Nurses’ Perceptions of Their Self-confidence and the Benefits and Risks of Family Presence During Resuscitation

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Family presence during in-hospital cardiopulmonary resuscitation: effects of an educational online intervention on self-confidence and attitudes of healthcare professionals

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.

Critical Care Nurses' Attitudes About Family Presence During Resuscitation: An Integrative Review

BACKGROUND

Family presence during resuscitation was introduced into clinical practice 30 years ago. Despite adoption of family-centered care by several health organizations and support for family presence during resuscitation by professional organizations such as the American Heart Association, critical care nurses' attitudes about family presence during resuscitation vary widely.

OBJECTIVE

To examine current evidence on critical care nurses' attitudes about, perceptions of, and behaviors related to practicing family presence during resuscitation.

METHODS

The method of Whittemore and Knafl guided the integrative review. Databases searched were CINAHL, PubMed, and Scopus. Articles included were English-language studies published from 2008 to 2022 that examined the perceptions of critical and emergency care nurses from adult units regarding family presence during resuscitation.

RESULTS

Twenty-two articles were included. Levels and strength of evidence were assessed with the Johns Hopkins nursing evidence-based model. The articles in this integrative review included a total sample size of 4780 health care professionals; 3808 were critical and acute care nurses.

DISCUSSION

Themes synthesized from current evidence included attitudes, benefits, barriers, demographic influence, cultural influence, and facilitators. Barriers and facilitators were associated with nursing practice in rural versus urban settings, age-related factors, years of experience, and unit-based differences in practice. Developing interventions to address identified factors can increase the practice of family presence during resuscitation in critical care settings.

CONCLUSIONS

Several factors influence the practice of family presence during resuscitation in critical care settings. Nurse leaders should consider these factors to enhance the practice of family presence during resuscitation.

Trauma-informed and family-centered paediatric resuscitation: Defining domains and practices

Aim

For paediatric patients and families, resuscitation can be an extremely stressful experience with significant medical and psychological consequences. Psychological sequelae may be reduced when healthcare teams apply patient- and family-centered care and trauma-informed care, yet there are few specific instructions for effective family-centered or trauma-informed behaviours that are observable and teachable. We aimed to develop a framework and tools to address this gap.

Methods

We reviewed relevant policy statements, guidelines, and research to define core domains of family-centered and trauma-informed care, and identified observable evidence-based practices in each domain. We refined this list of practices via review of provider/team behaviours in simulated paediatric resuscitation scenarios, then developed and piloted an observational checklist.

Results

Six domains were identified: (1) Sharing information with patient and family; (2) Promoting family involvement in care and decisions; (3) Addressing family needs and distress; (4) Addressing child distress; (5) Promoting effective emotional support for child; (6) Practicing developmental and cultural competence. A 71-item observational checklist assessing these domains was feasible for use during video review of paediatric resuscitation.

Conclusion

This framework can guide future research and provide tools for training and implementation efforts to improve patient outcomes through patient- and family-centered and trauma-informed care.

A Concept Analysis of Family Presence During COVID-19

BACKGROUND

In 2020, the COVID-19 pandemic required health care organizations throughout the United States to implement strict visitor restriction policies to mitigate the spread of the virus. These policy changes had a direct impact on family presence (FP) in hospital settings.

PURPOSE

The aim of this study was to conduct a concept analysis of FP during the COVID-19 pandemic.

METHODS

Walker and Avant's 8-step method was used.

RESULTS

Four defining attributes of FP during COVID-19 were derived based on a review of the literature: being there or with, seeing is believing, during challenging times, and subjective advocates. The COVID-19 pandemic was the main antecedent of the concept. The consequences and empirical referents were discussed. Model, borderline, and contrary cases were developed.

CONCLUSION

This concept analysis provided an understanding of the concept of FP during COVID-19, which is imperative to optimizing patient care outcomes, as literature identified a support person or system as an extension of the care team that facilitates successful care management. Whether by advocating for their patients to have a support person present during team rounds, or by stepping in as the patient's main support system in the absence of family, nurses must find a way to do what is best for their patients even during the unprecedented times of a global pandemic.

