Family witnessed resuscitation in UK emergency departments: a survey of practice:

Owner experiences with and perceptions of owner-witnessed CPR in veterinary medicine

OBJECTIVE

To examine owner experiences with and perceptions of owner-witnessed resuscitation (OWR) in veterinary medicine and to determine if previous experience with family-witnessed resuscitation (FWR) influenced perceptions.

DESIGN

Multicenter survey.

SETTING

Two academic and 2 private practice referral hospitals in the United States.

SUBJECTS

Four hundred and seven clients presenting their small animal or exotic pet to the emergency service, or owners of patients hospitalized in the small animal ICU, April 1 to May 15, 2019.

INTERVENTIONS

None MEASUREMENTS AND MAIN RESULTS: Anonymous, online survey. Demographic variables, familiarity with CPR, previous experience with FWR or OWR, and open-ended questions and 4-point Likert items assessing level of agreement with statements on OWR were included. Scores equal or greater than 2 represented positive agreement. An overall OWR mean score was calculated from Likert items. Seventy-nine (19.4%; 95% confidence interval [CI], 15.7%-23.7%) participants reported having been involved with FWR, and 13 (3.2%; 95% CI, 1.8%-5.5%) reported having witnessed CPR on their pet. Owners were significantly more likely to participate in OWR if they had been present for FWR (P = 0.0004). Ninety-two percent of respondents who had been present for OWR would elect to be present again (95% CI, 62.1%-99.6%). Whether present for OWR or not, owners believed there may be benefits from witnessing CPR and had overall positive feelings toward the practice (OWR mean score, 2.87, SD 0.45 and 2.68, SD 0.54, respectively). Most respondents (78.6%; 95% CI, 74.2%-82.4%) felt that owners should be offered the opportunity to witness CPR on their pets.

CONCLUSIONS

Owners expressed overall positive experiences with and attitudes toward OWR and believe the option for presence should be provided. As pet owners become more aware of FWR in human medicine, veterinarians may need to be prepared to entertain the possibility of OWR and owners' wishes to remain with their pet during CPR.

Family presence during resuscitation: a needs assessment of education, policy, and opinion in Canada

PURPOSE

Family presence during resuscitation (FPDR) has been widely endorsed. Nevertheless, there is limited information available on current education and training used to support FPDR implementation, including that of relevant policy. Understanding the current state of FPDR educational opportunities, policies, and practices across Canadian hospitals is crucial to advancing and standardizing these within our medical community. Our objective was to identify the current and desired state of education and policy on FPDR, as well as current practices and opinions of Canadian healthcare professionals.

METHODS

We selected questionnaire topics and employed a modified Delphi consensus technique using a group of subject matter experts in resuscitation. We contacted a stratified sample of Canadian healthcare professionals via select listservs and surveyed the cohort using RedCAP™. We used descriptive statistics and conducted quantitative analyses to describe and test for significant differences among groups.

RESULTS

In total, 635 surveys were completed. Only 46.3% of participants reported ever attending an educational opportunity involving learning how to manage FPDR; however, 92% wanted training. Only 11% knew if they had an official FPDR policy in their current hospital but 62.9% indicated they wanted one. In support of FPDR, 88% agreed that family members should be allowed to be present during a resuscitation.

CONCLUSION

While opinions are mostly positive towards FPDR, there exists a gap between the current and desired state of education and policy supporting it within Canada.

A Scoping Review of the Impact of Family Presence on Pediatric Resuscitation Team Members

OBJECTIVES

The purpose of this scoping review was to identify the extent, range, and nature of information currently available on family presence during pediatric resuscitation on resuscitation team members and their performance.

DATA SOURCES

A comprehensive search strategy was created and executed by identifying primary keywords in central articles, pretesting key words and combinations of them in databases to confirm articles returned fell within the search parameters, and checking that key articles were returned which confirmed the search strategy was not too narrow.

STUDY SELECTION

Two members of the research team independently conducted relevance screening using predetermined inclusion and exclusion parameters. Titles and abstracts of retrieved articles were reviewed using the set criteria involving. From the refined list of selected articles, full texts of each article were considered for final determination of inclusion.

DATA EXTRACTION

Key items of information were gathered from each article selected using a predefined extraction list. The extracted information was then sorted into themes and relevant issues.

DATA SYNTHESIS

Of the 3,012 studies initially identified, 48 met the inclusion criteria. Themes identified included as follows: 1) attitudes and opinions on family presence during pediatric resuscitation; 2) reasons in support of or against family presence during pediatric resuscitation; 3) education, training, and support; and 4) resuscitation performance and outcomes. Our review of the available information highlighted that the majority of work done to this point has focused heavily on healthcare provider opinions and relied mainly on survey method.

CONCLUSIONS

We propose that future research employ more rigorous research techniques, such as randomized control trials, place greater emphasis on healthcare provider behaviors and clinical outcomes during family presence during pediatric resuscitation, and increase exploration into the education and training needs of healthcare providers who already currently manage family presence during pediatric resuscitation.

