Myungsun Yi; Sang Eun Oh; Eun Ok Choi; In Gak Kwon; Sungbok Kwon; Kyung-mi Cho; Youngah Kang; Jeonghui Ok

doi:10.4040/jkan.2008.38.2.298

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Original Article
Hospital Nurses' Experience of Do-Not-Resuscitate in Korea: Myungsun Yi, Sang Eun Oh, Eun Ok Choi, In Gak Kwon, Sungbok Kwon, Kyung-mi Cho, Youngah Kang, Jeonghui Ok; Journal of Korean Academy of Nursing 2008;38(2):298-309.
DOI: https://doi.org/10.4040/jkan.2008.38.2.298
Published online: April 30, 2008

¹Professor, College of Nursing, Seoul National University, Seoul, Korea.

²Professor, College of Nursing, Chonnam National University, Gwangju, Korea.

³Associate Professor, Department of Nursing & Research Institute of Geriatric Health, Inje University, Busan, Korea.

⁴Professor, Department of Clinical Nursing Science, Samsung Medical Center, Seoul, Korea.

⁵Assistant Professor, Department of Nursing, Dongshin University, Naju, Korea.

⁶Associate Professor, Department of Nursing, Kyungin Women's College, Incheon, Korea.

⁷Nurse Coordinator, Department of Hematology, Asan Medical Center, Seoul, Korea.

⁸Nurse, Department of Nursing, Asan Medical Center, Seoul, Korea.

Address reprint requests to: Yi, Myungsun. College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-799, Korea. Tel: 82-2-740-8829, Fax: 82-2-6442-8829, donam@snu.ac.kr

• Received: January 22, 2008 • Accepted: March 31, 2008

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Abstract
NOTES
REFERENCES

Abstract

Purpose
The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses.
Methods
Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data.
Results
Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR.
Conclusion
Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.
Keywords: Bioethics; Resuscitation Orders; Qualitative Research; Nurses

This research was supported by the Korean Association for Qualitative Research in Nursing.

REFERENCES

1. Beauchamp TL, Childress JF. Principle of biomedical ethics. 2001;5th ed. New York, Oxford University Press.
2. Chung SP, Yoon CJ, Oh JH, Yoon SY, Chang WJ, Lee HS. A retroperspective review of the Do-Not-Resuscitate patients. Journal of the Korean Society of Emergency Medicine. 1998;9:271–276.
3. Condon JC. Interpersonal communication. 1977;New York, Macmillan Publishing Company.
4. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24:105–112.Article PubMed
5. Hall ET. Beyond culture. 1976;Doubleday Garden City, New York, Anchor Press.
6. Han SS. Ethical issues on DNR (Do Not Resuscitate) by patients with incurable disease. Korean Journal of Medical Ethics Education. 2005a;8:11–20.Article PDF
7. Han SS. The moral distress experienced by hospital nurses. Journal of the Korean Bioethics Association. 2005b;6(2):31–47.
8. Han SS, Chung SA, Ko GH, Han MH, Moon MS. Nurses' understanding and attitude on DNR. Journal of Korean Academy of Nursing Administration. 2001;7:403–413.
9. Han SS, Kim JH, Moon IS, Yong JS. Proposal of "request and order form" of Do Not Resuscitate (DNR). Journal of the Korean Bioethics Association. 2005;6:49–62.
10. Han SS, Park HA, Ahn SH, Oh HS, Kim KU. Korean nursing students' experience of ethical problems and use of ethical decision-making models. Journal of Korean Academy of Nursing. 2001;31:846–857.Article PDF
11. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005;15:1277–1288.Article PubMed PDF
12. Kim YS. Effect of ethics education on nurse's moral judgement. Journal of Korean Academy of Nursing. 2000;30:183–193.Article PDF
13. Kong BH. Asthetical-ethical paradigm of care ethics in nursing. Journal of Korean Academy of Nursing. 2002;32:364–372.
14. Lee SH, Kim JS, Hwang MJ, Hwang BD, Park YJ. Ethical dilemma associated with DNR: The attitude of clinical nurse. Clinical Nursing Rsearch. 1998;4:147–161.
15. Lee SM. A cross-cultural approach to biomedical ethics: Medical decision making. Korean Journal of Medical Ethics Education. 2007;10:23–32.Article PDF
16. Morgan DL. Qualitative content analysis: A guide to paths not taken. Qualitative Health Research. 1993;3:112–121.Article PubMed PDF
17. Park YO, Chang BH, Yoo MS, Cho YS, Kim HS. Nurses' perception over withdrawl of life-sustaining treatment. Korean Journal of Medical Ethics Education. 2004;7:198–216.
18. Sandelowski M. Focus on research method: Whatever happened to qualitative description? Research in Nursing & Health. 2000;23:334–340.
19. Son MS. Ethical and legal aspect of termination of hospital care. Journal of Korean Medical Association. 1998;41:707–711.

