Benefits of Family Presence During Resuscitation Efforts

Report
BENEFITS OF FAMILY PRESENCE
DURING RESUSCITATION EFFORTS
Tina Bombe, Melissa Hayes, Chelsea Melrose, Kathleen
Michalak, and Laura Zwagerman
FAMILY PRESENCE DURING RESUSCITATION
Benefits have been debated for a long time
 Over 117 systematic reviews, research articles & metaanalyses were found
 Purpose of this EBP analysis is to consider the benefits
of family presence during resuscitation efforts and the
growing need for the development of written policies and
guidelines to support this initiative.

RESEARCH METHODS
Performed a literature review of current quantitative and
qualitative studies
 Analyzed the evidence to provide support of the data
 Applied the evidence into practice
 Suggested appropriate recommendations based on the
evidence provided

LITERATURE REVIEW
Databases utilized: STAT!Ref, PubMed, Medline, &
CINAHL
 Key Terms searched: family presence resuscitation,
bedside resuscitation, resuscitation efforts, and benefits
of family being bedside
 All articles chosen were relevant to the topic and
supported by the subject matter identified.
 Five articles were selected

ARTICLE #1: “USING RESEARCH TO DETERMINE SUPPORT FOR A
POLICY ON FAMILY PRESENCE DURING RESUSCITATION” BY
ROBERTA BASOL, KATHLEEN OHMAN, JOYCE SIMONES, KIRSTEN SKILLINGS
Descriptive, correlational study
 Study asked two questions:

What are the attitudes, concerns, and beliefs related to family
presence during CPR and BIPS of *staff caring for patients
from a variety of patient care units?
 Is there a relationship between the attitudes, concerns, and
beliefs of *staff caring for patients from a variety of patient
care units and certain demographic variables?

“USING RESEARCH TO DETERMINE SUPPORT FOR A POLICY ON FAMILY
PRESENCE DURING RESUSCITATION” BY ROBERTA BASOL, KATHLEEN
OHMAN, JOYCE SIMONES, KIRSTEN SKILLINGS
Distributed *surveys (1,402 surveys with 625 being
returned)
 Most participants were:

White 97.3%
 Female 80.3%
 RNs 78.8%

Age range 23 to 81 years (Mean age of 42.6 years)
 After review of the surveys, a hospital-wide policy was
recommended for family presence during resuscitation
 Policy was developed and implemented
 A follow-up survey is in development stages to identify
response to policy change

SIGNIFICANT FINDINGS

The study conducted by Basol et al. (2009) found
“positive experiences with family presence including the
perception that families have made choice to stop efforts
earlier than what the team may have done. There have
been no negative experiences reported with the family
presence” (p.243-244).
RECOMMENDATIONS FROM STUDY
After review of the benefits of family presence during
resuscitation, Basol et al. (2009) recommended the
“implementation of a hospital wide policy for family
presence during resuscitation” (p.242).
 Findings supported the idea of families having the option
to be present or not during resuscitation or bedside
procedures (Basol et al., 2009, p.246).
 Findings also support development of hospital-wide
policies giving families the option to be present during
resuscitation.

ARTICLE #2: “IDENTIFYING FACTORS INHIBITING OR ENHANCING
FAMILY PRESENCE DURING RESUSCITATION IN THE EMERGENCY
DEPARTMENT” BY JUDY DAVIDSON, RUTH BUENAVISTS, KEYNAN HOBBS, &
KATHLEEN KRACHT
Qualitative study
 Purpose: To explore inhibitors and enhancing factors
surrounding the practice of allowing family presence in
the emergency room.
 Data sources: interviews and observation
 12 interviews of staff RNs and DRs were audiotaped and
transcribed verbatim
 Barriers and Enhancing Factors included: staff emotions,
personalizing the patient, seeing/hearing everything,
closure, emotional support of the family and “if it were
me”.