Family presence during invasive procedures: a pilot study to test a tool

BACKGROUND

Family Presence During Invasive Procedures (FPDI) generates controversy among healthcare professionals. Twibell and her team designed an instrument that measured nurses' Risk-Benefit and Self-Confidence perceptions regarding family presence during resuscitation and was used in numerous studies.

OBJECTIVES

Evaluate the new tool for Family Presence Risk-Benefit and Family Presence Self-Confidence during invasive procedures and find out the opinions of the medical and nursing staff on FPDIP.

METHOD

Cross-sectional methodological pilot study. Online and paper questionnaires modified from a previous translation. A factor analysis was performed for the validity of the indices and bivariate analysis for all the variables. Ethical approvals and research permissions were obtained according to national standards.

RESULTS

One hundred twenty healthcare professionals (22.18%) answered the survey. Cronbach's α on the Family Presence Risk-Benefit scale was 0.877. Cronbach's α on the Family Presence Self-Confidence scale was 0.937. The correlation between the Risk-Benefit and Self-confidence variables is significant and with a moderate intensity of the relationship. A lower predisposition to Family Presence During Invasive Procedures is observed. Physicians are more reluctant than nurses.

CONCLUSIONS

The FPDI generates controversy as it alters health professionals' routines when they decide whether to allow it or not. There is a tendency for younger professionals to support FPDI. In general, health professionals, mainly physicians, do not favor FPDI. Health workers who perceive fewer risks and more benefits in FPDI and have greater self-confidence are more in favor of FPDI. The psychometric properties and internal consistency of the questionnaire indicate the validity and reliability of this tool.

Association between nurses' perceived self-confidence in performing family witnessed resuscitation and implementation of the practice at Siaya County Referral Hospital in Kenya

Objectives

This study aimed to identify the relationship between nurses' perceived self-confidence in performing family-witnessed resuscitation and the implementation of the practice among nurses and to describe nurses' preferences regarding family-witnessed resuscitation practice.

Methods

This study was a cross-sectional survey. A stratified random sampling design was used to obtain study participants from various units within the medical-surgical departments of the hospital. Data was collected using the Family Presence Self-confidence Scale designed by Twibel et al. Chi-square test and binary logistic regression were used to analyze the association between levels of perceived self-confidence and the implementation of family-witnessed resuscitation practice.

Results

There was a significant association between nurses' perceived self-confidence (χ ² = 8.06, P = 0.01) and the implementation of family-witnessed resuscitation practice. The nurses who were quite/very confident were 4.9 times more likely to perform witnessed resuscitation than those who were somewhat confident (OR = 4.94, 95% CI 1.07-22.71).

Conclusion

The perceived self-confidence in performing family-witnessed resuscitation varied widely among nurses. To achieve successful implementation of family-witnessed resuscitation practice, medical-surgical nurses should get higher levels of perceived self-confidence in the presence of patients' families through advanced specialized training and practice on resuscitation.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Increasing Nurses' Knowledge of and Self-confidence With Family Presence During Pediatric Resuscitation

BACKGROUND

Family presence during resuscitation is becoming more common, and pediatric critical care nurses regularly facilitate this process. However, most hospitals lack policies and education to support nurses in this practice.

OBJECTIVE

To increase pediatric intensive care unit nurses' knowledge and self-confidence with family presence during resuscitation through an educational intervention.

METHODS

The project used a pre-post intervention study design with anonymous online cross-sectional surveying. Participant demographic data were collected along with participants' responses to 2 instruments measuring perceived risks and benefits of family presence during resuscitation and participant self-confidence with the process. The educational session consisted of a 2-hour structured session incorporating content presentation, discussion, simulation videos, and parental testimony.

RESULTS

Thirty-six nurses participated in this project. Overall mean scores of both tools and scores of almost every item within each tool significantly increased after the intervention.

CONCLUSION

Formalized and structured education on family presence during resuscitation appears to promote pediatric intensive care unit nurses' knowledge, increase their perception of benefits outweighing risks, and enhance their self-confidence in supporting family members. Providing information about family presence during resuscitation and how best to facilitate this practice should be a priority and included as part of standard educational support for pediatric intensive care unit nurses.

