Family presence during resuscitation: A Canadian Critical Care Society position paper

What the curtains do not shield: A phenomenological exploration of patient-witnessed resuscitation in hospital. Part 2: Healthcare professionals' experiences

Aims

To explore healthcare professionals' experiences of patient‐witnessed resuscitation in hospital.

Design

Descriptive phenomenology.

Methods

Healthcare professionals involved in hospital resuscitation activities were recruited from medical, intensive care, resuscitation and education departments in a university hospital in England. Data were collected through face‐to‐face and focus group interviews, between August 2018 and January 2019. Data were analysed using Giorgi's phenomenological approach.

Results

Nine registered nurses, four healthcare assistants and seven doctors participated in four individual interviews and three focus groups. Findings were related to three themes: (1) Protecting patients from witnessing resuscitation: healthcare professionals used curtains to shield patients during resuscitation, but this was ineffective. Thus, they experienced challenges in explaining resuscitation events to the other patients and communicating sensitively. (2) Emotional impact of resuscitation: healthcare professionals recognized that witnessing resuscitation impacted patients, but they also felt emotionally affected from performing resuscitation and needed coping strategies and support. (3) Supporting patients who witnessed resuscitation: healthcare professionals recognized the importance of patients' well‐being, but they felt unable to provide effective and timely support while providing life‐saving care.

Conclusion

Healthcare professionals involved in hospital resuscitation require specific support, guidance and education to care effectively for patients witnessing resuscitation. Improving communication, implementing regular debriefing for staff, and allocating a dedicated professional to support patients witnessing resuscitation must be addressed to improve clinical practice.

Impact

The WATCH study uncovers patients' and healthcare professionals' experiences of patient‐witnessed resuscitation, a phenomenon still overlooked in nursing research and practice. The main findings highlight that, in common with patients, healthcare professionals are subject to the emotional impact of resuscitation events and encounter challenges in supporting patients who witness resuscitation. Embedding the recommendations from this research into clinical guidelines will impact the clinical practice of healthcare professionals involved in hospital resuscitation and the quality and timeliness of care delivered to patients.

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.

Turkish validation of the family presence during resuscitation risk-benefit scale

BACKGROUND

There are no validated tools to examine the risk and benefits of family presence and nurses' self-confidence during resuscitation in Turkey.

AIM

This study aimed to test the validity and reliability of the family presence risk- benefit scale and the family presence self-confidence scale in Turkish as well as its psychometric characteristics.

METHODS

The sample of the study consisted of 427 nurses. The forward-backward translation method was used. Exploratory and confirmatory factor analyses were used to examine the factor structure and construct validity of the scales. In order to evaluate the time invariances of the scales, the relationship between the scores obtained from the first and second applications was examined using the Pearson correlation coefficient.

RESULTS

The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) value of the family presence risk-benefit scale was found to be 0.876 while the KMO value of the family presence self-confidence scale was found to be 0.927. Positive linear correlations with high levels of significance and respective values of 82.5% and 93.5% were found between the total scores of the family presence risk-benefit and family presence self-confidence scales and their retest scores.

CONCLUSION

The Turkish versions of the family presence during resuscitation risk- benefit scale and the family presence self-confidence scale were found to be valid and reliable tools that could be used to determine the perceptions of nurses regarding the risks and benefits of family presence during resuscitation.

RELEVANCE TO CLINICAL PRACTICE

Using the family presence risk-benefit and family presence self-confidence scales, both of which have been tested for validity and reliability in Turkish, the perceptions of intensive care nurses regarding the risks and benefits of family presence during resuscitation can be determined as well as their self-confidence on the subject, making the development of policies on the subject possible.

A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study

Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses' emotional labor, and organizational culture.

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.

[Ethics of resuscitation and end of life decisions]

These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.

Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review

CONTEXT

Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted.

OBJECTIVE

To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation.

DATA SOURCES

Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020.

STUDY SELECTION

3200 titles were retrieved in the initial search; 36 ultimately included for review.

DATA EXTRACTION

Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology.

RESULTS

The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority.

LIMITATIONS

English language only; lack of randomized control trials; quality of the publications.

CONCLUSIONS

Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes.

PROSPERO REGISTRATION NUMBER

CRD42020140363.

European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions

These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.

Family presence during resuscitation: a needs assessment of education, policy, and opinion in Canada

PURPOSE

Family presence during resuscitation (FPDR) has been widely endorsed. Nevertheless, there is limited information available on current education and training used to support FPDR implementation, including that of relevant policy. Understanding the current state of FPDR educational opportunities, policies, and practices across Canadian hospitals is crucial to advancing and standardizing these within our medical community. Our objective was to identify the current and desired state of education and policy on FPDR, as well as current practices and opinions of Canadian healthcare professionals.

