Impact of a Multifaceted Intervention on Nurses’ and Physicians’ Attitudes and Behaviors Toward Family Presence During Resuscitation

Family witnessed resuscitation: nationwide survey of 337 prehospital emergency teams in France

OBJECTIVE

To assess the practices and opinions of prehospital emergency medical services (EMS) with regard to family witnessed resuscitation (FWR) and to analyse the differences between physicians' and nurses' responses.

DESIGN

An anonymous questionnaire (30 yes/no questions on demographics and FWR) was sent to all prehospital emergency staff (physicians, nurses and support staff) working for the 377 Mobile Intensive Care Units in France.

RESULTS

Of the 2689 responses received 2664 were analysed. Mean respondent age was 38 ± 8 years, the male to female ratio was 1:2. 87% of respondents had already performed FWR and 38% had offered relatives the option to be present during resuscitation. Most respondents (90%) felt that FWR might cause psychological trauma to the family; 70% thought that FWR might impact on the duration of resuscitation and 68% on EMS team concentration. In the 28% of cases when relatives had asked to be present, 59% of respondents had acquiesced but only 27% were willing to invite relatives to be routinely present.

CONCLUSIONS

Prehospital EMS teams in France seems to support FWR but are not yet ready to offer it systematically to relatives. Following our survey, written guidelines are currently in development in our department. These guidelines could be the first step of a national strategy for developing FWR in France. We await results from other studies of family members' opinions to compare prehospital practitioners' and family members' views to further develop our practice.

Attitudes of healthcare staff and patients' family members towards family presence during resuscitation in adult critical care units

AIM AND OBJECTIVES

This study examines the attitudes of healthcare staff and patients' family members towards family presence during resuscitation (FPDR) in critical care units in Hong Kong.

BACKGROUND

A wealth of literature is available on FPDR in various hospital and healthcare settings. The findings include many anecdotal accounts of both the positive and the negative effects of family presence. There is little documentation on the comparisons of staff and family members' perceptions and the predictors of staff attitudes towards FPDR practice.

DESIGN

Cross-sectional survey design.

METHOD

A convenience sample of 163 healthcare staff and 69 family members was recruited from the intensive care units.

RESULTS

There was significant difference in the attitudes of healthcare staff and patients' families towards FPDR. The regression analysis showed that the healthcare staff would be more supportive to FPDR if family members could share the dying moments with patients, family members were accompanied by a bereavement team member, there was adequate staff to support the family and staff members were adequately trained. If healthcare staff feel that family members may have the impression that the resuscitation is chaotic, witness resuscitation is traumatic experience for the family, family presence will increase risk of litigation and colleagues will not allow family members to stay during resuscitation making them less supportive of FPDR. Nurses were more supportive to FPDR than doctors.

CONCLUSION

The results provide information for healthcare professionals on the development of FPDR programmes for patients and their family members. Through multi-disciplinary collaborations, the effective and safe implementation of FPDR practice can be enhanced.

RELEVANCE TO CLINICAL PRACTICE

The results could help the clinical staff to develop written guidelines to produce an integrated and consistent approach to this sensitive issue in clinical practice.

Family engagement regarding the critically ill patient

The Institute of Medicine strongly recommends a health care system that supports family members. Nowhere is the need for family-centered care greater than with critically ill patients. Simplistically, family-centered care is primarily about communication. Unfortunately, family perception of communication in the intensive care unit (ICU) is quite poor. This article reviews some strategies to improve communication, including family meetings and family presence at resuscitation. It also highlights some of the areas within the realm of ICU care in which family engagement is particularly important, including advance directives, end-of-life care, brain death, and organ donation.

Attitudes, implementation and practice of family presence during resuscitation (FPDR): a quantitative literature review

AIM

To undertake a review of the quantitative research literature, to determine emergency staff and public attitudes, to support the implementation and practice of family presence during resuscitation in the emergency department.