Emergency Room Nurses' Attitudes toward Family Presence during Resuscitation: A Cross-Sectional Study

INTRODUCTION

Although there are guidelines that encourage the family presence during cardiopulmonary resuscitation, literature that reported on the healthcare team's attitudes suggested that this practice is often discouraged, and it remains a debatable topic.

AIM

To assess the Emergency Room Nurses' Attitudes toward family presence during cardiopulmonary resuscitation procedures.

RESEARCH DESIGN

A cross-sectional descriptive correlation research design was used for this study.

PARTICIPANTS AND RESEARCH CONTEXT

A non-probability convenience sample for this study comprised 222 registered nurses who have worked in emergency departments. The study used Family Presence During Resuscitation scale to collect the data related to nurses' attitude toward family presence during CPR.

ETHICAL CONSIDERATIONS

This study was approved by the ethics committee at Al-Zaytoonah University of Jordan.

RESULTS

Jordanian nurses had a positive attitude toward the health beliefs with a mean score of (3.71 ± 0.81), followed by cues and triggers (3.60 ± 0.82). The least attitude endorsed by nurses was perceived self-efficacy with a mean score of (2.87 ± 0.80). Point-biserial correlation yielded a positive correlation between marital status and cues or triggers (r = 0.055; p = 0.043). Moreover, person correlation showed a positive relationship between age and health beliefs (r = 00.134; p = 0.040) and a negative correlation between experience and self-efficacy (r=-0.141; p = 0.043).

CONCLUSION

Enhancing nurses' confidence based on evidence-based practice would prepare nurses to handle family presence during resuscitation.

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.

Family presence during resuscitation: adaptation and validation into Spanish of the Family Presence Risk-Benefit scale and the Self-Confidence scale instrument

BACKGROUND

Family Presence during Cardiopulmonary Resuscitation has been studied both to identify the opinions of health professionals, patients, and family members, and to identify benefits and barriers, as well as to design protocols for its implementation. R. Twibell and her team designed an instrument that measured nurses' perceptions of Risks-Benefits and Self-Confidence regarding Family Presence during Resuscitation. There are few studies in Spain on this practice.

METHODS

The aim is to adapt and validate into Spanish the Family Presence Risk-Benefit scale and Family Presence Self-Confidence scale instrument. For this purpose, this instrument was translated cross-culturally, and administered in paper and online version. Statistical tests were carried out for the validity of the questionnaire. Five hundred forty-one healthcare professionals were invited to respond. The results were analyzed by the same statistical procedures as in the original scale. Ethical approvals and research permissions were obtained according to national standards.

RESULTS

Two hundred thirty-seven healthcare professionals (43.8%) answered the survey (69% women), of whom 167 were nurses. Validation of instruments: Cronbach's α in Family Presence Risk-Benefit scale was 0.94. Cronbach's α in Family Presence Self-Confidence scale was 0.96. Factor Analysis Kaiser, Meyer and Olkin (KMO) was greater than 0.9. The correlation between the two measured scales, is significant and has a moderate intensity of the relationship (r = 0.65 and α < 0.001). A lower predisposition to Family Presence during Cardiopulmonary Resuscitation is observed, but the pure detractors are only 12%. Doctors are more reluctant than nurses.

CONCLUSIONS

The psychometric properties of the questionnaire in Spanish indicate high validity and reliability. Risk-Benefit perception and Self-Confidence are related to the healthcare professionals who consider the Family Presence to be beneficial. More studies in different contexts are necessary to confirm the psychometric results and validity of this instrument in Spanish.

Factors affecting women entrepreneurs' success: a study of small- and medium-sized enterprises in emerging market of Pakistan

In the present era, women are recognized as successful entrepreneurs through their strong desire, qualities, and capabilities for robust economic development. Due to such an important contribution of women in economic development, we propose to investigate the factors which affect women entrepreneur's success in Pakistan. Data were collected through structured questionnaires from 181 registered SMEs operating in Pakistan. A conceptual model is developed, while SPSS and AMOS software's are used for analysis. The results indicate that the internal factors including the need for achievements, risk-taking, and self-confidence and external factors including economic factors and socio-cultural factors have a positive and significant influence on the success of women-owned enterprises. This research recommends Small and Medium Enterprises Development Authority (SMEDA), policymakers, and practitioners to encourage women entrepreneurs to run their businesses for the long term by providing a variety of incentives and supports related to those internal and external factors. Numerous studies have been conducted to test the different factors' effects on women's entrepreneurial success, but our study investigated some psychological, cultural, and religious factors that are still almost untouched especially in Pakistan. The current study also contributes to the existing literature through empirical shreds of evidence.

