Predicting nurses' intentions in allowing family presence during resuscitation: A cross‐sectional survey

Family Presence During Resuscitation: Perspectives of Saudi Emergency Medicine Providers

Background Family presence during resuscitation (FPDR) has been a long-debated topic in medical circles in the last 40 years. Studies usually concentrate on the opinions and responses of the family members of the patients being resuscitated. Only a handful of studies have focussed on the medical practitioner's opinions and beliefs on the topic. Hence, this study aimed to investigate opinions and beliefs regarding FPDR among emergency medicine practitioners (EMPs) in the Kingdom of Saudi Arabia. Methodology This was a self-filled, questionnaire-based study conducted among 450 EMPs across the Kingdom of Saudi Arabia. Proportions and subgroup analyses were conducted with respect to gender, experience, and seniority. EMPs were asked about the number of family members they would allow to attend the resuscitation of a patient under their care in different clinical scenarios. Results A total of 392 (87.1%) EMPs participated in this study. Overall, 64% (n = 250) of EMPs reported that they would not allow FPDR in cases that involved trauma, or if the patient being revived was female. This percentage dropped to about 33% (n = 129) when the patient being resuscitated was a child or in out-of-hospital arrest. The majority of EMPs believed that the decision to allow FPDR was the physician's decision (n = 251, 64.8%) and not the right of the family (n = 133, 34.7%). Moreover, emergency medicine board-certified physicians were more likely to allow FPDR in different cases with 19 (18.5%) in adult arrest cases, 18 (18%) in pediatric cases, and 16 (15.1%) in trauma cases, than non-board-certified practitioners (p = 0.001, 0.007, and 0.031, respectively). Female EMPs were more likely to refuse FPDR than their male counterparts (p < 0.001). Conclusions Approximately, 60-70% of EMPs allowed a member of the family to attend the resuscitation of their loved one. However, this percentage dropped in cases where the patient was a female, or the case was a trauma case instead of a medical case. Most Saudi EMPs believed that FPDR hurts the resuscitating team and might hinder the resuscitation efforts.

A presença dos pais durante procedimentos pediátricos invasivos: depende de quê?

Resumo Objetivo: o atendimento centrado na família durante procedimentos invasivos tem sido endossado por muitas organizações profissionais de saúde. O objetivo deste estudo foi avaliar as atitudes dos profissionais de saúde em relação à presença dos pais durante o procedimento invasivo realizado em seus filhos. Método: os prestadores de serviços de saúde pediátricos (divididos em categorias profissionais e faixa etária) de um dos maiores hospitais da Espanha foram solicitados a preencher um questionário e escrever comentários de texto livre. Resultados: a pesquisa foi respondida por 227 pessoas. A maioria (72%) dos participantes, em suas respostas, relatou que os pais algumas vezes estão presentes durante as intervenções, embora houvesse diferenças entre as categorias profissionais a esse respeito. Os procedimentos em que os pais estavam presentes eram aqueles considerados “menos invasivos” (96% dos casos), enquanto apenas 4% estavam presentes naqueles considerados “mais invasivos”. Quanto mais velho o profissional, a presença dos pais foi considerada menos necessária. Conclusão: as atitudes em relação à presença dos pais durante o procedimento pediátrico invasivo são influenciadas pela categoria profissional, a idade do prestador de serviço de saúde e a invasividade do procedimento.

Presencia de los padres durante procedimientos pediátricos invasivos: ¿De qué depende?

