Family Presence during Resuscitation

Report
FAMILY PRESENCE
DURING
RESUSCITATION
IRB 014-138
Pamela Green, APRN, MSN, FNP-C, DNP-S
Baylor Medical Center at Carrollton
Family Presence during Resuscitation
Purpose Statement: To determine if awareness of
the benefits of and guidelines for family presence
in the resuscitation room has a positive impact on
physician opinion.
Although CPR forecasts likely poor outcome, less
than five percent of acute care facilities across the
United States have policies and protocols to allow
for family presence in the resuscitation room. (MacLean et
al., 2003)
Healthcare Provider Perception
• Family presence would interfere with
resuscitation efforts.
• Resuscitation event would be too stressful for
family members.
• Provider stress and performance anxiety when
family present.
• Provider fear of increased litigation.
Guidelines and Position Statements
• Emergency Nurses Association (ENA) guidelines
recommend family members be included during
invasive procedures and resuscitation
(Emergency Nurses Association [ENA], 2012).
• The American Heart Association recommended
family members be offered the opportunity to be
present during resuscitation. (American Heart Association [AHA],
2000)
• American Association of Critical Care Nurses practice
alert in 2010 stated all family members should be
given the option of family presence during
resuscitation
(American Association of Critical Care Nurses [AACN], 2010)
Evidence: Delay in Care
• No significance difference identified in the number of
shocks delivered with family present and appropriate
protocol in place versus no family presence
• No significant difference identified in the minutes to first
defibrillation shock with family present and appropriate
protocol in place versus no family presence
(Fernandez,
R., Compton, S., Jones, K. A. & Velilla, M. A. (2009). The presence of a family witness impacts physician performance during
simulated medical codes. Critical Care Medicine, 37:6, 1956-1960)
Evidence: Family Stress
• No studies indicated decrease in family member
satisfaction or increase in stress when present during
resuscitation. Many expressed they not only wanted to be
present, but felt it was their right.
(Tinsley et al., 2008; Mortelmans et al., 2009; Piira, Sugiura, Champion, Donnelly, & Cole, 2005; Dingeman, Mitchell,
Meyer, & Curley, 2007; Dudley et al., 2009; McGahey-Oakland, Lieder, Young, & Jefferson, 2007)
• Family presence creates transparency. Family members
who had witnessed a resuscitation event felt everything
had been attempted to save their loved one. (McGahey-Oakland et
al., 2007; Tinsley et al., 2008; Emergency Nurses Association [ENA], 2007)
Evidence: Provider Stress
• Providers in the emergency and critical care areas
revealed providers were 82% in favor of family presence
during resuscitation. (Demir, 2008)
• Healthcare providers identify family presence allows the
family the opportunity to say goodbye when resuscitation
efforts are unsuccessful, promotes family acceptance of
their loved one’s death, and facilitates grieving. (Dingeman et al.,
2007; Demir, 2008; McClement, Fallis, & Pereira, 2009; Walker, 2008).
Evidence: Litigation
• No evidence to support
providers fear of increased
litigation when family members
are present in the resuscitation
room.
(Walker, 2008; Madden & Condon, 2007; McClement et al., 2009; Dingeman et al., 2007; Demir, 2008; Fernandez
et al., 2009)
Consumer Opinion
• Family members perceive the experience to have
a positive effect on grieving and adjusting to loss.
(Doyle et al., 1987; Meyers et al., 2000; Meyers, Eichhorn, & Guzzetta, 1998)
• Of those survivors, all were content with family
presence during resuscitation. (Robinson, Mackenzie-Ross, Hewson,
Egleston, & Prevost, 1998).
• Hospitalized patients with life threatening illness
indicated they would prefer family to be present
during CPR. (Mortelmans et al., 2009).
Next Steps
• Baylor Health Care System, like most other acute
care facilities, does not have policies in place to
support family presence during resuscitation.
