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      Lived experiences of Rwandan ICU nurses caring for patients with a do-not-resuscitate order



      Southern African Journal of Critical Care (Online)

      Health & Medical Publishing Group

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          BACKGROUND. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the Rwandan setting. PURPOSE. The purpose of this study was to explore the lived experiences of nurses caring for a patient with a DNR order in an intensive care unit (ICU) in Kigali, Rwanda, in order to suggest nursing recommendations. METHODS. Using a phenomenological approach, two semi-structured interviews were conducted with each participant to explore their lived experiences of caring for patients with DNR orders. The sample comprised six nurses from an ICU in a large tertiary-level hospital in Kigali, Rwanda. RESULTS. The data were organised into categories based on a review of the data from the interviews of the six participants. The categories were: feeling emotional distress; barrier to optimal care; and not part of decision-making. CONCLUSION. DNR orders are a fairly new concept in Rwanda and the practice of DNR orders in ICU is very demanding for the staff, especially the ICU nurses. Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work.

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          Most cited references 22

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          Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions.

          Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.
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            Relationship between ICU nurses' moral distress with burnout and anticipated turnover.

            Moral distress is one of intensive care unit nurses' major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses' personal and professional practice, recognizing moral distress is very important.
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              Do Not Attempt Cardiopulmonary Resuscitation orders in acute medical settings: a qualitative study.

               S Cohn,  Z Fritz,  J M Frankau (2013)
              Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders have been shown to be independently associated with patients receiving fewer treatments, reduced admission to intensive care and worse outcomes even after accounting for known confounders. The mechanisms by which they influence practice have not previously been studied.

                Author and article information

                Role: ND
                Role: ND
                Southern African Journal of Critical Care (Online)
                South. Afr. j. crit. care (Online)
                Health & Medical Publishing Group (Cape Town, Western Cape Province, South Africa )
                July 2017
                : 33
                : 1
                : 19-22
                Durban orgnameUniversity of KwaZulu-Natal orgdiv1School of Nursing and Public Health South Africa
                Kigali orgnameUniversity of Rwanda orgdiv1School of Medicine and Health Sciences Rwanda

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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