Family Presence During Resuscitation

Family Presence
During Resuscitation
Julie K. Kuzin RN, CPNP-AC/PC
Shino S. Thomas RN, NNP-BC
1) Identify the perceived risk and reward received by families
present during resuscitation of infants and children.
2) Discuss interventions that provide support to families during
resuscitation events.
3) Discuss the desired outcomes of family presence during
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Family Centered Care is the 3rd of 6
central aims to improve healthcare
Providing care that is respectful of and responsive to
individual patient preferences, needs, and values and
ensuring that patient values guide all clinical decisions.
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Historical Timeline
Family Centered Care (FCC)
History of Family Visitation in Hospitals
• 1894 Boston Children’s Hospital
•Visit 2 days per week
• 1910 Massachusetts General Hospital
•Crying children moved into isolation
• 1959 Platt Report
•Advocated for open visitation
(Markel 2008, Ismail & Mulley 2007)
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History of Family Centered Care
(Kuo, et al. 2012)
• Maternal and Child Health Bureau and Surgeon General offices
advocated for family centered care
• Institute of Medicine named patient centered care as crucial for health
care quality
• AAP had incorporated FCC into multiple policy statements and
affirmed FCC as the standard of health care for all children
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History of Family Presence During
Resuscitation (FPDR)
1982 Foote Hospital in Michigan
• 2 family member requested to be present during
• Survey showed 13 of 18 family members wished they
had been present
(Boehm 2008)
1985 Program Developed by Foote
• 47 bereaved family members responded to survey
• 76% stated being present helped them grieve
• 64% felt their presence helped dying family member
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History of FPDR
Dingeman, et al. 2007, Henderson and Knapp 2005
1993 Emergency
Nurses Association
• First to develop a
resolution supporting
family presence
2000 & 2005 American
Heart Association
• Resolution
supporting families
be given option
• Presence of support
personnel for family
2002 American
Association of Critical
Care Nurses
• Health care
organizations have
written policy
regarding FPDR
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2004 American
Academy of Pediatrics
• 18 organizations
convened to develop
recommendations for
Current Literature
• Institutional Support
•About 9% of hospitals have written policy (Dingeman, et al 2007)
•One of three nurses surveyed offered families the option (Halm, 2005)
•Increasing demand
•1991 survey reported half of families would choose to be present
•About a decade later 87% would be present
•86% felt it was their parental Right
(Dingeman et al 2007)
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Patient Perspective
Adult patient data
•Endorsed their humanity
•Benefit to family members outweighed risks
•Did not create embarrassment
•Wanted family members present, even if it was traumatizing (Mortelmans, 2009)
•3 survivors were content that family present (Dudley, 2009)
(ENA 2009, Dingeman 2007, McGahey, 2007; Meyers, 2000; Pirra, 2005; Tinsley, 2008;
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Family Perspective
• Decreased anxiety, Increased satisfaction
• Improved Coping “Everything could be done was done”
• Helpful, comforting to their child during trauma resuscitation
• 72% of pts & family wanted family present (Benjamin, 2004)
• 94% would repeat their decision to be present during invasive procedure (Powers &
Rubenstein, 1999)
• Family “Right” & should have the option, 100% said it was helpful (Meyers, 2000)
• 11% were asked, 69% would have wanted the opportunity, 62% would have chosen to
be present (Barrett & Wallis, 1998)
(Dingeman 2007, Dudley 2009, ENA CPG 2009, Mortelmans 2009, Piira 2005, Tinsley 2008)
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Provider Perspective
Violation of
Adult patient
perspective in support
stress on
No delay in care
RNs and senior
physicians support
Parents key to
providing medical
Supported patient
risk of
No literature to
No difference in
procedure success
No delay in stopping
79% felt residents
should be trained in
FDPR (Gold, 2006)
Humanized the patient
Too traumatic
for families to
Improved grieving
Less depression,
PTSD and anxiety
long term follow-up
Promoted family
acceptance of death,
know everything was
(Halm 2005; Dingeman et al 2007, ENA CPG 2009)
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Randomized Control Trial
Jabre et al (France)
New England Journal of Medicine 2013
570 relatives
15 EMS units
(driver, RN,
to offer FPDR
or follow
FPDR did not
PTSD higher
group 79%
in the control resuscitation,
present for
group and
higher in those survival, staff
Control group
who did not
stress, or
43% present
witness CPR
for CPR
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Cultural Perspective
Singapore - 75% of physicians and 78% of nurses families should not be present
United Kingdom - 62% of families would have chosen to be present if given the chance
United Kingdom – 63% did not favor FPDR -mostly physician
Scotland – 13% supported FPDR, 48% were unsure, 71% wanted a policy
Sweden – Nurses and physicians thought few families would want FPDR, more nurses than physicians would always
respect families wishes.