A Qualitative Exploration of the Impact of a Distressed Family Member on Pediatric Resuscitation Teams

BACKGROUND AND OBJECTIVES

Family presence during resuscitation (FPDR) is commonplace in many hospitals today. Research has supported the positive effects it can have on family members; however, there is little research about how it may affect the resuscitation team's performance, especially in a pediatric population. Our objective was to identify how resuscitation team members perceive and respond to the presence of a distressed family member during a resuscitation.

METHODS

This is a qualitative study in which we examine FPDR-related themes raised by pediatric resuscitation team members after a resuscitation simulation. As part of a team training educational intervention, pediatric resuscitation teams, composed of nurses, respiratory therapists, and resident physicians, participated in a video-recorded simulated event in which they attempted to resuscitate an infant. During the scenario, a confederate actor played the role of a distressed "parent." Video-recorded debriefs occurred immediately after each simulation. Video recordings were transcribed verbatim, and then transcripts were coded and analyzed via thematic analysis to saturation.

RESULTS

Thirteen postevent video debriefs were analyzed. A total of 74 participants took part in these simulations and debriefs. Analysis revealed 15 major and 29 minor themes, which were mapped to 5 factors, namely resuscitation environment, affective responses, cognitive responses, behavioral responses, and team dynamics.

CONCLUSIONS

FPDR has an impact on resuscitation team members' responses and influences their adaptive behavior. If not managed well, this may pose potential patient safety concerns. Policy and training of specific teamwork skills are ways in which we can better equip health care providers to effectively manage FPDR.

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.

Parental presence during cardiopulmonary resuscitation of children: the experience, opinions and moral positions of emergency teams in France

OBJECTIVE

To evaluate the experience, opinions and moral positions of French emergency physicians (EP) who had taken a paediatric university course on parental presence during child cardiopulmonary resuscitation (CPR), and to compare it with the responses of nurses on their teams.

METHODS

A questionnaire was sent to 550 EPs who had taken the course during the previous 6 years; the EPs were also asked to give a copy of the questionnaire to nurses on their staff. Data were collected on experience of parental presence during child CPR, opinions on the practice, arguments for and against parental presence, and the moral positions of respondents regarding their perception of life and the sharing of medical/parental power in the decision-making process.

RESULTS

343 responses were analysed, 47% from EPs (29% response rate) and 53% from nurses. 52% of respondents had experienced parental presence during child CPR, but it had been the physician's wish on only 6% of these occasions. Only 17% of respondents favoured parental presence, with EPs (27%) being favourable more often than nurses (12%). The reasons against parental presence were psychological trauma for the parents, risk of interference with medical management, and care team stress. Respondents not in favour of parental presence expressed this view more for medical reasons than for parent-related reasons. The physicians not in favour of parental presence espoused a moral position predicated on medical power.

CONCLUSIONS

A majority of EPs and nurses were reluctant to have parents present during child CPR. Their attitude involved medical paternalism.

The Presence of Relatives during Brainstem Death Testing in an Intensive Care Unit

The issue of allowing relatives to witness brainstem death testing has sparked debate between all members of the multidisciplinary team working in intensive care. A literature search was carried out, highlighting the advantages and disadvantages of relatives observing brainstem death testing. Databases searched were the NHS Knowledge Network, OVID, CINAHL, the Cochrane Library, and Medline. Search items included: brainstem death, brainstem death testing, brain death, intensive care, relatives, families and witnessed cardiopulmonary resuscitation. Articles which were under ten years old were included; however articles which were pertinent to the topic were not excluded if outside this timeframe.

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.

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.

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 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.

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.

Survey of Family-Witnessed Brain Stem Death Testing in Intensive Care Units

It is not currently known how often relatives are present during brain stem death (BSD) testing. A telephone survey of a selection of UK intensive care units (ICUs) was therefore performed asking about their experience with family-witnessed BSD testing. Forty-eight ICUs participated. Relatives were allowed to witness BSD testing in 21 ICUs (44%). Despite initial concerns by some ICU staff, none had experienced any problems with the family being present during the testing procedure.

A study of Turkish critical care nurses' perspectives regarding family-witnessed resuscitation

AIM

. This paper reports a study to determine the experiences and attitudes of Turkish critical care nurses concerning family presence during cardiopulmonary resuscitation.

BACKGROUND

The debate surrounding family-member presence in resuscitation areas has been evolving since the 1980s. The practice of performing resuscitation of adults in the presence of family members is controversial and has stimulated discussion and debate worldwide.

DESIGN

A descriptive survey.

METHOD

The survey was carried out in 2007 with 135 critical care nurses from two university hospitals in Izmir. A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a three-point Likert scale. The attitudes of the nurses were explored in three areas: decision making, processes and outcomes of resuscitation.

