Nurses’ Attitudes Toward Do-Not-Resuscitate Orders in Intensive Care Units of Tertiary Care Hospitals in Lahore: A Descriptive Cross-Sectional Study

Abstract

Background: Do-Not-Resuscitate (DNR) orders are essential components of end-of-life care that guide healthcare professionals in withholding cardiopulmonary resuscitation (CPR) when it is unlikely to provide meaningful benefit to patients. Intensive Care Unit (ICU) nurses play a pivotal role in implementing DNR decisions and supporting patients and families during end-of-life care.

Objective: To assess the attitudes of nurses working in intensive care units toward DNR orders in tertiary care hospitals in Lahore, Pakistan.

Methods: A descriptive cross-sectional study was conducted among 202 registered nurses working in the ICUs of Jinnah Hospital and Lahore General Hospital, Lahore. Participants were selected using purposive sampling. Data were collected using a structured questionnaire adapted from Naghshbandi et al. (2019), comprising demographic characteristics and 11 attitude-related items measured on a five-point Likert scale. Data were analyzed using SPSS version 26. Descriptive statistics including frequencies, percentages, means, and standard deviations were used.

Results: Among the 202 participants, 75.2% were female and 24.8% were male. Positive attitudes toward DNR orders were observed across most questionnaire items, with mean scores ranging from 4.07 ± 0.86 to 4.29 ± 0.59. The highest agreement was reported for the statements “If CPR for my loved ones is futile, I would like to order DNR for them” (Mean = 4.29 ± 0.59) and “DNR order is not in conflict with my religious beliefs” (Mean = 4.29 ± 0.59). The negatively worded item regarding cultural barriers demonstrated a low mean score (1.69 ± 0.68), indicating disagreement with the statement. Overall, 93.6% of participants exhibited positive attitudes toward DNR orders, while 6.4% demonstrated neutral attitudes.

Conclusion: ICU nurses in tertiary care hospitals demonstrated predominantly positive attitudes toward DNR orders, reflecting acceptance of ethical end-of-life decision-making and recognition of patient dignity. Continuous professional education, institutional policies, and ethical training are recommended to strengthen confidence and consistency in DNR implementation.