Family Presence During Resuscitation: Beyond Debate to Practice Integration.

Family Presence During Resuscitation: Perceptions and Attitudes of Health-care Staff at an Inner-City Academic Hospital

The objective was to consider family presence during resuscitation (FPDR) from the perspective of the family member. FPDR has been a topic of interest internationally since the first report of this practice more than 25years ago. Worldwide, many studies have provided insight into the perspective of healthcare professionals (HCPs); however, there is limited research on the perspective and experiences of family members. An integrative review was conducted. An electronic database search was conducted for the years from 1994-2017. The Cumulative Index of Nursing and Allied Health Literature (CINAHL), PyschINFO, Academic Search, SocINDEX, PubMed, ProQuest databases and Google Scholar were searched. Search terms were family perceptions, family presence and resuscitation. Twelve reviews met inclusion criteria. Findings suggest that family members view family presence as a fundamental right. Family members involved in a FPDR experience reported that their presence benefitted the patient and healthcare team. In an international sample of studies, family presence overall was viewed positively by family members and they voiced wanting to be given an option to be present during a loved one's resuscitation. Findings support that family members' desire for FPDR; however, the literature reflects that HCPs do not always embrace the practice of FPDR. Stronger educational preparation of nurses and other HCPs related to FPDR is warranted. Policy initiatives include the formulation of policies that allow family presence during resuscitation of a family member. The findings are relevant for a clinical practice that promotes a more family-centred approach to allowing FPDR. Creating policy and providing FPDR education for HCPs based on evidence provide more consistency in clinical practice and help to eliminate the moral distress experienced by clinical nurses forced to make difficult decisions during a stressful event.

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. 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. 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. 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. 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.

BACKGROUND:Researchers have investigated the presence of families during cardiopulmonary resuscitation (CPR) to determine its benefits and barriers and the points of view of healthcare professionals, patients, and families. Family presence during resuscitation (FPDR) is debatable. Many professional health organizations worldwide, such as the Emergency Nurses Association, have suggested that healthcare facilities implement rules and policies that encourage the attendance of families and relatives during CPR. However, this does not consider the nurses’ points of view or self-confidence during FPDR. The main aim of this study is to evaluate nurses’ perceptions and self-confidence related to family presence during CPR in Saudi Arabia.MATERIALS AND METHODS:This descriptive correlation study was conducted between March and April 2022 at King Abdul Aziz University Hospital in Jeddah. A survey was completed by participants to collect their sociodemographic data. The relationship between Family Presence Risk-Benefit Scale (FPS-BS) and the Family Presence Self-Confidence Scale (FPS-CS) was analyzed using Pearson's correlation test.RESULTS:The study's participants consisted of 147 nurses. Regarding the FPDR, nurses had a moderately positive perception and level of confidence. Moreover, the level of self-confidence varied significantly by age group and years of experience. The results of the Pearson correlation indicated that there was a significant association between FPS-CS and FPR-BS (r = 0.221, P < .001). When implementing FPDR, nurses who see more benefits from it are more confident.CONCLUSION:According to the findings, the nurses who felt more comfortable including patients’ families in resuscitation efforts also saw FPDR as having more advantages. FPDR has several effects on the healthcare team providing CPR. Nursing leaders should develop policies for their teams and instruct nurses and other healthcare professionals. Considering the clear benefits of clinical practice and family involvement in resuscitation, it is suggested to give this experience first using simulation and role-playing.

Family presence during resuscitation (FPDR) is a growing hospital praxis despite lack of high-quality evidence. The aim of this qualitative evidence synthesis review was to synthesize current evidence regarding healthcare professionals (HCP) perspectives on barriers and facilitating factors of FPDR and the potential impact of FPDR on HCP performance. We conducted a systematic literature search May 17, 2023 including primary studies with qualitative study designs. We applied NVivo for data analysis. Data was coded with line-by-line coding and organized into themes and categories following the method for thematic synthesis described by Thomas and Harden to analyse data. The studies underwent quality appraisal by Critical Appraisal Skills Program. We used GRADE CERQual to assess the confidence in the evidence. We identified 8241 articles suitable for screening, 141 articles were full text screened, and nine studies included from Australia, UK and USA. In total, 134 HCP participated, between 2005 and 2019. Most studies lacked sufficiently rigorous data analysis and findings were appraised to have moderate GRADE CERQual confidence. We identified three analytical themes ("Facilitating factors for FPDR", "Barriers for FPDR" and "How staff are affected by FPDR") with eight descriptive subthemes. One finding was of high GRADE CERQual confidence: a belief that FPDR is "the right thing to do" which was a "Facilitating factor of FPDR." The evidence on HCP perspectives is of low to moderate confidence. The interviewed consent that FPDR is the "right thing to do", and an ethical principle of beneficence is dominant, especially regarding children.

