Factors influencing decision-making around family presence during resuscitation: a grounded theory study

Parental supporter in pediatric resuscitation: A mixed-method study with Delphi and analytic hierarchy process

INTRODUCTION

Providing support to parents is an evidence-based practice and a crucial part of family-centered nursing care. However, it is not clear who and how to provide the best support to parents during and after their child's resuscitation attempts.

PURPOSE

This study was conducted to explore the characteristics and roles of parental supporters responsible for caring for parents during and after their child's resuscitation.

METHODS

This is a mixed-method study combining the Delphi technique and the Analytic Hierarchy Process. A list of potentially important items describing the characteristics and roles of parental supporters caring for parents during and after pediatric resuscitation was developed through qualitative interviews with parents and members of the resuscitation team, and a thorough literature search. Then, the Delphi round was conducted with key experts. In the final step, the Analytic Hierarchy Process was used for ranking items in the order of their importance.

RESULTS

A list with 69 items describing the characteristics and roles of parental supporters was developed. 15 items (21.74%) were related to the "Characteristics of parental supporter" category; 8 items (11.59%) were related to the "Roles of a parental supporter during resuscitation" category; 13 items (18.84%) were related to the "Roles of a parental supporter after successful resuscitation" category; 23 items (33.34%) were related to the "Roles of a parental supporter after unsuccessful resuscitation" category; and 10 items (14.49%) were related to the "Roles of a parental supporter after unsuccessful resuscitation with help of other staff of the hospital" category.

CONCLUSION

The findings of this study can be used to develop guidelines that include parental supporter characteristics and roles to support parents during and after their child's resuscitation according to family-centered care practices in pediatric settings.

CLINICAL RELEVANCE

Study findings indicate the need for the presence of a parental supporter during and after pediatric resuscitation, whether witnessed by the parents or not. Knowledge regarding the characteristics and roles of parental supporters can be used in practice to uphold family-centered nursing care during critical situations.

Family presence during resuscitation: Perceptions and confidence of intensive care nurses in an Australian metropolitan hospital

BACKGROUND

While literature supporting family presence during resuscitation (FPDR) was first published over three decades ago, the practice remains controversial. Benefits have been confirmed, and barriers to practice identified through international research. The extent that FPDR is practised in Australian intensive care units (ICUs) is currently unknown.

OBJECTIVES

To examine ICU nurses' previous exposure and experiences with FPDR To establish their perceptions of the risks and benefits of the practice, as well as their confidence participating.

METHODS

A descriptive, cross-sectional study design, using validated FPDR risk-benefits and confidence scales, was distributed electronically to registered nurses working within a single adult ICU in Australia.

RESULTS

Fifty-six percent (n = 45) of respondents had never witnessed FPDR. Respondents were divided on whether families had the right to be present or should be given the option. ICU nurses perceived benefits for families but not for the patients involved or for the nurses participating. Nurses indicated they felt conflicted between the needs of the family, preserving the quality of the care delivered to a deteriorating patient, and protecting the safety of all stakeholders. Support for FPDR was often dependent on the availability of resources such as a family-support person.

CONCLUSION

This research establishes that ICU nurses lacked exposure to FPDR but were confident in their ability to perform, be observed, and support families during a resuscitation event. Therefore, confidence is likely not a factor in a decision to reject the practice. Further education is indicated as there remained a reluctance to adopt FPDR practice, despite many of the barriers reported having already been largely disproven by the available literature. Institutions have a role in policy development, ensuring adequate resources, and education.

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.

Parental supporter during pediatric resuscitation: Qualitative exploration of caregivers' and healthcare professionals' experiences and perceptions

BACKGROUND

Child resuscitation is a critical and stressful time for family caregivers and healthcare professionals. The aim of this study was to explore caregivers' and healthcare professionals' experiences and perceptions of a parental supporter during pediatric cardiopulmonary resuscitation to provide guidance to healthcare professionals on supporting parents and other family caregivers during resuscitation.

