Doctoral project: Cardiac arrest in special accommodation
Previous research indicates that there are deficiencies in the treatment of sudden cardiac arrests in special residences (Säbo) and deficiencies in routines regarding attitudes towards cardiopulmonary resuscitation (CPR). This research project aims to investigate the attitudes and experiences regarding CPR decisions, from the conversation with the patient to documentation, among healthcare personnel working both in primary care and in elderly care.
Project information
Project name
Cardiac arrest in special accommodation – occurrence, treatment and outcome. Experiences and attitudes regarding do-not-resuscitate orders.
Doctoral student
Åsa Mobaeck
Supervisor
Anders Bremer
Assistant supervisors
Johan Israelsson, Region Kalmar län
Jörg Carlsson, Linnaeus University
Timetable
Jan 2023–
Subject
Caring science (Department of Health and Caring Sciences, Faculty of Health and Life Sciences)
More about the project
According to the Swedish National Board of Health and Welfare's regulations and general advice on life-sustaining care, the responsible physician should consult with another licensed healthcare professional, the patient, and their relatives before deciding not to perform cardiopulmonary resuscitation (CPR). The regulation also describes how decisions and information should be documented.
The Patient Act regulates a patient's right to information about illness and treatment. If the patient cannot receive information, relatives should be given the information instead.
According to the National Board of Health and Welfare, Swedish patients do not have the right to choose treatment options that go against science and proven experience. This means that a patient cannot request specific treatment if the doctor does not believe that the treatment will benefit the patient.
In Sweden, patients have the right to influence and participate in their own care. This also includes the right to refuse treatment.
Ethical guidelines
The Swedish Medical Association, the Swedish Nurses' Association, and the Swedish Council for Resuscitation have issued Ethical Guidelines for Cardiopulmonary Resuscitation (CPR). In its guidelines for life-sustaining treatment, reasons are given that may be relevant for withholding CPR, and one of the reasons mentioned is the patient's willingness not to receive life-sustaining treatment with CPR. The patient's attitude towards or position on, for example, refusing CPR may emerge in conversations when care is planned or through the patient's own expression of their will.
These guidelines place great emphasis on these conversations and what they should contain. All healthcare and care staff should follow the patient's wishes and communicate these to the attending physician. A decision to withhold CPR should be documented in the patient's medical record based on the conversation and communicated to other healthcare personnel. The term used is "NO CPR".
Great need for improvements
Research shows a great need for improvements in the handling of decisions about CPR. It is expressed that decisions are often made late in the course of the disease or that nursing staff express concerns about discussing existential issues.
One problem that needs to be addressed is that decisions made about "No CPR" without the knowledge of the patient or relatives, without careful documentation, or without updating/reviewing when changing healthcare institutions. This is not in accordance with the guidelines and the basic principle of patient self-determination.
Investigating the attitudes of healthcare personnel is important. Through education and reflection, knowledge and insight into attitudes about CPR can be improved.
Scientific purpose
The risk of cardiac arrest increases with age, and many elderly people live in special care homes. In palliative care, issues related to CPR are discussed, but there are concerns that conversations do not take place to a sufficient extent with people living in special care homes. This can both lead to people in special care homes risking not receiving life-saving treatment in the event of a sudden cardiac arrest, and those who do not wish or should be given CPR risk being subjected to prolonged suffering but also infringe on the patient's right to a dignified death.
Research has focused on discussions about CPR in acute situations in a hospital setting, but there are no Swedish studies on primary care and elderly care. This research project aims to investigate the attitudes and experiences regarding CPR decisions, from the conversation with the patient to documentation, among healthcare personnel working both in primary care and in elderly care. The project also aims to investigate the frequency of CPR training.
The project is part of the research in The innovative Cardiac Arrest REsearch group (iCARE).