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Paramedic attitudes towards DNACPR orders

02 October 2017
Volume 9 · Issue 10

Abstract

Background:

Qualitative research involving paramedics and their involvement in end-of-life (EoL) care has already been published, but there have been no published attitudinal studies specifically relating to do not attempt cardiopulmonary resuscitation (DNACPR) orders and paramedics working in the pre-hospital setting in the UK.

Objective:

To gain an understanding of paramedic attitudes towards an increasingly common aspect of paramedic practice, focusing specifically on the pre-hospital environment and identifying any corelation between gender, length of service, and level of educational attainment.

Design:

A paper-based questionnaire was distributed to all paramedic grades, operational out of two ambulance stations of a regional NHS ambulance service in March 2017. The questionnaires were designed using a combination of free-text boxes and Likert scales. A total of 33 questionnaires were issued and 11 completed questionnaires were returned.

Results:

Respondents indicated the importance of communication in relation to DNACPR orders, as well as the role of allied health professionals and family members in the process. Respecting the patient's wishes was considered paramount, as was educational provision surrounding DNACPRs.

Conclusion:

The majority of respondents reported that they were comfortable incorporating DNACPR orders in their clinical practice, although more modest responses were returned regarding the level of education received in this area of paramedicine.

Paramedics are increasingly becoming involved in end-of-life (EoL) care. Despite approximately 33% of paramedics seeing a terminally ill patient at least once a shift (Munday et al, 2011), they can represent a significant challenge (Mengual et al, 2007). Professional guidance for paramedics exists from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC, 2016), yet every decision concerning resuscitation must be made after careful assessment of each patient's situation and such decisions never dictated by ‘blanket’ policies (Resuscitation Council UK, 2016).

A systematic review of published literature was performed in November 2016, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses convention (Moher et al, 2009). Similar searches were performed of the ‘CINHAL PLUS with Full Text’ database, and two professional journals in the UK which target the paramedic profession, namely the Journal of Paramedic Practice and the British Paramedic Journal.

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