Cultural perspectives of older nursing home residents regarding signing their own DNR directives in Eastern Taiwan: a qualitative pilot study

• Published in: BMC palliative care Vol. 15; no. 45; p. 45
• Main Authors: Lee, Hsin-Tzu Sophie, Cheng, Shu-Chen, Dai, Yu-Tzu, Chang, Mei, Hu, Wen-Yu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.05.2016; BioMed Central
• Subjects: Advance Directives - psychology; Aged; Aged, 80 and over; Analysis; Attitude; Attitudes; Buddhism; Confucianism; Confucius (551-479 BC); Consent; Content analysis; Culture; Decision Making; Do-not-resuscitate orders; Ethics; Family - psychology; Female; Humans; Interviews as Topic; Life Support Care - psychology; Long term health care; Male; Mental Competency; Mindfulness meditation; Nursing home patients; Nursing Homes; Older parents; Older people; Palliative care; Pilot Projects; Psychological aspects; Qualitative Research; Resuscitation Orders - psychology; Science; Studies; Taiwan; Taoism; Taiwan; Advance directives (ADs); Decision-making; Cultural perspective; End of life (EOL); Nursing home; Do not resuscitate (DNR)
• ISSN: 1472-684X; 1472-684X
• DOI: 10.1186/s12904-016-0117-4

Chinese tradition and culture developed from Taoism, Confucianism, and Buddhism and have influenced ethnic Chinese for thousands of years, particularly thoughts on death. Many ethnic Chinese, particularly older people, refrain from discussing death-related concerns, making it difficult to obtain advance directives, including do-not-resuscitate (DNR) directives, signed independently by older people. This study explored the attitudes of older nursing home residents in Taiwan toward signing their own DNR directives. This study adopted purposive sampling and collected data through in-depth interviews. The data were analysed using qualitative inductive content analysis, and the study location was a nursing home in Eastern Taiwan. A total of 11participants were recruited from a sample of 12 eligible participants. Most of the older residents in this study refused to make decisions independently regarding DNR directives. Content analysis of the interviews revealed four themes concerning refusing to sign DNR directives independently: not going against nature, accepting the results of cause and effect, viewing the family as a decision-making system, and practising self-effacement. Chinese cultural aspects, including Taoist, Buddhist, and Confucian philosophy, affected the autonomy of the older residents, and they relied on others to make decisions for them. Professionals must respect this family-oriented decision-making thinking of older residents because it reflects personal choice. Otherwise, healthcare providers may play a mediating role in coordinating and communicating between older residents and their families regarding EOL-care-related concerns, replacing the traditional practice of holding a family meeting.