METHODS

We selected questionnaire topics and employed a modified Delphi consensus technique using a group of subject matter experts in resuscitation. We contacted a stratified sample of Canadian healthcare professionals via select listservs and surveyed the cohort using RedCAP™. We used descriptive statistics and conducted quantitative analyses to describe and test for significant differences among groups.

RESULTS

In total, 635 surveys were completed. Only 46.3% of participants reported ever attending an educational opportunity involving learning how to manage FPDR; however, 92% wanted training. Only 11% knew if they had an official FPDR policy in their current hospital but 62.9% indicated they wanted one. In support of FPDR, 88% agreed that family members should be allowed to be present during a resuscitation.

CONCLUSION

While opinions are mostly positive towards FPDR, there exists a gap between the current and desired state of education and policy supporting it within Canada.

Witnessed resuscitation: A concept analysis

BACKGROUND

The advance in the practice of resuscitation is globally recognised and fully sanctioned in scientific world. However, practicing family presence during resuscitation, also known as witnessed resuscitation, is yet to be endorsed by healthcare professionals. Many professional nursing and physician organisations have endorsed the practice of witnessed resuscitation by issuing guidelines. These organisations support family presence during resuscitation due to the research proving its benefit for patients and families.

PURPOSE

The purpose of this paper is to analyse the concept of witnessed resuscitation.

METHOD

A concept analysis was undertaken using Rodger's (2000) evolutionary method.

FINDINGS

The concept analysis suggests that witnessed resuscitation refers to the presence of a family member or relative during a resuscitation procedure, mostly in emergency and complex critical care areas. The defining attributes are family centred care approach, exercising patients and family rights and autonomy in end of life care decisions and involvement of family as active and passive observers during a resuscitation event.

CONCLUSION

Clarity surrounding witnessed resuscitation will guide the development of a conceptual framework, expand nursing knowledge and identify the research required to advance understanding of witnessed resuscitation in practice.

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

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

Healthcare providers' perspectives on family presence during resuscitation in the emergency departments of the Kingdom of Bahrain

BACKGROUND

Worldwide, policies exist on family presence during resuscitation (FPDR), however, this is still lacking in the Gulf Corporation Countries (GCC) in general and in the Kingdom of Bahrain in particular. The aim of this study is to assess the perspectives of healthcare providers (HP) on FPDR among those working in the emergency departments (EDs) in the Kingdom.

METHODS

A self-administered anonymous electronic survey was collected from 146 HPs (emergency physicians and nurses) working in the three major EDs in the Kingdom of Bahrain. Besides demographic data, 18 items measuring HPs' perceptions of FPDR were generated using the 5-point Likert scale.

RESULTS

Surveys (n = 146) from physicians and nurses were analysed (45.9% vs. 54.1%, respectively). There were significant differences between physicians and nurses in terms of personal beliefs, FPDR enhancing professional satisfaction and behaviour, and the importance of a support person and saying goodbye (p < 0.001). However, general responses demonstrated that the majority of HPs encouraged and supported FPDR, but with greater support from physicians than nurses.

CONCLUSION

The study reflects that many HPs in EDs participated in and are familiar with FPDR, with the majority of ED physicians supporting it. Further studies should investigate the reasons for the lack of support from nurses. Results may contribute to the development of hospital ED policies that allow FPDR in the region.

Post-traumatic Stress Disorder in Family-witnessed Resuscitation of Emergency Department Patients

Introduction

Family presence during emergency resuscitations is increasingly common, but the question remains whether the practice results in psychological harm to the witness. We examine whether family members who witness resuscitations have increased post-traumatic stress disorder (PTSD) symptoms at one month following the event.

Methods

We identified family members of critically ill patients via our emergency department (ED) electronic health record. Patients were selected based on their geographic triage to an ED critical care room. Family members were called a median of one month post-event and administered the Impact of Event Scale-Revised (IES-R), a 22-item validated scale that measures post-traumatic distress symptoms and correlates closely with Diagnostic and Statistical Manual of Mental Disorders-IV criteria for post-traumatic stress disorder (PTSD). Family members were placed into two groups based on whether they stated they had witnessed the resuscitation (FWR group) or not witnessed the resuscitation (FNWR group). Data analyses included chi-square test, independent sample t-test, and linear regression controlling for gender and age.

