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Gradilla SM, Balakrishnan A, Silverstein DC, Pratt CL, Fletcher DJ, Wolf JM. Owner experiences with and perceptions of owner-witnessed CPR in veterinary medicine. J Vet Emerg Crit Care (San Antonio) 2022; 32:322-333. [PMID: 35043551 DOI: 10.1111/vec.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Sarah M Gradilla
- The Emergency and Critical Care Service, Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Anusha Balakrishnan
- The Emergency and Critical Care Service, Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chap L Pratt
- The Emergency and Critical Care Service, Wheat Ridge Animal Hospital by Ethos Veterinary Health, Wheat Ridge, Colorado, USA
| | - Daniel J Fletcher
- Clinical Programs Center, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Jacob M Wolf
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence. Dimens Crit Care Nurs 2018; 37:167-179. [PMID: 29596294 DOI: 10.1097/dcc.0000000000000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events. OBJECTIVE This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation. METHODS By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale. RESULTS Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001). DISCUSSION These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.
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García-Martínez AL, Meseguer-Liza C. Emergency nurses’ attitudes towards the concept of witnessed resuscitation. Rev Lat Am Enfermagem 2018; 26:e3055. [PMID: 30208161 PMCID: PMC6136531 DOI: 10.1590/1518-8345.1382.3055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/22/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: to review the most relevant evidence on the nurses’ attitudes towards
witnessed resuscitation, in the inpatient and out-of-hospital spheres. Method: integrative literature review, covering the period from 2008 till 2015, using
the databases PubMed, Lilacs and SciELO; in Spanish, English and Portuguese.
The pediatric context was excluded from the study. Results: the synthesis of the data resulted in the inclusion of 10 articles,
categorized as: positive attitudes and negative attitudes. Conclusions: discrepancies exist among the nurses from different contexts and geographical
regions towards the concept; protocols need to be established for this
situation, in view of the advantages evidenced in the literature, for the
nursing professionals as well as the relatives. Witnessed resuscitation can
represent an opportunity to understand and cope with the rational and
irrational in the situation in a shared manner, as well as mitigate or
dignify the mourning.
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Abstract
The purpose of this study was to examine the effects of family presence during resuscitation (FPDR) in patients who survived trauma from motor vehicle crashes (MVC) and gunshot wounds (GSW). A convenience sample of family members participated within three days of admission to critical care. Family members of 140 trauma patients (MVC n = 110, 79%; GSW n = 30, 21%) participated. Family members ranged in age from 20-84 years (M = 46, SD = 15, Mdn = 47). The majority were female (n = 112, 80%) and related to the patient as spouse (n = 46, 33%). Participating in the FPDR option reduced anxiety (t = -2.43, p =.04), reduced stress (t = -2.86, p = .005), and fostered well-being (t = 3.46, p = .001). Results demonstrate the positive initial effects of FPDR on family members of patients surviving trauma injury.
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Affiliation(s)
- Jane S. Leske
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee WI
- Froedtert and the Medical College of Wisconsin-Froedtert Hospital, Milwaukee WI
| | - Natalie S. McAndrew
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee WI
- Froedtert and the Medical College of Wisconsin-Froedtert Hospital, Milwaukee WI
| | - Karen J. Brasel
- Oregon Heath & Science University, Division of Trauma, Critical Care & Acute Care Surgery, Portland OR
| | - Suzanne Feetham
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee WI
- Children’s National Health System, Washington DC
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Twibell R, Siela D, Riwitis C, Neal A, Waters N. A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation. J Clin Nurs 2017; 27:e320-e334. [PMID: 28677220 DOI: 10.1111/jocn.13948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Renee Twibell
- School of Nursing, Ball State University, Muncie, IN, USA.,Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
| | - Debra Siela
- School of Nursing, Ball State University, Muncie, IN, USA
| | - Cheryl Riwitis
- Indiana University Health LifeLine, Indianapolis, IN, USA
| | - Alexis Neal
- Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
| | - Nicole Waters
- Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
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A literature review examining the barriers to the implementation of family witnessed resuscitation in the Emergency Department. Int Emerg Nurs 2016; 30:31-35. [PMID: 27915124 DOI: 10.1016/j.ienj.2016.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Caring for people near death in the Emergency Department (ED) is challenging for professionals, duty bound to respond to the needs of the dying. Family witnessed resuscitation (FWR) is practiced internationally, allowing relatives to be present at the time of a patient's death, offering comfort to the dying and aiding the bereaved along a healthy grief trajectory. AIM The literature review elicits barriers to the implementation of FWR in the ED, examining why practice is sporadic despite numerous professional bodies calling for implementation. FWR is often met with opposition from staff, subsequently largely dependent upon who is on duty as opposed to adherence with best practice guidelines, risking inconsistent idiosyncratic practice. FINDINGS Barriers include; a lack of organisational support; shortage of manpower for provision of a family support person; absence of champions for the concept; willful non-adherence due to personal beliefs; restriction on coping strategies reliant upon the ability to emotionally detach, enhancing staff resilience facing repeated exposure to emotionally labile events. CONCLUSION All resuscitation efforts can be successful, whether the patient lives or dies, if practice supports healthy grieving. The challenge remains with such divided, entrenched and passionate views, how FWR can be adopted as accepted practice.
