Table 3 Barriers and facilitators of decision-making in initiation of resuscitation

Patient-related factors

Patient’s demographic characteristics

- Elderly

- Young adults

- Social status

Patient’s clinical characteristics

- Having terminal illnesses

- Acute conditions

- Positive past medical history

- Altered level of consciousness

- The underlying disease, ongoing treatment status, or medical condition as the cause of arrest

- Low oxygenation saturation

- Asystole persisting for more than 20 min with no reversible cause

- Altered systolic blood pressure

- Pre-morbid state or diagnosis of cancer

- Being labeled as DNR/DNI

- Unfavorable quality of life

Patient and family members’ desires

- Patients’ previous preferences

- Having living wills (advance directives)

- Family members’ previous preferences

- Family members inappropriately insisting on IOR

HCP-related factors

HCP characteristics

Nurses’ characteristics

- Lack of self-confidence

- Lack of nurse attentiveness

- Stress and anxiety

Physicians’ characteristics

- High job satisfaction (OR = 1.17)

- Physician’s specialty (internal medicine specialists made fewer decisions for active CPR (10%) compared with general practitioners (19%) Physician nationality

- Experience with terminally ill patients

- Physician’s country of practice

- Physicians who were not parents

- Young physicians

HCP worldview

HCP attitude

- Considering a futile resuscitation

- Consideration of the length of life as an important factor opted by physicians

- Physician’s positive attitudes and life experiences to withholding life-sustaining treatment

- Unprofessional attitude and behavior of some physicians

HCP beliefs and values

- Physician’s beliefs and values regarding unfamiliarity with the patient

- Religious beliefs of HCPs

- Religious values of physicians, degree of religiosity

HCP ethics

- Ethical dilemma

- Ethical and cultural norms

- Fear of litigation

HCP dynamics

Teamwork/culture of teamwork

- Lack of coordination

- Delegation of tasks/allocation of roles in resuscitation

- Effective collaboration between the ward staff

- lack of consensus among team members

- Good teamwork

Leadership

- Power struggles or leadership conflicts

- Nurses leadership skills

- Flexibility

- Presence of a specific leader with clear roles and responsibilities

- Leadership competency

- Situational leadership

Communication

- Absence of verbalization/ silence

- Effective information exchange through closed-loop communication

- Interprofessional conflict within teams

- Situational awareness through effective verbalization

Interprofessional collaboration

- Nurses prior consultation with physicians about DNR

- The presence of experienced nurses on the morning shift

- Nurses consultation and seeking input from colleagues

- Collegial support

- Impact of nurses on physicians’ decisions to initiate resuscitation

- Physician-nurse interactions

HCP competence

Knowledge

- Incomplete patient information

- Knowing the patient

- Nurses’ Insufficient Knowledge of Resuscitation

- Knowing the condition

- Knowledge from experience

- Knowledge about the organization

- Knowledge of the patient’s baseline

- Possessing tacit knowledge

-Physician’s level of knowledge about resuscitation

- Nurse’s good CPR knowledge

CPR performance

- Took a long time to first rhythm check

- Adherence to CPR guidelines

- Strictly adhering to a set of pre-established guidelines without clinical judgment

- Proficiency in the implementation

- Lack of nursing skills

- Swift rhythm check

- Algorithmic decision-making in resuscitation

Education/ training

- Nurses’ level of education

- Attending in CPR courses

- Using evidence-based learning methods for nurses’ continuous education

Experience

- Novice nurse

- Previous experience

Healthcare system-related factors

Healthcare staffing shortages

- Insufficient number of HCPs

- Adequate manpower

- Heavy workload

- ED crowding

Communication system deficiencies

- Inadequate and ineffective communication systems

Equipment availability

- Malfunctioning of equipment or delays or absence of equipment

- Monitored wards

- Availability of advanced resuscitative gadgets