RESUSCITATION DECISIONS IN RESIDENTS WITH NO DNR ORDER

本研究的目的是疗养院的复苏决策

The purpose of this study of resuscitation decisions for nursing home residents with no "do not resuscitate" (DNR) order is to provide empirical information about the knowledge and preferences of competent residents regarding CPR, the congruence between resident preferences and those of persons they identify as decision makers in the event that they become incompetent, nursing home practices related to CPR for non-DNR residents, and staff decisions about resuscitating non-DNR residents. Information will be obtained about a subset of predictor variables do differentiate between decisions for or against resuscitation in nursing home residents who do not have a DNR order. For residents, the putative predictor variables are age, sex, education, religious affiliation, perceived health, functional status, and understanding of CPR. For health care providers, the putative predictor variables are their role, age, sex, education, religious affiliation, perception of efficacy of CPR, and four characteristics of hypothetical residents in vignettes (sex, physical status, cognitive status, interpersonal "appeal"). Nursing home characteristics to be examined as predictors of CPR practice include size, ownership, location, having a written policy regarding resuscitation, having an ethics committee, requiring CPR certification of staff, having CPR-related resources. From a stratified random sample of 50 licensed nursing homes, a random sample of 100 competent residents with no DNR order will be interviewed, as will their designated decision makers. A mail survey of 250 health care providers from the 50 facilities (the director of nursing, three staff nurses, and the medical director from each nursing home) will be conducted to elicit data regarding nursing home practices, provider characteristics, and CPR decisions in response to four vignettes. Such information will be useful in designing larger scale studies that will: a) contribute to the development of substantive and procedural standards for decisions about resuscitation of residents with no DNR orders, and b) help to determine needs of consumers and health care providers for education about these issues.