Results

A convenience sample of 423 family members responded to the phone interview: 250 FWR and 173 FNWR. The FWR group had significantly higher mean total IES-R scores: 30.4 vs 25.6 (95% confidence interval [CI], −8.73 to −0.75; P<.05). Additionally, the FWR group had significantly higher mean score for the subscales of avoidance (10.6 vs 8.1; 95% CI, −4.25 to −0.94; P<.005) and a trend toward higher score for the subscale of intrusion (13.0 vs 11.4; 95% CI, −3.38 to .028; P = .054). No statistical significant difference was noted between the groups in the subscale of hyperarousal (6.95 vs 6.02; 95% CI, −2.08 to 0.22; P=.121). All findings were consistent after controlling for age, gender, and immediate family member (spouse, parent, children, and grandchildren).

Conclusion

Our results suggest that family members who witness ED resuscitations may be at increased risk of PTSD symptoms at one month. This is the first study that examines the effects of family visitation for an unsorted population of very sick patients who would typically be seen in the critical care section of a busy ED.

A Qualitative Exploration of the Impact of a Distressed Family Member on Pediatric Resuscitation Teams

BACKGROUND AND OBJECTIVES

Family presence during resuscitation (FPDR) is commonplace in many hospitals today. Research has supported the positive effects it can have on family members; however, there is little research about how it may affect the resuscitation team's performance, especially in a pediatric population. Our objective was to identify how resuscitation team members perceive and respond to the presence of a distressed family member during a resuscitation.

METHODS

This is a qualitative study in which we examine FPDR-related themes raised by pediatric resuscitation team members after a resuscitation simulation. As part of a team training educational intervention, pediatric resuscitation teams, composed of nurses, respiratory therapists, and resident physicians, participated in a video-recorded simulated event in which they attempted to resuscitate an infant. During the scenario, a confederate actor played the role of a distressed "parent." Video-recorded debriefs occurred immediately after each simulation. Video recordings were transcribed verbatim, and then transcripts were coded and analyzed via thematic analysis to saturation.

RESULTS

Thirteen postevent video debriefs were analyzed. A total of 74 participants took part in these simulations and debriefs. Analysis revealed 15 major and 29 minor themes, which were mapped to 5 factors, namely resuscitation environment, affective responses, cognitive responses, behavioral responses, and team dynamics.

CONCLUSIONS

FPDR has an impact on resuscitation team members' responses and influences their adaptive behavior. If not managed well, this may pose potential patient safety concerns. Policy and training of specific teamwork skills are ways in which we can better equip health care providers to effectively manage FPDR.

Patient and Family Engagement in Care in the Cardiac Intensive Care Unit

Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.

Family presence during paediatric resuscitation and invasive procedures: the parental experience: An integrative review: An integrative review

BACKGROUND

The evolvement of family-centred care has been an ongoing process since the Platt Report 1959. Family-centred care has become the modern working model in paediatrics and obstetrics. Parental participation is central to family-centred care. Whether it is applied consistently remains to be concluded.

AIM

The aim of the study was to describe the family experiences of being present during paediatric resuscitation and invasive procedures.

METHOD

The design used in this study is an integrative review by Whittemore & Knafl. Databases PubMed and CINAHL were searched for primary research concerning the parental experiences of participating in paediatric resuscitation and invasive procedures. Eighteen studies were included in the study. A quality assessment tool was applied.

FINDINGS

A pro-parental presence was the results of 17 of the 18 included studies. Six common themes were found: 'Being there', 'Calming child', 'Calming parent', 'Having the right', 'Do it again' and 'Seeing is believing'.

CONCLUSION

Including family in resuscitation and invasive procedures requires openness as a working model and demands organisational changes and the updating of guidelines. The inseparability of parent-child is attachment theory practised, an innate quality of being a child as well as a parent. Recommendations are to have a facilitator present during resuscitation and invasive procedures to alleviate stress on everyone's part, enabling family participation.

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.

Family for Life and Death: Family Presence during Resuscitation

The dilemma of whether to allow relatives to see or even touch their loved one while she undergoes cardiopulmonary resuscitation (CPR) has been discussed for roughly four decades. However, Family Presence During Adult Resuscitation (FPDR) is still not widely implemented. In this paper, I espouse relational autonomy to make a case for a clinical approach of family-centered care and FPDR. In recent years, family-centered care (FCC) has gained increasing support. I argue that relational autonomy provides a conceptual framework for both FCC and FPDR. In turn, FCC provides a plausible clinical approach to justify FPDR, while the empirical evidence that supports FPDR provides a useful example to justify FCC.

