Bellini, S.,& Damato, E. G. (2009).Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(2), 195-205.

While society has become more comfortable with do-not-resuscitate (DNR) orders and advanced directives for adults, little if any literature has been published in this area with children. Consensus is often lacking between providers when facing the decision of DNR for an infant and may be related to an inability to predict outcomes based on MRI or EEG or on the basis of some genetic diagnoses. Additionally, several studies have pointed to the fact that the definition of DNR and DNR policies are often not clear or well understood by nurses and other providers. The purpose of this comparative descriptive study was to examine the knowledge, attitudes/beliefs and practices of nurses working in a level III nursery in the northeastern United States. Sixty-six NICU nurses were anonymously surveyed using an instrument adapted from one utilized to assess perceptions of critical care nurses caring for adults with DNR orders. The researchers found that there was a significant lack of knowledge related to the definition of DNR. In this study, only 24% of participants were able to correctly define DNR status as "withholding CPR only." The nurses in this study were, however, supportive of the family role in DNR decision-making and also believed that nurses needed to be involved in this process. As with other studies, almost half of these participants were unaware if a DNR policy existed in their NICU. The differences between knowledge, attitudes/beliefs, and practices pointed to years of experience versus educational level of the nurses as more influential. While this study had several limitations, including small sample size, single setting, and lack of psychometric evaluation of the instrument, the findings are interesting and pose many implications for education of NICU nurses. There is no excuse for nurses not knowing the correct definition of DNR or whether a DNR policy exists in their institution. Such lack of clarity only contributes to confusion, greater stress in an already extremely charged situation, and of course poor care outcomes for neonates and families.