Figure & Data

REFERENCES

1. Beauchamp TL, Childress JF. Principle of biomedical ethics. 2001;5th ed. New York, Oxford University Press.
2. Chung SP, Yoon CJ, Oh JH, Yoon SY, Chang WJ, Lee HS. A retroperspective review of the Do-Not-Resuscitate patients. Journal of the Korean Society of Emergency Medicine. 1998;9:271–276.
3. Condon JC. Interpersonal communication. 1977;New York, Macmillan Publishing Company.
4. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24:105–112.Article PubMed
5. Hall ET. Beyond culture. 1976;Doubleday Garden City, New York, Anchor Press.
6. Han SS. Ethical issues on DNR (Do Not Resuscitate) by patients with incurable disease. Korean Journal of Medical Ethics Education. 2005a;8:11–20.Article PDF
7. Han SS. The moral distress experienced by hospital nurses. Journal of the Korean Bioethics Association. 2005b;6(2):31–47.
8. Han SS, Chung SA, Ko GH, Han MH, Moon MS. Nurses' understanding and attitude on DNR. Journal of Korean Academy of Nursing Administration. 2001;7:403–413.
9. Han SS, Kim JH, Moon IS, Yong JS. Proposal of "request and order form" of Do Not Resuscitate (DNR). Journal of the Korean Bioethics Association. 2005;6:49–62.
10. Han SS, Park HA, Ahn SH, Oh HS, Kim KU. Korean nursing students' experience of ethical problems and use of ethical decision-making models. Journal of Korean Academy of Nursing. 2001;31:846–857.Article PDF
11. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005;15:1277–1288.Article PubMed PDF
12. Kim YS. Effect of ethics education on nurse's moral judgement. Journal of Korean Academy of Nursing. 2000;30:183–193.Article PDF
13. Kong BH. Asthetical-ethical paradigm of care ethics in nursing. Journal of Korean Academy of Nursing. 2002;32:364–372.
14. Lee SH, Kim JS, Hwang MJ, Hwang BD, Park YJ. Ethical dilemma associated with DNR: The attitude of clinical nurse. Clinical Nursing Rsearch. 1998;4:147–161.
15. Lee SM. A cross-cultural approach to biomedical ethics: Medical decision making. Korean Journal of Medical Ethics Education. 2007;10:23–32.Article PDF
16. Morgan DL. Qualitative content analysis: A guide to paths not taken. Qualitative Health Research. 1993;3:112–121.Article PubMed PDF
17. Park YO, Chang BH, Yoo MS, Cho YS, Kim HS. Nurses' perception over withdrawl of life-sustaining treatment. Korean Journal of Medical Ethics Education. 2004;7:198–216.
18. Sandelowski M. Focus on research method: Whatever happened to qualitative description? Research in Nursing & Health. 2000;23:334–340.
19. Son MS. Ethical and legal aspect of termination of hospital care. Journal of Korean Medical Association. 1998;41:707–711.

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Hospital Nurses' Experience of Do-Not-Resuscitate in Korea

Journal of Korean Academy of Nursing. 2008;38(2):298-309. Published online April 30, 2008

DOI: https://doi.org/10.4040/jkan.2008.38.2.298

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Hospital Nurses' Experience of Do-Not-Resuscitate in Korea