Original Research: Family Presence During Resuscitation: Medical-Surgical Nurses' Perceptions, Self-Confidence, and Use of Invitations

BACKGROUND

Family presence during resuscitation (FPDR) upholds family-centered care principles and can result in better family member outcomes; yet it isn't routinely implemented by nurses. Prior studies have examined predictors of support for FPDR among nurses caring for high acuity patients, but limited research involves medical-surgical nurses. This is problematic because resuscitation occurs in all inpatient settings.

PURPOSE

This study sought to examine the personal, professional, and workplace factors associated with medical-surgical nurses' perceptions, self-confidence, and use of invitations regarding FPDR. It also aimed to explore potential barriers to FPDR and nurses' educational preferences, in order to inform the design of interventions that might improve FPDR implementation in this practice setting.

METHODS

A cross-sectional survey design was used to examine which factors are predictors of medical-surgical nurses' FPDR perceptions, self-confidence, and use of invitations. Data on nurses' perceptions of barriers and educational preferences were collected via survey as well.

RESULTS

The sample of 51 medical-surgical nurses reported overall neutral perceptions of FPDR. Yet 63% had never invited family members to experience resuscitation. The most significant predictor of more favorable perceptions, higher self-confidence, and greater use of invitations was having prior experience with FPDR. Analysis of perceived barriers indicates that these can be addressed through providing nurses with supportive FPDR policies and education. But only 14% of participants reported that their facility or unit had a written FPDR policy and just 16% had ever received any FPDR education.

CONCLUSIONS

FPDR is not commonly practiced on medical-surgical units. Providing medical-surgical nurses with experience, policies, and education is recommended to improve FPDR implementation rates in this practice setting.

The effects of family-witnessed resuscitation on health professionals

Aim:

To gain an understanding of the effects of family-witnessed resuscitation (FWR) on health professionals.

Background:

FWR has been the subject of an ongoing debate for almost 30 years. Historically, emergency departments (EDs) have excluded family members of a critically ill or injured patient from the treatment area during resuscitation.

Methodology:

A systematic literature search of six nursing-focused databases was undertaken using pertinent keywords. Only studies published in English, focused on ED staff and undertaken after 2007 (published up to 2017) were included.

Findings:

FWR is not commonly practised by health professionals. The four themes identified were: fear of adverse litigation; the importance of the role of the facilitator; lack of FWR policies in the workplace; and staff lack of knowledge and education regarding FWR, resulting in fear and stress.

Conclusion:

By implementing policies in the workplace, and having a facilitator to provide support and guidance to families, stress and anxiety can be greatly reduced. The implementation of educational programmes can increase staff awareness and knowledge surrounding the benefits of FWR

Self-confidence and attitude of acute care nurses to the presence of family members during resuscitation

AIM:

the present study aimed to assess the relationship between attitude to the presence of family members during cardiopulmonary resuscitation and confidence of acute care nurses in performing cardiopulmonary resuscitation in the presence of family.

METHODS:

this descriptive-analytical study was conducted on nurses working in acute care units (intensive care unit, coronary care unit, and emergency department) in Iran in 2017. A total of 150 nurses entered the study by convenience sampling. Data were collected on nurses' attitude towards the presence of family scale and nurses' self-confidence in presence of family scale.

RESULTS:

of the 150 participants, 48 (32%) were men and 102 (68%) were women. Total mean score of attitude was 67±10.4 (obtained scores by nurses ranged from 32 to 100). Total mean score of self-confidence was 53.86 ±11.7 (obtained scores by nurses ranged from 23 to 81). Pearson correlation test showed a significant negative relationship between nurses' attitude toward presence of family members during cardiopulmonary resuscitation and their self-confidence (rr=-0.45, p=0.001).

CONCLUSION:

the present study showed that nurses with a higher self-confidence have a more positive attitude toward presence of family members during cardiopulmonary resuscitation. Given the importance of the subject, it should be considered by nursing managers and planners.

Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence

BACKGROUND

Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events.