Family presence during resuscitation (FPDR): A survey of emergency personnel in Victoria, Australia.

This study examines the attitudes of healthcare staff and patients' family members towards family presence during resuscitation (FPDR) in critical care units in Hong Kong. A wealth of literature is available on FPDR in various hospital and healthcare settings. The findings include many anecdotal accounts of both the positive and the negative effects of family presence. There is little documentation on the comparisons of staff and family members' perceptions and the predictors of staff attitudes towards FPDR practice. Cross-sectional survey design. A convenience sample of 163 healthcare staff and 69 family members was recruited from the intensive care units. There was significant difference in the attitudes of healthcare staff and patients' families towards FPDR. The regression analysis showed that the healthcare staff would be more supportive to FPDR if family members could share the dying moments with patients, family members were accompanied by a bereavement team member, there was adequate staff to support the family and staff members were adequately trained. If healthcare staff feel that family members may have the impression that the resuscitation is chaotic, witness resuscitation is traumatic experience for the family, family presence will increase risk of litigation and colleagues will not allow family members to stay during resuscitation making them less supportive of FPDR. Nurses were more supportive to FPDR than doctors. The results provide information for healthcare professionals on the development of FPDR programmes for patients and their family members. Through multi-disciplinary collaborations, the effective and safe implementation of FPDR practice can be enhanced. The results could help the clinical staff to develop written guidelines to produce an integrated and consistent approach to this sensitive issue in clinical practice.

Is It Time for Family Presence During Resuscitation in the OR?

Family presence during resuscitation (FPDR) remains controversial despite growing acceptance in Western countries. This study explored Malaysian doctors' views on FPDR within critical care environments.A cross-sectional survey of 169 doctors working in critical care units of Hospital Kuala Lumpur (HKL) and Hospital Canselor Tuanku Muhriz UKM (HCTM) was conducted between October 2023 and January 2024. Data analysis included descriptive statistics, chi-square tests, simple logistic regression, and multivariable logistic regression.A total of 27.7% (n = 44) of respondents agreed to allow FPDR, with no significant association found between acceptance and demographic or professional characteristics. Major concerns included increased staff stress, potential misinterpretation of procedures, space limitations, privacy violations, emotional distress for families, difficulty stopping futile resuscitation, and litigation risks. Healthcare providers recognised FPDR's educational value and potential to promote professionalism. Opinions were divided on FPDR's impact on family participation, support, and bonding. Most did not believe FPDR reduces family anxiety. Respondents who have had personal FPDR experience were more likely to support it (OR: 8.823 (95% CI: 3.670 - 21.212), p < 0.001).This study revealed that the majority of respondents working in critical care settings in HKL and HCTM are opposed to FPDR. Their reluctance is due to the perceived negative effects of FPDR. Experience in FPDR significantly influenced the willingness to practise FPDR.

Family-centered care (FCC) has been cited as important to patient care; however, little is known about nurses' perspectives toward FCC. Family presence during resuscitation (FPDR) is an example of the implementation of FCC; however, nurses do not necessarily agree with FPDR, especially those from non-Western countries. It is also unknown whether there is an association between FPDR and FCC. The objective of the study was to determine (a) the attitudes of nurses toward FCC and FPDR and (b) whether there is an association between FCC and FPDR. A convenience sample of 96 Israeli intensive care unit and cardiovascular registered nurses completed 5 questionnaires: a demographic data questionnaire, Nursing Activities for Communication With Families-Revised, Barriers to Providing Family-Centered Care-Revised (Barriers), Nurses' Experiences of Family-Witnessed Resuscitation, and Attitudes to Family Presence During Resuscitation. Descriptive statistics and Pearson correlations were conducted. The item mean values for the Nursing Activities for Communication With Families-Revised and the Barriers scales were only 3.7 of 5 and a moderate 2.4 of 4, respectively. Only 19 of the sample (20%) had experienced FPDR, of which 17 reported a negative as opposed to a positive experience. Overall, nurses objected to FPDR (mean item score = 1.8 of 5). No statistically significant relationship was found between FCC and FPDR. A significant negative correlation was found between the Barriers scale and FPDR (r = -0.36, P = .0001). Although FCC has moderate support, objection still remains to FPDR. Family presence during resuscitation has been used as an example of FCC, but at least in certain populations, this example might not be applicable. Increased education and policy changes should be encouraged to promote FCC and FPDR.

