Family presence during resuscitation in emergency departments: professionals' attitudes in Brazil

Family-witnessed resuscitation in the emergency department in a low-income country

Cardiac arrest is often a sudden and traumatic event. Family-witnessed resuscitation was first recommended by the American Heart Association over two decades ago. Since then several global professional bodies have identified a range of potential benefits for relatives; however, it remains contentious. For nurses working in emergency departments (EDs) in low-income countries, the evidence for, and experience of, family-witnessed resuscitation is limited. This article critically appraises the literature relating to the perceptions of medical professionals and critically ill patients and their families about communication, family presence and their involvement during resuscitation in the ED. Three themes relating to family-witnessed resuscitation in the ED were identified by a focused literature search. These were: leadership and communication, limitation of policies and guidelines and relatives' views. The recommendations from this review will be used to develop emergency and trauma nursing practice guidelines in Zambia, a low-income country in sub-Saharan Africa.

Nurses' attitudes towards family importance in nursing care across Europe

AIMS AND OBJECTIVE

To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries.

BACKGROUND

Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice.

DESIGN

A cross-sectional survey across European countries.

METHOD

A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results.

RESULTS

There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score.

CONCLUSION

Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes.

RELEVANCE FOR CLINICAL PRACTICE

In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.

Health Care Providers' Lived Experience Caring for Victims of Youth Violence Separated From Family During Trauma Resuscitation

BACKGROUND

Family presence during trauma resuscitation is increasingly emphasized; yet it is inconsistently applied and has not been studied in victims of youth violence from the perspective of the health care provider.

OBJECTIVE

The purpose of this study is to explore the lived experience of health care providers involved in the care of children who are separated from their family during trauma resuscitation for injuries sustained from youth violence.

METHODS

A qualitative, transcendental phenomenological study was conducted to examine health care providers' experiences. Data were collected from March 2021 to April 2021 using open-ended, semistructured interviews conducted via Zoom or telephone. Data were transcribed and analyzed following the transcendental phenomenological reduction approach.

RESULTS

Seven health care providers were interviewed. Ages of the participants ranged from 31 to 60 years (mean: 52.1 years). Years of practice ranged from 9.5 to 36 years (mean: 26 years). The participants' professions included surgeon, registered nurse, violence interventionalist, and social worker. From the data collected, 6 major themes emerged: current landscape, decision making, safety and security, law enforcement presence, characteristics of families of victims of youth violence, and staff reflections.

CONCLUSIONS

This study demonstrates the value of incorporating health care providers' experiences to inform the barriers, facilitators, and nuances of implementing family presence during trauma resuscitation for pediatric victims of violence.

A Corbin and Strauss Grounded Theory on the Experiences of Patients, Relatives, and Health Professionals About the Family Presence During Emergency Care

This study aimed to explore the experiences of patients, relatives, and health professionals about family presence during emergency care. In this grounded theory, 42 participants were interviewed from October 2016 to February 2017 in 2 Brazilian emergency rooms. Data collection and analysis were based on the constant comparative method. Findings identified that there is a social meaning about family presence during emergency care, which is conditioned, sporadic, and variable, and health professionals are responsible for the decision. The implementation of family systems care in emergency rooms is required to meet the needs of both patients and families. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A30.

Physicians' Characteristics Associated with Their Attitude to Family Presence during Adult Cardiopulmonary Resuscitation

Healthcare providers have disparate views of family presence during cardiopulmonary resuscitation; however, the attitudes of physicians have not been investigated systematically. This study investigates the patterns and determinants of physicians' attitudes to FP during cardiopulmonary resuscitation in Saudi Arabia. A cross-sectional design was applied, where a sample of 1000 physicians was surveyed using a structured questionnaire. The study was conducted in the southern region of Saudi Arabia for over 11 months (February 2014-December 2014). The collected data was analyzed using the Pearson chi-square test. Spearman's correlation analysis and chi-square test of independence were used for the analysis of physicians' characteristics with their willingness to allow FP. 80% of physicians opposed FP during cardiopulmonary resuscitation. The majority of them believed that FP could lead to decreased bedside space, staff distraction, performance anxiety, interference with patient care, and breach of privacy. They also highlight FP to result in difficulty concerning stopping a futile cardiopulmonary resuscitation, psychological trauma to family members, professional stress among staff, and malpractice litigations. 77.9% mostly disagreed that FP could be useful in allaying family anxiety about the condition of the patient or removing their doubts about the care provided, improving family support and participation in patient care, or enhancing staff professionalism. Various concerns exist for FP during adult cardiopulmonary resuscitation, which must be catered when planning for FP execution.

The process of giving information to families in intensive care units: A narrative review

AIM

Information is one of the most important needs of families of critical patients. Healthcare professionals also identify the great value of communication with families to reduce their anxiety and stress. Despite this, families may feel inadequately informed, causing added suffering. The purpose of this study is to provide an understanding of both families' and healthcare professionals' perspectives on information giving within intensive care units (ICU).

METHOD

A narrative review was conducted using MEDLINE, CINAHL, PsycINFO databases and the Cochrane Library to identify studies published in either English or Spanish from 2002 to 2018.

RESULTS

47 studies were included, and five categories were identified: 1)"the need to know"; 2)family satisfaction with the information received; 3)impact of information on families' experiences in the ICU; 4)nurses and physicians' perceptions of information transmission, and 5)information process in the ICU.

CONCLUSIONS

Providing honest and truthful information to the families of critical patients is essential to reduce family anxiety and increase family control, although this often appears to be inadequately accomplished by staff. Interdisciplinary involvement in information giving may be beneficial for both families and ICU professionals. This review brings new understanding about the process of information to families of ICU patients and it can be used to improve the quality and humanization of care in the ICUs.

The absence of the family in emergency care contributes to suffering in patients and family members

AIM

To understand what the absence of the family during emergency care means to adult patients and their families to.

METHOD

A grounded theory study was conducted in two emergency units of two public hospitals in southern Brazil. From October 2016 to February 2017, 15 interviews with patients and 15 with family members were carried out. The data were analyzed following the comparative method.

RESULTS

The patients and families experienced the absence of the family in emergency care as a process of suffering caused by the separation of patient and family; they did not understand the reasons for family exclusion, and were resigned to the situation.

CONCLUSION

Urgent care per se entails suffering in patients and their relatives; this suffering intensifies when the family is separated and cannot accompany the patient during emergency care. These results show the need to develop health strategies and policies that contribute to the comprehensive care of patients and families in hospital emergency units.