BACKGROUND

FPDR although endorsed by numerous resuscitation councils, cardiac, trauma and emergency associations, continues to be topical, the extent to which it is implemented and practiced remains unclear.

REVIEW METHODS

A review of the quantitative studies published between 1992 and October 2011 was undertaken using the following databases: CINAHL, Ovid Medline, PSYCHINFO, Pro-Quest, Theses Database, Cochrane, and Google Scholar search engine. The primary search terms were 'family presence', and 'resuscitation'. The final studies included in this paper were appraised using the Critical Appraisal Skills Programme criteria.

RESULTS

Fourteen studies were included in this literature review. These included quantitative descriptive designs, pre and post-test designs and one randomized controlled trial (RCT). The studies were divided into three main research areas; investigation of emergency staff attitudes and opinions, family and general public attitudes, and four papers evaluating family presence programs in the emergency department. Studies published prior to 2000 were included in the background.

CONCLUSION

FPDR in the emergency department is well recognised and documented among policy makers, the extent in which it is implemented and practiced remains unclear. Further research is needed to assess how emergency staff are educated and trained in order to facilitate family presence during resuscitation attempts.

Family presence during resuscitation: a descriptive study of nurses' attitudes from two Saudi hospitals

BACKGROUND

The presence of family in the patient care area during resuscitation events is a matter of current debate among health care professionals in many communities. Family presence is highly recommended by many health organizations worldwide for several reasons including patient and family rights. There are no policies or guidelines in Saudi Arabia to guide health professionals in their practice regarding the option of family being present during resuscitations. The purpose of this study was to identify the attitudes of nurses towards family presence during resuscitation in the Muslim community of Saudi Arabia.

DESIGN

This is a descriptive survey using data from a convenience sample of 132 nurses using a self-administered questionnaire. The study took place in two major trauma centres in the eastern region of Saudi Arabia.

RESULTS

The analysis of the data revealed that nurses (n = 132) had negative attitudes towards family presence during resuscitation. A high percentage (77·2%) agreed that witnessing resuscitation is a traumatic experience for the family members. Almost all participants (92·3%) disagreed with the statement that the practice of allowing family members to be present during the resuscitation of a loved one would benefit the patient and 78% disagreed with the statement that it would benefit families. The majority of the participants (65%) revealed that the presence of family would negatively affect the performance of the resuscitation team. However, almost half of the sample (43·8%) would prefer a written policy allowing the option of family presence during resuscitation in Saudi Arabia.

CONCLUSION

The findings of the study strongly suggest the need for the development of written policies offering families the option to remain with patients during resuscitation in Saudi Arabia. The study further recommends the development of education programs for staff and public for the safe implementation of the practice.

How Families and Health Care Practitioners Experience Family Presence during Resuscitation and Invasive Procedures

BACKGROUND

The presence of family members during resuscitation and invasive procedures has been, and continues to be debated in the literature.

OBJECTIVE

To synthesize the best available research evidence on how families and health care practitioners experience family presence during resuscitation and invasive procedures.

INCLUSION CRITERIA

Studies about families and health care practitioners experiencing family presence during resuscitation and invasive procedures were considered.This review considered family members and health care practitioners who had experienced the phenomena of family presence during resuscitation or invasive procedures.Family members and health care practitioners experience of family presence during resuscitation or invasive procedures.Qualitative evidence consisting of, but not limited to, designs such as interpretive, descriptive-exploratory, observational, phenomenology, ethnography, grounded theory, hermeneutics, participatory action research, and critical theory were included in the review.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished research articles from 1985 to 2009. The review was limited to papers written in English.

METHODOLOGICAL QUALITY

Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised tools developed by the Joanna Briggs Institute.

DATA COLLECTION

Data were using standardized data extraction tools developed by the Joanna Briggs Institute.

DATA SYNTHESIS

The Joanna Briggs Institute' approach for meta-synthesis by meta-aggregation was used.