METHODS

This study used an exploratory descriptive qualitative approach. The setting was two large referral pediatric governmental hospitals. Participants were 17 caregivers who had experienced their child's resuscitation, and 13 healthcare professionals who served on resuscitation teams in emergency rooms or intensive care wards. Semi-structured, in-depth interviews were conducted and data were analyzed using thematic analysis. COREQ guidelines were followed.

RESULTS

Participants shared their experiences and perceptions of a parental supporter during pediatric resuscitation in three themes: 1) Requirement for the presence of a parental supporter, 2) Expectations of the parental supporter, and 3) Characteristics of the parental supporter.

CONCLUSIONS

Study findings highlight the need for a parental supporter during pediatric resuscitation; however, there is no defined parental supporter role in current guiding policies due to limited research on this role. More research on the parental supporter role is needed so effective policies and protocols can be developed to enhance family-centered care practices in pediatric emergency and acute care settings.

The healthcare professionals' perspectives and experiences with family presence during resuscitation: A qualitative evidence synthesis

INTRODUCTION

Family presence during resuscitation (FPDR) is a growing hospital praxis despite lack of high-quality evidence. The aim of this qualitative evidence synthesis review was to synthesize current evidence regarding healthcare professionals (HCP) perspectives on barriers and facilitating factors of FPDR and the potential impact of FPDR on HCP performance.

METHODS

We conducted a systematic literature search May 17, 2023 including primary studies with qualitative study designs. We applied NVivo for data analysis. Data was coded with line-by-line coding and organized into themes and categories following the method for thematic synthesis described by Thomas and Harden to analyse data. The studies underwent quality appraisal by Critical Appraisal Skills Program. We used GRADE CERQual to assess the confidence in the evidence.

RESULTS

We identified 8241 articles suitable for screening, 141 articles were full text screened, and nine studies included from Australia, UK and USA. In total, 134 HCP participated, between 2005 and 2019. Most studies lacked sufficiently rigorous data analysis and findings were appraised to have moderate GRADE CERQual confidence. We identified three analytical themes ("Facilitating factors for FPDR", "Barriers for FPDR" and "How staff are affected by FPDR") with eight descriptive subthemes. One finding was of high GRADE CERQual confidence: a belief that FPDR is "the right thing to do" which was a "Facilitating factor of FPDR."

CONCLUSION

The evidence on HCP perspectives is of low to moderate confidence. The interviewed consent that FPDR is the "right thing to do", and an ethical principle of beneficence is dominant, especially regarding children.

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.

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.

Family support person role during resuscitation: A qualitative exploration

AIMS AND OBJECTIVES

To provide guidance to nurses by examining how critical care nurses perceive and perform the family support person role during resuscitation.

BACKGROUND

Nurses can serve as family support person when families witness a loved one's resuscitation. However, few studies have examined the role of family support person to provide nurses with sufficient knowledge to enact the role.

DESIGN

An exploratory-descriptive qualitative design with individual, semi-structured interviews.

METHODS

Sixteen critical care nurses who had served as family support person completed interviews. The data were analysed by thematic analysis. COREQ guidelines were followed.

RESULTS

Six themes were identified: Hard but Rewarding Role, Be With, Assess, First Moments, Explain and Support. Findings explicated nurses' perceptions of the role and key role activities.

CONCLUSIONS

Nurses perceived the role as hard but rewarding. Role challenges included the need for quick, accurate assessments and interventions to keep family members safe, informed and supported, while allowing them to witness resuscitation. Key role activities included: being fully present and compassionately attentive to family, continuously assessing family members, coordinating the first moments when family presence during resuscitation commences, explaining in simple, tailored terms the resuscitation activities, and supporting the family emotionally and psychologically through a variety of strategies. Nurses noted the high variability in how families respond and the complexity of simultaneously performing the multi-faceted role activities.

