated in this study. The mean age of participants was 34.5 ± 7.7 years; 92.6% were women; 56.4% had bachelor’s degrees, and 28.8% were intensive care, oncology, or palliative care nurses. Most participants (94.3%) agreed that healthcare professionals involved in DNR decision-making processes should have ethical competence, while they were mostly undecided (43%) about the statement whether or not DNR should be legal. More than half the participants (60.2%) disagreed with the idea that DNR implementation causes an ethical dilemma. Participants’ opinions on DNR decisions significantly differed according to the number of years of employment and unit of duty. The results showed that most of the nurses had positive attitudes towards DNR orders despite it being illegal. Future studies are needed to better understand family members’ and decision makers’ perceptions of DNR orders for patients.

scholarly journals Implementation of a novel prehospital advance directive protocol in southeastern Ontario

CJEM ◽  
2007 ◽  
Vol 9 (04) ◽  
pp. 250-259 ◽  
Author(s):  
Rose P. Mengual ◽  
Michael J. Feldman ◽  
Gord R. Jones
Keyword(s):  
Prospective Observational Study ◽  
Small Sample Size ◽  
Small Sample ◽  
Decision Makers ◽  
Prehospital Setting ◽  
Do Not Resuscitate ◽  
Surrogate Decision Makers ◽  
The Mean ◽  
Surrogate Decision

ABSTRACTIntroduction:Do not resuscitate (DNR) orders are commonly accepted in most health care settings, but are less widely recognized in the prehospital setting. We describe the implementation of and satisfaction with a prehospital DNR protocol that allows paramedics to honour verbal and non-standard written DNR requests.Methods:This prospective observational study reviewed all cardiac arrests in southeastern Ontario between March 1, 2003 and September 31, 2005. Following a verbal or non-standard written DNR request, paramedics completed a questionnaire and a follow-up structured telephone interview was conducted with surrogate decision makers (SDMs).Results:There were 1890 cardiac arrests during the study period, of which 86 met our inclusion criteria. Paramedic surveys were available for 82 cases (95%), and surrogate decision makers (SDMs) were successfully contacted in 50 (58%) of them. Two SDMs declined to be interviewed. The mean patient age was 72.7 (standard deviation 13.8) years and 65% were male. Sixty-three (73%) of DNR requests were verbal, and 23 (27%) were written. The mean paramedic comfort was rated 4.9 on a 5-point Likert scale (with 5 being “very comfortable” ) (95% confidence interval [CI] 4.9–5.0). The mean SDM comfort was rated by paramedics as 4.9 (95% CI 4.8 –4.9). SDMs reported comfort in withholding CPR in 47 of 48 cases (98%), and with paramedic care in all cases. One SDM stated that although it was consistent with the patient's wishes, she was uncomfortable having to make the DNR request.Conclusions:Satisfaction with this novel prehospital DNR protocol was uniformly high among paramedic and SDM respondents. It appears that such a protocol is feasible and acceptable for the prehospital setting. Our conclusions are limited by a small sample size, the lack of a comparison group, and limited follow-up.

Orders Not to Resuscitate: The Sharon Siebert Case

1981 ◽  
Vol 2 (5) ◽  
pp. 3-7
Author(s):  
George J. Annas
Keyword(s):  
Do Not Resuscitate ◽  
Lower Court ◽  
Legal Standard ◽  
Dnr Orders

In a previous column I discussed the testimony of a number of nurses in the case of Ms. Sharon Siebert. That case was decided by a lower court on February 13, 1981, and this column discusses Judge Lindsay G. Arthur's opinion. Jane Hoyt, a friend, not a relative, of Ms. Siebert, brought suit to enjoin an order not to resuscitate that had been written on Ms. Siebert. The case raised a number of important issues, including whether the court would allow a suit brought by someone in Ms. Hoyt's position vis-à-vis the patient, and if it did, what legal standard the court might require in the writing of Do Not Resuscitate (DNR) orders.

