Family Presence: Evidence Versus Tradition

A Conceptual Framework for the Domain of Evidence-Based Design

The physical facilities in which healthcare services are performed play an important role in the healing process. Evidence-based design in healthcare is a developing field of study that holds great promise for benefiting key stakeholders: patients, families, physicians, and nurses, as well as other healthcare staff and organizations. In this paper, the authors present and discuss a conceptual framework intended to capture the current domain of evidence-based design in healthcare. In this framework, the built environment is represented by nine design variable categories: audio environment, visual environment, safety enhancement, wayfinding system, sustainability, patient room, family support spaces, staff support spaces, and physician support spaces. Furthermore, a series of matrices is presented that indicates knowledge gaps concerning the relationship between specific healthcare facility design variable categories and participant and organizational outcomes. From this analysis, the authors identify fertile research opportunities from the perspectives of key stakeholders.

Presence of patients' families during cardiopulmonary resuscitation: physicians' and nurses' opinions

AIM

This paper is a report of a study to determine the opinions of physicians and nurses who work in a university hospital intensive care unit and emergency department about the presence of patients' families during cardiopulmonary resuscitation in these units.

BACKGROUND

Healthcare professionals have conflicting opinions about the presence of patients' families during cardiopulmonary resuscitation. Families who are allowed to be present have less fear and worry, feel they have supported their family member and are able to cope more easily.

METHOD

The data for this descriptive questionnaire study were collected between November 2006 and January 2007. The respondents were 62 physicians and 82 nurses who worked in an emergency department or in cardiology or anaesthesia intensive care units in Turkey. The data were collected using a questionnaire and the responses summarized using frequencies and percentages. The chi-squared test was performed to test for differences in the opinion by profession, educational level, or number of years of working experience in the profession.

FINDINGS

The response rate was 79%. Of the respondents, 82.6% did not think it was appropriate for patients' families to be present during cardiopulmonary resuscitation. The most common concerns mentioned were that the family would interfere with the team's activities (56.3%) and that resuscitation is a very traumatic procedure (43.6%).

CONCLUSION

Policies need to be developed regarding this topic because the absence of policy can cause misunderstanding and differences in practice. Further research is needed to determine what public education is needed to facilitate implementation of such policies.

To hold her hand: family presence during patient resuscitation

Family presence at the bedside during resuscitation is an important component of the patient's care. Many families report feeling that their presence at such a time is helpful to both them and the patient. Some studies suggest that family presence may reduce the chance of legal action regarding the patient's outcome because it decreases the mystery surrounding the level of effort undertaken to save the patient's life. However, many facilities are reluctant to allow family presence during resuscitation typically because of the belief that family presence will somehow disrupt the providers' ability to conduct the resuscitation. This article explores the background behind this issue and the studies done to date on family presence and makes suggestions for adopting policies allowing family presence during resuscitation.

Parental presence during pediatric invasive procedures

Parental presence during pediatric invasive procedures is becoming more common, yet it remains a controversial issue related to providing family-centered care. A literature review related to this important issue was performed. Credible arguments supporting parental presence during invasive procedures as well as opposing arguments were discussed. One must consider both views in order to create a nonbiased analysis of the issue. Parental presence during invasive procedures raises critical debates related to maintaining or altering the continuum of holistic patient care. Additional research would provide an objective approach to the problem. Development of an evidence-based protocol would provide a framework for this issue.

Review of effective advanced cardiac life support training using experiential learning

AIMS AND OBJECTIVES

This paper examines issues of contention regarding current practices and suggests the application of the experiential theory of learning (incorporating reflective practice) to advanced cardiac life support (ACLS) training.

BACKGROUND

The need for formalized training in cardiopulmonary resuscitation (CPR) and ACLS is well documented. However, the effectiveness of traditional training programmes has not been firmly established. The question still remains - how to best ensure transfer of learning enabling learners to apply classroom knowledge successfully in the clinical setting. It is argued that educators can no longer rely on traditional teaching methods and more effective learner-centred education techniques are required.

METHOD

A review of available literature regarding ACLS training has been conducted for this discussion.

DATA SOURCES AND SELECTION

MEDLINE, CINAHL, OVID, Expanded Academic and Proquest were searched using textwords. English-language articles related to CPR and ACLS practices and also experiential learning were reviewed. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Articles related to CPR/ACLS and experiential learning practices published within the last 10 years were reviewed.

RESULTS

There is evidence that past ACLS training programmes have proven inconsistent and inadequate, with numerous studies reporting trainees have poor retention; and, therefore, ineffective ACLS skills as a result.