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 resuscitation: A narrative review of the practices and views of critical care nurses

BACKGROUND

The option of family presence during resuscitation was first presented in the late 1980s. Discussion and debate about the pros and cons of this practice has led to an abundant body of international research.

AIM

To determine critical care nurses' experiences of, and support for family presence during adult and paediatric resuscitation and their views on the positive and negative effects of this practice.

METHODS

A narrative literature review of primary research published 2005 onwards. The search strategy comprised an electronic search of three bibliographic databases, supplemented by exploration of a web-based search engine and hand-searching.

RESULTS

Twelve studies formed the review. Research primarily originated from Europe. The findings were obtained from a moderately small number of nurses, and their views were mostly based on conjecture. Among the factors influencing family presence during resuscitation were dominant concerns about harmful effects. There was a noticeable absence of compliance with recommended guidelines for practice, and the provision of a unit protocol or policy to assist decision-making.

CONCLUSION

A commitment to family-centred care, educational intervention and the uptake of professional guidance are recommended evidence-informed strategies to enhance nurses' support for this practice in critical care.

Nursing knowledge of and attitude in cardiopulmonary arrest: cross-sectional survey analysis

Background

Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. That is why it is crucial that they keep their knowledge and skills up-to-date and their attitudes to resuscitation are very important. The main aim of this study was to analyse whether the level of theoretical and practical understanding affected the attitudes of nursing staff.

Methods

A questionnaire was designed using the Delphi technique (three rounds). The questionnaire was adjusted and it was piloted on a test-retest basis with a convenience sample of 30 registered nurses. The psychometric characteristics were evaluated using a sample of 347 nurses using Cronbach’s alpha. Descriptive analysis was performed to describe the sociodemographic variables and Spearman’s correlation coefficient to assess the relationship between two scale variables. Pearson’s chi-squared test has been used to study the relationship between two categorical variables. Wilcoxon Mann Whitney test and the Kruskal–Wallis test were performed to establish relationships between the demographic/work related characteristics and the level of understanding.

Results

The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic information, theoretical and practical understanding, and attitudes of ethical issues. Cronbach’s alpha for the internal consistency of the attitudes questionnaire was 0.621. The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly affected their attitudes. Their responses raised a number of bioethical issues.

Conclusions

CAEPCR questionnaire is the first one which successfully linked knowledge of cardiopulmonary resuscitation to the attitudes towards ethical issues Health policies should ensure that CPR training is mandatory for nurses and all healthcare workers, and this training should include the ethical aspects.

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.

Parent experience in the resuscitation room: how do they feel?

The aim of this study is to describe the experience of parents present in the resuscitation room during the attention given to their children in the pediatric emergency department, and to identify areas for improvement in this regard. This was a prospective study carried out in a third-level pediatric hospital. Children with life-threatening pathologies are treated in the resuscitation room of the pediatric emergency department. A survey was carried out among parents present in the resuscitation room during the period September 2016-August 2017. Excluded were the parents of children that died and those with a language barrier. The parents were interviewed in person or over the phone within 72 h of the care provided in the resuscitation room. Fifty surveys were completed (15 in person and 35 by phone). Forty mothers and 10 fathers responded, with an average age of 41. In the resuscitation room, 39 parents were accompanied by a health professional and 22 were given information about how the resuscitation room operated. The feelings most frequently reported by the parents were nervousness (39) and trust in the healthcare provided (20). All of the parents wished to be present. They felt that their presence was beneficial for the child (46), for themselves (50), and for the healthcare personnel (28).Conclusion: The experience of the parents in our resuscitation room is a positive one. Nevertheless, some aspects need to be improved, such as accompaniment of the parents and the information that they are provided. What is Known: • There is an international recommendation for parental presence during invasive procedures and cardiopulmonary resuscitation. • Few studies have been carried out on how parents in the resuscitation room feel and how they encounter the experience. What is New: • Even though most of the parents feel nervous in the resuscitation room, they expressed confidence in the medical team and they would wish to be present under similar circumstances.

Humanization of critical care-psychological effects on healthcare professionals and relatives: a systematic review

PURPOSE

To systematically review and evaluate the effects of humanized care of the critically ill on empathy among healthcare professionals, anxiety among relatives, and burnout and compassion fatigue in both groups.