A systematic review into healthcare professionals’ attitudes towards self-harm in children and young people and its impact on care provision

2021 ◽  
pp. 136749352110144
Author(s):  
Lea Raquel Ribeiro Coimbra ◽  
Amy Noakes
Keyword(s):  
Young People ◽  
Healthcare Professionals ◽  
Educational Opportunities ◽  
Emotional Impact ◽  
Valuable Insight ◽  
Care Provision ◽  
Children And Young People ◽  
Positive Attitudes ◽  
Self Harm ◽  
Impact Patient Care

Self-harming behaviours in children and young people are an alarming reality, with provision of effective treatment historically compromised. The present systematic literature review highlights attitudes displayed by healthcare professionals towards this health problem, providing valuable insight by analysing how these attitudes can impact patient care. Ten studies were included, allowing creation of a narrative synthesis of qualitative, quantitative and mixed-methods evidence. Six themes emerged: negativity, positivity, worry or fear, the emotional impact of working with these patients, professional roles and ward-dependent concerns. Overall, professional negativity towards this patient group, in the form of apprehensiveness, was accentuated by fear of worsening their symptoms. The attitude aforementioned impacts on treatment by hindering creation of meaningful therapeutic relationships. Educational opportunities that increase healthcare professionals’ knowledge of self-harm have the potential to provide invaluable power by promoting positive attitudes.

Association between obstructive sleep apnea and persistent-postural perceptual dizziness

2021 ◽  
pp. 1-6
Author(s):  
Anand K. Bery ◽  
Jayson Lee Azzi ◽  
Andre Le ◽  
Naomi S. Spitale ◽  
Judith Leech ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sensitivity And Specificity ◽  
Berlin Questionnaire ◽  
Future Studies ◽  
Obstructive Sleep ◽  
Chronic Dizziness ◽  
Patients At Risk ◽  
The Mean ◽  
The Relationship

BACKGROUND: Obstructive sleep apnea (OSA) has been linked to vestibular dysfunction, but no prior studies have investigated the relationship between Persistent Postural Perceptual Dizziness (PPPD), a common cause of chronic dizziness, and OSA. OBJECTIVE AND METHODS: We determined the frequency of OSA in an uncontrolled group of PPPD patients from a tertiary dizziness clinic based on polysomnogram (PSG). We then assessed the sensitivity and specificity of common OSA questionnaires in this population. RESULTS: Twenty-five patients with PPPD underwent PSG (mean age 47, 60% female, mean BMI 29.5). A majority, or 56%, of patients were diagnosed with OSA, and in most, the OSA was severe. OSA patients were older (56 years versus 40 years, p = 0.0006) and had higher BMI (32 versus 26, p = 0.0078), but there was no clear gender bias (56% versus 64% female, p = 1.00). The mean sensitivity and specificity of the STOP BANG questionnaire for detecting OSA was 86% and 55%, respectively. Sensitivity and specificity of the Berlin Questionnaire was 79% and 45%, respectively. CONCLUSIONS: The prevalence of OSA was much higher in our small PPPD group than in the general population. Screening questionnaires appear to demonstrate good sensitivity to detect PPPD patients at risk of OSA in this small study. Future studies should confirm these findings and determine whether treatment of OSA improves symptoms in PPPD.

scholarly journals Diurnal Body Temperature and Rate of Passage of Loggers in Lions

Animals ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1388
Author(s):  
Ted Friend ◽  
Giulia Corsini ◽  
Vincent Manero ◽  
Raffaella Cocco
Keyword(s):  
Body Temperature ◽  
Time Frame ◽  
Heat Lamp ◽  
Future Studies ◽  
Ambient Temperatures ◽  
Diurnal Patterns ◽  
Data Loggers ◽  
The Mean ◽  
African Lions ◽  
Circadian Patterns