CONCLUSIONS

The reviewed literature demonstrates that the need for effective ACLS training is clear. Increasing numbers of critically ill patients in hospitals means that it has never been more important to ensure the competence of healthcare professionals. Training must give learners a chance to pull together all aspects of ACLS and the use of experiential learning has the potential to achieve this aim.

RELEVANCE TO CLINICAL PRACTICE

It is argued that providing training designed and implemented using experimental learning enhances learning through critical thinking and reflection, and subsequently should improve ACLS outcomes.

Paediatric critical care nurses' attitudes and experiences of parental presence during cardiopulmonary resuscitation: a European survey

BACKGROUND

Although recent resuscitation guidelines are supportive of family presence during cardiopulmonary resuscitation literature from the last decade suggests that it is often discouraged, and the subject remains a controversial issue.

OBJECTIVES

To determine the experiences and attitudes of European paediatric critical care nurses about parental presence during the resuscitation of a child.

DESIGN

A survey design was employed.

PARTICIPANTS

A convenience sample of European paediatric critical care nurses was used.

METHODS

A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a 5-point Likert scale. Differences in attitudes were explored in three areas: decision-making, processes and outcomes of resuscitation.

RESULTS

The results from this survey suggest that European paediatric nurses are very supportive of parental presence during cardiopulmonary resuscitation. Only a few nurses reported that their unit had a policy that covered parental presence during cardiopulmonary resuscitation and most nurses did not support the use of a dedicated nurse to look after the parents during resuscitation.

CONCLUSIONS

Compared with previous studies relating to adult cardiopulmonary resuscitation, paediatric nurses experience family member presence more frequently than adult critical care nurses and appear to be more supportive of relatives' presence. It is recommended that paediatric intensive care units establish local policies that cover parental presence during cardiopulmonary resuscitation.

Family presence during CPR: a study of the experiences and opinions of Turkish critical care nurses

BACKGROUND

The concern over family witnessed cardiopulmonary resuscitation has been a frequent topic of debate in many countries.

OBJECTIVES

The aim of this descriptive study is determine the experiences and opinions of Turkish critical care nurses about family presence during cardiopulmonary resuscitation and to bring this topic into the critical care and the public limelight in Turkey.

METHODS

Study population consisted of critical care nursing staff at four hospitals affiliated with the Ministry of Health, three hospitals affiliated with universities and three hospitals affiliated with Social Security Agency Hospitals. A total of 409 eligible critical care nurses were surveyed using a questionnaire which is consisted of 43 items under 3 areas of inquiry.

RESULTS

None of the hospitals that participated in this study had a protocol or policy regarding family witnessed resuscitation. More than half of the sample population had no experience of family presence during cardiopulmonary resuscitation and none of the respondents had ever invited family members to the resuscitation room. A majority of the nurses did not agree that it was necessary for family members to be with their patient and did not want family members in resuscitation room. In addition, most of the nurses were concerned about the violation of patient confidentiality, had concerns that untrained family members would not understand CPR treatments, would consider them offensive and thereby argue with the resuscitation team. The nurses expressed their concern that witnessing resuscitation would cause long lasting adverse emotional effects on the family members.

CONCLUSION

This study reveals that critical care nurses in Turkey are not familiar with the concept of family presence during cardiopulmonary resuscitation. In view of the increasing evidence from international studies about the value of family presence during cardiopulmonary resuscitation we recommend educational program about this issue and policy changes are required within the hospitals to enhance critical care in Turkey.

A European survey of critical care nurses’ attitudes and experiences of having family members present during cardiopulmonary resuscitation

This paper presents the results of a survey into the experiences and attitudes of 124 European critical care nurses to the presence of family members during cardiopulmonary resuscitation (CPR). Nurses from mainland Europe were less experienced and less sure about the consequences of relatives witnessing resuscitation than United Kingdom (UK) nurses. Generally, nurses supported the presence of family members, although UK nurses held significantly more positive attitudes than their non-UK counterparts in the areas of decision-making, processes and outcomes of resuscitation. Differences in attitudes are explored in the discussion. On the basis of results from this study, it is recommended that further policy guidance is required.

Pediatric Post-resuscitation Care

Current literature demonstrates a paucity of information on post-resuscitation care of pediatric clients. This lack of information is somewhat understandable in light of the relatively low incidence of occurrence and the statistically poor outcome. Nurses must be aware, however, of many issues when dealing with pediatric clients and their families after an arrest episode. This article explores key concepts involved with post-resuscitation care, including the outcome of cardiopulmonary resuscitation, immediate post-resuscitation needs, emotional outcomes for the child, and family stress and grief.