Therapeutic approach of nurses towards patients with the “do-not-resuscitate” directive in the intensive care unit and their family members

Introduction: Nurses play a critical role in end-of-life care (EOLC), as they are always present at patients' bedsides and provide care and monitor their status. While providing EOLC, nurses must examine their actions and behaviors that may hinder patients from passing away peacefully and with dignity. The implementation of “do-not-resuscitate” (DNR) may present challenges for nurses, such as power conflicts, tension, and ethical di- lemmas. The present study aimed to assess therapeutic approaches (empathy vs. sympathy) of nurses towards patients with the DNR directive in the intensive care unit (ICU) and their family members. Methods: This cross-sectional study involved 128 nurses working in ICUs at a hospital in Saudi Arabia enrolled using a non-probability convenient sampling approach. Results: During nursing care for patients and their families under DNR directive, ICU nurses exhibit greater sympathy (composite mean: 4.17; standard deviation [SD]: 0.84) than empathy (composite mean: 3.11; SD: 0.74). Meanwhile, no significant difference was observed in the empathy and sympathy levels of the nurses when grouped by demographics (p > 0.05). Notably, only empathy was important for nurses' educational certification (p = 0.0145, less than the significance threshold of 0.05). Conclusion: Most ICU nurses exhibited sympathy more than empathy when caring for patients with the DNR directive and communicating with their family members. Nurses should prioritize empathy over sympathy or compassion when caring for patients and interacting with their family members in end-of-life circumstances. The findings of this study may guide the development of programs to improve nurses' therapeutic approaches during EOLC.