"It's just what we do": a qualitative study of emergency nurses working with well-established family presence protocol

Critical Care Nurses' Attitudes About Family Presence During Resuscitation: An Integrative Review

BACKGROUND

Family presence during resuscitation was introduced into clinical practice 30 years ago. Despite adoption of family-centered care by several health organizations and support for family presence during resuscitation by professional organizations such as the American Heart Association, critical care nurses' attitudes about family presence during resuscitation vary widely.

OBJECTIVE

To examine current evidence on critical care nurses' attitudes about, perceptions of, and behaviors related to practicing family presence during resuscitation.

METHODS

The method of Whittemore and Knafl guided the integrative review. Databases searched were CINAHL, PubMed, and Scopus. Articles included were English-language studies published from 2008 to 2022 that examined the perceptions of critical and emergency care nurses from adult units regarding family presence during resuscitation.

RESULTS

Twenty-two articles were included. Levels and strength of evidence were assessed with the Johns Hopkins nursing evidence-based model. The articles in this integrative review included a total sample size of 4780 health care professionals; 3808 were critical and acute care nurses.

DISCUSSION

Themes synthesized from current evidence included attitudes, benefits, barriers, demographic influence, cultural influence, and facilitators. Barriers and facilitators were associated with nursing practice in rural versus urban settings, age-related factors, years of experience, and unit-based differences in practice. Developing interventions to address identified factors can increase the practice of family presence during resuscitation in critical care settings.

CONCLUSIONS

Several factors influence the practice of family presence during resuscitation in critical care settings. Nurse leaders should consider these factors to enhance the practice of family presence during resuscitation.

The effects of family-witnessed resuscitation on health professionals

Aim:

To gain an understanding of the effects of family-witnessed resuscitation (FWR) on health professionals.

Background:

FWR has been the subject of an ongoing debate for almost 30 years. Historically, emergency departments (EDs) have excluded family members of a critically ill or injured patient from the treatment area during resuscitation.

Methodology:

A systematic literature search of six nursing-focused databases was undertaken using pertinent keywords. Only studies published in English, focused on ED staff and undertaken after 2007 (published up to 2017) were included.

Findings:

FWR is not commonly practised by health professionals. The four themes identified were: fear of adverse litigation; the importance of the role of the facilitator; lack of FWR policies in the workplace; and staff lack of knowledge and education regarding FWR, resulting in fear and stress.

Conclusion:

By implementing policies in the workplace, and having a facilitator to provide support and guidance to families, stress and anxiety can be greatly reduced. The implementation of educational programmes can increase staff awareness and knowledge surrounding the benefits of FWR

Family presence during resuscitation (FPDR): A qualitative study of implementation experiences and opinions of emergency personnel

AIM

To explore the experiences of nurses and doctors on the implementation of family presence during resuscitation (FPDR) in Victorian emergency departments.

METHODS

An interpretative qualitative study design was utilized which incorporated the open ended responses on a state wide Victorian survey of emergency department nurses and doctors. A thematic analysis of the responses was conducted involving data reduction, identification of key words, phrases and themes.

RESULTS

A total of 18 emergency departments consented to participate with a mean participant age of 41 years, made up of 91 (81) nurses and 21(19) doctors. The participants came from both metropolitan (64 (57), hospitals 300 - >500 beds) and regional (48 (43), hospitals <80 - 300 beds) health services. There were four emerging themes from the analysis; Depends on the day, impact family have on staff, organisational considerations and incorporating family centred care.

CONCLUSION

There remain a number of variables which have been identified as continuing to create barriers to implementation of family presence during resuscitation that need to be investigated further in order to ensure emergency personnel have consistency of FPDR practice.

A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation

AIMS AND OBJECTIVES

To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation.

BACKGROUND

Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence.

DESIGN

Qualitative exploratory-descriptive.

METHODS

Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared.

RESULTS

Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit.

CONCLUSIONS

Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of factors that influence the decision-making of interprofessional colleagues can improve collaboration and communication in crisis events of family presence during resuscitation.

Social workers' experiences as the family support person during cardiopulmonary resuscitation attempts

During inhospital cardiopulmonary resuscitation attempts, a designated family support person (FSP) may provide guidance and support to family members. Research on nurses and chaplains in this role has been published. Social workers also regularly fulfill this service, however, little is known about how they perceive and enact this role. To explore their experiences, qualitative interviews (n = 10) were conducted with FSP social workers. Critical realist thematic analysis identified five themes: walking in cold, promoting family presence, responding to the whole spectrum of grief, going beyond the family support role, and repercussions of bearing witness. Social workers perform a variety of tasks to promote family presence during resuscitation attempts and provide psychosocial support over the continuum of care. The FSP role impacts social workers emotionally and professionally. Implications for hospital policy, staffing, and clinical practice are discussed.

Family presence during resuscitation: A descriptive study with Iranian nurses and patients' family members

BACKGROUND

Family presence during resuscitation (FPDR) has advantages for the patients' family member to be present at the bedside. However, FPDR is not regularly practiced by nurses, especially in low to middle income countries. The purpose of this study was to determine Iranian nurses' and family members' attitudes towards FPDR.