The documentation of diurnal patterns in body temperature in lions could be important because disruption of circadian patterns can be a useful measure of distress. This study quantified changes in body temperature of seven African lions (Panthera leo) at 5 min intervals during cold conditions from noon until the ingested body temperature loggers were expelled the next day. Thirteen loggers were fed to 11 lions during their daily noon feeding, while ambient temperatures were also recorded using six data loggers. The lions had continuous access to their dens and exercise pens during the day but were restricted to their heavily bedded dens that also contained a heat lamp from 23:00 until 08:00 the next day. Body temperatures averaged 37.95 ± 0.42 °C at 15:50, and 36.81 ± 0.17 °C at 06:50 the next day, 30 min before the first loggers passed from a lion, and were significantly different (t-test, t = 8.09, df = 6, p < 0.0003). The mean duration for the time of passage was 22 ± 2.69 (h ± SD), so future studies using the noninvasive feeding of temperature loggers need to consider that time frame.

scholarly journals Comparing Sudden Stratospheric Warming Definitions in Reanalysis Data*

2015 ◽  
Vol 28 (17) ◽  
pp. 6823-6840 ◽  
Author(s):  
Froila M. Palmeiro ◽  
David Barriopedro ◽  
Ricardo García-Herrera ◽  
Natalia Calvo
Keyword(s):  
Seasonal Cycle ◽  
Winter Season ◽  
Reanalysis Data ◽  
Sudden Stratospheric Warming ◽  
Pronounced Increase ◽  
Future Studies ◽  
Common Peak ◽  
Before And After ◽  
The Mean ◽  
Large Case

Abstract Sudden stratospheric warmings (SSWs) are characterized by a pronounced increase of the stratospheric polar temperature during the winter season. Different definitions have been used in the literature to diagnose the occurrence of SSWs, yielding discrepancies in the detected events. The aim of this paper is to compare the SSW climatologies obtained by different methods using reanalysis data. The occurrences of Northern Hemisphere SSWs during the extended-winter season and the 1958–2014 period have been identified for a suite of eight representative definitions and three different reanalyses. Overall, and despite the differences in the number and exact dates of occurrence of SSWs, the main climatological signatures of SSWs are not sensitive to the considered reanalysis. The mean frequency of SSWs is 6.7 events decade−1, but it ranges from 4 to 10 events, depending on the method. The seasonal cycle of events is statistically indistinguishable across definitions, with a common peak in January. However, the multidecadal variability is method dependent, with only two definitions displaying minimum frequencies in the 1990s. An analysis of the mean signatures of SSWs in the stratosphere revealed negligible differences among methods compared to the large case-to-case variability within a given definition. The stronger and more coherent tropospheric signals before and after SSWs are associated with major events, which are detected by most methods. The tropospheric signals of minor SSWs are less robust, representing the largest source of discrepancy across definitions. Therefore, to obtain robust results, future studies on stratosphere–troposphere coupling should aim to minimize the detection of minor warmings.

scholarly journals Carotid Plaque Characterization Using Digital Image Processing and its Potential in Future Studies of Carotid Endarterectomy and Angioplasty

1998 ◽  
Vol 5 (3) ◽  
pp. 240-246 ◽  
Author(s):  
Giorgio M. Biasi ◽  
Paolo M. Mingazzini ◽  
Lucia Baronio ◽  
Maria Rosa Piglionica ◽  
Stefano A. Ferrari ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Carotid Endarterectomy ◽  
Carotid Plaque ◽  
Screening Tool ◽  
Brain Infarction ◽  
Carotid Stent ◽  
Plaque Characterization ◽  
Duplex Scan ◽  
Future Studies ◽  
The Mean

Purpose: To corroborate the validity of a computerized methodology for evaluating carotid lesions at risk for stroke based on plaque echogenicity. Methods: The records of 96 carotid endarterectomy patients (59 men; median age 69.5 years, range 52 to 83) with stenoses > 50% were studied retrospectively. Forty-one patients (43%) had been symptomatic preoperatively. All patients had undergone computed tomography (CT) to detect infarction in the carotid territory and a duplex scan to measure carotid stenosis. Plaque echogenicity was analyzed by computer, expressing the echodensity in terms of the gray scale median (GSM). The incidence of CT-documented cerebral infarction was analyzed in relation to symptomatology, percent stenosis, and echodensity. Results: Symptoms correlated well with CT evidence of brain infarction: 32% of symptomatic patients had a positive CT scan versus 16% for asymptomatic plaques (p = 0.076). The mean GSM value was 56 ± 14 for plaques associated with negative CT scans and 38 ± 13 for plaques from patients with positive scans (p < 0.0001). However, there was no difference in the GSM value between plaques with > or < 70% stenosis. Furthermore, the incidence of CT infarction was 40% in the cerebral territory of carotid plaques with a GSM value < 50 and only 9% in those with a GSM > 50 (p < 0.001). Conclusions: Computerized analysis of plaque echogenicity appears to provide clinically useful data that correlates with the incidence of cerebral infarction and symptoms. This method of analyzing plaque echolucency could be used as a screening tool for carotid stent studies to identify high-risk lesions better suited to conventional surgical treatment.

