Family-witnessed Resuscitation Research Articles

Emergency service health care workers’ opinions and experiences on the practice of family-witnessed resuscitation: a cross-sectional study during the COVID-19 pandemic in Türkiye

Despite the evidence and recommendations regarding the benefits of family-witnessed resuscitation, the opinions and attitudes of healthcare professionals vary widely. This descriptive cross-sectional study was conducted on 154 healthcare professionals working at the emergency departments of four hospitals within the borders of Ankara, Türkiye to examine their opinions and experiences on the practice of family-witnessed resuscitation. Data were collected by using the demographic form and the Family Presence Risk-Benefit Scale. Descriptive statistical analyses, t-test for samples, Mann-Whitney U test and Kruskal-Wallis tests were used in the evaluation of the data. Results indicated that majority of emergency department healthcare workers (85.8%) had no previous experience of family witnessed resuscitation, and most of them (96.8%) opposed the practice of resuscitation with family presence. Although nurses tended to favour family witnessed resuscitation more than physicians, most of the participants expressed their concerns about the presence of family during the CPR. It is recommended that institutional policies be developed on family-witnessed resuscitation, and inter-professional education be provided to increase the awareness of families and to change the opinions and attitudes of health care professionals.

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

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. 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. 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.

Family-Witnessed Cardiopulmonary Resuscitation during Emergency Department Cardiac Arrest Care: A Resident Perspective.

For centuries, an individual’s birth and death most often occurred within their home while surrounded by family. However, with advancements in modern medicine and industrialization, these 2 natural occurrences have been sequestered behind hospital walls. Until the 1960s, fathers were routinely excluded from the delivery room during childbirth. An obstetric physician was quoted as: “…he [father] would faint and fall on the floor and the nurse would have to take care of him... Your infection rate would go up, and your malpractice rate would go up.” 1 Miller J.S. ‘Return the joy of home delivery’ with fathers in the delivery room. Hosp Top. 1966; 44: 105-109https://doi.org/10.1080/00185868.1966.12083087 Crossref PubMed Scopus (5) Google Scholar Over the past 50 years, a shift toward patient- and family-centric obstetrical care has resulted in the partner’s presence at the bedside being commonplace during delivery. 2 Chan K.K.L. Paterson-Brown S. How do fathers feel after accompanying their partners in labour and delivery?. J Obstet Gynaecol. 2002; 22: 11-15https://doi.org/10.1080/01443610120101628 Crossref PubMed Scopus (58) Google Scholar

Health professionals and family members during cardiopulmonary resuscitation: A qualitative study on the experience of witnessing resuscitation in Jordanian critical care units

BackgroundThe interaction between healthcare professionals (HCPs) and family members during cardiopulmonary resuscitation (CPR) in critical care units (CCUs) has received significant attention. In the Arabic region, family members are typically excluded from participating in critical care treatments, despite the cultural and religious significance of their presence. This highlights a lack of policies and research addressing the cultural factors related to family involvement in CPR within this context. ObjectivesThe purpose of this study was to explore the nature of the relationship between HCPs and family member relations during CPR in Jordanian CCUs. MethodsThis study employed a qualitative research design. Data were collected through semi-structured interviews with 45 participants, including 31 HCPs and 14 family members of patients who had undergone CPR in Jordan. Data was managed, organized, and thematically analyzed using NVivo. ResultsThe study revealed three main themes: Family-Witnessed Resuscitation (FWR) through the eyes of HCPs, FWR through the eyes of family members, and the relationship between HCPs and family members during CPR. The last theme has three subthemes: "Looking out for the Patient," "Looking out for Ourselves," and "Looking out for Each Other.” These themes highlighted the complex and dynamic relationships between HCPs and family members during CPR in Jordan. Participants emphasized the importance of clear communication, mutual respect, and a collaborative approach to decision-making during CPR. ConclusionThe resultant study model uniquely explains the relationship between Jordanian health professionals and family members during CPR, with important implications for clinical practice and healthcare policies regarding family involvement during resuscitation in Jordan. Further research is needed to explore the cultural and societal factors influencing family involvement in resuscitation in Jordan and other Arab countries.

Experiences of family-witnessed cardiopulmonary resuscitation in hospital and its impact on life: An interview study with cardiac arrest survivors and their family members.

