Nurses’ involvement in ‘do not resuscitate’ decisions on acute elder care wards Cindy De Gendt 1 , Johan Bilsen 2 , Robert Vander Stichele 3 , Nele Van Den Noortgate 4 , Margareta Lambert 5 & Luc Deliens 6 Accepted for publication 31 August 2006 1 Cindy De Gendt MSc Researcher End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium 2 Johan Bilsen PhD RN Professor in Health Sciences and Nursing, End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium and Centre for Environmental Philosophy and Bioethics, Ghent University, Ghent, Belgium 3 Robert Vander Stichele MD PhD Professor of Pharmacology Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium 4 Nele Van Den Noortgate MD PhD Professor of Geriatric and Palliative Care Medicine Department of Geriatrics, Ghent University Hospital, Ghent, Belgium 5 Margareta Lambert MD Geriatrician Department of Geriatrics, Academic Hospital Vrije Universiteit Brussel, Brussels, Belgium 6 Luc Deliens PhD Professor of Health Sciences End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium and Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands Correspondence to Cindy De Gendt: e-mail: cdegendt@vub.ac.be DE GENDT C., BILSEN J., VANDER STICHELE R., VAN DEN NOORTGATE N., DE GENDT C., BILSEN J., VANDER STICHELE R., VAN DEN NOORTGATE N., LAMBERT M. & DELIENS L. (2007) LAMBERT M. & DELIENS L. (2007) Nurses’ involvement in ‘do not resuscitate’ decisions on acute elder care wards. Journal of Advanced Nursing 57(4), 404–409 doi: 10.1111/j.1365-2648.2006.04090.x Abstract Title. Nurses’ involvement in ‘do not resuscitate’ decisions on acute elder care wards Aim. This paper reports the involvement of nurses in ‘do not resuscitate’ decision- making on acute elder care wards and their adherence to such decisions in the case of an actual cardiopulmonary arrest. Background. Previous literature showed that nurses are involved in half or less than half of ‘do not resuscitate’ decisions in hospitals, but their involvement in this decision-making on acute elder care wards in particular has not been investigated. Method. A questionnaire was sent in 2002 to the head nurses of all acute elder care wards in Flanders, Belgium (n ¼ 94). They were asked whether nurses had been involved in the last ‘do not resuscitate’ decision-making process on their ward and whether nurses ‘never’, ‘rarely’, ‘sometimes’, ‘often’ or ‘always’ started resuscitation in case of cardiopulmonary arrest of patients with ‘do not resuscitate’ status and of those without. Results. The response rate was 86Æ2% (n ¼ 81). In 74Æ7% of the last ‘do not resuscitate’ decisions on acute elder care wards in Flanders, a nurse was involved in the decision-making process. For patients with ‘do not resuscitate’ status, 54Æ3% of respondents reported that cardiopulmonary resuscitation was ‘never’ started on their ward, ‘rarely’ on 39Æ5% and ‘sometimes’ on 6Æ2%. For patients without ‘do not resuscitate’ status, nurses started cardiopulmonary resuscitation ‘rarely’ or ‘sometimes’ on 22Æ2% of all wards, and ‘often’ or ‘always’ on 77Æ8%. Conclusion. To make appropriate ‘do not resuscitate’ decisions and to avoid rash decision-making in cases of actual cardiopulmonary arrest, nurses should be in- volved early in ‘do not resuscitate’ decision-making. If institutional ‘do not resus- citate’ guidelines were to stress more clearly the important role of nurses in all kinds of end-of-life decisions, this might improve the ‘do not resuscitate’ decision-making process. Keywords: acute care, cardiopulmonary resuscitation, ‘do not resuscitate’, elder care, nurses, questionnaire, survey ORIGINAL RESEARCH JAN 404 Ó 2007 The Authors. Journal compilation Ó 2007 Blackwell Publishing Ltd