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Abstract
Purpose
Subjective Attitudes toward cardiopulmonary resuscitation (CPR) can be diverse. The purpose of this study was to identify subjective attitudes toward CPR among hospital nurses working in emergency room and intensive care units.
Methods
The Q methodology was used. The 42 Q-statements selected by each of the 38 participants were classified into a shape of normal distribution. The collected data were analyzed using a QUANL program.
Results
Three types of attitudes emerged: ‘ TypeI, CPR requires professionalism(medical person-nel-centered)’, ‘ Type II, CPR requires reality (patient-centered)’, and ‘ Type III, CPR requires ethicality (human dignity-centered)’.
Conclusion
The findings suggest that nursing intervention programs for the three types should be developed. Mandatory repeat education programs for TypeI, Development of guidelines for the prohibition and termination of CPR for TypeII. Continuing education on wills and advance directives for TypeIII can be helpful
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Table 1.
Q-Statements and Z-Scores according to Types of Attitude (N=38)
| Q-Statement | Z-Score | ||
|---|---|---|---|
| Type I (n=19) | Type II (n=15) | Type III (n=4) | |
| 1. CPR is a medical action in emergency situations. | 1.52 | 1.30 | 0.38 |
| 2. CPR minimizes brain damages and helps a rapid recovery. | 1.51 | 0.72 | 0.38 |
| 3. CPR is simply to extend the length of life. | -1.81 | -0.56 | -0.95 |
| 4. CPR helps people to live another life. | 0.42 | -0.01 | -0.76 |
| 5. CPR is unnecessary if the further medical treatment is meaningless. | -0.96 | 1.85 | -0.38 |
| 6. CPR is unnecessary if there is family consent or DNR notice. | 0.16 | 2.17 | -0.19 |
| 7. CPR should be done even if rescuers are in a dangerous situation or tired. | -0.79 | -1.01 | -0.57 |
| 8. Attitude of rescuers toward CPR may vary with the patient's age | -0.82 | 1.37 | -0.57 |
| 9. No one has the right to stop CPR because human life is precious. | 0.04 | -1.45 | -1.52 |
| 10. CPR is unnecessary when absolute clinical evidence of death exists. | -0.20 | 0.75 | -0.76 |
| 11. CPR is unnecessary if the patient wants to die with dignity. | 0.41 | 1.82 | 1.90 |
| 12. CPR should be done until family members come even if there is little hope for recovery. | -1.51 | -1.09 | -0.76 |
| 13. CPR is unnecessary if the patient is highly likely to become a vegetative state after being resuscitated. | -1.57 | 0.25 | -1.71 |
| 14. CPR is unnecessary if the patient is brain-dead. | -1.18 | -0.03 | -0.19 |
| 15. Communication with the patient's family is necessary while CPR is performed on the patient. | 0.34 | 1.42 | -0.19 |
| 16. Success of CPR depends on early detection and rapid response and hospital systems. | 1.87 | 1.33 | 0.00 |
| 17. CPR is unnecessary if the chance of survival is low. | -1.46 | 0.39 | -1.90 |
| 18. Review the quality of CPR performance applied can increase the success rate of the next CPR case. | 1.00 | 0.63 | -0.94 |
| 19. CPR requires the teamwork and rescuers' willingness to resuscitate. | 1.25 | 0.34 | -1.71 |
| 20. Updating on the latest CPR knowledge is necessary. | 1.22 | 0.79 | -0.94 |
| 21. CPR is really hard and psychologically stressful every time. | -0.01 | -0.09 | 0.76 |
| 22. Even if the patient is resuscitated, there is psychological burden on future treatment. | -0.17 | -0.41 | 0.57 |
| 23. I feel good when the CPR went well whereas I feel guilty when the CPR went wrong. | -0.35 | -1.32 | -0.38 |
| 24. CPR seems like a show for the patient's family. | -1.10 | -0.19 | 0.75 |
| 25. After performing CPR without any feelings, I become depressed. | 0.18 | 0.29 | 1.90 |
| 26. I think about ethics when medical teams do not seem serious while performing CPR. | 0.79 | -0.44 | 0.18 |
| 27. CPR requires a lot of experience and expertise. | 1.69 | 0.68 | 0.57 |
| 28. Post-CPR routine workloads are overwhelmingly difficult to manage (e.g., records, etc). | -0.24 | -0.99 | -1.14 |
| 29. Human dignity is not present if physical damages occur to the patients due to the CPR. | -1.16 | -0.41 | 1.71 |
| 30. I think about the patient's quick resuscitation only during CPR. | 0.60 | -0.83 | 0.00 |
| 31. I am proud of being a nurse when the patient is resuscitated after performing the CPR | 1.30 | -0.49 | 1.33 |
| 32. After CPR performance is completed, I feel like I should do better for my patients. | 0.73 | -0.50 | -0.19 |
| 33. I become emotional when the family grieve for the loss of their beloved one after CPR. | 0.55 | -0.71 | 0.95 |
| 34. When the patient dies even after CPR, I feel the futility of life. | -0.44 | -1.18 | 1.33 |
| 35. I always feel there is something lacking after CPR. | -0.25 | -1.33 | 0.94 |
| 36. CPR is always a tense and difficult situation even for the experienced medical teams. | 1.00 | -0.05 | -0.00 |
| 37. I hate medical teams shouting or screaming at each other during the CPR. | -0.08 | 0.22 | 0.76 |
| 38. CPR usually requires a lot of training and simulation. | 1.32 | 1.01 | -0.00 |
| 39. I feel limited as a nurse whenever CPR case occurs. | -1.07 | -1.99 | -1.14 |
| 40. Because the CPR seems too painful, I do not want CPR to my parents and family. | -0.95 | -0.23 | 1.14 |
| 41. I feel limited ability of human and medicine while CPR is performed.† | -0.86 | -1.42 | -1.52 |
| 42. I want to help the patient dies with dignity rather than receiving CPR. | -0.88 | -0.61 | 1.14 |
Table 2.
Demographic Characteristics of and Correlations among Types of Attitude (N=38)
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