There is a growing awareness of the futility of providing cardiopulmonary resuscitation (CPR) for all victims of cardiac arrest. For terminally ill patients, resuscitation prolongs the dying process. Certain patients may benefit from the "do-not-resuscitate" (DNR) designation that prevents the initiation of CPR.

In the wake of the Patient Self-Determination Act, persons have been encouraged to formulate advance directives that allow them to express their wishes about treatment options if they become incapacitated. Public awareness of end-of-life and quality-of-life issues has spurred an increase in the execution of advance directives, and physicians have responded by designating more patients as DNR.

Feelings, perceptions, and needs of family members of critically ill DNR patients have not been extensively studied. A qualitative study was designed to explore and describe the knowledge level and the meaning of DNR to the family members of critically ill DNR patients. Grounded theory methodology was used to address the knowledge level and understanding of the meaning of DNR. The 2 research questions were (a) What do family members of critically ill patients who are designated DNR know about the DNR designation? and (b) What is the meaning of DNR to family members of critically ill patients who are designated DNR?.

Eighteen family members who represented 13 critically ill patients from 2 acute care settings were interviewed. The knowledge level of the family members appeared adequate. The core concept, "the DNR designation," emerged from the data. The core concept linked the 2 main themes of "making the decision" and "living with the prospect of imminent death." Making the decision included the processes of communicating, understanding, experiencing, and reaching agreement. Components of living with the prospect of imminent death included supporting, facing mortality, dealing with feelings of uncertainty, and having faith and hope. The entire process was embedded within the context of the patient's uncertain prognosis.

Implications for nursing practice include initiating discussions about DNR, keeping family informed, and encouraging active family involvement with care. Implications for nursing education and recommendations for further research are also provided.