Pengalaman Perawat IGD Merawat Pasien Do Not Resuscitate pada Fase Perawatan Menjelang Ajal

Maria Imaculata Ose


Do Not Resuscitate (DNR) menjadi keputusan yang tidak mudah diambil oleh dokter dan membutuhkan pertimbangan dan rekomendasi dari perawat. Keterbatasan pengalaman, pengetahuan dan informasi DNR, kriteria IGD yang lebih berfokus pada perawatan gawat darurat menyebabkan tidak dapat maksimalnya peran perawat dalam perawatan menjelang ajal. Tujuan penelitian ini adalah mengeksplorasi pengalaman perawat di IGD dalam merawat pasien DNR di ruang IGD. Desain Penelitian dengan metode Kualitatif pendekatan Fenomenologi interpretif, partisipan empat perawat IGD. Data dikumpulkan melalui Indepth interview, menggunakan analisis tematik Braun dan Clark. Hasil Penelitian empat tema yaitu 1. Memahami kegagalan resusitasi merupakan pasien DNR, 2. Melakukan resusitasi sebagai Protap Penanganan awal, 3. Berkolaborasi mengambil keputusan DNR, 4. Menyiapkan kematian pasien dengan baik. Kesimpulannya yaitu pengambilan keputusan DNR (Do Not Resuscitate) membutuhkan pertimbangan dan pemahaman pada kriteria DNR, selain itu perawat harus terlibat dalam kolaborasi dengan tim yang merawat pasien, sehingga keputusan DNR tepat. Perawatan DNR di IGD memberikan resusitasi sebagai tindakan awal dan mempersiapkan kematian pasien dengan baik dengan melibatkan keluarga pasien.




Experience of ER Nurse in Treating Do Not Resuscitate Patients in End of Life Care Phase. Do Not Resuscitate (DNR) is a difficult decision for doctors to make. In making the decision, the doctors need to consider nurses’ recommendation. Due to limited knowledge, experiences, and information of DNR, plus the criteria of emergency department which are only focused on emergency treatments, the nurses cannot maximize their roles in the end of life care. This study, thus, aimed to explore the nurses’ experiences in the emergency rooms especially in taking care of DNR patients. This research employed a qualitative method that was interpretive phenomenology approach involving four nurses who were working in the emergency department. Data was collected through in depth interview, using thematic analysis suggested by Braun & Clark. The results of the study cover four themes; they are to 1. Understand the failure of resuscitation during the treatment, 2. Perform resuscitation as an early standard operating procedure to treat patients 3. Collaborate in making decision on DNR, 4. Prepare patients for a good death. The conclusion is before deciding to perform DNR (Do Not Resuscitate), doctors need to understand the criteria of DNR and get nurses involved in it. DNR treatment in the emergency rooms is an early standard operating procedure to treat patients at the end of life phase and to prepare them for a good death by also engaging their family members.  


Keywords: DNR, end of life care, emergency of nursing


DNR; perawatan menjelang ajal; perawat IGD


Alligood, M. R. (2014). Nursing theorists and their work. Atlanta, USA: Elsevier Health Sciences.

Amestiasih, T., Ratnawati, R., & Rini, I.S. (2015). Studi fenomenologi: Pengalaman perawat dalam merawat pasien dengan do not resuscitate (DNR) di Ruang Icu Rsup Dr. Soeradji Tirtonegoro Klaten. Medika Respati, X, 1–11. Diperoleh dari http://journal.resp

Bailey, C., Murphy, R., & Porock, D. (2011). Professional tears: Developing emotional intelligence around death and dying in emergency work. Journal of Clinical Nursing, 20 (23–24), 3364–3372. doi: 10.1111/j.1365-2702.2011.03860.x.

Boyd, D., Merkh, K., Rutledge, D.N., & Randall, V. (2011). Nurses’ perceptions and experiences withs end-of-life communication and care. Oncology nursing forum, 38 (3), E229–E239.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychologi. Qualitative Research in Psychology, 3, 77–101.

Brizzi, M., Abul-Kasim, K., Jalakas, M., Selariu, E., Pessah-Rasmussen, H., & Zia, E. (2012). Early do-not-resuscitate orders in intracerebral haemorrhage; frequency and predictive value for death and functional outcome. A retrospective cohort study. Scandinavian journal of trauma, resuscitation and emergency medicine, 20 (1), 1–6.

Calvin, A.O., Kite-Powel, D.M., & Hickey, J.V. (2007). The neuroscience ICU nurse’s perceptions about end of life care. Journal of Neuroscience Nursing, 39 (3), 143–150.

Chan, G.K. (2005). Understanding end-of-life caring practices in the emergency department. Nursing Philosophy, 6 (1), 19–32.

Chan, G.K. (2011). Trajectories of approaching death in the emergency department: clinician narratives of patient transitions to the end of life. Journal of pain and symptom management, 42 (6), 864–881.

Doran, K.M., Vashi, A.A., Platis, S., Curry, L.A., Rowe, M., & Gang, M. (2013). Navigating the boundaries of emergency department care: Addressing the medical and social needs of patients who are homeless. Am J Public Health, 103 (Suppl 2), S355–S360. doi: 10.2105/AJPH.2013.301540.

Mcmahon-Parkes, K., Moule, P., Benger, J., & Albarran, J.W. (2009). The views and preferences of resuscitated and non-resuscitated patients towards family-witnessed resuscitation: A qualitative study. International journal of nursing studies, 46 (2), 220–229.

Saczynski, J.S., Gabbay, E., McManus, D.D., McManus, R., Gore, J.M., Gurwitz, J.H., … Goldberg, R.J. (2012). Increase in the proportion of patients hospitalized with acute myocardial infarction with do-not-resuscitate orders already in place between 2001 and 2007: A nonconcurrent prospective study. Clinical Epidemiology, 4 (1), 267–274. S32034.

Seiler, A.J., & Moss, V.A. (2012). The experiences of nurse practitioners providing health care to the homeless. Journal of the American Academy of Nurse Practitioners, 24 (5), 303–312.

Steiger, N.J., & Balog, A. (2010). Realizing patient-centered care: Putting patients in the center, not the middle. Frontiers of health services management, 26 (4), 15–26.

Somes, J., & Donatelli, N.S. (2012). Do Not intubate/do not resuscitate: Treating the severely ill or injured geriatric patient in the emergency department. Journal of Emergency Nursing, 38 (3), 283–286.

Park, Y.R., Kim, J.A., & Kim, K. (2011). Changes in how ICU nurses perceive the DNR decision and their nursing activity after implementing it. Nursing ethics, 18 (6), 802–813.

Wolf, L.A., Altair, M.D, et al. (2015). Exploring the management of death: Emergency nurses’ perceptions of challenges and facilitators in the provision of end-of-life care in the emergency department. Journal of Emergency Nursing, 41 (5), e23–e33.

--------- Laporan Tahunan Rumah Sakit dr. Saiful Anwar Malang Tahun 2010.


  • There are currently no refbacks.