To explore experiences of cardiac arrest in-hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation. Guidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family-witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family. A qualitative design consisting of joint in-depth interviews with patients and family members. Family interviews were conducted with seven patients and their eight corresponding family members (aged 19-85 years) 4-10 months after a family-witnessed in-hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist. The participants felt insignificant and abandoned following the in-hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death-powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed-feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again-making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future. Surviving and witnessing a cardiac arrest in-hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation. It is important to provide support to family members who witness the resuscitation of a loved one in-hospital. Structured follow-up care is crucial for cardiac arrest survivors and their families. To promote person-centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow-up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed. In-hospital cardiac arrest patients and family members were involved when designing the study.

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

ObjectivesThis 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. MethodsThis 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. ResultsThere was a significant association between nurses’ perceived self-confidence (χ2 = 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) ConclusionThe 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.

Critical care nurses' perceptions of family witnessed resuscitation in the Kingdom of Saudi Arabia

Resuscitation can be visually disturbing and stressful, even to the most experienced of clinical staff. Allowing family members to remain with patients during resuscitation efforts has sparked controversy among medical and nursing staff members. A quantitative descriptive study was conducted to describe the perceptions of critical care nurses of family witnessed resuscitation (FWR) and the factors contributing to these perceptions at one tertiary hospital in the Kingdom of Saudi Arabia (KSA). A non-probability convenience sample of 70 critical care nurses was used to collect data. The findings of the study revealed that the majority of critical care nurses were not in favour of FWR. These nurses believed that the process of witnessing a loved one being resuscitated would be traumatic for relatives, and increase possible litigation against medical and nursing personnel. The study recommended that a clear policy about FWR should be in place. Critical care training should include the trends that will empower its nurses to address the gaps in their knowledge and to reflect on FWR.

Owner experiences with and perceptions of owner-witnessed CPR in veterinary medicine.

To examine owner experiences with and perceptions of owner-witnessed resuscitation (OWR) in veterinary medicine and to determine if previous experience with family-witnessed resuscitation (FWR) influenced perceptions. Multicenter survey. Two academic and 2 private practice referral hospitals in the United States. Four hundred and seven clients presenting their small animal or exotic pet to the emergency service, or owners of patients hospitalized in the small animal ICU, April 1 to May 15, 2019. None MEASUREMENTS AND MAIN RESULTS: Anonymous, online survey. Demographic variables, familiarity with CPR, previous experience with FWR or OWR, and open-ended questions and 4-point Likert items assessing level of agreement with statements on OWR were included. Scores equal or greater than 2 represented positive agreement. An overall OWR mean score was calculated from Likert items. Seventy-nine (19.4%; 95% confidence interval [CI], 15.7%-23.7%) participants reported having been involved with FWR, and 13 (3.2%; 95% CI, 1.8%-5.5%) reported having witnessed CPR on their pet. Owners were significantly more likely to participate in OWR if they had been present for FWR (P=0.0004). Ninety-two percent of respondents who had been present for OWR would elect to be present again (95% CI, 62.1%-99.6%). Whether present for OWR or not, owners believed there may be benefits from witnessing CPR and had overall positive feelings toward the practice (OWR mean score, 2.87, SD 0.45 and 2.68, SD 0.54, respectively). Most respondents (78.6%; 95% CI, 74.2%-82.4%) felt that owners should be offered the opportunity to witness CPR on their pets. Owners expressed overall positive experiences with and attitudes toward OWR and believe the option for presence should be provided. As pet owners become more aware of FWR in human medicine, veterinarians may need to be prepared to entertain the possibility of OWR and owners' wishes to remain with their pet during CPR.

Family involvement in the intensive care unit in four Nordic countries.

Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement. To describe family involvement, communication practices and visiting policies in adult ICUs. A cross-sectional survey. A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries. The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments. The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement.