SIGNIFICANT FINDINGS AND
RECOMMENDATIONS
The researchers results found there was “evidence in the
literature to support the practice of family presence”
however, “many staff felt unprepared to deal with the
emotional burden” (Davidson et al., 2009, p.342).
 Recommendations:





Staff education and support
Provide a family liaison
Consider environmental factors (ie small spaces, crowded
conditions, lack of privacy)
The researchers also suggested that drivers used in this
study would “help to guide the policy revision to
facilitate family presence at the bedside” (Davidson et
al., 2009, p. 342).
ARTICLE #3: “FAMILY PRESENCE DURING TRAUMA
RESUSCITATION: READY FOR PRIMETIME?” BY MAE ANN PASQUALE,
MICHAEL PASQUALE, LESLIE BAGA, SHERRINE EID, JANE LESKE
Prospective, comparative study
 Assessed 50 adult family members, 25 who were present
and 25 who were not present, with their severely injured
adult family member.
 The studies “primary objective was to measure the
effects of family presence during trauma resuscitation
(FPTR) on family outcomes of anxiety, satisfaction and
well-being in patients experiencing traumatic injury”
(p.1092-1093).

SIGNIFICANT FINDINGS AND
RECOMMENDATIONS
The study found that “given the option, family members
desire to be present during resuscitation” (Pasquale et al.,
2010, p.1097).
 The researchers concluded “family members present
during trauma resuscitation suffered no ill psychological
effects and scored equivalent to those family members
who were not present on anxiety, satisfaction and wellbeing measures” (Pasquale et al., 2010, p. 1092).

ARTICLE #4: “THE IMPACT OF EDUCATION ON PROVIDER
ATTITUDES TOWARD FAMILY-WITNESSED RESUSCITATION” BY LORI
FEAGAN, NANCY FISHER
2-phase quantitative, before/after study
 Phase 1: A convenience sample of DRs and RNs from 2
facilities were surveyed about their opinions and beliefs
regarding family-witnessed resuscitation (FWR)
 Phase 2: Clinician subgroups in the community hospital
were re-surveyed following an educational program that
used EBP information.

“THE IMPACT OF EDUCATION ON PROVIDER ATTITUDES TOWARD
FAMILY-WITNESSED RESUSCITATION” BY LORI FEAGAN, NANCY
FISHER

Primary focus of this study:
To evaluate local trends in provider attitudes toward offering
the option of family presence during resuscitation (Feagan &
Fisher, 2011)
 Test the effect of an educational program that used evidencebased information to improve clinician acceptance of family
witnessed resuscitation (FWR) (Feagan & Fisher, 2011).

SIGNIFICANT FINDINGS AND
RECOMMENDATIONS
Feagan and Fisher (2011) recommended “The success of
adopting family presence guidelines may be greater if
clinicians are presented with evidence-based data and
ethical reasoning that address common provider
concerns” (p. 238).
 The researchers also concluded “family presence during
resuscitation may become a commonplace component of
family-centered care” (p. 238).

ARTICLE #5: “EMERGENCY NURSING RESOURCE: FAMILY PRESENCE DURING INVASIVE
PROCEDURES AND RESUSCITATION IN THE EMERGENCY DEPARTMENT” DEVELOPED BY
2009 ENA EMERGENCY NURSING RESOURCE DEVELOPMENT COMMITTEE
Comprehensive review and analysis of current data from
an evidence based perspective
 The researchers provided a thorough review and critical
analysis of 117 research studies regarding the benefits of
family presence during resuscitation.

SIGNIFICANT FINDINGS AND
RECOMMENDATIONS

Based on the researchers literature review, the following
evidence was found:
Evidence that patients would prefer to have their family members
present during resuscitation
 Evidence that family members wish to be offered the option to be
present
 Evidence that family member presence does NOT interfere with
patient care
 Evidence that health care professionals support the presence of a
designated liaison, that is assigned to provide explanations and
comfort family members who are present


ENA’s Recommendation: family member presence during
invasive procedures or resuscitation should be offered as an
option to appropriate family members and should be based on
written institution policy (p.5).
EVIDENCE IN PRACTICE

Family presence during resuscitation: is it beneficial?
The study by Pasquale et al., 2010 reviewed collected data
over a 5 month period from 50 family members (25 present
and 25 not present during trauma resuscitation).
 Of those present during resuscitation efforts, 18 of the 25
family members responded positively to the experience.
 The researchers found that no one from this group responded
negatively.
 Survey results suggested that family members had a better
understanding of the seriousness of the situation as a result of
being present during resuscitation efforts.

