Madeline Bass, BSc (Hons), RGN
Palliative Care Nurse Specialist, Ipswich Hospital NHS Trust, SuffolkThis paper will examine the results of a small-scale research study carried out in June 2000 on nurses working in an acute oncology and haematology unit. The research examined how some of these nurses felt about resuscitation decisions for oncology patients. It questioned what they felt their role was, if any, in such decisions and if this role was then fulfilled in practice. A phenomenological approach was used with semi-structured questionnaires. The main aims of the research are shown in Box 1.
A full literature review (Medline and Cinahl, 1995 to 2000) revealed that no previous studies had examined nurses' perceptions of their role within resuscitation decisions for oncology patients.
A phenomenological approach was used for the research, to provide qualitative data. The questionnaire was tested initially using five trained nurses from within the oncology and haematology unit (both inpatient and outpatient areas). This resulted in some minor grammatical changes to the wording of the questions. Semi-structured questionnaires were used, and were given to 30 trained nurses. The nurses were randomly chosen from a total population of 58. Seventeen anonymous responses were collected. The data were analysed, and sorted into eight main themes (Box 3).
The resuscitation processWhen asked about their role in resuscitation most nurses answered in terms of the practical aspects of the process of cardiopulmonary resuscitation itself, not in terms of other aspects, such as decision-making.
Certain variables could have affected the results:
Although the trained nurses in this study perceived their roles in resuscitation decisions to include accountability and advocacy, the majority of them felt unable to raise the subject themselves, or to initiate such discussion with patients/carers. Addressing such issues can be highly emotive and distressing for patients, their carers and staff. However, with increasing nurse autonomy within the clinical area comes increasing responsibility. Certain nurses may be more suited to discuss resuscitation with patients/carers than other members of the multidisciplinary team. Bearing this in mind, is it fair to expect nurses to carry out this discussion if it needs to be the doctor in charge who has the final say? Guidelines on such decisions (BMA et al, 2001) state that they should be multidisciplinary and include the patient, or carer. Nurses, as well as doctors, need the confidence and training to allow them to embrace this ideal (Box 4).
This study examined nurses' perceptions of their roles in the resuscitation status of oncology patients. Results from semi-structured questionnaires were examined through thematic analysis and revealed that, although nurses perceived their role as being that of an advocate, few felt they were able to act in this way. They also perceived their role towards the patients as one of an 'ethical protector' from the prospect of a futile resuscitation procedure. Most perceived their role to include accountability, mainly making sure that resuscitation forms had been completed. None of the respondents were aware of legal guidelines on resuscitation, and most were unsure of being involved in aiding patient autonomy within a resuscitation decision. It is clear that the decisions, although finally down to the doctor in charge, should be discussed by the multidisciplinary team, particularly those members who have had involvement with the patient.
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