(MacLean et al., 2003)
• Three studies indicated hospital policy
surrounding family presence would have a
positive impact on provider attitude regarding
family presence during resuscitation. (Basol et al., 2009;
Madden & Condon, 2007; Howlett, Alexander, & Tsuchiya, 2010)
• ENA recommends that institutional policy should
be written to support the recommendation of
family presence during resuscitation. (Emergency Nurses
Association [ENA], 2012)
References
• Agency for Healthcare Research and Quality. (2001). Translating research into practice (TRIP) - II. Retrieved from
http://archive.ahrq.gov/research/findings/factsheets/translating/tripfac/trip2fac.html
• American Association of Critical Care Nurses. (2010). American Association of Critical Care Nurses Practice Alert: Family
presence during resuscitation and invasive procedures. Retrieved from
http://www.aacn.org/wd/practice/docs/practicealerts/family%20presence%2004-2010%20final.pdf
• American Heart Association. (2000). Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care,
part 2: ethical aspects of CPR and ECC. Circulation, 102, 112-121. Retrieved from
http://circ.ahajournals.org/content/102/suppl_1/I-12.full
• Basol, R., Ohman, K., Simones, J., & Skillings, K. (2009). Using research to determine support for a policy on family presence
during resuscitation. Dimensions in Critical Care Nursing, 28, 237-247. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/19700973
• Chelluri, L. P. (2008, April-June). Quality and performance improvement in critical care. Indian Journal of Critical Care , 12, 6773. Retrieved from http://www.bioline.org.br/pdf?cm08016
• Critchell, C. D., & Marik, P. E. (2007). Should family members be present during cardiopulmonary resuscitation? A review of
the literature. American Journal of Hospice and Palliative Medicine, 24, 311-317. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/17895495
• Demir, F. (2008, August). Presence of patients’ families during cardiopulmonary resuscitation: physicians’ and nurses’
opinions. Journal of Advanced Nursing, 63, 409-416. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18727768
• Dingeman, R. S., Mitchell, E. A., Meyer, E. C., & Curley, M. A. (2007, October). Parent presence during complex invasive
procedures and cardiopulmonary resuscitation: A systematic review of literature. Pediatrics, 120, 842-854. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/17908772
References
• Doyle, C. J., Post, H., Burney, R. E., Maino, J., Keefe, M., & Rhee, K. J. (1987, February 3). Family participation during
resuscitation: an option. Annals of Emergency Medicine, 16:6, 673-675. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/3578974
• Dudley, N. C., Hansen, K. W., Furnival, R. A., Donaldson, A. E., Van Wagenen, K. L., & Scaife, E. R. (2009). The effect of
family presence on the efficiency of pediatric trauma resuscitations. Annals of Emergency Medicine, 53, 777-784. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmed/19013688
• Emergency Nurses Association. (2007). Presenting the Option for Family Presence. Des Plains, IL: Emergency Nurse
Association. Retrieved from http://rn-aim.org/docs/MuldoonChapter%206%20slides%20ppt%20%20nsg%20retr.pdf
• Emergency Nurses Association. (2012). Clinical Practice Guideline: Family presence during invasive procedures and
resuscitation . Retrieved from https://www.ena.org/practice-research/research/CPG/Documents/FamilyPresenceCPG.pdf
• Feagan, L. M., & Fisher, N. J. (2011, May). The impact of education on provider attitudes toward family witnessed
resuscitation. Journal of Emergency Nursing, 37, 231-239. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21550455
• Fernandez, R., Compton, S., Jones, K. A., & Vilella, M. A. (2009). The presence of a family witness impacts physician
performance during simulated medical codes. Critical Care Medicine, 37, 1956-1960. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/19384215
References
•
Howlett, M. S., Alexander, G. A., & Tsuchiya, B. (2010). Health care providers’ attitudes regarding family presence during
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MacLean, S. L., Guzzetta, C. E., White, C., Fontaine, D., Eichhorn, D. J., Meyers, T. A., & Desy, P. (2003, June). Family
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