OBJECTIVE

This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation.

METHODS

By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale.

RESULTS

Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001).

DISCUSSION

These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.

Emergency nurses’ attitudes towards the concept of witnessed resuscitation

Objective:

to review the most relevant evidence on the nurses’ attitudes towards witnessed resuscitation, in the inpatient and out-of-hospital spheres.

Method:

integrative literature review, covering the period from 2008 till 2015, using the databases PubMed, Lilacs and SciELO; in Spanish, English and Portuguese. The pediatric context was excluded from the study.

Results:

the synthesis of the data resulted in the inclusion of 10 articles, categorized as: positive attitudes and negative attitudes.

Conclusions:

discrepancies exist among the nurses from different contexts and geographical regions towards the concept; protocols need to be established for this situation, in view of the advantages evidenced in the literature, for the nursing professionals as well as the relatives. Witnessed resuscitation can represent an opportunity to understand and cope with the rational and irrational in the situation in a shared manner, as well as mitigate or dignify the mourning.

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.

Cultural aspects of death notification following cardiopulmonary resuscitation

AIMS

To explore the lived experience of resuscitation team members involved in notifying family members when a patient dies following a resuscitation event in an Iranian cultural context.

BACKGROUND

Death notification to the family is indeed a difficult and an important issue for resuscitation team members. The way health professionals deliver news to family members should incorporate elements of sensitivity, timing and adequate clinical explanations with emphasis on the efforts made by the professionals during the resuscitation.

DESIGN

A phenomenological study.

METHOD

Over a period of 5 months (June 2016-November 2016) eleven nurses and six physicians were interviewed using an in-depth interview process applying Van Manen's hermeneutic phenomenological approach for data collection and analysis. The participants were recruited from six tertiary hospitals in Tabriz, Iran.

FINDINGS

There were two main themes that emerged from the data analysis including: "contributing factors on the impact of notification" and "notification strategies". A further 13 subthemes emerged under the main themes. Several culturally related issues emerged with the participants feeling more comfortable informing male rather than female relatives about the death of the patient following a resuscitation.

CONCLUSIONS

Notifying family members of a patient's death is a stressful and culturally sensitive task for the resuscitation team members. The nature of the patient's presenting condition, together with the various resuscitation interventions can result in relatives responding unpredictably. Providing health professionals with the appropriate training and skills to effectively communicate with family members will ensure that the families' level of preparedness, understanding and cultural beliefs are taken into consideration.

Family Presence During Resuscitation After Trauma

The purpose of this study was to examine the effects of family presence during resuscitation (FPDR) in patients who survived trauma from motor vehicle crashes (MVC) and gunshot wounds (GSW). A convenience sample of family members participated within three days of admission to critical care. Family members of 140 trauma patients (MVC n = 110, 79%; GSW n = 30, 21%) participated. Family members ranged in age from 20-84 years (M = 46, SD = 15, Mdn = 47). The majority were female (n = 112, 80%) and related to the patient as spouse (n = 46, 33%). Participating in the FPDR option reduced anxiety (t = -2.43, p =.04), reduced stress (t = -2.86, p = .005), and fostered well-being (t = 3.46, p = .001). Results demonstrate the positive initial effects of FPDR on family members of patients surviving trauma injury.

Psychological effects on patient's relatives regarding their presence during resuscitation

Introduction: Presence of family and patients’ relatives throughout resuscitation procedure is one of the most challenging concerns.

Methods: In an interventional (quasi-experimental) study that was conducted during a 6 months period, the patients’ relatives were randomly divided into two groups of intervention (the relatives who were eager to be present throughout the resuscitation procedure- under the family protection protocol, all of the procedure steps were explained to the relatives by an expert nurse who was not involved in the resuscitation procedure and control group (those who were not invited routinely to be present throughout the resuscitation procedure. However, if the control group were eager to be present, they were allowed to observe the procedure (these people were not supported by the protocol). After 90 days, subjects were contacted through telephone and filled standard questionnaires (Hospital Anxiety and Depression Scale [HADS]) and Impact of Event Scale (IES) were completed for all subjects. These questionnaires focus on anxiety, depression and post-traumatic stress disorder (PTSD). The obtained data were analyzed.

