Slow codes: perspective of nurses and doctors

Background
Slow codes are cardiopulmonary resuscitative efforts intentionally conducted too slowly for resuscitation to occur. While some authors argue that a slow code is a nonmaleficent and beneficent act towards the hopelessly ill patient, others believe that this practice is harmful and deceptive, that it disregards patient and surrogate autonomy and deprives the patient
of a peaceful death.

Aim
The aim of this research study was to ascertain nurses’ and doctors’ perspectives on the practice of slow codes to understand why they take place despite the availability of do-not-resuscitate orders.

Methods
A Heidiggerian phenomenological study, using unstructured interviews with a sample of 3 nurses and 2 doctors was carried out in an acute hospital in Ireland in 2005 to examine the experiences of nurses and doctors practicing a slow code. Data analysis involved the use of Colazzi’s (1978) reductive procedure.

Findings
Health care professionals believed that slow codes were intended as beneficent acts towards the irreversibly ill patient. However, participants indicated that slow codes were undignified and pointless when intrusive measures were used.

Conclusions
This study concluded that clinical guidelines regarding CPR need to be devised for use in Ireland to prevent slow codes. Legislative clarity needs to be addressed, possibly, in the form of advance medical directives, to assist practitioners in decision-making regarding CPR. Training for health care professionals in sensitive communication skills with patients and families and the provision of an explanatory leaflet regarding CPR for patients and families is also recommended.