RESULTS

Of the nurses, only 22.2% experienced a situation where family members were present during cardiopulmonary resuscitation. Most of these nurses (n = 20) had one or more negative experiences. The majority disagreed that family members should always be offered the opportunity to be with the patient during cardiopulmonary resuscitation. The most common concerns for not favouring family-witnessed resuscitation were reported as performance anxiety, fear of causing psychological trauma to family members and increased risk of litigation.

CONCLUSIONS

Many Turkish critical care nurses have no knowledge of family-witnessed resuscitation and do not support the practice. We suggest that Turkish critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation and the culturally appropriate policies concerning this subject should be changed in Turkish hospitals.

RELEVANCE TO CLINICAL PRACTICE

Most critical care nurses in Turkey are not supportive of family-witnessed resuscitation. All critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation.

Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature review

AIM

This paper is a report of a critical literature review to identify the positive and negative effects of family presence during adult resuscitation, as perceived by accident and emergency healthcare staff based in primary (out-of-hospital) and secondary (in-hospital) environments of care.

BACKGROUND

The controversial practice of family presence during resuscitation of adults has stimulated debate over the past two decades, giving rise to a growing body of literature and the development of clinical guidelines for practice.

METHODS

A search was carried out for the period 1987-2007 using the Science Direct, CINAHL, Medline, EMBASE, psychINFO and BNI databases and the search terms resuscitation, witnessed resuscitation, family presence, relatives' presence, attitudes and opinions and accident and emergency.

RESULTS

Eighteen studies were included in the critical review, primarily comprising retrospective survey research. The majority of studies were descriptive in design. A standardized approach to the appraisal process was achieved through the utilization of guidelines for critiquing self-reports. The findings revealed that accident and emergency healthcare staff perceive both positive and negative effects as a consequence of family presence during adult resuscitation and their opinions suggest that there are more risks than benefit.

CONCLUSION

Further research is essential if family presence during resuscitation of adults is to be better defined and understood. Qualitative methods of enquiry are recommended as a way of gaining a deeper insight into and understanding of this practice.

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 &lt; .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P &lt; .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.

Should family members be present during cardiopulmonary resuscitation? A review of the literature

During resuscitation, family members are often escorted out of the room for fear of immediate and long-term consequences to the family, the patient, and the physician. However, mounting evidence suggests that family presence during resuscitation could, in fact, be beneficial. The Emergency Nurses Association and the American Heart Association endorse family-witnessed resuscitation and the development of hospital policies to facilitate this process. However, the opinions on family-witnessed resuscitation vary widely, and few hospitals in the United States have developed formal policies on the presence of families during cardiopulmonary resuscitation. In this article, we review the current status of family-witnessed resuscitation and provide recommendations on the development of hospital policies for family-witnessed resuscitation.

Parent presence during complex invasive procedures and cardiopulmonary resuscitation: a systematic review of the literature

We conducted a systematic review of the literature on parent presence during complex invasive pediatric procedures and/or resuscitation. We identified 15 studies that met our inclusion criteria. All studies were summarized chronologically according to level of evidence. The studies all demonstrated that parents prefer to have the choice about whether they remain at their child's side during complex invasive procedures and resuscitation, but they also revealed that apprehensions and controversy abound among clinicians regarding this practice. Despite the endorsements of the American Academy of Pediatrics and the Society of Critical Care Medicine and the recommendations of the American Heart Association, few pediatric institutions have drafted guidelines, conducted clinical education, or committed sufficient staff resources to fully support this practice. We present this review not only to illustrate the various perspectives of parents/guardians, clinicians, and pediatric patients themselves that have been reported to date but also to encourage more research so that the practice can be performed safely and benefit parents, their children, and clinicians alike.

Family Presence During Resuscitation: A Critical Review of the Literature

Presence of patients’ families during resuscitation has emerged as an important practice issue, sparking considerable controversy worldwide. Early advocates of allowing patients’ families to be present during resuscitation faced more resistance than did current advocates because the former had little or no scientific research results to support their ideas. In the past 15 years, a number of quantitative studies, especially descriptive surveys, have been conducted. Qualitative researchers have also explored the lived experience of family members present during resuscitation and less commonly the perspectives of patients and healthcare providers. In this review of the literature, the current state of the science is critically reviewed and the ethical-theoretical perspectives of respective researchers and staff participants in the reviewed studies are discussed. Surveys were used to collect data in most studies to date. Limitations of these designs include small convenience samples, low response rates, use of retrospective surveys and the associated potential selection bias, and lack of consistency in survey instruments, factors that make comparison of findings between studies difficult. Recommendations to address the gaps in the current state of knowledge about family members’ presence during resuscitation are discussed. Experimental and qualitative methods are especially needed to investigate the effect of family presence during resuscitation on patients, families, nurses and physicians, and other multidisciplinary staff members.