scholarly journals Survey of general practitioners' attitudes towards psychiatry

2010 ◽  
Vol 34 (12) ◽  
pp. 525-528 ◽  
Author(s):  
Catherine Thompson ◽  
Nisha Dogra ◽  
Robert McKinley
Keyword(s):  
General Practitioners ◽  
Role Models ◽  
Positive Attitude ◽  
Demographic Data ◽  
Current Data ◽  
Undergraduate Teaching ◽  
Individual Response ◽  
Positive Attitudes ◽  
The Mean ◽  
Teaching Psychiatry

Aims and methodThere is a lack of current data regarding attitudes of doctors towards psychiatry. General practitioners (GPs) are increasingly involved in teaching psychiatry, and their attitudes towards psychiatry may affect their ability to promote psychiatry. The main aim of the study is to inform on current attitudes of GPs towards psychiatry as a discipline. The Attitudes Towards Psychiatry (ATP-30) questionnaire was administered to all GPs within Shropshire.ResultsThe response rate was 61% (n = 145 from N = 239). The mean score for the ATP-30 was 113.9. An association was found between GP trainer status and higher ATP-30 scores. Positive associations were found between demographic data (age, length of career, postgraduate experience of psychiatry, involvement in undergraduate teaching, GP trainer status) and individual response items on the ATP-30 scale.Clinical implicationsGeneral practitioners in Shropshire have a positive attitude towards psychiatry. Associations between demographic data and ATP-30 scores indicate that GPs with more experience of psychiatry and those involved in training may have more positive attitudes. The main limitation of the study is the lack of proven validity of the scale for use in this population. The positive attitude towards psychiatry is consistent with GPs providing the role models needed if they are to be involved to a greater degree with teaching and promoting psychiatry as a career. The need for the development of a more specific tool or an update to the existing tool is discussed.

Framing Information Technology Governance in the Public Sector: Opportunities and Challenges

2015 ◽  
Vol 11 (4) ◽  
pp. 89-101 ◽  
Author(s):  
Khalifa Al-Farsi ◽  
Ramzi EL Haddadeh
Keyword(s):  
Decision Making ◽  
Information Technology ◽  
Public Sector ◽  
It Governance ◽  
Decision Makers ◽  
The Public ◽  
Technology Governance ◽  
Support Organizations ◽  
Information Technology Governance ◽  
Decision Making Processes

Information technology governance is considered one of the innovative practices that can provide support for decision-makers. Interestingly, it has become increasingly a de facto for organizations in seeking to optimise their performance. In principle, information technology governance has emerged to support organizations in the integration of information technology (IT) infrastructures and the delivery of high-quality services. On the other hand, decision-making processes in public sector organisations can be multi-faceted and complex, and decision makers play an important role in implementing technology in the public sector. The aim of this paper is to shed some light on current opportunities and challenges that IT governance is experiencing in the context of public sector services. In this respect, this paper examines the factors influencing the decision-making process to fully appreciate IT governance. Furthermore, this study focuses on combining institutional and individual perspectives to explain how individuals can take decisions in response to institutional influences.

Do Not Resuscitate (DNR) Orders

2004 ◽  
pp. 149-153
Author(s):  
Ronald L. Eisenberg
Keyword(s):  
Do Not Resuscitate ◽  
Dnr Orders
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