Moral distress among critical care nurses when excecuting do-not-resuscitate (DNR) orders in a public critical care unit in Gauteng

BACKGROUND: A critical care unit admits on a daily basis patients who are critically ill or injured. The condition of these patients’ may deteriorate to a point where the medical practitioner may prescribe or decide on a ‘do not resuscitate’ (DNR) order which must be executed by a professional nurse, leading to moral distress which may manifest as poor teamwork, depression or absenteeism. OBJECTIVES: To explore and describe factors contributing to moral distress of critical care nurses executing DNR orders. DESIGN: The explorative descriptive qualitative design was selected to answer the research questions posed. METHODS: Critical care nurses of a selected public hospital in Gauteng Province were selected via purposive sampling to participate in the study, and data were collected through semi-structured interviews. PARTICPANTS: A shift leader assisted with selection of participants who met the eligibility criteria. The mean age of the participants was 36 years; most of them had more than five years’ critical care nursing experience. Twelve critical care nurses were interviewed when data saturation was reached. Thereafter two more interviews were conducted to confirm data saturation. A total of 14 interviews were conducted. RESULTS: Tesch’s eight-step method was utilised for data analysis. The findings were classified under three main themes: moral distress, communication of DNR orders and unavailability of psychological support for nurses. CONCLUSION: The findings revealed that execution of DNR orders is a contributory factor for moral distress in critical care nurses. National guidelines and/or legal frameworks are required to regulate processes pertaining to the execution of DNR orders. The study further demonstrated the need for unit-based ethical platforms and debriefing sessions for critical care nurses. CONTRIBUTION OF THE STUDY: The main contribution of this study was to explore and describe the factors contributing to Moral distress when executing a DNR order. This study raised awareness amongst healthcare providers on the factors contributing to moral distress amongst critical care nurses. This study highlighted the importance of developing national guidelines and legal frameworks pertaining to execution of DNR orders. This study alluded to the value of initiating debriefing sessions for critical care nurses involved in the execution of DNR orders.