SOURCE

MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and ProQuest Dissertations were searched from inception to 29 June 2017 for studies that investigated the effects of interventions with potential to humanize care of the critically ill on the following outcomes: empathy among critical care professionals, anxiety among relatives, and burnout and compassion fatigue in either group. We defined a humanizing intervention as one with substantial potential to increase physical or emotional proximity to the patient. Two reviewers independently selected studies, extracted data, and assessed risk of bias and data quality.

PRINCIPAL FINDINGS

Twelve studies addressing four discrete interventions (liberal visitation, diaries, family participation in basic care, and witnessed resuscitation) and one mixed intervention were included. Ten studies measured anxiety among 1,055 relatives. Two studies measured burnout in 288 critical care professionals. None addressed empathy or compassion fatigue. Eleven of the included studies had an overall high risk of bias. No pooled estimates of effect were calculated as a priori criteria for data synthesis were not met.

CONCLUSIONS

We found insufficient evidence to make any quantitative assessment of the effect of humanizing interventions on any of these psychologic outcomes. We observed a trend towards reduced anxiety among family members who participated in basic patient care, liberal visitation, and diary keeping. We found conflicting effects of liberal visitation on burnout among healthcare professionals.

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.

Factors associated with nurses' perceptions, self-confidence, and invitations of family presence during resuscitation in the intensive care unit: A cross-sectional survey

BACKGROUND

Family presence during resuscitation is not widely implemented in clinical practice. Prior research about nurse factors that may influence their decision to invite family members to remain in the room during resuscitation is contradictory and inconclusive.

OBJECTIVES

To describe intensive care unit nurses' perceptions, self-confidence, and invitations of family presence during resuscitation, and to evaluate differences according to nurse factors.

DESIGN

A cross-sectional survey design was used for descriptive and correlational analyses.

SETTING

Data collection occurred online.

PARTICIPANTS

A convenience sample of 395 nurses working in intensive care units across the United States was obtained.

METHODS

Participants completed a survey to collect personal, professional, and workplace information. The Family Presence Risk-Benefit Scale and Family Presence Self-confidence Scale were administered, and frequency of inviting family members to be in the room during resuscitation was collected by self-report. Following descriptive analysis of univariate distributions, a series of hierarchical OLS regression analyses was used to identify which personal, professional, or workplace factors yielded the largest unique impact on nurse perceptions, self-confidence, and invitations of family presence during resuscitation.

RESULTS

Despite high frequency of performing resuscitative care, one-third of participants had never invited family members to be in the room during resuscitation during their careers, and another 33% had invited family members to be present just 1-5 times. Having had clinical experience with family presence during resuscitation was the strongest predictor of positive perceptions, higher self-confidence, and increased invitations. In addition, having received education on family presence during resuscitation and a written facility policy were found to be key professional and workplace predictors of perceptions and invitations.

CONCLUSIONS

Nurses who work in a facility with a policy on family presence during resuscitation, are educated on it, and have experienced it in the clinical setting are more likely to have positive perceptions and higher self-confidence, and to invite family members to be in the room during resuscitation with increased frequency. Nurses in leadership roles should create policies for their units and provide education to nurses and other healthcare providers. Due to the apparent importance of clinical experience with family presence during resuscitation, it is recommended to initially provide this experience using simulation and role modeling.

Family presence during resuscitation - The experiences and views of Polish nurses

Understanding healthcare professionals perceptions of family presence during resuscitation (FPDR) may help in choosing an effective strategy of implementing this concept in everyday clinical practice.

OBJECTIVES

To determine the experiences and views of Polish nurses about family witnessed resuscitation.

DESIGN

A cross sectional survey study.

SETTING

Delegates (n = 720) attending the Polish Association of Anaesthesia and Intensive Care Nurses conference participated in the study. A total of 240 questionnaires were correctly completed and returned.

MAIN OUTCOME MEASURES

Validation of the Polish version of the tool was undertaken. Exploratory factor analysis extracted three main factors: staff opinions on the benefits of FPDR (α-Cronbach 0.86), opinions on the negative effects (α-Cronbach 0.74) and general views on this practice (α-Cronbach 0.54). These three extracted factors were defined as dependent variables.

RESULTS

Out of the sample, 113 (47%) nurses worked in adult intensive care units (ICUs) and 127 (53%) in other acute clinical settings. ICU nurses reported having experiences of FPDR (n = 66, 54%); out of this group 12 (10%) had positive encounters and 46 (38%) reported negative ones. ICU nurses had undetermined opinions on the benefits and potential negative effects of FPDR. Having positive experiences with FPDR influenced ICU nurses' views on the negative effects of FPDR (Z = -2.16, p< 0.03).

