1
|
Waldemar A, Bremer A, Strömberg A, Thylen I. Family presence during in-hospital cardiopulmonary resuscitation: effects of an educational online intervention on self-confidence and attitudes of healthcare professionals. Eur J Cardiovasc Nurs 2024; 23:486-496. [PMID: 38165264 DOI: 10.1093/eurjcn/zvad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
AIMS Guidelines support family-witnessed resuscitation (FWR) during cardiopulmonary resuscitation in hospital if deemed to be safe, yet barriers amongst healthcare professionals (HCPs) still exist. This study aimed to evaluate the effects of an educational online video intervention on nurses' and physicians' attitudes towards in-hospital FWR and their self-confidence in managing such situations. METHODS AND RESULTS A pre- and post-test quasi-experimental study was conducted October 2022 to March 2023 at six Swedish hospitals involving the departments of emergency care, medicine, and surgery. The 10 min educational video intervention was based on previous research covering the prevalence and outcome of FWR, attitudes of HCP, patient and family experiences, and practical and ethical guidelines about FWR.In total, 193 accepted participation, whereof 91 answered the post-test survey (47.2%) with complete data available for 78 and 61 participants for self-confidence and attitudes, respectively. The self-confidence total mean scores increased from 3.83 to 4.02 (P < 0.001) as did the total mean scores for attitudes towards FWR (3.38 to 3.62, P < 0.001). The majority (71.0%) had positive views of FWR at baseline and had experiences of in-hospital FWR (58.0%). Self-confidence was highest amongst participants for the delivery of chest compressions (91.2%), defibrillation (88.6%), and drug administration (83.3%) during FWR. Self-confidence was lowest (58.1%) for encouraging and attending to the family during resuscitation. CONCLUSION This study suggests that a short online educational video can be an effective way to improve HCP's self-confidence and attitudes towards the inclusion of family members during resuscitation and can support HCP in making informed decisions about FWR.
Collapse
Affiliation(s)
- Annette Waldemar
- Department of Cardiology in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, SE-351 95 Växjö, Sweden
| | - Anna Strömberg
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Ingela Thylen
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| |
Collapse
|
2
|
Yu R. Optimizing Family Presence through Medical Education. THE JOURNAL OF CLINICAL ETHICS 2024; 35:136-141. [PMID: 38728700 DOI: 10.1086/729419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
AbstractMany family members are wary of asking whether they can be present in the intensive care unit (ICU) while patients are receiving care. However, the opportunity to be present can be profoundly beneficial, especially to family members as they approach the grieving process. In the long run, this may decrease emotional complications such as post-traumatic stress disorder (PTSD) and complex grief. Family presence may also be profoundly important to patients, who may find comfort in the presence of their loved ones. Optimizing the needs of distressed families remains a controversial topic because it may distract physicians from providing needed medical care. Both parties may benefit maximally, however, through proactive training and early education during medical school, as this article will outline. Family members who may want to visit but are unable to be present in person may also benefit through virtual telehealth visits. Finally, we acknowledge specific cases that may pose ethically difficult dilemmas for ICU providers. Solutions that may be optimal in these situations will be suggested.
Collapse
|
3
|
Rubin MA, Meulengracht SES, Frederiksen KAP, Thomsen T, Møller AM. The healthcare professionals' perspectives and experiences with family presence during resuscitation: A qualitative evidence synthesis. Acta Anaesthesiol Scand 2024; 68:101-121. [PMID: 37669907 DOI: 10.1111/aas.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Monika Afzali Rubin
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | | | - Katja Anna Poulsen Frederiksen
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Ann Merete Møller
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| |
Collapse
|
4
|
Seelandt JC, Boos M, Kolbe M, Kämmer JE. How to enrich team research in healthcare by considering five theoretical perspectives. Front Psychol 2023; 14:1232331. [PMID: 37637888 PMCID: PMC10448055 DOI: 10.3389/fpsyg.2023.1232331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.
Collapse
Affiliation(s)
| | - Margarete Boos
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
| | - Michaela Kolbe
- Simulation Center, University Hospital Zürich, Zürich, Switzerland
- ETH Zurich, Zürich, Switzerland
| | - Juliane E. Kämmer
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Sellmann T, Nur M, Wetzchewald D, Schwager H, Cleff C, Thal SC, Marsch S. COVID-19 CPR-Impact of Personal Protective Equipment during a Simulated Cardiac Arrest in Times of the COVID-19 Pandemic: A Prospective Comparative Trial. J Clin Med 2022; 11:jcm11195881. [PMID: 36233748 PMCID: PMC9570578 DOI: 10.3390/jcm11195881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Guidelines of cardiopulmonary resuscitation (CPR) recommend the use of personal protective equipment (PPE) during the resuscitation of COVID-19 patients. Data on the effects of PPE on rescuers’ stress level and quality of CPR are sparse and conflicting. This trial investigated the effects of PPE on team performance in simulated cardiac arrests. Methods: During the pandemic period, 198 teams (689 participants) performed CPR with PPE in simulated cardiac arrests (PPE group) and were compared with 423 (1451 participants) performing in identical scenarios in the pre-pandemic period (control group). Video recordings were used for data analysis. The primary endpoint was hands-on time. Secondary endpoints included a further performance of CPR and the perceived task load assessed by the NASA task-load index. Results: Hands-on times were lower in PPE teams than in the control group (86% (83−89) vs. 90% (87−93); difference 3, 95% CI for difference 3−4, p < 0.0001). Moreover, PPE teams made fewer change-overs and delayed defibrillation and administration of drugs. PPE teams perceived higher task loads (57 (44−67) vs. 63 (53−71); difference 6, 95% CI for difference 5−8, p < 0.0001) and scored higher in the domains physical and temporal demand, performance, and effort. Leadership allocation had no effect on primary and secondary endpoints. Conclusions: Having to wear PPE during CPR is an additional burden in an already demanding task. PPE is associated with an increase in perceived task load, lower hands-on times, fewer change-overs, and delays in defibrillation and the administration of drugs. (German study register number DRKS00023184).
