University of Central Oklahoma
Department of Nursing

Nurse's Attitudes Toward
Do Not Resuscitate Orders

In Partial Fulfillment of the Requirements
for Nursing 4522
Nursing Research II

Presented to
Allen Nottingham, R.N., B.S.

Meggin Bean
Jessica Brownell
Shannon Genzer
Leslie Looman
Shanna McIntosh

April 20, 1998


I. INTRODUCTION?????????????????????1 Background??????????????????????1
Theoretical Framework?????????????????. 4
Problem Statement??????????????????? 5 Statement of Purpose??????????????????..5
Research Question???????????????????..6
Theoretical Definitions?????????????????.. 6 Operational Definitions?????????????????..7

II. REVIEW OF LITERATURE?????????????????9
Introductory Statement??????????????????9
Conceptual Framework?????????????????..10
1. Pre-Conventional Level?????????????11
2. Conventional Level??????????????.. 17
3. Post-Conventional Level????????????.. 21

III. METHODOLOGY????????????????????.. 26
Introductory Statement?????????????????.. 26
Research Setting????????????????????. 27
Subjects???????????????????????.. 27
Procedure??????????????????????? 28
Instrumentation????????????????????.. 29
Assumptions related to Methodology????????????. 31

IV. REFERENCES??????????????????????. 32

V. APPENDICES??????????????????????. 36
Appendix A?????????????????????? 36
Appendix B?????????????????????? 41
Appendix C?????????????????????? 42
Appendix D?????????????????????? 43
Appendix E?????????????????????? 45



Many influences such as cultural background, values, morals, and beliefs bring great force to bear upon almost every decision a person must make throughout an average day whether it be a choice, idea , or action. These influences are used in the formation of attitudes about one's self in general, and about right or wrong. All people have these childhood influences to credit for our attitudes, choices, ideas, and even beliefs that are held dear. Attitudes developed during childhood and throughout life play a key role in the way people interact with one another, handle crises, or even deal with day-to-day problems that occur in their lives. These beliefs are central to every human whether they be carpenter, politician, or registered nurse. So enmeshed in our daily lives are these values, that very often their role in the decision process goes unnoticed. In fact, one can live their entire life and never have awareness as to what triggers certain emotions, feelings toward the other sex, or even what drives the direction of thought. Yet, they are passed on to every generation often blindly, with every gesture, every arched eyebrow, and every fairy tale. The awareness of their presence is secondary to the need to have them. They are the thread that stitches communities together, brings people to a common ground, and gives many a purpose for living.
Attitudes about death and dying are derived from a lifelong process of experiencing life and the beliefs about death that one accepts as their own. In many cultures beliefs and issues surrounding death are the ones held dearest and closest to oneself. Many, if not all, cultures accept that death is but another step in the process of life. However, differences in how one may choose to welcome or elude death are varied and many. How one chooses to face death, what instrumentation, and even where to die (when one has the choice) are all matters of personal preference. Use of Do Not Resuscitate (DNR) orders or exhaustive measures are also matters of preference ( when there is a living will and these decisions are made ahead of time), and these preferences affect many lives ranging from friend to caregiver. As a caregiver, the nurse must deal with death and those that are dying on an almost daily basis. As a nurse, one must be aware of his or her own personal feelings and beliefs regarding death and be prepared to respect the wishes of the patient regarding this issue.
More often, the nurse will be the very person to carry out a DNR order. This means that the nurse may have to stand and watch or take the hand of a patient while he or she dies. The decision that a nurse will make will be based on attitudes toward death and dying, as well as the very notion of the DNR order. Some nurses may perceive a DNR order as an easy way out of expensive medical bills and a direct hand in the death of the patient, while others may see it as a merciful end to a painful and tormented existence. When confronted with the legality of DNR orders and the humanity of caring and wanting to preserve life, the nurse is often confronted with a dilemma. The nurse's decision can be one that can affect her career as well as the wishes of the patient. Whatever the nurse's feelings are, they must be addressed in order to better serve the patient and to ensure that the patient's rights and best interests are at the center of the concern. By addressing the nurse's issues with DNR orders or just death itself, the patient benefits from the knowledge that the nurse has an understanding of