RESULTS

25 studies were included in the review. 154 findings were extracted and synthesized into 14 categories and 5 synthesized findings.

CONCLUSIONS

A tension is created between the belief of most family members that being present is a right and health care practitioners who believe they should have control over the circumstances of the practice. Although healthcare practitioners express concern that the practice will cause the family to experience psychological trauma the data does not suggest that this is the case. Most family members describe their presence as an opportunity to comfort and to gain closure.

IMPLICATIONS FOR PRACTICE

IMPLICATIONS FOR RESEARCH.

Reactions of staff members and lay people to family presence during resuscitation: the effect of visible bleeding, resuscitation outcome and gender

AIM

This article is a report on a study conducted to examine the views of healthcare professionals and lay people regarding the effect of family presence during resuscitation on both the staff performing the resuscitation and the relatives who witness it.

BACKGROUND

Family presence during resuscitation is controversial. Although many professional groups in different countries have recently issued position statements about the practice and have recommended new policy moves, the Israel Ministry of Health has not issued guidelines on the matter.

METHODS

Study design is factorial within-between subjects. Data were collected in Israel in 2008 from a convenience sample of 220 lay people and 201 healthcare staff (52 physicians and 149 nurses) using a questionnaire based on eight different resuscitation scenarios and manipulating blood involvement and resuscitations outcome. Data were analysed using one-way analysis of variance.

FINDINGS

Overall, both staff and lay people perceived family presence during resuscitation negatively. Visible bleeding and an unsuccessful outcome significantly influenced both staff's and lay people's perceptions. Female physicians and nurses reacted more negatively to family presence than did male physicians and nurses; lay men responded more negatively than lay women.

CONCLUSIONS

Changing the current negative perceptions of family presence at resuscitation requires (a) establishing a new national policy, (b) educating healthcare staff to the benefits of the presence of close relatives and (c) training staff to support relatives who want to be present.

Family presence during resuscitation and invasive procedures: physicians' and nurses' attitudes working in pediatric departments in Greece

BACKGROUND

Family presence during resuscitation and invasive procedures (FPDRAIP) has been a frequent topic of debate among healthcare personnel worldwide. This paper determines the knowledge, experiences and views of Greek physicians and nurses on FPDRAIP and examines possible correlations and factors promoting or limiting the implementation of the issue.

METHODS

The data for this descriptive questionnaire study were collected between March and June 2009. The study population consisted of 44 physicians and 77 nurses working in neonatal-pediatric departments and intensive care units in Patras, Greece, who answered an anonymous questionnaire.

RESULTS

The majority of the participants (73.6%) were not familiar with FPDRAIP, were neither educated (72.7%) nor did they agree with the issue (71.9%). No written policy on FPDRAIP existed in the hospitals surveyed. Participants who were familiar with existing guidelines on the issue, or those who had relevant personal experience (76.9%), were positive for practising it as well. The degree of invasiveness of the medical intervention was the major determinant for healthcare personnel to consent for FPDRAIP. Finally, 43.2% of physicians believed that the decision of allowing FPDRAIP should be made only by them, whereas, 40.3% of nurses thought it should be a joint one.

CONCLUSIONS

This study reveals that healthcare personnel in Greece are not familiar with the issue of FPDRAIP. In view of the increasing evidence on the advantages of this practice, we recommend implementation of relevant educational programs and institutional guidelines and policies.

Family presence during invasive procedures at the emergency department: what is the opinion of Spanish medical staff?

OBJECTIVES

Family presence (FP) during invasive procedures (IPs) in children remains controversial among pediatric emergency department (PED) staff. The authors aimed to determine health care providers' attitudes toward FP during IPs in Spain, to learn whether parents are given the option of being present during different IPs, and to study which factors influence the providers' opinions.

METHODS

Observational study. Physicians and nurses were asked to answer a questionnaire, which was sent to 43 PEDs and was available at the Spanish Pediatric Emergency Society Web site.