Australia – 62% would consider FPDR, 70% would want it for themselves, 76% procedure offensive to family
Turkey, Saudi Arabia, Germany, Hong Kong (guarded or negative attitudes)
(Dingeman et al 2007, ENA 2009, Halm 2005)
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In summary
• No negative effect on delivery of care
• Not evidence of harm in the literature
• Improves psychological impact on families
• Patients and families want the option
• Healthcare providers hold unfounded fears
• FPDR is a key component of Family Centered Care
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Family Panel
Griffin & Grayson
Where do we go from here?
Institutional policy
Healthcare provider education
Family support person
What is the patient’s voice?
Ongoing evaluation of effect on families?
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Reference List
American Academy of Pediatrics Committee on Hospital Care Family-centered care and the pediatrician’s role. Pediatrics. 2003;112:691–
697. doi: 10.1542/peds.112.3.691.
Barrett F., Wallis, DN (1998). relatives in the resuscitation room: Their point of view. Journal of Accident and Emergency Medicine 15(2),
Boehm, J., (2008) Family presence during resuscitation. Code Communications, 3(5). Available at Accessed 23 Dec 2013
Curley, M.A., Meyer, E.C., Scoppettuolo, L.A., McGann, E.A., Trainor, B.P., et al. (2012) Parent presence during invasive procedures and
resuscitation: Evaluating a clinical practice change. American Journal of Respiratory and Critical Care Medicine, 186(11), 1133-1139
Dingeman, R.S., Mitchell, E.A., Meyer, E.C., & Curley, M.A. (2007). Parent presence during complex invasive procedures and
cardiopulmonary resuscitation: A systematic review of literature. Pediatrics, 120(4), 842-854.
Dudley, N.C., Hansen, K.W., Furnival, R.A., Donaldson, A.E., Van Wagene, K.L., & Saife, E.R. (2009). The effect of family presence on the
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procedures and resuscitation. Emergency Nurses Association. Available at Accessed 23 Dec 2013
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Reference List
Halm, M. A. (2005) Family presence during resuscitation: A critical review of the literature. American Journal of Critical Care, 14(6) 494-511
Henderson, D.P., Knapp, J.F. (2005). Report of the national consensus conference on family presence during pediatric cardiopulmonary
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Ismail, S., Mulley, G. (2007) Visiting times. British Medical Journal, 335, 1316
Jabre, P. et al. (2013) Family presence during cardiopulmonary resuscitation. The New England Journal of Medicine, 368, 1008-1018.
Kuo, D.Z., Houtrow, A.J., Arango, p., Kuhlthau, K.A., Simmons, J.M., Neff, J.M., (2012) . Family centered Care: Current applications and
future directions in pediatric health care. Maternal and Child Health Journal, 16(2), 297-305.
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Reference List
Markel, H., (2008) .When hospitals kept children from parents. The New York Times. Available at Accessed 7 Nov 2013.
Maternal and Child Health Bureau. Definition of Family-Centered Care: 2005. Accessed Dec 29 2013.
McGahey-Oakland PR, Lieder HS, Young A, Jefferson LS.
McGahey-Oakland, P.R., Lieder, H.S., Young, A., Jefferson, L.S. (2007). Family experiences during resuscitation at a children's hospital
emergency department. Journal of Pediatric Healthcare, 21(4), 217-225.
Mortelmans, L.J.M., Van Broeckhoven, V., Van Boxstael, S., De Cauwer, H.G., Verfaillie, L., Van Hellemond, P.L.A., et al. (2009). Patients’
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Piira, T., Sugiura, T., Champion, G.D., Donnelly, N., & Cole, A.S.J. (2005). The role of parental presence in the context of children’s medical
procedures: A systematic review. Child: Care, Health & Development, 31(2), 233-243.
Tinsley, C., Hill, J.B., Shar, J., Zimmerman, G., Wilson, M., Freier, K., & Abd-Allah, S. (2008). Experience of families during
cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics, 122(4), e799-e804.
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