EVIDENCE IN PRACTICE

It was found during a critical review of 20 articles (as
examined by Bourdeaux et al.) that family presence
during resuscitation efforts in the emergency department:
When given the option, family members choose to be present
during these situations.
 This study also revealed that family members felt as though
their presence was beneficial to the patient.


Note: Nurses in this study were more favorable toward family
presence than physicians.
EVIDENCE IN PRACTICE

Should hospitals have a written policy regarding family
presence during resuscitation?


Although professional organizations and critical care experts
support family presence during resuscitation, only 5% of
critical care units in the United States have written policies
(Basol et al., 2009).
Prior to the development of a policy, both the benefits
and possible negative effects must be considered.
EVIDENCE IN PRACTICE

Perceived barriers to family resuscitation


Studies show that there is some reluctance of emergency room staff to
allow family presence during resuscitation and emergency procedure
efforts.
Perceived barriers include:










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fears that family members may interfere;
poor staff performance will be observed;
family members will hamper the staff’s performance;
family will misinterpret the team’s activities;
future litigation may occur;
the room may be overcrowded;
there may be negative psychological effects to the family;
families would be more likely to complain that not enough was done/too
much was done;
the resuscitation procedure was stopped too soon or not carried on long
enough;
physicians or RNs may be uncaring in their attitudes;
inappropriate remarks could be made (Basol et al., 2009).
EVIDENCE OF PRACTICE

Benefits of family presence resuscitation:





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fosters great appreciation for code efforts;
enhances family understanding of patient’s condition;
reduces family guilt and anxiety;
focuses staff attention on patients’ privacy and dignity;
encourages professional behavior among staff;
helps staff provide more holistic care (Basol et al., 2009).
RECOMMENDATIONS

Each article researched agreed on this:


DEVELOP A HOSPITAL POLICY
Policy Development Recommendations:
Consider potential barriers
 Provide education to staff
 Assess attitudes, beliefs

REFERENCES
Basol, R., Ohman, K., Simones, J., & Skillings, K. (2009). Using research to determine support
for a policy on family presence during resuscitation. Dimensions Of Critical Care
Nursing, 28(5), 237-249. doi:10.1097/DCC.0b013e3181ac4bf4
Davidson, J. E., Buenavista, R., Hobbs, K., & Kracht, K. (2011). Identifying Factors Inhibiting
or Enhancing Family Presence During Resuscitation in the Emergency Department.
Advanced Emergency Nursing Journal, 33(4), 336-343. doi:10.1097/TME.
0b013e318234e6a0
Egging, D., Crowley, M., Arruda, T., Proehl, J., Walker-Cillo, G., Papa, A., Li, S., & Walsh, J.
(2009, December). Emergency nursing resource: Family presence during invasive
procedures and resuscitation in the emergency department. Retrieved from
http://www.ena.org/IENR/ENR/Documents/FamilyPresenceENR.pdf
Feagan, L. M., & Fisher, N. J. (2011). The Impact of Education on Provider Attitudes Toward
Family-Witnessed Resuscitation. JEN: Journal Of Emergency Nursing, 37(3), 231239.
doi:10.1016/j.jen.2010.02.023
Pasquale, M., Pasquale, M., Baga, L., Eid, S., & Leske, J. (2010). Family presence during
trauma resuscitation: ready for primetime?. Journal Of Trauma, 69(5), 1092-1100.
doi:10.1097/TA.0b013e3181e84222

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