In-hospital family-witnessed resuscitation with a focus on the prevalence, processes, and outcomes of resuscitation: A retrospective observational cohort study

AimInternational and national guidelines support in-hospital, family-witnessed resuscitation, provided that patients are not negatively affected. Empirical evidence regarding whether family presence interferes with resuscitation procedures is still scarce. The aim was to describe the prevalence and processes of family-witnessed resuscitation in hospitalised adult patients, and to investigate associations between family-witnessed resuscitation and the outcomes of resuscitation. MethodsNationwide observational cohort study based on data from the Swedish Registry of Cardiopulmonary Resuscitation. ResultsIn all, 3257 patients with sudden, in-hospital cardiac arrests were included. Of those, 395 had family on site (12%), of whom 186 (6%) remained at the scene. It was more common to offer family the option to stay during resuscitation if the cardiac arrest occurred in emergency departments, intensive-care units or cardiac-care units, compared to hospital wards (44% vs. 26%, p < 0.001). It was also more common for a staff member to be assigned to take care of family in acute settings (68% vs. 56%, p = 0.017). Mean time from cardiac arrest to termination of resuscitation was longer in the presence of family (20.67 min vs. 17.49 min, p = 0.020), also when controlling for different patient and contextual covariates in a regression model (Stand(β) 0.039, p = 0.027). No differences were found between family-witnessed and non-family-witnessed resuscitation in survival immediately after resuscitation (57% vs. 53%, p = 0.291) or after 30 days (35% vs. 29%, p = 0.086). ConclusionsIn-hospital, family-witnessed resuscitation is uncommon, but the processes and outcomes do not seem to be negatively affected, suggesting that staff should routinely invite family to witness resuscitation.

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

IntroductionFamily 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.MethodsWe 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.ResultsA 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).ConclusionOur 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.

The effects of family-witnessed resuscitation on health professionals.

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

Exploring the implementation of family-witnessed resuscitation in children and young people.

There are varying opinions about family-witnessed resuscitation in children and young people throughout the literature and the guidance on this practice is outdated and imprecise. Family-witnessed resuscitation can have psychological benefits for relatives; however, healthcare practitioners are often prevented from implementing this practice because of the perceived negative effect on their work through distraction or interference. Healthcare practitioners can also find it challenging to negotiate the ethics of family-witnessed resuscitation, particularly in relation to whether this practice can be considered caring or compassionate. The limited guidance on family-witnessed resuscitation in children and young people also means that it can be challenging for healthcare practitioners who want to implement the practice to identify available evidence to justify their actions. This article explores the evidence for and against the practice of family-witnessed resuscitation in children and young people and provides recommendations for healthcare practitioners who are implementing this practice.

Attitudes of Community Hospital Critical Care Nurses Toward Family-Witnessed Resuscitation.

Family-witnessed resuscitation is not consistently practiced in critical care despite the fact that it is recommended and research shows that it supports the emotional needs of families and patients and improves decision-making, care, and communication. Nurses support the idea of family-witnessed resuscitation but may not believe it should be standard practice. To examine the attitudes of American community hospital critical care nurses about family-witnessed resuscitation and to identify differences in attitudes between nurses who have and have not experienced it. This cross-sectional, descriptive study of 40 critical care nurses was conducted at 2 community hospitals. Demographic data were collected and a previously developed questionnaire was used to survey participants on their attitudes about family-witnessed resuscitation factors including decision-making, process, and outcomes. Most participants (92%) had experienced family-witnessed resuscitation and most had positive attitudes about the benefits and outcomes of family-witnessed resuscitation. Participants did not believe that family presence is too distressing for families or that resuscitation team performance would be negatively affected. Participants indicated that fear of litigation, family disruption of resuscitation, and family misinterpretation of procedures would not increase with family presence. Findings show that community hospital critical care nurses support family-witnessed resuscitation. Prior experiences and cultural beliefs should be considered when developing family-witnessed resuscitation policies. Further research is needed on the influence of these factors on nurses' attitudes toward family presence to inform practice.