RELEVANCE TO CLINICAL PRACTICE

To effectively support the growing global trend of family presence during resuscitation, nurses need the knowledge this study provides about how to fulfil the family support person role. Identifying the role activities may facilitate development of clinical guidelines and educational preparation for the role. Nurses can refine the many skills this role requires, building their competence and confidence, to increase opportunities for family members to experience family presence during resuscitation in a safe, and high-quality manner.

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.

Advancing the Practice of Family Presence During Resuscitation: A Multifaceted Hospital-Wide Interprofessional Program

BACKGROUND

After 3 decades of research, much is understood about the benefits of family presence during resuscitation (FPDR), yet translation into clinical practice has been lagging. This article provides guidance for nurse leaders seeking to advance FPDR by sharing the experience of establishing a multifaceted, hospital-wide program of education and policy development.

OBJECTIVES

This quality improvement project aimed to (1) implement a hospital-wide FPDR program guided by policy, (2) evaluate classroom and simulation educational interventions, (3) examine chart review data for evidence of FPDR practice change, and (4) act on information learned to further improve the FPDR program and increase practice implementation.

METHODS

The Plan-Do-Study-Act (PDSA) cycle provided the model for cyclic evaluation of the FPDR program at a rural Midwestern United States hospital. Interventions were classroom education for existing nursing staff, simulation for new nurses, and implementation of a hospital-wide policy. Outcome measures included nurses' perceptions of FPDR risks and benefits, self-confidence with FPDR, and evidence of practice change via retrospective chart review.

RESULTS

Pilot data demonstrated a statistically significant improvement in nurses' perceptions of FPDR benefits and self-confidence post education, and the rate of FPDR practiced in the facility tripled. The PDSA cycle provided a useful paradigm for ongoing process improvement and program sustainability.

DISCUSSION

After the delivery of an FPDR policy along with classroom and simulation education, an increase in the clinical implementation of FPDR occurred. The use of the PDSA cycle resulted in expanded approaches including the addition of FPDR to in situ mock codes.

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.

Family Presence and Support During Resuscitation

Family presence during cardiopulmonary resuscitation (FPDR) is an evidence-based practice in the hospital setting. Members of the interdisciplinary team should adhere to ethical principles and patient and family-centered care concepts when offering interventions to support the family member during this potential end-of-life crisis. FPDR is an option for family members who are interested, screened as appropriate, and supported by a family facilitator. Essential components to guide this practice include developing an FPDR policy, educating the health care team, and creating evaluation methods.

Witnessed resuscitation of adult and paediatric hospital patients: An umbrella review of the evidence

OBJECTIVE

To examine the research evidence about whether families were allowed to witness cardiopulmonary resuscitation on hospitalised adult and paediatric patients; and the views of patients, families and health professionals, about witnessed cardiopulmonary resuscitation.

DESIGN

An umbrella review methodology of systematic reviews with sufficient methodological quality.

REVIEW METHODS

Papers published in Spanish and English between, 1 January 2009 and 31 December 2018 were considered. The following databases were searched: PubMed, CINAHL, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, PsycInfo, Embase, the Central Supplier Database and the Joanna Briggs Institute, Evidence-based Practice Database. Two independent reviewers assessed the papers for methodological quality employing instruments from the Joanna Briggs Institute. Critical appraisal, extraction and synthesis were carried out, employing the established methods for umbrella reviews and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO number CRD42019145610).

RESULTS

The search identified 12 systematic reviews with moderate-to-high quality, which covered 110 original papers. Habitually, health professionals expressed controversial views and showed some reluctance to let families be present during cardiopulmonary resuscitation. In contrast, family members felt strongly that they should be present and patients agreed. Key factors that facilitated witnessed cardiopulmonary were a formal institutional policy, educating health professionals, and designating a health professional to support the family. Educational and cultural backgrounds influenced healthcare professionals' experiences and their attitudes towards witnessed cardiopulmonary resuscitation. In general, Anglo-Saxon countries showed greater support for this practice. These included the United States, which was the country that dominated the literature on this subject.

