A European survey of critical care nurses' attitudes and experiences of having family members present during cardiopulmonary resuscitation

This paper presents the results of a survey into the experiences and attitudes of 124 European critical care nurses to the presence of family members during cardiopulmonary resuscitation (CPR). Nurses from mainland Europe were less experienced and less sure about the consequences of relatives witnessing resuscitation than United Kingdom (UK) nurses. Generally, nurses supported the presence of family members, although UK nurses held significantly more positive attitudes than their non-UK counterparts in the areas of decision-making, processes and outcomes of resuscitation. Differences in attitudes are explored in the discussion. On the basis of results from this study, it is recommended that further policy guidance is required.     

Paediatric critical care nurses' attitudes and experiences of parental presence during cardiopulmonary resuscitation: a European survey

BACKGROUND: Although recent resuscitation guidelines are supportive of family presence during cardiopulmonary resuscitation literature from the last decade suggests that it is often discouraged, and the subject remains a controversial issue. OBJECTIVES: To determine the experiences and attitudes of European paediatric critical care nurses about parental presence during the resuscitation of a child. DESIGN: A survey design was employed. PARTICIPANTS: A convenience sample of European paediatric critical care nurses was used. METHODS: A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a 5-point Likert scale. Differences in attitudes were explored in three areas: decision-making, processes and outcomes of resuscitation. RESULTS: The results from this survey suggest that European paediatric nurses are very supportive of parental presence during cardiopulmonary resuscitation. Only a few nurses reported that their unit had a policy that covered parental presence during cardiopulmonary resuscitation and most nurses did not support the use of a dedicated nurse to look after the parents during resuscitation. CONCLUSIONS: Compared with previous studies relating to adult cardiopulmonary resuscitation, paediatric nurses experience family member presence more frequently than adult critical care nurses and appear to be more supportive of relatives' presence. It is recommended that paediatric intensive care units establish local policies that cover parental presence during cardiopulmonary resuscitation.     

Interacting with relatives in intensive care unit. Nurses' perceptions of a challenging task

Aims: To describe how Danish intensive care unit (ICU)‐nurses perceive personal knowledge and skills (self‐efficacy) and outcome expectations to interacting with relatives. Moreover, to explore relationships between self‐efficacy and outcome expectations and the nurses' attitude towards involving relatives in care‐related tasks and allowing relatives to be with the patient during critical situations. Background: Interacting with relatives can be a challenging task, and nurses play a leading role in integrating relatives in ICU. Little is known about how ICU‐nurses cope with this part of nursing Design: Cross‐sectional Method: Sixty‐eight ICU‐nurses responded to a self‐administered questionnaire based on Bandura's self‐efficacy theory adjusted to critical care. Results: The nurses' perceptions of personal knowledge, skills and expectations to the outcome of interacting with relatives were positive. There were disparities in nurses' level of agreement on when to involve relatives in caring activities. Generally, the nurses did not support the presence of relatives in critical situations. Nurses' outcome expectations were correlated to their attitude towards involving relatives in caring activities. No other statistically significant correlations were found between general attitude, knowledge, skills, and attitude of nurses towards involving relatives in caring activities or allowing them to be with the patient at cardiac arrest or acute intubation. Conclusion: The nurses' outcome expectations and self‐efficacy in terms of knowledge and skills interacting with relatives were high. There was considerable variation in the nurses' agreement on when to involve relatives in caring activities or allowing them to be with the patient in critical situations. The self‐efficacy theory was not supported as a result of lack of correlation between nurses' self‐efficacy and outcome expectations and their attitude towards involving relatives in ICU. Relevance to clinical practice: The study provides important knowledge to clinicians, educators and managers on how to educate and supervise ICU‐nurses to support their efforts to interact proficiently with relatives.     

Job satisfaction as a mediator between structural empowerment and intent-to-leave: A study of critical care nurses

BackgroundNurse turnover is an issue that impacts a hospital’s financial resources and the quality of patient care. There is a need to discover what actions can be taken to improve nurse retention.ObjectiveNurses’ job satisfaction has been shown to improve organizational outcomes, such as nurses’ retention. The objective of this study is to examines the relationship between intent to leave, job satisfaction and structural empowerment (SE), providing a theoretical basis for further research.MethodsA convenience sample of 83 critical care nurses, recruited from two Facebook groups and the AACN website. The nurses completed a survey that used three tools; Conditions of Work Effectiveness II (CWEQ II), Job Satisfaction Survey (JSS), and Turnover Intention (TIS-6) to address 4 hypotheses to determine the relationship of the three constructs.ResultsFindings indicated that SE was not significantly related to intent-to-leave; SE was positively related to job satisfaction (β = 0.760, p < 0.01) , and job satisfaction was negatively related to Intent-to-leave (β = −0.610, p < 0.01).ConclusionThe research provided a theoretical framework for further research on SE and its importance in improving job satisfaction and reducing turnover in critical nurse.     

How to communicate with family members of the critically ill in the intensive care unit: A scoping review

ObjectiveTo map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits.MethodsWe conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding.ResultsThe search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs.ConclusionThe current approaches to communication with patients’ family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.     