Clinical Pearls

Heart failure is the single most common cause of hospitalization in people age 65 years and older. This chronic disease is characterized by acute decompensation that often requires hemodynamic monitoring with a pulmonary artery catheter (PAC). Patient care with a PAC usually requires bed rest, yet early mobility can shorten stays in the intensive care unit and improve physical functioning.Mattioli et al studied the physiological and emotional impact of ambulation on adult patients with a PAC in the cardiac intensive care unit. They found the following:The authors state that presence of a PAC should not preclude walking in patients with heart failure whose condition is stable. Protocols should include careful measurement and documentation of patients’ response.See Article, pp 101-108Family presence during resuscitation (also called family-witnessed resuscitation [FWR]) has many benefits for patients and families and is supported by national health care organizations such as the American Association of Critical-Care Nurses. Although FWR has been extensively studied for years, most of the research has been in teaching hospitals or medical centers.Gomes and colleagues examined the attitudes of critical care nurses based in community hospitals and found the following:Some differences between nurses with FWR experience and nurses without FWR experience were found. The authors recommend further study on nurses’ attitudes and cultural beliefs to help establish policies and guidelines that support FWR.See Article, pp 142-148Sepsis and septic shock are major causes of mortality for intensive care patients. Nutritional support is an important factor that providers must consider when caring for critically ill patients, with indirect calorimetry used as the gold standard for energy calculation. This noninvasive method provides specific and objective parameters; however, it is unknown how sepsis affects these parameters.Menegueti and colleagues used indirect calorimetry to evaluate the difference in resting energy expenditure, respiratory quotient, oxygen consumption, and carbon dioxide production between patients with vs without sepsis. They found the following:Findings suggest that the energy supply does not need to be increased for patients with sepsis. Although more research is needed, the authors suggest that patients with sepsis may not be able to increase their metabolic rate because of failure of the defense system; thus, indirect calorimetry may be inappropriate.See Article, pp 136-141Patients undergo various experiences in the intensive care unit (ICU) that can cause physical and psychological stress. However, little is known about patients’ perception of specific types of stress-provoking events.Carey et al had adult ICU patients complete a survey after cardiac surgery to rate 23 events. They foundThe top stressors are all amenable to high-quality nursing care. Although further research is warranted, the authors indicate that better understanding of these experiences can help clinicians strategize on best care delivery.See Article, pp 149-151

Owner-witnessed cardiopulmonary resuscitation in small animal emergency veterinary medicine.

OBJECTIVE To determine opinions of veterinary emergency health-care providers on the topic of owner-witnessed CPR in small animal emergency medicine and to identify reasons for opposition or support of owner-witnessed CPR. DESIGN Cross-sectional survey. SAMPLE 358 surveys completed by American College of Veterinary Emergency and Critical Care diplomates and residents as well as other emergency-care veterinarians and veterinary technicians between August 14, 2016, and September 14, 2016. PROCEDURES An internet-based survey was used to collect data on respondent demographics, CPR experience, and opinions about owner-witnessed CPR. Responses were collected, and the Fisher exact test or χ2 test was used to compare distributions of various opinions toward owner-witnessed CPR among certain respondent groups. RESULTS Owner presence during CPR was opposed by 277 of 356 (77.8%) respondents, with no substantial differences among demographic groups. Respondents with ≤ 10 years of experience were less willing to allow owner presence during CPR, compared with respondents with > 10 years of experience. Respondents who worked at practices that allowed owner presence during CPR were more likely to report emotional benefit for owners. CONCLUSIONS AND CLINICAL RELEVANCE Veterinary professionals surveyed had similar concerns about owner-witnessed CPR, as has been reported by human health-care providers about family-witnessed resuscitation. However, emotional benefits from family-witnessed resuscitation in human health care have been reported, and emotional impacts of owner-witnessed CPR could be an area of research in veterinary medicine. In addition, investigation is needed to obtain more information about pet owner wishes in regard to witnessing CPR performed on their pets.

Healthcare professionals’ experiences and attitudes towards family-witnessed resuscitation: A cross-sectional study

BackgroundFamily-witnessed resuscitation (FWR) offers the option for family to be present during a cardiac arrest, which has been proven to help them in their grieving process. International guidelines highlight the importance of FWR, but this has not yet been widely implemented in clinical practice in Europe. AimExplore nurses’ and physicians’ experiences and attitudes toward FWR in cardiac care units. MethodsCross-sectional web-based multicentre survey study including the seven university hospitals in Sweden, with 189 participants. ResultsThe most common concern was that the resuscitation team may say things that are upsetting to the family member during resuscitation, with 68% agreeing with this statement. Physicians opposed FWR more strongly than nurses (3.22 vs. 2.93, p < .001). Twenty-five percent stated that family should not be present during resuscitation, as it would be far too painful for them, while 23% of the nurses and 11% of the physicians considered that FWR is beneficial to the patient, p < 0.001. There was strong agreement that there should always be a healthcare professional dedicated to take care of family (92%). None of the hospitals had local guidelines regarding FWR. ConclusionMany concerns still exist in relation to FWR, suggesting that those barriers must be taken into consideration when planning for implementation of FWR in everyday practice.