CONCLUSIONS

The best available evidence supports allowing the family to be present during cardiopulmonary resuscitation. It is necessary to include this practice in educational curricula and to train emergency personnel in its implementation. Culturally sensitive policies need to be designed, and the public to be aware of their right to be present.

Meanings attributed by family and patients to family presence in emergency rooms

OBJECTIVE

to understand the process that leads adult and family patients to support family presence in emergency care.

METHOD

a qualitative study that adopted Symbolic Interactionism as a theoretical reference and the Grounded Theory as a methodological framework. The theoretical sample consisted of 15 relatives and 15 patients assisted at two emergency units in the South of Brazil. Data were analyzed using open, axial and selective coding.

RESULTS

the central category "Convergence of ideas: family members and patients supporting family presence in emergency care" is supported by the categories: "Affectionate relationship among family members"; "Tacit obligation to care for the sick relative"; "Benefits for the family"; "Benefits for the patient"; and "Benefits for the health team".

CONCLUSION

family presence in emergency care provides maintenance and strengthening of affectionate bonds among relatives and the experience of more sensitive and qualified care.

Nurses' perceptions and experiences of caring for patients who die in the emergency department setting

INTRODUCTION

The number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians' perceptions and experiences of providing such care when the death is sudden and unexpected.

AIM

This study explored nurses' perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED.

METHODS

Open-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically.

RESULTS

211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected.

CONCLUSIONS

ED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED.

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.

Family presence during cardiopulmonary resuscitation and invasive procedures: a meta-synthesis

OBJECTIVE

To synthesize the best qualitative evidence regarding the perception of family members, patients and health professionals about family presence during cardiopulmonary resuscitation and invasive procedures.

METHOD

Systematic review with meta-synthesis performed in the databases of Web of Science, Scopus, CINAHL, PsycINFO, LILACS, MEDLINE, Embase and VHL. Articles published between 2010 and 2017 were included and evaluated with use of the Qualitative Data Extraction Instrument.

RESULTS

In total, were found 2,391 articles, out of which 26 were selected, and 24 were analyzed. The identified meta-theme was 'A pendular perspective: different views on family presence during cardiopulmonary resuscitation and invasive procedures', which is supported by the following themes: Benefits resulting from family presence; Disadvantages and/or limiting factors of family presence; and Context: environmental, sociocultural and care factors influencing the perception of family presence.

CONCLUSION

The perception of family members, patients and professionals about family presence is still controversial. The sensitization of these subjects can potentiate the practice by making it more systematized and qualified.

PRESENCE OF THE FAMILY DURING EMERGENCY CARE: PATIENT AND FAMILY LIVING

ABSTRACT Objective: to understand how family members and adult patients perceive the family's presence in emergency care. Method: qualitative study that used Symbolic Interactionism as a theoretical reference and the Data Grounded Theory as a methodological reference. Data collection took place in two emergency rooms, located in southern Brazil, between October 2016 and February 2017, through open interviews with four patients and eight relatives. Results: the relative presence in the emergency care was signified/perceived as positive, due to the benefits identified for patients, family members and health professionals. However, the experience was also marked by mishaps for the family-patient relationship, such as fear, doubts, anguish about the forced separation of family members and the experience of feelings of regret. Conclusion: due to the fact that the presence of the family in the emergency room is perceived as positive and beneficial, it is suggested that the health services, to the extent of their possibilities, implement this practice. However, such units need to be better prepared to mitigate the pitfalls faced by patients and their families.

Factors Affecting Family Presence During Fracture Reduction in the Pediatric Emergency Department

Introduction

Asking family members to leave during invasive procedures has historically been common practice; however, evidence-based recommendations have altered the trend of family presence during pediatric procedures. The aim of this study was to determine factors related to family members’ choice to be present or absent during fracture reductions in a pediatric emergency department (ED), and their satisfaction with that choice.