Results: One hundred thirty three relatives were divided into two groups of control (59 subjects) and intervention (74 people). No significant difference was observed between two groups regarding demographic features. The evaluation after 90 days revealed depression, anxiety disorders and PTSD to be significantly more prevalent in control group than the intervention group (P < 0.0001 ).

Conclusion: Emotional and psychological support and intervention on the patients’ relatives are efficient and can prevent the emergence of psychological disorders.

Family presence during resuscitation: A descriptive study with Iranian nurses and patients' family members

BACKGROUND

Family presence during resuscitation (FPDR) has advantages for the patients' family member to be present at the bedside. However, FPDR is not regularly practiced by nurses, especially in low to middle income countries. The purpose of this study was to determine Iranian nurses' and family members' attitudes towards FPDR.

METHOD

In a descriptive study, data was collected from the random sample of 178 nurses and 136 family members in four hospitals located in Iran. A 27-item questionnaire was used to collect data on attitudes towards FPDR, and descriptive and correlational analyses were conducted.

RESULTS

Of family members, particularly the women, 57.2% (n=78) felt it is their right to experience FPDR and that it has many advantages for the family; including the ability to see that everything was done and worry less. However, 62.5% (n=111) of the nurses disagreed with an adult implementation of FPDR. Nurses perceived FPDR to have many disadvantages. Family members becoming distressed and interfering with the patient which may prolong the resuscitation effort. Nurses with prior education on FPDR were more willing to implement it.

CONCLUSION

FPDR was desired by the majority of family members. To meet their needs, it is important to improve Iranian nurses' views about the advantages of the implementation of FPDR. Education on FPDR is recommended to improve Iranian nurses' views about the advantages of the implementation of FPDR.

Family Presence During Resuscitation: Impact of Online Learning on Nurses' Perception and Self-confidence

BACKGROUND

Family presence during resuscitation (FPDR) is supported by patients and their family members. Nurses, however, including critical care nurses who frequently implement resuscitative care, have mixed views.

OBJECTIVES

To determine the impact of online learning on critical care nurses' perception of and self-confidence with FPDR.

METHODS

A 2-group, random assignment, pretest and posttest quasi-experimental study was conducted with critical care nurses recruited nationally. An online learning module on FPDR was developed and administered to the intervention group. Perceptions and self-confidence for FPDR were measured by using the Family Presence Risk- Benefit Scale (FPR-BS) and the Family Presence Self-confidence Scale (FPS-CS). Two-factor, mixed-model factorial analysis of variance was used to compare mean scores.

RESULTS

A total of 74 critical care nurses participated in the study. Mean FPR-BS and FPS-CS scores were significantly greater in the intervention group than in the control group. For the intervention group, mean scores on the FPR-BS increased from 3.63 to 4.07 (P < .001) and on the FPS-CS increased from 4.24 to 4.57 (P < .001), signifying improved perception and self-confidence. Scores did not change significantly in the control group: mean FPR-BS score increased from 3.82 to 3.88 (P = .23) and the mean FPS-CS score of 4.40 did not change (P > .99).

CONCLUSIONS

Online learning is a feasible and effective method for educating large numbers of critical care nurses about FPDR. Online learning can improve perceptions and self-confidence related to FPDR, which may promote more widespread adoption of FPDR into practice.

Family presence during resuscitation: Validation of the risk–benefit and self-confidence scales for student nurses

Background. There is increasing debate about the advantages and disadvantages of family-witnessed resuscitation. Research about the views of healthcare providers depends upon reliable tools to measure their perceptions. Two tools have been developed for use with nurses (26-item cost-benefit tool, 17-item self-confidence tool). Objectives. Firstly, to validate these tools for use with student nurses in the UK. Secondly, to report on the perceived risks and benefits reported by student nurses, and their self-confidence in dealing with this situation. Methods. A sample of 79 student nurses were invited to complete the tools. Item-total correlations and Cronbach’s α were used to determine internal consistency. Factor analysis was computed to assess construct validity. The correlation between the two scales was explored. Results. 69 students completed a questionnaire. Very few had experience of family-witnessed resuscitation. Mean total scores were 3.16 (standard deviation 0.37; range 2.04–4.12) on the risk-benefit scale and 3.14 (standard deviation 0.66; range 1.94–4.82) on the self-confidence scale. Four of the original items were removed from the risk-benefit scale (Cronbach's α 0.86; 95% confidence interval ≥0.82). None were removed from the self-confidence scale (Cronbach's α 0.93; 95% confidence interval ≥0.91). There was a significant correlation between the two scales ( r = 0.37, p = 0.002). Conclusions. There is growing evidence that these tools are valid and reliable for measuring student nurses’ perceptions about family-witnessed resuscitation.