ICU护士评判性思维的现状及影响因素分析

目的 调查ICU护士评判性思维的现状,并探讨其相关影响因素.方法 采用一般资料调查表及评判性思维能力量表对长沙市7所三级甲等医院ICU的324名护士进行横断面调查.结果 ICU护士的评判性思维能力总分为（284.22±23.62）分;职称、第一学历、从事ICU工作年限、参加活动频率和学习频率是ICU护士评判性思维能力的影响因素.结论 ICU护士的评判性思维能力总体表现为正性,但离评判性思维能力强的标准还有很大的差距,还有待进一步培养和强化.     

A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit

BackgroundPartnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically.ObjectiveThe objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU).MethodsA retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from “poor” (0) to “excellent” (100).ResultsIn total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients’ treatment in the ICU and appreciation for the care, skill, and professionalism of the staff.ConclusionVery high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.     

Relationship between clinical performance and professional self-concept in critical care nurses

Objective: To determine the relationship between clinical performance and professional self-concept in critical care nurses.Methods: This study was conducted on 308 critical care nurses. Data gathering instruments were nurses' clinical performance questionnaire (NCPQ) and nursing professional self-concept measure (NPSCM). Independent sample t-test, one-way analysis of variance (ANOVA), and Pearson correlation coefficient were used for data analyses.Results: The average age of the nurses was 33.74 ± 7.01 years. The clinical performance score of female nurses was significantly higher than male nurses. In the domain of clinical performance, clinical judgment and clinical inquiry had the highest and lowest scores, respectively. In the nurses' professional self-concept, the highest and lowest scores were awarded to the subscales of selfconfidence and staff relations, respectively. In addition, there was a significant positive correlation between self-concept and clinical performance of nurses.Conclusions: Increasing professional self-concept improves the clinical performance of critical care nurses. Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.     

Attitudes of healthcare staff and patients' family members towards family presence during resuscitation in adult critical care units

Aim and objectives: This study examines the attitudes of healthcare staff and patients’ family members towards family presence during resuscitation (FPDR) in critical care units in Hong Kong. Background: A wealth of literature is available on FPDR in various hospital and healthcare settings. The findings include many anecdotal accounts of both the positive and the negative effects of family presence. There is little documentation on the comparisons of staff and family members’ perceptions and the predictors of staff attitudes towards FPDR practice. Design: Cross‐sectional survey design. Method: A convenience sample of 163 healthcare staff and 69 family members was recruited from the intensive care units. Results: There was significant difference in the attitudes of healthcare staff and patients’ families towards FPDR. The regression analysis showed that the healthcare staff would be more supportive to FPDR if family members could share the dying moments with patients, family members were accompanied by a bereavement team member, there was adequate staff to support the family and staff members were adequately trained. If healthcare staff feel that family members may have the impression that the resuscitation is chaotic, witness resuscitation is traumatic experience for the family, family presence will increase risk of litigation and colleagues will not allow family members to stay during resuscitation making them less supportive of FPDR. Nurses were more supportive to FPDR than doctors. Conclusion: The results provide information for healthcare professionals on the development of FPDR programmes for patients and their family members. Through multi‐disciplinary collaborations, the effective and safe implementation of FPDR practice can be enhanced. Relevance to clinical practice: The results could help the clinical staff to develop written guidelines to produce an integrated and consistent approach to this sensitive issue in clinical practice.     

Family support liaison in the witnessed resuscitation: A phenomenology study

BackgroundFamily-witnessed resuscitation remains controversial among clinicians from implementation to practice and there are a number of countries, such as Iran, where that is considered a low priority.ObjectiveTo explore the lived experience of resuscitation team members with the presence of the patient's family during resuscitation.DesignThe hermeneutic phenomenology.SettingsThe emergency departments and critical care units of 6 tertiary hospitals in Tabriz, Iran.ParticipantsThere were potentially 380 nurses and physicians working in the emergency departments and acute care settings of 6 tertiary hospitals in Tabriz. A purposive sample of these nurses and physicians was used to recruit participants who had at least 2 years of experience, had experienced an actual family witnessed resuscitation event, and wanted to participate. The sample size was determined according to data saturation. Data collection ended when the data were considered rich and varied enough to illuminate the phenomenon, and no new themes emerged following the interview of 12 nurses and 8 physicians.MethodsSemi-structured, face- to- face interviews were held with the participants over a period of 6 months (April 2015 to September 2015), and Van Manen’s method of data analysis was adopted.ResultsThree main themes emerged from the data analysis, including ‘Futile resuscitation’, ‘Family support liaison’, and ‘Influence on team’s performance’. A further 9 sub-themes emerged under the 3 main themes, which included ‘futile resuscitation in end-stage cancer patients’, ‘when a patient dies’, ‘young patients’, ‘care of the elderly’, ‘accountable person’, ‘family supporter’, ‘no influence’, ‘positive influence’, and ‘negative influence’.ConclusionsParticipants noted both positive and negative experiences of having family members present during cardiopulmonary resuscitation. Welltrained and expert resuscitation team members are less likely to be stressed in the presence of family. A family support liaison would act to decrease family anxiety levels and to de-escalate any potentially aggressive person during the resuscitation. It is recommended that an experienced health care professional be designated to be responsible for explaining the process of resuscitation to the patient’s family.