Family support liaison in the witnessed resuscitation: A phenomenology study

Reliability and validity of the Chinese version of the family presence risk-benefit and self-confidence scales in Chinese nurses

BACKGROUND

Controversy surrounding Family Presence during Resuscitation (FPDR) continues internationally. The attitudes of medical professionals toward FPDR are particularly important for its clinical implementation. Currently, there is a lack of validated tools to evaluate medical professionals' perceptions of FPDR in China. The study aimed to: (1) Cross-culturally adapt and validate the Family Presence Risk-Benefit Scale (FPR-BS) and the Self-Confidence Scale (FPS-CS) for use in China; and (2) investigate the nurses' perceptions of FPDR and explore the relationships between the nurses' perceptual variables and demographic variables.

METHODS

The English version of the FPR-BS and FPS-CS underwent a rigorous process of translation, back-translation, proofreading, and cultural adaptation to create the Chinese versions. In the first stage, a sample of 200 nurses were recruited to evaluate the reliability and validity of the scales. In the second stage, a larger cohort 519 nurses were invited to assess their perceptions of FPDR and the relationships between these perceptual variables and demographic variables.

RESULTS

Exploratory factorial analysis identified a single dimension for both the FPR-BS and FPS-CS, explaining 43.84% and 48.43% of the variance, respectively. The Scale-level content validity index (S-CVI) of the FPR-BS and the FPS-CS was 0.98 and 0.97, respectively. Reliability assessments yielded Cronbach's alpha coefficients of 0.933 for the FPR-BS and 0.930 for the FPS-CS. The split-half reliability coefficients were 0.832 for the FPR-BS and 0.835 for the FPS-CS, while the retest reliability coefficients were 0.742 and 0.927, respectively. The average scores obtained were 2.76 (SD = 0.52) for the FPR-BS and 3.43 (SD = 0.58) for the FPS-CS. Statistical analyses revealed that factors such as patient type, family members' prior experience with resuscitation, and the number of times nurses invited family members during resuscitation significantly influenced perceptions of the benefits and risks associated with FPDR (P < 0.05). Furthermore, obtaining certification as an intensive care specialist was positively associated with nurses' self-confidence in managing FPDR (P < 0.05).

CONCLUSIONS

The FPR-BS and FPS-CS were validated as effective instruments for measuring nurses' perceptions of PFDR, demonstrating acceptable levels of validity and reliability. While nurses reported fewer benefits and greater risks of FPDR, they exhibited increased self-confidence in managing family presence during resuscitation.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

Family presence during adult resuscitation from cardiac arrest: A systematic review

AIM

Objective: To conduct a systematic review of the published evidence related to family presence during adult resuscitation from cardiac arrest.

METHODS

This review, registered with PROSPERO (CRD42021242384) and reported according to PRISMA guidelines, included studies of adult cardiac arrest with family presence during resuscitation that reported one or more patient, family or provider outcomes. Three databases (Medline, CINAHL and EMBASE) were searched from inception to 10/05/2022. Two investigators screened the studies, extracted data, and assessed risks of bias using the Mixed Method Appraisal Tool (MMAT). The synthesis approach was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines and a narrative synthesis method.

RESULTS

The search retrieved 9,459 citations of which 31 were included: 18 quantitative studies (including two RCTs), 12 qualitative studies, and one mixed methods study. The evidence was of very low or low certainty. There were four major findings. High-certainty evidence regarding the effect of family presence during resuscitation on patient outcomes is lacking. Family members had mixed outcomes in terms of depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and experience of witnessing resuscitation. Provider experience was variable and resuscitation setting, provider education, and provider experience were major influences on family presence during resuscitation. Finally, providers reported that a family support person and organisational guidelines were important for facilitating family presence during resuscitation.

CONCLUSION

The effect of family presence during resuscitation varies between individuals. There was variability in the effect of family presence during resuscitation on patient outcomes, family and provider outcomes and perceptions.

Family support role in hospital rapid response teams: a scoping review

OBJECTIVE

The objective of this review was to identify and understand the primary research investigating the family support role in hospital rapid response teams.

INTRODUCTION

Individual studies have described the benefits of providing emotional and psychosocial support to family members of a person receiving emergency medical care from a rapid response team in a hospital setting. To the authors' knowledge, there are no studies that have identified and described these studies together.

INCLUSION CRITERIA

All empirical qualitative and quantitative papers investigating a family support role delivered in a rapid response team in a hospital setting were included.

METHODS

This review followed a published a priori protocol. The four databases searched were MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and OpenGrey. The search strategy was not limited by the age of participants within studies or by the language the study was published in. The title and abstracts of all citations were reviewed by two authors independently, and studies meeting the inclusion criteria were considered for inclusion. The full text of the remaining studies were retrieved and reviewed by two authors independently. Data from eligible studies were extracted by two authors separately using a predetermined data extraction form and summarized in table and narrative format.