Methods

We administered role-specific, anonymous surveys to a convenience sample of patients’ family members in the ED of a Level I pediatric trauma center. All family members were given a choice of where to be during the procedure.

Results

Twenty-five family members of 18 patients completed surveys. Seventeen family members chose to stay in the room. Family member satisfaction with their decision to be inside or outside the room during the procedure (median = very satisfied) was almost uniformly high and not associated with any of the following variables: previous presence during a medical procedure; provider-reported procedure difficulty, or anxiety levels. Family member perception of procedure success (median = extremely well) was also high and not associated with other variables. Location during the procedure was associated with a desire to be in the same location in the future (Fisher’s exact test, p=0.001). Common themes found among family members’ reasons for their location decisions and satisfaction levels were a desire to support the patient, high staff competence, and their right as parents to choose their location.

Conclusion

Family members self-select their location during their child’s fracture reduction to high levels of satisfaction, and they considered the ability to choose their location as important.

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

AIM

The study explored the views and attitudes of nurses and physicians on family presence during resuscitation in emergency departments in Brazil.

BACKGROUND

International emergency associations endorse family presence during resuscitation; however, the extent to which it is practiced remains unclear, particularly in the Brazilian context. Research of emergency staff views and attitudes towards this practice is desirable so that actions can be identified to support families at the bedside.

METHODS

A qualitative research was conducted. Thirty-two health professionals (11 physicians and 21 nurses) working in two emergency departments in southern Brazil were purposefully recruited in January 2015. In-depth interviews were conducted, and data were analysed using content analysis.

FINDINGS

Nurses and physicians found family presence during resuscitation controversial and the general attitude towards this practice was negative. They reported that 'changes are needed' to adapt hospital infrastructures for family presence, and to train staff to respond to the information and emotional needs of families.

DISCUSSION

Translating a family nursing framework into clinical practice involves the need for reassessing educational and management policies in clinical contexts.

CONCLUSION

This research brings new understanding about the attitudes of some Brazilian nurses and physicians on the implementation of family presence during resuscitation and identifies the need to develop policies and strategies to improve family presence in emergency departments.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Hospital-based policies are required to improve family-centred care in emergency departments while providing a criterion of legality and safety to professionals to invite families to be present during invasive procedures. Also, family-focused education in health science degrees, continuing education and in the community is required.

Decidindo “caso a caso” a presença familiar no serviço de atendimento emergencial

Resumo Objetivo Compreender como médicos e enfermeiros vivenciam e percebem a presença da família no serviço de atendimento emergencial. Métodos Estudo qualitativo que utilizou o Interacionismo Simbólico como referencial teórico e a Teoria Fundamentada nos Dados como referencial metodológico. Participaram 20 profissionais – divididos equitativamente entre médicos e enfermeiros – que atuavam em duas Salas de Emergência localizadas no Sul do Brasil. Os dados foram coletados entre outubro de 2016 e fevereiro de 2017, por meio de entrevistas. Resultados Identificou-se a existência de uma cultura social de exclusão familiar, amplamente difundida e praticada pelos profissionais. Contudo, às vezes, as famílias permanecem com seus entes queridos na Sala de Emergência, visto que os profissionais analisam e decidem “caso a caso”, considerando diferentes aspectos ao longo do processo assistencial. Conclusão Para médicos e enfermeiros múltiplos aspectos estão relacionados na determinação da presença familiar durante o atendimento emergencial. Assim, não é aconselhável uma diretiva única para a presença da família. Em realidade, sugere-se que cada unidade de saúde elabore seus protocolos considerando as particularidades locais.

