Engaging in resuscitation status conversations in psychiatry: A qualitative study of nurses’ perspectives

• Published in: Journal of psychiatric and mental health nursing 2021-12, Vol.28 (6), p.995-1004, Article 995-1004
• Main Authors: Provencal Levesque, Olivia, Vandyk, Amanda, Vanderspank‐Wright, Brandi, Kaluzienski, Mark, Jacob, Jean Daniel
• Format: Article
• Language: English
• Subjects: Advance directives; Cardiopulmonary resuscitation; Communication; CPR; Decision making; mental illnesses; Nurses; Nursing; Palliative care; Psychiatric-mental health nursing; Psychiatry; qualitative; Qualitative research; resuscitation status
• ISSN: 1351-0126; 1365-2850
• DOI: 10.1111/jpm.12791

Accessible Summary What is known on the subject? Discussion and documentation of a patient’s resuscitation status are essential aspects of any hospital admission, and yet, they seldomly occur in psychiatry. Nurses play an important role in resuscitation status determination by being an information broker, supporter and advocate. Persons with mental illness may be competent to engage in the determination of their resuscitation status and deserve the same respect and autonomy as other patients during this process. There are no published qualitative studies exploring healthcare providers experiences in initiating resuscitation status conversations in the psychiatric setting. What does this paper add to existing knowledge? An in‐depth qualitative understanding of the complexity of resuscitation status determination in psychiatry. The shared experiences of nurses enacting their role in resuscitation status determination with patients admitted to psychiatry. The challenges of implementing a ‘one‐size fits all’ approach to resuscitation status policies, and the ways in which depression and/or suicidal ideation influence the process. What are the implications for practice? Role clarity and improved communication between providers about resuscitation status determination in psychiatry are needed. Hospital policies for resuscitation status determination must account for the psychiatric context to ensure patients’ goals of care are known and upheld. Nurses working in psychiatry should initiate and more readily engage in resuscitation status conversations. Introduction Patients with mental illness experience stigma and marginalization, which affects the quality of their health care. In most settings, end‐of‐life decisions, including goals of care, must be discussed with all patients upon hospital admission, including determining cardiopulmonary resuscitation preferences in the event of a medical emergency. Despite this requirement, these conversations do not routinely occur in inpatient psychiatry. By default, patients become a ‘full code status’, mandating life‐sustaining interventions. Aim To explore how and why resuscitation status conversations occur, or do not occur, in inpatient psychiatry from the perspectives of healthcare providers. Method Qualitative descriptive study using focus groups with nurses working in psychiatry. Results Nurses’ experiences with initiating and engaging in resuscitation status conversations related to Working in Psychiatry, which repr