Resumen Objetivo: la atención centrada en la familia durante procedimientos invasivos ha sido respaldada por muchas organizaciones profesionales dedicadas al cuidado de la salud. El objetivo de este estudio fue evaluar las actitudes de los profesionales de la salud con respecto a la presencia de los padres durante los procedimientos invasivos realizados en niños. Método: a los prestadores de atención médica en Pediatría (divididos en categorías profesionales y rangos de edad) de uno de los hospitales más importantes de España se les solicitó que respondieran un cuestionario y redactaran comentarios de texto libre. Resultados: un total de 227 profesionales respondieron la encuesta. En sus respuestas, la mayoría (72%) de los participantes informó que, en ocasiones, los padres están presentes durante las intervenciones, aunque se registraron diferencias entre las distintas categorías profesionales al respecto. Los procedimientos en los que los padres estuvieron presentes se consideraron como “menos invasivos” (96% de los casos), mientras que solamente el 4% estuvo presente en los considerados “más invasivos”. A mayor edad de los profesionales, menos necesaria se consideró la presencia de los padres. Conclusión: las actitudes con respecto a la presencia de los padres durante procedimientos pediátricos invasivos se vieron influenciadas por la categoría profesional, la edad del prestador de salud y la invasividad de los procedimientos.

Developing a Decision Pathway for Family Presence During Resuscitation

BACKGROUND

The standard of care for family presence during resuscitation (FPDR) is evolving, and leading organizations collectively recommend establishing institutional policy for its practice. Although FPDR is supported at this single institution, the process was not standardized.

METHODS

An interprofessional group authored a decision pathway to standardize the care of families during inpatient code blue events at one institution. The pathway was reviewed and applied in code blue simulation events to highlight the role of the family facilitator and the importance of interprofessional teamwork skills.

RESULTS

The decision pathway is a patient-centered algorithm that promotes safety and family autonomy. Pathway recommendations are shaped by current literature, expert consensus, and existing institutional regulations. An on-call chaplain responds to all code blue events as the family facilitator and conducts assessments and decision making per the pathway. Clinical considerations include patient prioritization, family safety, sterility, and team consensus. One year after implementation, staff felt that it positively affected patient and family care. The frequency of inpatient FPDR did not increase after implementation.

CONCLUSION

As a result of the decision pathway implementation, FPDR is consistently a safe and coordinated option for patients' family members.

Parental presence during invasive pediatric procedures: what does it depend on?

OBJECTIVE

family-centered care during invasive procedures has been endorsed by many professional health care organizations. The aim of this study was to evaluate the health professionals' attitudes towards parental presence during their child's invasive procedure.

METHOD

pediatric healthcare providers (divided in professional categories and range of ages) from one of the Spain's largest hospitals were asked to complete a questionnaire and write free-text comments.

RESULTS

227 responded the survey. Most (72%) participants, in their answers, reported that parents are sometimes present during interventions, although there were differences between professional categories in this respect. The procedures in which the parents were present were those considered "less invasive" (96% of cases), while only 4% were present in those considered "more invasive". The older the professional, the less necessary parental presence was considered.

CONCLUSION

the attitudes towards parental presence during pediatric invasive procedure are influenced by the professional category, the age of the healthcare provider and the invasiveness of the procedure.

The Effect of Family Presence During Resuscitation and Invasive Procedures on Patients and Families: An Umbrella Review

INTRODUCTION

The concept of family presence during resuscitation and invasive procedures is a controversial issue and has not been universally adopted by health care providers. Owing to the sheer number of studies in this field, we conducted this umbrella study to provide an overview of this concept with the aim of investigating the impact of family presence on patients, families, and resuscitation and invasive procedures.

METHODS

In this review, using the Joanna Briggs Institute levels of evidence umbrella methodology guidelines, the authors searched PubMed, Google Scholar, Embase, MEDLINE, Web of Science, Scopus, and the Cochrane database for systematic review and meta-analysis studies that evaluated the presence of family during resuscitation and invasive procedures without time limit until July 2020. The following key words were used for the search: family presence; family witness; parent presence; parent witness; and resuscitation.

RESULTS

A total of 254 articles published between January 1967 and July 2020 were screened. Five articles (1 meta-analysis and 4 systematic reviews) met the inclusion criteria. The review showed that family presence during resuscitation or invasive procedures does not have negative effects on family members, patients, or the resuscitation or invasive intervention process. Family members focus on the patients, not the ongoing treatment. The presence of family members is beneficial for both family members and health care staff. None of the reviewed studies reported a negative effect on family members.

DISCUSSION

The presence of parents and other immediate family members during resuscitation and invasive procedures has positive impacts on patients, families, and health care staff.