RESULTS

We obtained 222 questionnaires from 36 Spanish hospitals. A total of 65.8% of the surveys were answered by physicians (66.4% pediatricians) and 34.2% by nurses. The median age of the respondents was 32 years, and 69.2% were women. Parents were given the option of being present during blood sampling (36.4%), intravenous line placement (32.7%), urethral catheterization (32.1%), lumbar puncture (13.5%), and resuscitation (1%). More than 60% of providers approved of FP during blood sampling, sutures, intravenous line placement, and urethral catheterization; however, only 10.8% of providers encourages FP during resuscitation. Against FP, health care staff argue procedural invasiveness (75.6%), parents' anxiety (87.6%), and worsened performance of the procedure (66%). Commonly expressed advantages were reducing patient distress (72.9%) and parent anxiety (62.3%). Physicians, especially the older ones, are more likely to encourage FP than nurses for some IPs.

CONCLUSIONS

The PED staff tend to prefer parents not to be present during IPs as the level of invasiveness increases. Family presence is not common in Spanish PEDs. Older physicians are more likely to support FP than nurses.

An introduction to the multisystem model of knowledge integration and translation

Many nurse researchers have designed strategies to assist health care practitioners to move evidence into practice. While many have been identified as "models," most do not have a conceptual framework. They are unidirectional, complex, and difficult for novice research users to understand. These models have focused on empirical knowledge and ignored the importance of practitioners' tacit knowledge. The Communities of Practice conceptual framework allows for the integration of tacit and explicit knowledge into practice. This article describes the development of a new translation model, the Multisystem Model of Knowledge Integration and Translation, supported by the Communities of Practice conceptual framework.

Family presence preference when patients are receiving resuscitation in an accident and emergency department

AIM

This paper is a report of a study to illuminate the experience of family members whose relatives survived the resuscitation in an accident and emergency department, and their preferences with regard to being present.

BACKGROUND

Family presence during resuscitation can offer benefits to both patient and family members, and large healthcare organizations support and recommend offering the option for their presence. However, many staff believe that this is too distressing or traumatic for families and that they would interfere with the resuscitation process.

METHODS

An interpretive phenomenological approach was used to collect data in 2007-2008 with 18 family members of patients who survived life-sustaining interventions in an accident and emergency department in Hong Kong. Audio-recorded interviews were transcribed verbatim for thematic analysis and verified with the participants in second interviews.

FINDINGS

None of the family members was present in resuscitation room during the life-sustaining interventions, and five entered the room after the patients' condition was stable. The majority indicated a strong preference to be present if given the option. Three interrelated themes emerged: (i) emotional connectedness, (ii) knowing the patient, and (iii) perceived (in)appropriateness, with 10 subthemes representing affective, rational and contextual determinants of family presence preferences. The interplay of these determinants and how they contributed to strong or weak preference for family presence was analysed.

CONCLUSION

Variations among the contributing determinants to each family member's preference to be present were revealed. Appropriate nursing interventions, policy and guidelines should be developed to meet individualized needs during such critical and life-threatening moments in accident and emergency departments.

The impact of education on provider attitudes toward family-witnessed resuscitation

INTRODUCTION

The majority of acute care facilities have not developed policies or guidelines to facilitate family presence during cardiopulmonary resuscitation. Prior studies have shown that the personal beliefs and attitudes of hospital personnel involved in resuscitation efforts are the primary reasons family presence is not offered.

METHODS

This 2-phase, before/after study was conducted in a 388-bed academic trauma center, and in a 143-bed community hospital in eastern Washington State in 2008. In phase I, a convenience sample of physicians and registered nurses from both facilities were surveyed about their opinions and beliefs regarding family-witnessed resuscitation (FWR). Spearman's rho and independent t-tests were used to compare support of FWR between and within roles and practice location subgroups. In phase II of the study, clinician subgroups in the community hospital were re-surveyed following an educational program that used evidence-based information. Independent t-test and one-way ANOVA were used to compare pre and post-education mean scores of subgroups on indicators of effective teaching strategies and improved FWR support.