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Goldberger ZD, Nallamothu BK, Nichol G, Chan PS, Curtis JR, Cooke CR. Policies allowing family presence during resuscitation and patterns of care during in-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes 2015; 8:226-34. [PMID: 25805646 DOI: 10.1161/circoutcomes.114.001272] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 02/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND A growing number of hospitals have begun to implement policies allowing for family presence during resuscitation (FPDR). However, the overall safety of these policies and their effect on resuscitation care is unknown. METHODS AND RESULTS We conducted an observational cohort study of 252 hospitals in the United States with 41,568 adults with cardiac arrest. Multivariable hierarchical regression models were used to evaluate patterns of care at hospitals with and without an FPDR policy. Primary outcomes included return of spontaneous circulation and survival to discharge. Secondary outcomes included resuscitation quality, interventions, and facility-reported potential resuscitation systems errors. There were no significant differences in facility characteristics between hospitals with and without an FPDR policy, nor were there significant differences in return of spontaneous circulation (adjusted risk ratio, 1.02; 95% confidence interval, 0.95-1.06) or survival to discharge (adjusted risk ratio, 1.05; 95% confidence interval, 0.95-1.15). There was a small, borderline significant decrease in the mean time to defibrillation at hospitals with an FPDR policy compared with hospitals without the policy (mean difference, 0.32 minutes; 95% confidence interval, -0.01 to 0.64). Resuscitation quality, interventions, and facility-reported potential resuscitation systems errors did not meaningfully differ between hospitals with and without an FPDR policy. CONCLUSIONS Hospitals with an FPDR policy generally have no statistically significant differences in outcomes and processes of care as hospitals without this policy, suggesting such policies may not negatively affect resuscitation care. Further study is warranted about the direct effect of FPDR attempts on adult patients with an in-hospital cardiac arrest and their families.
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Affiliation(s)
- Zachary D Goldberger
- From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.).
| | - Brahmajee K Nallamothu
- From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.)
| | - Graham Nichol
- From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.)
| | - Paul S Chan
- From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.)
| | - J Randall Curtis
- From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.)
| | - Colin R Cooke
- From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.)
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Tabak N, Itzhaki M, Sharon D, Barnoy S. Intentions of nurses and nursing students to tell the whole truth to patients and family members. J Clin Nurs 2012; 22:1434-41. [PMID: 23134310 DOI: 10.1111/j.1365-2702.2012.04316.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate the intentions of nurses and nursing students to telling the truth to patients and families, based on the Theory of Planned Behavior which examines intention to perform behaviours. BACKGROUND In recent decades, the perception that patients have a moral and legal right to truthful and reliable information has become dominant. However, the study of telling the truth to non-oncology patients has received scant attention and little is known about the intention of nurses and nursing students to tell the truth. DESIGN A cross-sectional design. METHODS We used a scenario-based questionnaire, illustrating eight different situations in which nurses/nursing students are asked to tell the truth to a patient or family member regarding a devastating disease with which the patient is afflicted. Data were analysed using the Mann-Whitney U-test and ridge regression. RESULTS The sample included 150 participants, 110 registered nurses and 40 third year nursing students, with a response rate of 87%. The results show that nurses and nursing students intend to tell the whole truth even if this is not easy for them. Nurses more than students think that it is important to tell the whole truth and intend to do so. Head nurses tend to tell the truth more than staff nurses. For nurses, the components of the Theory of Planned Behaviour predicted intention to tell the truth, whereas among students subjective norms were the only predictor of intention. CONCLUSION The Theory of Planned Behaviour is a powerful predictor of nurse intention to tell the whole truth to patients and their families. Students perceive social pressure as the most important incentive of their intention to tell the truth. RELEVANCE TO CLINICAL PRACTICE Nurses and nursing students should receive additional training in dealing with various situations involving truth telling.
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Affiliation(s)
- Nili Tabak
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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