Perceptions of care following initiation of do-not-resuscitate orders.

PURPOSE: Documenting do-not-resuscitate (DNR) status in the surgical intensive care unit (ICU) can be controversial; some providers believe that DNR orders change care. This survey evaluates current perceptions. MATERIALS AND METHODS: IRB approved survey consisting of 31 validated questions divided into 3 factors (1. palliation, 2. active treatment, and 3. trust/communication). Individual questions were compared using Fisher's exact-tests and factors were compared via t-tests. RESULTS: Both surgical and ICU staff believe care decreases after DNR order initiation (43%). More surgical staff report decreased care aggressiveness versus ICU staff (63% vs 25%, p < 0.005 and Factor 2, 25.8 versus 29.8, p < 0.001), and felt that electrical cardioversion outside of the setting of ACLS would not be performed (57% vs 24%, p < 0.005). CONCLUSIONS: Surgical staff expressed more concern about care after DNR status than their ICU counterparts. Determining whether care actually changes clinically warrants further investigation.

Perceptions of ICU Care Following Do-Not-Resuscitate Orders: A Military Perspective.

Although do-not-resuscitate orders only prohibit cardiopulmonary resuscitation in the case of cardiac arrest, the common initiation of this code status in the context of end-of-life care may lead providers to draw premature conclusions about other goals of care. The aim of this study is to identify concerns regarding care quality in the setting of do-not-resuscitate orders within the Department of Defense and compare differences in perceptions between members of the critical care team. DESIGN: A cross sectional observational study was conducted. SETTING: This study took place in the setting of critical care within the Department of Defense. SUBJECTS: All members of the Uniformed Services Section of the Society of Critical Care Medicine were invited to participate. INTERVENTIONS: A validated 31-question survey exploring the perceptions of care quality in the setting of do-not-resuscitate status was distributed. MEASUREMENTS AND MAIN RESULTS: Exploratory factor analysis was used to categorically group survey questions, and average factor scores were compared between respondent groups using t tests. Responses to individual questions were also analyzed between comparison groups using Fisher exact tests. Factor analysis revealed no significant differences between respondents of different training backgrounds; however, those with do-not-resuscitate training were more likely to agree that active treatment would be pursued (p = 0.024) and that trust and communication would be maintained (p = 0.005). Although 38% of all respondents worry that quality of care will decrease, 93% agree that life-prolonging treatments should be offered. About a third of providers wrongly believed that a do-not-resuscitate order must be reversed prior to an operation. CONCLUSIONS: Although providers across training backgrounds held similar concerns about decreased care quality in the ICU, there is wide belief that the routine and noninvasive interventions are offered as indicated. Those with do-not-resuscitate training were more likely to believe that standards of care continued to be met after code status change.

Peer Tutoring for Anatomy Workshops in Cambodia.

Historical loss of staff and teaching resources in Cambodia has resulted in significant challenges to anatomy education. Small group anatomy teaching opportunities are limited. A visit to Cambodia by a teaching team from the University of Melbourne in 2010 demonstrated it was possible to implement well-resourced anatomy workshops for this purpose. However, continuation of the workshop program was inhibited by the limited number of local teaching staff. In 2015, another team from the University of Melbourne returned to Cambodia to implement anatomy workshops that incorporated peer tutoring. The objective was to improve teacher-to-student ratios and to demonstrate that interactive anatomy workshops could be delivered successfully despite low staff numbers. The anatomy workshops were attended by 404 students of Medicine, Dentistry, Nursing, and Midwifery at the University of Puthisastra. Medical students were invited to act as peer tutors for nursing students. A five-point Likert scale questionnaire was used to determine student satisfaction with both the workshops and peer tutoring. The overwhelming majority were positive about the workshops and keen for them to continue. Almost all medical students who acted as peer tutors agreed or strongly agreed that this role increased their anatomical knowledge (98%) and confidence (94%). Most nursing students agreed or strongly agreed with statements that they would like peer tutoring to continue (94%) and that they would like to be peer tutors themselves (88%). This report demonstrates that peer tutoring could be an effective tool in educational settings where poor staff-to-student ratios limit delivery of interactive workshops.