Family presence during resuscitation in a paediatric hospital: health professionals' confidence and perceptions

AIMS AND OBJECTIVES

To investigate medical and nursing staff's perceptions of and self-confidence in facilitating family presence during resuscitation in a paediatric hospital setting.

BACKGROUND

Family presence during resuscitation is the attendance of family members in a location that affords visual or physical contact with the patient during resuscitation. Providing the opportunity for families to be present during resuscitation embraces the family-centred care philosophy which underpins paediatric care. Having families present continues to spark much debate amongst health care professionals.

DESIGN

A descriptive cross-sectional randomised survey using the 'Family Presence Risk/Benefit Scale' and the 'Family Presence Self-Confidence Scale 'to assess health care professionals' (doctors and nurses) perceptions and self-confidence in facilitating family presence during resuscitation of a child in a paediatric hospital.

METHODS

Surveys were distributed to 300 randomly selected medical and nursing staff. Descriptive and inferential statistics were used to compare medical and nursing, and critical and noncritical care perceptions and self-confidence.

RESULTS

Critical care staff had statistically significant higher risk/benefit scores and higher self-confidence scores than those working in noncritical care areas. Having experience in paediatric resuscitation, having invited families to be present previously and a greater number of years working in paediatrics significantly affected participants' perceptions and self-confidence. There was no difference between medical and nursing mean scores for either scale.

CONCLUSION

Both medical and nursing staff working in the paediatric setting understood the needs of families and the philosophy of family-centred care is a model of care practised across disciplines.

RELEVANCE TO CLINICAL PRACTICE

This has implications both for implementing guidelines to support family presence during resuscitation and for education strategies to shift the attitudes of staff who have limited or no experience.

Factors associated with experiences and attitudes of healthcare professionals towards family-witnessed resuscitation: a cross-sectional study

AIMS

To examine factors associated with healthcare professionals' experiences and attitudes towards adult family-witnessed resuscitation in the emergency and intensive care units.

BACKGROUND

Family-witnessed resuscitation offers the option for patients' families to be present during in-hospital resuscitation. It is important to understand healthcare professionals' views about this practice to determine why, despite its benefits and general recommendation, this practice has not been widely implemented.

DESIGN

A descriptive, correlational, cross-sectional survey.

METHODS

A total of 390 Finnish and Polish Registered Nurses and physicians from six university hospitals took part in the study. A structured questionnaire that examined nurses' and physicians' experiences and attitudes was used. Data, collected between July-December 2013, were analysed with descriptive statistics, logistic and multiple linear regression analyses.

RESULTS

The results indicated that healthcare professionals are not well experienced in family-witnessed resuscitation. The general attitude towards this practice is somewhat negative. Physicians seem more confident about overcoming process-related barriers than nurses. Having previous positive experiences of family-witnessed resuscitation was associated with a more positive attitude towards this practice. Consequently a previous negative experience was associated with more negative attitudes.

CONCLUSION

Family-witnessed resuscitation awareness should be increased in daily clinical practice. It is important to find a way to improve experiences and attitudes of healthcare professionals related to this phenomenon. Furthermore, developing local guidelines and multidisciplinary training plans is needed to respond to the needs of patients and their families.

