Korean J Adult Nurs.  2019 Oct;31(5):540-551. 10.7475/kjan.2019.31.5.540.

Lived Experience of Primary Decision - Makers Regarding Do-Not-Resuscitate Instruction: Using Parse's Method

• Lee EY
• Shin SR

• KMID: 2461068
• DOI: http://doi.org/10.7475/kjan.2019.31.5.540

Abstract

PURPOSE
The purpose of this study was to identify the significance and structure of the painful experience of primary decision-makers regarding the Do-Not-Resuscitate (DNR) instruction.
METHODS
This study was a qualitative research based on Parse's qualitative research method. Participants were 7 family members who were primary decision-makers for regarding DNR instruction for the family member from July 28, to October 6, 2018.
RESULTS
The core concepts of the difficulties of the participants were Distress emerging from the pitiful condition of the patient, guilt, sadness and regret, Seeking comfort for loved ones, Uncertainty of DNR decision, Planning the resumption of daily life and decision about own DNR. The painful experience of participants can be defined as the process of empowering the patient through verbal communication with them, by valuing them, and by enabling them to overcome their limitations.
CONCLUSION
The result of this study is expected to contribute to a deep understanding of primary DNR decision-makers' suffering and developing guidelines for nursing care for health care professionals and primary DNR decision-makers who provide end-of-life care to the patients.

MeSH Terms

Delivery of Health Care
Guilt
Humans
Love
Methods*
Nursing Care
Qualitative Research
Resuscitation
Uncertainty

Reference

1. Bellini S, Damato EG. Nurses' knowledge, attitude/beliefs, and care practices concerning do not resuscitate status for hospitalized neonates. Journal of Obstetric Gynecologic & Neonatal Nursing. 2009; 38(2):195–205. https://doi.org/10.1111/j.1552-6909.2009.01009.x.

2. Jang SO. Experience of family with DNR and change of care after DNR decision - making in intensive care units [master's thesis]. Busan: Kyeong Sang National University;2000.

3. Kim A-K. The study of attitude to passive euthanasia among Korean nurses. Journal of Korean Academy of Fundamentals of Nursing. 2002; 9(1):76–85.

4. Baek SG. Dignity and dignity of life. The New Korean Philo-sophical Association Autumn Conference 2009. 2009. 1–17.

5. Statistics Korea. Life expectancy statistics of Korea [Internet]. Daejeon: Statistics Korea;2018. [cited 2019 February 4]. Available from:. http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1BPA201&vw_cd=MT_ZTITLE&list_id=A41_10&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=MT_ZTITLE.

6. Yoon M-S, Kim J-S. Factors to the withdrawing of life sustaining treatment among low income elderly. The Korean Academy of Mental Health & Social Work. 2015; 43(3):192–219.

7. Koh YS. Withdrawal of life-sustaining treatment for patients who are terminally ill. Journal of the Korean Medical Association. 2002; 45(6):650–2.

8. Byun EK, Choi HR, Choi AL, Hong KH, Kim NM, Kim HS. An investigative research on the attitudes of intensive care unit nurses and families on terminating life support. Journal of Korean Clinical Nursing Research. 2003; 9(1):112–24.

9. Baggs JG, Norton SA, Schmitt MH, Dombeck MT, Sellers CR, Quinn JR. Intensive care unit cultures and end-of-life decision making. Journal of Critical Care. 2007; 22(2):159–68. https://doi.org/10.1016/j.jcrc.2006.09.008.

10. Webster GC. Evaluation of a “do not resuscitate” policy in intensive care. Canadian Journal of Anaesthesia. 1991; 38(5):553–63.

11. Heagle J. Suffering and evil. Lee SY, translator. Seoul: Life Bible;2003. p. 21.

12. Larsen GA. Family members' experience with do-not-resusci-tate [dissertation]. Lincoln: The University of Nebraska;1993.

13. Handy CM, Sulmasy DP, Merkel CK, Ury WA. The surrogate's experience in authorizing a do not resuscitate order. Palliative & Supportive Care. 2008; 6(1):13–9. https://doi.org/10.1017/S1478951508000035.

14. Lind R, Lorem GF, Nortvedt P, Hevr⊘y O. Family members' experiences of "wait and see" as a communication strategy in end-of-life decisions. Intensive Care Medicine. 2011; 37(7):1143–50. https://doi.org/10.1007/s00134-011-2253-x.

15. Noome M, Dijkstra BM, van Leeuwen E, Vloet LC. Exploring family experiences of nursing aspects of end-of-life care in the ICU: a qualitative study. Intensive and Critical Care Nursing. 2016; 33:56–64. https://doi.org/10.1016/j.iccn.2015.12.004.

16. Kim J-H. Treatment withdrawal: characteristics of critically ill patients and experience of primary caregivers [master's thesis]. Seoul: Yonsei University;2003.

17. Ok J, Yi M. Understanding the experiences of family members who make Do-Not-Resuscitate decisions for cancer patients. Korean Journal of Medical Ethics. 2012; 15(1):34–51. https://doi.org/10.35301/ksme.2012.15.1.34.

18. Parse RR. Human becoming: Parse's theory of nursing. Nurse Science Quarterly. 1992; 5(1):35–42. https://doi.org/10.1177/089431849200500109.

19. Parse RR. Nursing science: major paradigms, theories, and cri-tiques. Philadelphia: Saunders;1987. p. 214.

20. Padget DK. Qualitative methods in social work research. Yu TG, translator. Paju: Nanam;2005. p. 280.

21. Park YO. The experience of family members on deciding to withdraw life-sustaining treatment for patients who are terminally ill. Korean Society of Nursing Science. 2004; 5:65–6.

22. Woo MG, Kim M. Nurses' experiences of Do-Not-Resuscitate (DNR) by the narrative inquiry. Korean Journal of Adult Nursing. 2013; 25(3):322–31. https://doi.org/10.7475/kjan.2013.25.3.322.

23. Lee SR, Shin D, Choi Y. Perceptions of caregivers and medical staff toward DNR and AD. The Korean Journal of Hospice and Palliative Care. 2014; 17(2):66–74. https://doi.org/10.14475/kjhpc.2014.17.2.66.

24. Song KO, Jo HS. Ethical awareness and attitudes of patients' families towards DNR (Do-Not-Resuscitate). Journal of Korean Clinical Nursing Research. 2010; 16(3):73–84.

25. Kwon JH. Do-not-resuscitation in terminal cancer patient. Korean Journal of Hospice and Palliative Care. 2015; 18(3):179–87. https://doi.org/10.14475/kjhpc.2015.18.3.179.

26. Gulanick M, Myers JL. Nursing care plans: diagnoses, intervention, and outcomes. 8th ed. Park EY, Song MR, Ryu EJ, Koh Y, Oh HJ, Bu SJ, translators. Seoul: Hyunmoon Publishing;2017. p. 403–12.

27. Han SS. Doctor's and nurses' perception and experiences of DNR. Journal of Korean Academy of Nursing Administration. 2005; 11(3):1–16.

28. Heo DS. Withholding futile interventions from terminally ill cancer patients. Journal of Korean Medical Association. 2001; 44(9):956–62. https://doi.org/10.5124/jkma.2001.44.9.956.

29. Kim K. Civil liability of medical doctors for withdrawing life sustaining treatment. Democratic Legal Studies. 2008; 38:137–62. https://doi.org/10.15756/dls.2008..38.137.

30. Westphal DM, McKee SA. end-of-life decision making in the intensive care unit: physician and nurse perspectives. American Journal of Medical Quality. 2009; 24(3):222–8. https://doi.org/10.1177/1062860608330825.