Collapse
Affiliation(s)
- Timur Sellmann
- Department of Anaesthesiology and Intensive Care Medicine, Bethesda Hospital, 47053 Duisburg, Germany
- Department of Anaesthesiology 1, Witten/Herdecke University, 58455 Witten, Germany
| | - Maria Nur
- Institution for Emergency Medicine, 59755 Arnsberg, Germany
| | | | | | - Corvin Cleff
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Serge C. Thal
- Department of Anaesthesiology 1, Witten/Herdecke University, 58455 Witten, Germany
| | - Stephan Marsch
- Department of Intensive Care, University Hospital, 4031 Basel, Switzerland
- Correspondence: ; Fax: +41-61-265-53-00
| |
Collapse
|
6
|
Sellmann T, Oendorf A, Wetzchewald D, Schwager H, Thal SC, Marsch S. The Impact of Withdrawn vs. Agitated Relatives during Resuscitation on Team Workload: A Single-Center Randomised Simulation-Based Study. J Clin Med 2022; 11:jcm11113163. [PMID: 35683550 PMCID: PMC9180995 DOI: 10.3390/jcm11113163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Guidelines recommend that relatives be present during cardiopulmonary resuscitation (CPR). This randomised trial investigated the effects of two different behaviour patterns of relatives on rescuers’ perceived stress and quality of CPR. Material and methods: Teams of three to four physicians were randomised to perform CPR in the presence of no relatives (control group), a withdrawn relative, or an agitated relative, played by actors according to a scripted role, and to three different models of leadership (randomly determined by the team or tutor or left open). The scenarios were video-recorded. Hands-on time was primary, and the secondary outcomes comprised compliance to CPR algorithms, perceived workload, and the influence of leadership. Results: 1229 physicians randomised to 366 teams took part. The presence of a relative did not affect hands-on time (91% [87−93] vs. 92% [88−94] for “withdrawn” and 92 [88−93] for “agitated” relatives; p = 0.15). The teams interacted significantly less with a “withdrawn” than with an “agitated” relative (11 [7−16]% vs. 23 [15−30]% of the time spent for resuscitation, p < 0.01). The teams confronted with an “agitated” relative showed more unsafe defibrillations, higher ventilation rates, and a delay in starting CPR (all p < 0.05 vs. control). The presence of a relative increased frustration, effort, and perceived temporal demands (all <0.05 compared to control); in addition, an “agitated” relative increased mental demands and total task load (both p < 0.05 compared to “withdrawn” and control group). The type of leadership condition did not show any effects. Conclusions: Interaction with a relative accounted for up to 25% of resuscitation time. Whereas the presence of a relative per se increased the task load in different domains, only the presence of an “agitated” relative had a marginal detrimental effect on CPR quality (GERMAN study registers number DRKS00024761).
Collapse
Affiliation(s)
- Timur Sellmann
- Department of Anaesthesiology and Intensive Care Medicine, Bethesda Hospital, 47053 Duisburg, Germany;
- Department of Anaesthesiology 1, Witten/Herdecke University, 58455 Witten, Germany;
| | - Andrea Oendorf
- Institute of Emergency Medicine, 59755 Arnsberg, Germany; (A.O.); (D.W.); (H.S.)
- Department of Internal Medicine, Gertrudis Hospital, 45701 Herten, Germany
| | - Dietmar Wetzchewald
- Institute of Emergency Medicine, 59755 Arnsberg, Germany; (A.O.); (D.W.); (H.S.)
| | - Heidrun Schwager
- Institute of Emergency Medicine, 59755 Arnsberg, Germany; (A.O.); (D.W.); (H.S.)
| | - Serge Christian Thal
- Department of Anaesthesiology 1, Witten/Herdecke University, 58455 Witten, Germany;
- Department of Anaesthesiology, Helios University Hospital, 42283 Wuppertal, Germany
| | - Stephan Marsch
- Department of Intensive Care, University Hospital, 4031 Basel, Switzerland
- Correspondence: ; Fax: +41-612-655-300
| |
Collapse
|