Ethics, orthodoxies and defensive practice: a cross-sectional survey of nurse’s decision-making surrounding CPR in deceased inpatients without Do Not Resuscitate orders

作者：G. Mcerlean, Suzanne Bowdler, Joanne Cordina, H. Hui, E. Light, W. Lipworth, Susan Maitland, Eamon Merrick, Amy Montgomery, A. Preisz, L. Sheahan, S. Sheppard‐Law, George Skowronski, Cameron Stewart, J. Teus, Michael Watts, Sahn Zanotti, I. Kerridge · 发表于：BMC Medical Ethics · 年份：2025 · DOI：10.1186/s12910-025-01224-2 · 研究领域：Medicine

In hospital, nurses are often the first to identify patients in cardiorespiratory arrest and must decide whether to call a CODE BLUE and commence cardiopulmonary resuscitation (CPR). In Australia, there are no legal or policy obligations to commence CPR when unequivocal signs of death are present. The use of CPR where it cannot provide any benefit to a patient raises profound questions about decision-making and ethical practice. The aim of this empirical ethics study was to describe hospital-based nurses’ decision-making, perspectives, and experiences of initiating CPR in hospitalised patients who have unequivocal signs of death but lack a Do-Not-Resuscitate (DNR) order. The study was a multisite cross-sectional descriptive survey conducted between October 2023—April 2024. Nurses were presented with two clinical scenarios in which patients were found to have no signs of life: Mr. D, an 84-year-old male with cancer, and Mr. G, a 35-year-old male post-motor vehicle accident. Eligible participants were all nurses working in in-patient units. Descriptive statistics, Pearson Chi-square or Fisher’s exact tests, McNemar test, and binomial logistic regression were used to analyse the data. 531 nurses completed the survey. For Mr D, 61.5% (n = 324) would call a CODE BLUE, 24.1% (n = 127) would perform limited CPR. Only 14.4% (n = 76) would confirm death. For Mr G, 93.9% (n = 492) would call a CODE BLUE, 4.4% (n = 23) would perform limited CPR, and 1.7% (n = 9) would confirm death. The...