[Presence of relatives during cardiopulmonary resuscitation: Perspectives of health professionals, patients and family in the Basque Country]

Objetivo

Explorar la percepción acerca de la presencia de familiares durante la reanimación cardiopulmonar (RCP) en pacientes adultos, de los propios pacientes y familiares, enfermeras y médicos.

Diseño

Se desarrolló un estudio cualitativo exploratorio y un análisis temático.

Emplazamiento

Atención Primaria, Atención Hospitalaria y Servicio de Emergencias del Servicio Vasco de Salud.

Participantes

La selección de los participantes se realizó a través de muestreo intencional. Se desarrollaron 4 grupos de discusión: uno de pacientes y familiares, 2 de enfermeras y uno de médicos.

Método

Se realizó un análisis temático. Se utilizaron técnicas de triangulación entre investigadores e investigador-informante. Se utilizó el programa informático Open Code 4.1.

Resultados

Se identificaron 3 categorías significativas: impacto de la actuación en la familia; peso de la responsabilidad ética y legal; poder, lugar donde sucede la parada y supuestos culturales.

Conclusiones

La RCP es un constructo social influido por los valores de los contextos socioculturales específicos. En este estudio, los pacientes y familiares describieron temor y resistencia a presenciar la RCP. Por su parte, los profesionales sanitarios consideran que su decisión reviste complejidad, siendo necesario valorar cada caso de forma independiente e integrando a pacientes y familiares en la toma de decisiones. Como líneas de investigación futuras sería recomendable profundizar sobre la experiencia subjetiva de familiares que hayan presenciado la RCP y el impacto de los elementos contextuales y socioculturales en sus percepciones.

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

AIMS AND OBJECTIVES

To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation.

BACKGROUND

Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear.

DESIGN

Secondary analysis of an existing qualitative data set using deductive category application of content analysis.

METHODS

We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation.

RESULTS

Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their individual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial.

CONCLUSIONS

The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making.

RELEVANCE TO CLINICAL PRACTICE

These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the equitable provision of safe, effective family-centred care during resuscitation events.

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.

Family support liaison in the witnessed resuscitation: A phenomenology study

BACKGROUND

Family-witnessed resuscitation remains controversial among clinicians from implementation to practice and there are a number of countries, such as Iran, where that is considered a low priority.

OBJECTIVE

To explore the lived experience of resuscitation team members with the presence of the patient's family during resuscitation.

DESIGN

The hermeneutic phenomenology.

SETTINGS

The emergency departments and critical care units of 6 tertiary hospitals in Tabriz, Iran.

PARTICIPANTS

There were potentially 380 nurses and physicians working in the emergency departments and acute care settings of 6 tertiary hospitals in Tabriz. A purposive sample of these nurses and physicians was used to recruit participants who had at least 2 years of experience, had experienced an actual family witnessed resuscitation event, and wanted to participate. The sample size was determined according to data saturation. Data collection ended when the data were considered rich and varied enough to illuminate the phenomenon, and no new themes emerged following the interview of 12 nurses and 8 physicians.

METHODS

Semi-structured, face- to- face interviews were held with the participants over a period of 6 months (April 2015 to September 2015), and Van Manen's method of data analysis was adopted.

RESULTS

Three main themes emerged from the data analysis, including 'Futile resuscitation', 'Family support liaison', and 'Influence on team's performance'. A further 9 sub-themes emerged under the 3 main themes, which included 'futile resuscitation in end-stage cancer patients', 'when a patient dies', 'young patients', 'care of the elderly', 'accountable person', 'family supporter', 'no influence', 'positive influence', and 'negative influence'.

CONCLUSIONS

Participants noted both positive and negative experiences of having family members present during cardiopulmonary resuscitation. Welltrained and expert resuscitation team members are less likely to be stressed in the presence of family. A family support liaison would act to decrease family anxiety levels and to de-escalate any potentially aggressive person during the resuscitation. It is recommended that an experienced health care professional be designated to be responsible for explaining the process of resuscitation to the patient's family.