An Analytical Comparison of the Opinions of Physicians Working in Emergency and Trauma Surgery Departments at Tabriz and Vienna Medical Universities Regarding Family Presence during Resuscitation

The present study evaluated the opinions of physicians working in the emergency and trauma surgery departments of Vienna Medical University, in Austria, and Tabriz Medical University, in Iran, regarding the presence of patients' relatives during resuscitation. In a descriptive-analytical study, the data obtained from questionnaires that had been distributed randomly to 40 specialists and residents at each of the participating universities were analyzed. The questionnaire consisted of two sections aimed at capturing the participants' demographic data, the participants' opinions regarding their support for the family's presence during resuscitation, and the multiple potential factors affecting the participants' attitudes, including health beliefs, triggers that could facilitate the procedure, self-efficacy, intellectual norms, and perceived behavioral control. The questionnaire also included a direct question (Question 16) on whether the participants approved of family presence. Each question could be answered using a Likert-type scale. The results showed that the mean scores for Question 16 were 4.31 ± 0.64 and 3.57 ± 1.31 for participants at Vienna and Tabriz universities, respectively. Moreover, physicians at Vienna University disapproved of the presence of patients' families during resuscitation to a higher extent than did those at Tabriz University (P = 0.018). Of the studied prognostic factors affecting the perspectives of Vienna Medical University's physicians, health beliefs (P = 0.000; B = 1.146), triggers (P = 0.000; B = 1.050), and norms (P = 0.000; B = 0.714) were found to be significant. Moreover, of the studied prognostic factors affecting the perspectives of Tabriz Medical University's physicians, health beliefs (P = 0.000; B = 0.875), triggers (P = 0.000; B = 1.11), self-efficacy (P = 0.001; B = 0.5), and perceived behavioral control (P = 0.03; B = 0.713) were significant. Most physicians at Vienna and Tabriz Medical universities were not open towards family members' presence during resuscitation.

Nurses' perceptions of family presence during resuscitation

BACKGROUND

Although strong evidence indicates that the presence of a patient's family during resuscitation has a positive effect on the family, the practice is still controversial and is not consistently implemented.

OBJECTIVES

To explore nurses' experience with resuscitation, perceptions of the benefits and risks of having a patient's family members present, and self-confidence in having family presence at their workplace. Differences in demographic characteristics and relationships between nurses' perceptions of self-confidence and perceived risks and benefits of family presence were evaluated.

METHODS

The study was descriptive, with a cross-sectional survey design. A convenience sample of 154 nurses working in inpatient and outpatient units at an urban hospital were surveyed. The 63-item survey included 2 previously validated scales, demographic questions, and opinion questions.

RESULTS

Nurses' self-confidence and perceived benefit of family presence were significantly related (r = 0.54; P < .001). Self-confidence was significantly greater in nurses who had completed training in Advanced Cardiac Life Support, had experienced 10 or more resuscitation events, were specialty certified, or were members of nurses' professional organizations. Barriers to family presence included fear of interference by the patient's family, lack of space, lack of support for the family members, fear of trauma to family members, and performance anxiety.

CONCLUSIONS

Changing the practice of family presence will require strengthening current policy, identifying a team member to attend to the patient's family during resuscitation, and requiring nurses to complete education on evidence that supports family presence and changes in clinical practice.

Facilitated family presence at resuscitation: effectiveness of a nursing student toolkit

BACKGROUND

Facilitated family presence at resuscitation is endorsed by multiple nursing and specialty practice organizations. Implementation of this practice is not universal so there is a need to increase familiarity and competence with facilitated family presence at resuscitation during this significant life event. One strategy to promote this practice is to use a nursing student toolkit for pre-licensure and graduate nursing students. The toolkit includes short video simulations of facilitated family presence at resuscitation, a PowerPoint presentation of evidence-based practice, and questions to facilitate guided discussion.

METHODS

This study tested the effectiveness of this toolkit in increasing nursing students' knowledge, perceptions, and confidence in facilitated family presence at resuscitation. Nursing students from five universities in the United States completed the Family Presence Risk-Benefit Scale, Family Presence Self-Confidence Scale, and a knowledge test before and after the intervention.

RESULTS

Implementing the facilitated family presence at resuscitation toolkit significantly increased nursing students' knowledge, perceptions, and confidence related to facilitated family presence at resuscitation (p<.001). The effect size was large for knowledge (d=.90) and perceptions (d=1.04) and moderate for confidence (d=.51).

CONCLUSIONS

The facilitated family presence at resuscitation toolkit used in this study had a positive impact on students' knowledge, perception of benefits and risks, and self-confidence in facilitated family presence at resuscitation. The toolkit provides students a structured opportunity to consider the presence of family members at resuscitation prior to encountering this situation in clinical practice.