Introduction: Evidence is mounting that appropriate family presence during resuscitation (FPDR) can be beneficial to patients and their families including lower rates of post-traumatic stress disorder after the event. Despite this, FPDR has not been widely adapted and continues to have legitimate barriers. Therefore, the focus of this quality improvement project was to conduct an organizational needs assessment at Duke University to create a systematic FPDR guideline that can be consistently implemented across the hospital. Methods: A 17-question survey tool was created using Ottowa Decision Making Framework and distributed to all members of a Cardiothoracic Intensive Care Unit code team including physicians, advanced practice providers, nurses, respiratory therapists, chaplains, perfusionists, pharmacists and social workers. The questions addressed FPDR experience, decision making influencers, situational comfort, and demographics. Results: There was a total of 200 responses. 46.6% Registered Nurses, 7.3% were Advanced Practice Providers, 7.8% Attending Physician, 6.2% Resident Physicians, 19.2% Respiratory therapists, 2.5% Chaplains. Four themes emerged - comfort based on experience, support for early chaplain involvement, need of family facilitator role, and absolute resistance. Multiple concerns were raised by the surveyed healthcare providers including logistics, risk for legal retribution, distraction from resuscitation, family suffering, and ill preparedness regarding FPDR. 72% of the respondents endorsed utilizing a family facilitator role to support the practice of FPDR. There was wariness regarding using the term ‘protocol’ for the guideline document. Conclusions: There are varying levels of comfort and support regarding the practice of FPDR amongst the resuscitation team. Many healthcare professionals acknowledge a need for family facilitation with a dedicated staff member, while others respond with a resolute unwillingness to practice FPDR. There is a need for education and publication of guidelines to assist staff in gaining consistency and confidence in the practice of FPDR.

This study examined nurses' intention to allow family presence during resuscitation (FPDR) by applying the theory of planned behaviour with an extended concept. Medical institutions, including nurses and other medical professionals working in emergency and intensive care units, are reluctant to allow FPDR. However, this practice reduces the family's anxiety and stress while fostering well-being and minimises their feelings of helplessness and distress by making them believe that they have helped the patient. A cross-sectional descriptive design was used in this study. The participants were 252 nurses who had been working for at least 3months in a general hospital in South Korea. Data were collected using self-report questionnaires in April 2020 and were analysed using descriptive statistics, Pearson's correlation analysis and multiple regression analysis. The instruments were intention to allow FPDR (five constructs: intention to allow FPDR, positive attitude, negative attitude, subjective norm and perceived behavioural control), perception of FPDR and self-confidence. The STROBE checklist was used for reporting this study. The mean score for the intention to allow FPDR was 3.47 out of 5. The regression analysis results indicated that perception of FPDR, positive attitude and negative attitude predicted the intention to allow FPDR. It is necessary to develop educational programmes to change the perceptions of and attitudes towards FPDR. Additionally, written policies and protocols for FPDR in South Korea are needed to develop systematic care for patients' families during cardiopulmonary resuscitation. The findings of this study provide baseline data for developing FPDR policies and guidelines that could minimise the family's distress and allow them to feel that they have helped the patient.

Objectives: We assessed the attitudes of emergency department (ED) consultants toward family presence during resuscitation (FPDR), to elucidate and provide proof of the benefits of allowing FPDR in Kingdom of Saudi Arabia. Methods: A cross-sectional descriptive study using a questionnaire electronically sent to all ED consultants from five major government hospitals in Riyadh, Saudi Arabia. The survey examined the consultants' beliefs and perception of FPDR, legalities, policies and the effects and outcomes of FPDR on the patient, family, and themselves. Results: The survey received 172 responses, 55.0% were 36–45 years old and 144 (83.7%) were men. Most respondents (91.36%) had experienced FPDR. Less than half (40.1%) believed that FPDR is beneficial to the patient, and 58.7% believed that FPDR could cause difficulties for the resuscitation team. A written policy for FPDR was preferred by 42% of respondents. Significantly more respondents 36-45 years old recommend allowing FPDR compared to other age groups, and significantly more male consultants in this age group believe there is a positive outcome of FPDR. Conclusion: The attitude and perception of emergency consultants towards the practice of FPDR was less positive than expected. Many consultants did not favor the advantages of FPDR, and were worried about negative outcomes, potential medico-legal repercussions, and the unpleasant experience for the family members, especially female consultants. However, a larger proportion of consultants nevertheless recommend FPDR. The ability of ED doctors to manage FPDR and their understanding of the benefits of FPDR needs to be strengthened.

Is it beneficial to allow the patient's family to attend cardiac resuscitation: Different cultural perspectives? A scoping review.

Family presence during resuscitation (FPDR): Perceived benefits, barriers and enablers to implementation and practice