Aims This study explored the thoughts and feelings of hospice nurses regarding Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) discussions and the potential extension of their role in this including formal documentation of the outcome of that discussion by signing the DNACPR form.
Methods Eight semi-structured interviews were carried out with senior hospice inpatient and day therapy nurses. Interpretive phenomenological analysis was used to explore the shared lived meaning of this phenomenon.
Results Four themes emerged:
1. Current practice around hospice nurses
2. How proposed changes to practice may enhance patient experience
3. The benefits to hospice nurses
4. The challenges of this change in role.
Participants appeared confident with the concept of nurses discussing and documenting DNACPR decisions. They could envisage that seamless advance care planning would enhance patient care, and that nurses’ rapport with patients made them best placed to have these conversations. Hospice nurses reported numerous potential barriers to extending their role including: impact on peer relationships and relationships with doctors; anxiety about having DNACPR discussions with some evidence of censoring of conversations and selection of which ones they would engage with; anxiety about the responsibility for such decisions if the patient changed place of care. Although participants did not perceive stable or prolonged illness trajectories as a barrier for discussing DNACPR, they did consider a patient’s uncertainty about the prognosis to be a barrier.
Conclusion Hospice nurses exhibited cognitive dissonance; they had discord between knowing what good practice was and completing it in action. They appeared to value ‘niceness’ over honesty and their censoring of conversations resonates with communication awareness theories.
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