RESULTS

Opinions on FWR vary within and between practice roles and locations, with the strongest variable of support being prior experience with FWR. Following FWR education, mean scores improved for survey variables chosen as indicators of FWR support and teaching effectiveness.

DISCUSSION

When CPR providers are presented with FWR education, their opinion-based beliefs may be modified, decreasing barriers to family witnessed resuscitation and improving overall support of FWR as an extension of family-centered care.

Family presence in final moments: a precious gift

The experience of a family and nurse who shared the acute illness of a teenager illustrates advocacy for family presence in the ICU and during resuscitation as well as integration of spiritual care in complex nursing practice. Family participation supports physical, emotional, and spiritual needs, allowing for open communication and the comfort of knowing that a loved one is receiving care. Although critical care, heart, and emergency nursing associations support family presence and holistic care, family presence remains controversial.

Family presence during resuscitation and invasive procedures

The practice of allowing family to be present during patient resuscitation or invasive procedures (Family Presence) is gaining acceptance in North America and the United Kingdom in controlled circumstances. Research into Family Presence has demonstrated multiple benefits for the patient, family and health care team. These advantages include helping the family to understand the severity of the illness/trauma and to see that appropriate attempts were undertaken to save their loved one. Family Presence can also facilitate improved communication between the health care team and family. In spite of evidence supporting Family Presence as a useful practice for patient, family and health care team, the use of Family Presence is uncommon within Australian emergency departments and hospitals. Clear expectations at organisational, governmental and professional levels are essential to effectively implement this approach. To be supported in the clinical area, the success of a Family Presence program requires an inclusive approach to program development. A critical component of a successful Family Presence program is a family facilitator who is adequately prepared for the role and committed to supporting the family during resuscitation or invasive procedures. Research exploring Family Presence in Australia is lacking and highlights the need for context specific research in this area.

Spirituality and support for family presence during invasive procedures and resuscitations in adults

BACKGROUND

Many health care professionals believe that they provide holistic care. The role of spirituality, a known variable of holism, has not been explored in relation to the support among health care professionals for family presence during invasive procedures and resuscitative efforts in adults.

OBJECTIVE

To determine the relationship between spirituality of health care professionals and their support for family presence during invasive procedures and resuscitative efforts in adults.

METHODS

In this descriptive correlational study, 108 participants (physicians, physician assistants, and nurses) completed the Howden Spirituality Assessment Scale and a survey to measure their support for family presence.

RESULTS

A significant positive relationship was found between spirituality and support for family presence during resuscitative efforts in adults (r = 0.24, P = .05) and a significant negative correlation was found between support for family presence and the age of the health care professional (r = - 0.27, P = .01). No significant correlations were found between any of the study variables and invasive procedures in adults.

CONCLUSIONS

Adopting a more holistic perspective may support family presence, especially during resuscitative efforts in adults. Allowing the option for patients' families to remain present promotes holistic family-centered care.

Nurses’ Perceptions of Their Self-confidence and the Benefits and Risks of Family Presence During Resuscitation

Background Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables.

Objectives To test 2 instruments used to measure nurses’ perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses’ self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence.

Methods Nurses (n = 375) completed the Family Presence Risk-Benefit Scale and the Family Presence Self-confidence Scale.

Results Nurses’ perceptions of benefits, risks, and self-confidence were significantly and strongly interrelated. Nurses who invited family presence during resuscitation were significantly more self-confident in managing it and perceived more benefits and fewer risks (P < .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P < .001). Data supported initial reliability and construct validity for the 2 scales.

Conclusions Nurses’ perceptions of the risks and benefits of family presence during resuscitation vary widely and are associated with how often the nurses invite family presence. After further testing, the 2 new scales may be suitable for measuring interventional outcomes, serve as self-assessment tools, and add to conceptual knowledge about family presence.