CONCLUSION

A positive experience of FPDR influences a nurse's views and attitudes in this evolving area of practice.

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.

CPR in medical TV shows: non-health care student perspective

INTRODUCTION

There are over a dozen medical shows airing on television, many of which are during prime time. Researchers have recently become more interested in the role of these shows, and the awareness on cardiopulmonary resuscitation. Several cases have been reported where a lay person resuscitated a family member using medical TV shows as a reference. The purpose of this study is to examine and evaluate college students' perception on cardiopulmonary resuscitation and when to shock using an automated external defibrillator based on their experience of watching medical TV shows.

METHODS

A total of 170 students (nonmedical major) were surveyed in four different colleges in the United States. The survey consisted of questions that reflect their perception and knowledge acquired from watching medical TV shows. A stepwise regression was used to determine the significant predictors of "How often do you watch medical drama TV shows" in addition to chi-square analysis for nominal variables.

RESULTS

Regression model showed significant effect that TV shows did change students' perception positively (p<0.001), and they would select shock on asystole as the frequency of watching increases (p=0.023).

CONCLUSION

The findings of this study show that high percentage of nonmedical college students are influenced significantly by medical shows. One particular influence is the false belief about when a shock using the automated external defibrillator (AED) is appropriate as it is portrayed falsely in most medical shows. This finding raises a concern about how these shows portray basic life support, especially when not following American Heart Association (AHA) guidelines. We recommend the medical advisors in these shows to use AHA guidelines and AHA to expand its expenditures to include medical shows to educate the public on the appropriate action to rescue an out-of-hospital cardiac arrest patient.

Family presence during resuscitation: extending ethical norms from paediatrics to adults

Many families of patients hold the view that it is their right to be present during a loved one's resuscitation, while the majority of patients also express the comfort and support they would feel by having them there. Currently, family presence is more commonly accepted in paediatric cardiopulmonary resuscitation (CPR) than adult CPR. Even though many guidelines are in favour of this practice and recognise potential benefits, healthcare professionals are hesitant to support adult family presence to the extent that paediatric family presence is supported. However, in this paper, we suggest that the ethical case to justify family presence during paediatric resuscitation (P-FPDR) is weaker than the justification of family presence during adult resuscitation (A-FPDR). We go on to support this claim using three main arguments that people use in clinical ethics to justify FPDR. These include scarcity of evidence documenting disruption, psychological benefits to family members following the incident and respect for patient autonomy. We demonstrate that these arguments actually apply more strongly to A-FPDR compared with P-FPDR, thereby questioning the common attitude of healthcare professionals of allowing the latter while mostly opposing A-FPDR. Importantly, we do not wish to suggest that P-FPDR should not be allowed. Rather, we suggest that since P-FPDR is commonly (and should be) allowed, so should A-FPDR. This is because the aforementioned arguments that are used to justify FPDR in general actually make a stronger case for A-FPDR.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

OBJECTIVE

To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012."

DESIGN

A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development.

METHODS

The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

RESULTS

The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions.

CONCLUSIONS

Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Family Presence in the Adult ICU During Bedside Procedures

PURPOSE

To understand perspectives of family members of adult patients admitted to the medical-surgical intensive care unit (ICU) regarding their presence during procedures.

METHODS

Respondents completed a questionnaire about procedures the patient had undergone, their desire to be present, and their experience. Procedures of interest were endotracheal intubation; chest compressions; vascular catheter insertion; and gastric, chest, and rectal tubes. Impact of Events Scale-Revised (IES-R) was completed at the time of questionnaire completion and again 1 month later to evaluate the psychological impact of witnessing a procedure.

RESULTS

Ninety-seven respondents completed the questionnaire on behalf of 72 patients. More than 90% patients had at least 1 procedure. Only 29 (30%) family members were present for at least 1 procedure, and 44% to 100% wished to be present. Of the 68 respondents not present for a procedure, 18 (26.5%) wanted to be present. The IES-R was completed by 52 (95%) of 55 respondents who witnessed any procedure at time 1 and 28 (51%) of 55 respondents at time 2; mean IES-R scores were 8.0 and 8.8 ( P = .68), respectively. Only 2 participants had IES-R >33, signifying the likely presence of posttraumatic stress disorder.

CONCLUSION

Family members wish to be present for ICU procedures, and there are no adverse psychological effects.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

OBJECTIVE

To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".

DESIGN

A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development.

METHODS

The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

RESULTS

The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions.

CONCLUSIONS

Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.