METHOD

In a descriptive study, data was collected from the random sample of 178 nurses and 136 family members in four hospitals located in Iran. A 27-item questionnaire was used to collect data on attitudes towards FPDR, and descriptive and correlational analyses were conducted.

RESULTS

Of family members, particularly the women, 57.2% (n=78) felt it is their right to experience FPDR and that it has many advantages for the family; including the ability to see that everything was done and worry less. However, 62.5% (n=111) of the nurses disagreed with an adult implementation of FPDR. Nurses perceived FPDR to have many disadvantages. Family members becoming distressed and interfering with the patient which may prolong the resuscitation effort. Nurses with prior education on FPDR were more willing to implement it.

CONCLUSION

FPDR was desired by the majority of family members. To meet their needs, it is important to improve Iranian nurses' views about the advantages of the implementation of FPDR. Education on FPDR is recommended to improve Iranian nurses' views about the advantages of the implementation of FPDR.

Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation

BACKGROUND

Family presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present.

OBJECTIVE

To explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation.

METHODS

A cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence.

RESULTS

About half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20-45 years old) were 6.28 times more likely than those ≥ 66 years old (P = .01) and nonwhite participants were 2.7 times more likely than white participants (P = .049) to want family presence.

CONCLUSION

Patients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present.

Family presence during resuscitation: A Canadian Critical Care Society position paper

BACKGROUND

Recent evidence suggests that patient outcomes are not affected by the offering of family presence during resuscitation (FPDR), and that psychological outcomes are neutral or improved in family members of adult patients. The exclusion of family members from the resuscitation area should, therefore, be reassessed.

OBJECTIVE

The present Canadian Critical Care Society position paper is designed to help clinicians and institutions decide whether to incorporate FPDR as part of their routine clinical practice, and to offer strategies to implement FPDR successfully.

METHODS

The authors conducted a literature search of the perspectives of health care providers, patients and families on the topic of FPDR, and considered the relevant ethical values of beneficence, nonmaleficence, autonomy and justice in light of the clinical evidence for FPDR. They reviewed randomized controlled trials and observational studies of FPDR to determine strategies that have been used to screen family members, select appropriate chaperones and educate staff.

RESULTS

FPDR is an ethically sound practice in Canada, and may be considered for the families of adult and pediatric patients in the hospital setting. Hospitals that choose to implement FPDR should develop transparent policies regarding which family members are to be offered the opportunity to be present during the resuscitation. Experienced chaperones should accompany and support family members in the resuscitation area. Intensive educational interventions and increasing experience with FPDR are associated with increased support for the practice from health care providers.

CONCLUSIONS

FPDR should be considered to be an important component of patient and family-centred care.

Predictors of public support for family presence during cardiopulmonary resuscitation: A population based study

BACKGROUND

The debate on whether individuals want their family to be present during cardiopulmonary resuscitation continues to be a contentious issue, but there is little analysis of the predictors of the general public's opinion. The aim of this population based study was to identify factors that predict public support for having family present during cardiopulmonary resuscitation.

DESIGN

Data for this cross-sectional population based study were collected via computer-assisted-telephone-interviews of people (n=1208) residing in Central Queensland, Australia.

RESULTS

Participants supported family members being present should their child (75%), an adult relative (52%) or they themselves (51%) require cardiopulmonary resuscitation. Reasons cited for not wanting to be present were; distraction for the medical team (30.4%), too distressing (30%) or not known/not considered the option (19%). Sex and prior exposure to being present during the resuscitation of adults and children were both predictors of support (p<0.05). Reasons for not wanting to be present differed significantly for males and females (p=0.001).

CONCLUSION

Individual support for being present during cardiopulmonary resuscitation varies according to; sex, prior exposure and if the family member who is being resuscitated is a family member, their child or the person themselves. A considerable proportion of the public have not considered nor planned for the option of being present during a cardiac arrest of an adult relative. Clinicians may find it useful to explain the experiences of other people who have been present when supporting families to make informed decisions about their involvement in emergency interventions.

Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire-family version

BACKGROUND

In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed.

SETTING

Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden.

METHOD

The Person-centred Climate Questionnaire-Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality--three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P.

AIM

The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context.

RESULTS

The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item-total correlations were >0.3 and <0.7.

CONCLUSION

In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.

Patient- and family-centered care of children in the emergency department

Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This revised technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care.

Family-Witnessed Resuscitation: Perceptions of Nurses and Doctors Working in an Australian Emergency Department

Inconsistencies abound in the literature regarding staff attitudes and perceptions toward family-witnessed resuscitation. Our study builds on previous research by using a validated tool to investigate emergency department staff perceptions of family-witnessed resuscitation. A cross-sectional survey was distributed to 221 emergency department doctors' and nurses'. We found few differences between doctors and nurses perceptions toward family-witnessed resuscitation. Both nurses and doctors who held a specialty certification, who were more highly qualified, who had more experience with family presence during resuscitation, and who had a personal preference for having family members present during their own resuscitation perceived more benefits and fewer risks, as well as more confidence in their ability to manage these events. However, nurses more than doctors want patients to provide advanced directives for family presence. The findings will enable clinicians, educators, and hospital management to provide better support to all stakeholders through these events.