Nursing and PharmD Undergraduate Students’ Attitude Toward the “Do Not Resuscitate” Order for Children with Terminally Ill Diseases

Figures & data

Table 1 Frequency Distribution of Socio-Demographic Characteristics of Undergraduate Students (n=402)

Variables	Frequency (%)	Nursing	PharmD	x^2	P value
Gender
Male	90(22.4)	53	37		0.07
Female	312(77.6)	189	123
Nationality
Jordanian	325 (80.8)	189	136	2.24	0.09
Other	77(19.2)	53	24
Age	M=22.1 (SD=2.6)	21.8	22.5	t=3.8	0.06
Mother education
Primary or secondary	125 (31.1)	84	41	7.1	0.07
Diploma	55 (13.7)	39	16
Bachelor	143 (35.6)	78	65
Graduate	79 (19.7)	41	38
Father education
Primary or secondary	118 (29.4)	80	38	8.2	0.06
Diploma	101 (25.1)	64	37
Bachelor	134 (33.3)	70	64
Graduate	49 (12.2	28	21
College level
Freshmen (first year)	23 (5.7)	22	1	5.6	0.08
Sophomore (second year)	30 (7.5)	23	7
Junior (third year)	78 (19.4)	66	12
Senior (fourth year)	130 (32.3)	98	32
Senior (fifth year)	105 (26.1)	24	81
Senior (sixth year)	36 (9.0)	0	36
Income (JD=1.5$)
Less than 400	47(11.7)	24	23	3.32	0.07
400 to 600	86 (21.4)	69	17
600 to 800	61 (15.2)	40	21
800 to 1000	85 (21.1)	46	39
More than 1000	123 (30.6)	63	60
Area of living
City	261 (64.9)	147	114	4.3	0.054
Village	141 (35.1)	95	46
Hear about DNR
No	150 (37.3)	99	51	3.32	0.067
Yes	252 (62.7)	143	109
Discuss DNR with others
No	350(87.1)	213	137	0.454	0.544
Yes	52 (12.9)	29	23
Reasons for preventing DNR
Religious reasons	78 (19.4)	36	42	4.2	0.052
Social reasons	78 (19.4)	29	19
Scientific	50 (12.4	34	16
Others	196 (48.8)	143	53

Table 2 Responses to DNR Items for Nursing and PharmD Students (n=402)

Items	Strongly Not Agree		Not Agree		Neutral		Agree		Strongly Agree
	Count	Row N %	Count	Row N %	Count	Row N %	Count	Row N %	Count	Row N %
1. DNR orders for terminally ill children help keep patients from suffering unnecessarily.	9	2.2%	36	9.0%	77	19.2%	107	26.6%	173	43.0%
2. I feel that the physician should make all the decisions regarding the patient’s treatment.	139	34.6%	103	25.6%	79	19.7%	43	10.7%	38	9.5%
3. I feel all patients that are permanently brain impaired should automatically have DNR orders for terminally ill children.	19	4.7%	29	7.2%	129	32.1%	148	36.8%	77	19.2%
4. I feel that the patient or the patient’s family should be in control of all medical decisions.	12	3.0%	19	4.7%	108	26.9%	164	40.8%	99	24.6%
5. It is futile to prolong the life of frail, elderly patients.	32	8.0%	76	18.9%	195	48.5%	70	17.4%	29	7.2%
6. It is difficult for me to talk to my patients about death.	62	15.4%	92	22.9%	136	33.8%	78	19.4%	34	8.5%
7. I feel the healthcare team must always provide hope to patients even when death is imminent.	22	5.5%	34	8.5%	94	23.4%	138	34.3%	114	28.4%
8. Life-prolonging equipment can undermine the natural process of death.	35	8.7%	38	9.5%	102	25.4%	96	23.9%	131	32.6%
9. The monetary factor of keeping terminally ill patients alive is difficult to justify.	42	10.4%	64	15.9%	92	22.9%	79	19.7%	125	31.1%
10. Am afraid the family will file a lawsuit if their family member is not resuscitated.	57	14.2%	93	23.1%	136	33.8%	70	17.4%	46	11.4%
11. I wish I had a better understanding of the legal ramifications of DNR.	40	10.0%	59	14.7%	132	32.8%	112	27.9%	59	14.7%
12. I wish I knew more about advance care directives.	34	8.5%	107	26.6%	116	28.9%	83	20.6%	62	15.4%
13. I would like to know more about patient’s rights.	91	22.6%	97	24.1%	120	29.9%	59	14.7%	35	8.7%
14. If my mother was end-stage terminally ill, I would not want DNR orders for terminally ill children written.	78	19.4%	104	25.9%	126	31.3%	60	14.9%	34	8.5%
15. My religious beliefs greatly influence my view of DNR.	125	31.1%	107	26.6%	110	27.4%	39	9.7%	21	5.2%
16. My cultural background makes it difficult for me to deal with the DNR issue.	19	4.7%	40	10.0%	81	20.1%	98	24.4%	164	40.8%
17. The patient or the patient’s family must give written permission in orders for the physician to initiate DNR orders for terminally ill children.	18	4.5%	22	5.5%	95	23.6%	92	22.9%	175	43.5%
18. I feel pressure from the hospital utilization review to push for DNR orders for terminally ill children.	54	13.4%	65	16.2%	157	39.1%	93	23.1%	33	8.2%
19. I feel I must conform to my peers wishes regarding DNR orders for terminally ill children.	31	7.7%	33	8.2%	150	37.3%	111	27.6%	77	19.2%

Note: Dr Dunn allowed the authors to adapt and use the instrument.

Table 3 Multiple Regression for Predictors of DNR of Terminally Ill Children

Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.
		B	Std. Error	Beta
1	(Constant)	93.260	10.232		9.114	0.000
	Age	−.539	0.393	−.093	−1.372	0.171
	Gender	−.364	1.573	−.013	−.231	0.817
	Participated in Research about DNR	0.511	2.280	0.013	0.224	0.823
	Hear about DNR	0.082	1.440	0.003	0.057	0.955
	Discuss DNR	−3.477	2.025	−.101	−1.718	0.087
	Prevent reasons	−1.197	0.549	−.124	−2.180	0.030
	Took Course about Ethics	−.197	0.59	−.014	−.180	0.080
	Income	0.203	0.506	0.024	0.401	0.689
	Living	2.614	1.418	0.107	1.844	0.066
	Nationality	−.170	1.693	−.006	−.100	0.920
	Year	1.098	0.699	0.107	1.570	0.117
	Father education	0.114	0.725	0.010	0.157	0.875
	Mother education	0.811	0.680	0.078	1.193	0.234

Note: Dependent variable, attitude toward DNR.