How Families and Health Care Practitioners Experience Family Presence during Resuscitation and Invasive Procedures

Abstract

Background The presence of family members during resuscitation and invasive procedures has been, and continues to be debated in the literature. Objective To synthesize the best available research evidence on how families and health care practitioners experience family presence during resuscitation and invasive procedures. Inclusion Criteria Studies about families and health care practitioners experiencing family presence during resuscitation and invasive procedures were considered. Types of Participants This review considered family members and health care practitioners who had experienced the phenomena of family presence during resuscitation or invasive procedures. Phenomena of Interest Family members and health care practitioners experience of family presence during resuscitation or invasive procedures. Types of Studies Qualitative evidence consisting of, but not limited to, designs such as interpretive, descriptive-exploratory, observational, phenomenology, ethnography, grounded theory, hermeneutics, participatory action research, and critical theory were included in the review. Search Strategy The search strategy sought to find both published and unpublished research articles from 1985 to 2009. The review was limited to papers written in English. Methodological Quality Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised tools developed by the Joanna Briggs Institute. Data Collection Data were using standardized data extraction tools developed by the Joanna Briggs Institute. Data Synthesis The Joanna Briggs Institute' approach for meta-synthesis by meta-aggregation was used. Results 25 studies were included in the review. 154 findings were extracted and synthesized into 14 categories and 5 synthesized findings. Conclusions A tension is created between the belief of most family members that being present is a right and health care practitioners who believe they should have control over the circumstances of the practice. Although healthcare practitioners express concern that the practice will cause the family to experience psychological trauma the data does not suggest that this is the case. Most family members describe their presence as an opportunity to comfort and to gain closure. Implications for Practice Institutions need to write policy on family presence during resuscitation and invasive procedures based on the best available evidence: 1) so staff has a clear decision making path and 2) to decrease idiosyncratic decision making amongst staff. Health care practitioners from all involved disciplines need to be actively involved in having input into the creation and subsequent review of policies and procedures of family presence in order to decrease uneasiness and enhance a sense of commitment to family care. Institutions need to design structures that provide support for health care practitioners to both practice and openly value family presence. Institutions need to provide experiences for its staff to practice resuscitation skills in order to increase feelings of competency and therefore experience less performance anxiety when the family is present. Institutions need to consider the addition of a credentialed family advocate or family facilitator to their code team who can support and answer questions before, during and after the event. Medical and nursing education programs should address family presence during the educational process. Health care practitioners need to be taught to value the creation of an atmosphere of shared respect when working with families in crisis situations. Health care practitioners should be taught that not all benefits will be immediately identifiable and that the memories of being present may far outweigh psychological trauma. Health care practitioners should be taught that family presence places responsibility on the staff. Implications for Research Additional studies that explore the distinctions between the differing disciplines on how they value family presence Additional studies that look in- depth at the outcomes of allowing the practice. For instance, incidences of psychological trauma or disruption of care.