The worldwide investigating nurses' attitudes towards do-not-resuscitate order: a review

Philos Ethics Humanit Med. 2021 Sep 7;16(1):5. doi: 10.1186/s13010-021-00103-z.


Background: The acceptance or practical application of the do-not-resuscitate order is substantially dependent on internal or personal factors; in a way that decision-making about this issue can be specific to each person. Moreover, most nurses feel morally and emotionally stressed and confused during the process decision-making regarding DNR order. Therefore, the purpose of the present study was to evaluate nurses' attitudes towards DNR order in a systematic review.

Methods: This critical survey was conducted using a systematic review protocol. To this end, the most relevant articles published in domestic and foreign databases with no time limits until October 2018 were searched. The inclusion and exclusion criteria were articles on DNR order, studies about nurses' attitudes, descriptive and analytical research papers, as well as those with download links and full texts. The given articles were also assessed in terms of their quality and their main results were extracted.

Results: Of the total number of 1663 articles searched in the process of systematic review to investigate nurses' attitudes towards DNR order, 88 articles were included in the full-text review step and finally 10 articles, meeting the inclusion criteria, were found. Assessing the quality of articles included in this review showed that 8 articles, in general, were of good quality and 2 studies were characterized with moderate quality. The main factors associated with nurses' attitudes towards DNR order were grouped into three categories of (1) nurses' attitudes towards DNR order, (2) guidelines for DNR order, and (3) decision-making by patients and their families about DNR order. In most of the studies examined, nurses' attitudes towards DNR order were reported positive.

Conclusion: It seemed that nurses were willing to get involved in DNR order and each hospital was recommended to develop a written DNR policy directing individuals and avoiding their confusion in this respect.

Keywords: Attitudes; DNR Order; Do-Not-Resuscitate Order; Iran; Nurses; Systematic Review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Attitude of Health Personnel
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Nurses*
  • Nursing Staff, Hospital*
  • Resuscitation Orders