RESULTS

After a full-text review of 110 studies, six studies met all inclusion criteria. All rapid response teams were set in hospital locations, and the studies were set in four nations. Charted data demonstrates that the family support role had been investigated predominantly by qualitative study designs from the perspective of staff delivering the role. One study reported health outcomes of family members who received family support. In all studies, the family support role was part of a resuscitation rapid response team. Family support was provided at all stages of the resuscitation procedure. The family support role was not a consistently defined role, with the activities of the family support person reported differently between studies. Twenty-five varying support activities were described, such as attending to the family members' comfort needs, explaining the process of resuscitation, and providing guidance to the family member. In all studies, the family support role was available to support the family witnessing the resuscitation. The family support role was delivered by professionals from varying disciplines, including social work, nursing, health care workers, and health care chaplains.

CONCLUSIONS

Family support roles are varied and are carried out by health professionals of various backgrounds highlighting the need to consider the support and training needs of the person performing the role. Future research using evaluation methods is recommended to deepen the understanding about the family support role in hospital-based rapid response teams.

Learning Needs of Iranian Patients with Coronary Heart Disease: A Cross-sectional, Comparative Study

BACKGROUND

Patient education requires modification as it is either nonexistent or implemented irregularly or inadequately.

STUDY’S PURPOSE

To examine the learning needs of patients with coronary heart disease from the perspective of the patients, their relatives, and health care providers.

METHODOLOGY

The cross-sectional, comparative study conducted at two cardiac hospitals of Tabriz and Ardebil, Iran from May 2016 to September 2016.Through convenience sampling perceptions of 137 patients, 137 relatives, 33 cardiologists, and 108 nurses were compared using the Cardiac Learning Need Inventory questionnaire.

MAJOR RESULTS

The most important learning needs of patients from the perspective of physicians, nurses, and patients' relatives was information about risk factors. In contrast, patient's perceived information about medication to be their most important learning need.

CLINICAL IMPLICATIONS

Patients' perceptions of their educational needs was different from the perceptions of physicians, nurses, and relatives of the patients. Therefore, when planning patient education a comprehensive review of the patients' learning needs is required in order to develop a suitable education plan by prioritizing patients' educational needs.

"Me First, Others Later" A focused ethnography of ongoing cultural features of waiting in an Iranian emergency department

BACKGROUND

Waiting is an inevitable experience in all emergency departments (EDs). This waiting time may negatively influence the patients and their relatives' satisfaction, healthcare professionals' (HCPs) performance, and the quality of care provided. This study aims to explore, gain understanding of and describe what it is like to wait in an Iranian emergency department (ED) with particular focus on cultural features.

METHOD

A focused ethnographic approach based on Spradley's (1980) developmental research sequence was conducted in the ED of a tertiary academic medical center in northwest Iran over a 9-month study period from July 2017 to March 2018. Participant observation, ethnographic interviews and examination of related documents and artefacts were used to collect data. All the data were recorded in either field notes or verbatim transcripts and were analysed using Spradley's ethnographic data analysis method concurrently.

RESULTS

The overarching theme of "Me first, others later" emerged. Within this overarching theme there were seven sub-themes as follows: human-related factors, system-related factors, patients and their relatives' beliefs and behaviors, HCPs' beliefs and behaviors, consequences for patients and their relatives, consequences for HCPs, and consequences for ED environment and care process.

CONCLUSION

The mentality 'me first, others later' as the main cultural barrier to emergency care, strenuously undermined our positive practice environment. An accountable patient/relative support liaison, a clearly-delineated process of ED care delivery, guidelines for providing culturally competent ED care, and public awareness programs are needed to address the concerns and conflicts which establish a mutual trust and rapport.

Cultural aspects of death notification following cardiopulmonary resuscitation

AIMS

To explore the lived experience of resuscitation team members involved in notifying family members when a patient dies following a resuscitation event in an Iranian cultural context.

BACKGROUND

Death notification to the family is indeed a difficult and an important issue for resuscitation team members. The way health professionals deliver news to family members should incorporate elements of sensitivity, timing and adequate clinical explanations with emphasis on the efforts made by the professionals during the resuscitation.

DESIGN

A phenomenological study.

METHOD

Over a period of 5 months (June 2016-November 2016) eleven nurses and six physicians were interviewed using an in-depth interview process applying Van Manen's hermeneutic phenomenological approach for data collection and analysis. The participants were recruited from six tertiary hospitals in Tabriz, Iran.

FINDINGS

There were two main themes that emerged from the data analysis including: "contributing factors on the impact of notification" and "notification strategies". A further 13 subthemes emerged under the main themes. Several culturally related issues emerged with the participants feeling more comfortable informing male rather than female relatives about the death of the patient following a resuscitation.

CONCLUSIONS

Notifying family members of a patient's death is a stressful and culturally sensitive task for the resuscitation team members. The nature of the patient's presenting condition, together with the various resuscitation interventions can result in relatives responding unpredictably. Providing health professionals with the appropriate training and skills to effectively communicate with family members will ensure that the families' level of preparedness, understanding and cultural beliefs are taken into consideration.