Preferences of patients’ family regarding family-witnessed cardiopulmonary resuscitation: A qualitative perspective of intensive care patients’ family members

ObjectivesTo describe preferences of intensive care patients’ family members regarding the idea of an inpatient family-witnessed cardiopulmonary resuscitation. Research methodology/designA descriptive qualitative design was used in this study. Twelve family members of intensive care patients took part in individual semi-structured interviews. Data were analysed using thematic analysis. SettingA population of Finnish and Polish former intensive care adult patients’ relatives. FindingsThe thematic analysis resulted in two main themes with four subthemes each: (Theme 1) Being more involved and engaged in patient’s care in case of cardiopulmonary resuscitation, with subthemes: (a) Having an option to decide, (b) Being in physical proximity to the patient, (c) Feeling like having more control and impact and (d) Having a better idea about the situation. (Theme 2) Being cared for and treated respectfully during possible cardiopulmonary resuscitation, with subthemes: (a) Need for more support and understanding from the staff, (b) Uniqueness of the family – patient relationship, (c) Need for staff to be more humane and less mechanical and (d) Professional and highly qualified staff. ConclusionResults of this study suggest a possible gap in family-centred care delivery in intensive care settings. System changes are necessary in order to increase nurses’ awareness of patients’ families’ preferences, and successfully implement recommended family-witnessed cardiopulmonary resuscitation.

Exploring the implementation of family-witnessed resuscitation.

Cardiac arrest is a traumatic event, both for patients and their family members. Traditionally, healthcare professionals have often been reluctant to offer family members the opportunity to witness cardiopulmonary resuscitation (CPR) attempts. However, professional bodies globally have begun to recommend the use of family-witnessed resuscitation (FWR) during CPR, identifying a range of potential benefits including supporting the patient, increasing family members' confidence in healthcare professionals and, in some cases, promoting acceptance of the patient's death. This article explores the benefits of, and barriers to, the implementation of FWR during CPR. Despite the perceived benefits of FWR identified by professional bodies, healthcare professionals, and patients and their families, the evidence indicates there is ongoing reluctance among some healthcare professionals to incorporate FWR in practice. Therefore, standardised global policies aimed at the multidisciplinary implementation of FWR are required. Additionally, multidisciplinary training and education in CPR should be readily available, particularly in areas where CPR is frequently used, such as emergency departments.

Family members’ views, opinions, and beliefs about witnessed resuscitation

A comprehensive search of Medline, Cinahl, Sociofile and Psychinfo was performed. The key words used were “rela-tives”, “family”, “family presence”, “family witnessing”, “staff attitudes”, “critical care”, “critical care settings”, “cardiopulmonary resuscitation”, “family centred care” and “holistic care”. The search for articles was conducted in three stages. Firstly, I searched throughout the above electronic data bases for the main terms and concepts of the study. Secondly, hand searching by reviewing the bibliographies of published studies was also used to locate relevant literature. This stage includes searching for related books, unpublished theses, and other significant studies such as studies about end-of-life care. Specific criteria were considered regarding studies about family witnessed resuscitation (FWR). Firstly, only English articles were selected for reviewing. Secondly, research evidences on adult patients were preferred. Thirdly, the search on FWR includes the studies that were conducted after 1985. Fourthly, all studies about families’ perceptions, patients’ beliefs, and staff attitudes regarding FWR were selected. Fifty five articles were finally identified for review. All of these articles are published studies. The literature date ranged from 1987 to 2009. Reviewing several essays and researchers’ views in this field was also done. It was found that eleven (20%) of the studies evaluated only family members. Twenty seven (49%) studies evaluated only health staff. Three studies were identified for evaluating only the perceptions of patients. Both family members and health staff were assessed in three studies. Patients, families, and health staff were investigated in only one study. Two studies were conducted among general patients and family members without specification of their cases. One study represented a report of nine years of experience in hospital, without specifying the characteristics of the participants.