Creating advocates for family presence during resuscitation

Research suggests that family presence at the bedside during resuscitation is beneficial for both family members and staff Education of health care personnel will help them communicate effectively with and guide distraught family members during a code. Tools to implement a family presence protocol are provided.     

Staff attitudes towards family presence during resuscitation

The presence of family members in the resuscitation room of an Emergency Department (ED) is a controversial issue. This has been the subject of discussion in recent years and has received a lot of publicity. Allowing family to be present with their relative in the time leading up to their dying moments may help initiate the grieving process and dealings with subsequent death. This study found that there are occasions where families are present informally during resuscitation attempts in metropolitan hospitals around Melbourne. The experiences of staff have been given voice, with comments from those involved.A survey of ED workers was conducted to examine staff attitudes and to identify the major factors of concern about family presence during resuscitation. The willingness of staff to consider the option was revealed by this study. Examination of issues relevant to this proposal reveal many concerns for ED workers. These issues must be addressed in order to gain commitment and support from staff. The main concerns are discussed and possible solutions suggested. Ideas for developing guidelines to prepare staff and possible visitors into the resuscitation room are included for those wishing to develop and pilot such a project in their own department.     

Challenges in conducting research after family presence during resuscitation

Family presence during resuscitation (FPDR) is an option occurring in clinical practice. National clinical guidelines on providing the option of FPDR are available from the American Association of Critical-Care Nurses, American Heart Association, Emergency Nurses Association, and Society of Critical Care Medicine. The FPDR option currently remains controversial, underutilized, and not the usual practice with trauma patients. This article is based on the methodological and practical research challenges associated with an ongoing study to examine the effects of the FPDR option on family outcomes in patients experiencing critical injury after motor vehicle crashes and gunshot wounds. The primary aim of this study was to examine the effects of the FPDR option on family outcomes of anxiety, stress, well-being, and satisfaction and compare those outcomes in families who participate in FPDR to those families who do not participate in FPDR. Examples of real clinical challenges faced by the researchers are described throughout this article. Research challenges include design, sampling, inclusion/exclusion criteria, human subjects, and procedures. Recruitment of family members who participated in the FPDR option is a complex process, especially after admission to the critical care unit.     

心肺复苏和介入性操作时患者家属在场问题的研究现状

心肺复苏和介入性操作时家属是否在场已经成了当下非常有争议的话题,受到医务工作者和媒体的普遍关注。纵观过去几十年国外的医疗和护理专业杂志中,都提出了医生和护士在患者家属在场(family present,FP)问题上不同程度的意见分歧。由于中国以及亚洲的医疗体制与西方国家大相径庭,国内少有对家属在场的类似研究。为进一步了解国外FP研究现状,我们借鉴国外经验,作如下综述。1FP的概念和背景在19世纪50年代晚期,濒死患者往往在家中与家人共同度过最后时刻,因而当时并不存在家属在场的伦理道德争论。由于高科技医疗水平的进展,患者从家里移…     

To hold her hand: family presence during patient resuscitation

Family presence at the bedside during resuscitation is an important component of the patient's care. Many families report feeling that their presence at such a time is helpful to both them and the patient. Some studies suggest that family presence may reduce the chance of legal action regarding the patient's outcome because it decreases the mystery surrounding the level of effort undertaken to save the patient's life. However, many facilities are reluctant to allow family presence during resuscitation typically because of the belief that family presence will somehow disrupt the providers' ability to conduct the resuscitation. This article explores the background behind this issue and the studies done to date on family presence and makes suggestions for adopting policies allowing family presence during resuscitation.     

Emergency medical service providers' experience with family presence during cardiopulmonary resuscitation

OBJECTIVE: To describe emergency medical service providers' experiences with family member presence during resuscitation, and to determine whether those experiences are similar within urban and suburban settings. METHODS: We conducted a personally distributed survey of a convenience sample of urban and suburban emergency medical service (EMS) providers presenting to two Midwestern Emergency Departments. Providers were questioned as to their experiences with resuscitating patients in the presence of family members. RESULTS: There were 128 respondents to the survey (59 urban and 69 suburban), of which 70.1% were EMT-Paramedics. No provider who was approached refused participation. Nearly all (122) had performed CPR in the presence of family members, with most (77%) performing greater than 20. Subjects averaged 12.3 years of experience. The majority of urban and suburban providers felt it was inappropriate for family to witness resuscitations (75.9% versus 60.3%, respectively; p=0.068). Many providers reported feeling uncomfortable with family presence (31.5% urban versus 44.8% suburban; p=0.136), and few preferred that family witness the resuscitation (13.2% urban versus 15.4 suburban; p=0.738). A minority of providers believed that family were better prepared to accept the death of the patient (37.0% urban versus 37.6% suburban; p=0.939). Approximately half felt comfortable providing emotional support (66.0% urban versus 53.7% suburban; p=0.173). Many felt that family caused a negative impact during resuscitation (53.7% urban and 36.8% suburban; p=0.061). Urban providers more often reported feeling threatened by family members during resuscitation (66.7% versus 39.7%; p=0.003), and felt that family often interfered with their ability to perform resuscitations (35.6% versus 16.4%, p=0.014). CONCLUSIONS: EMS providers have substantial experience with family witnessed resuscitations, are uncomfortable about their presence, and often must provide support for families. While urban providers tended to report more negative experiences and perceptions, there were minimal differences between the two groups.     

Family presence during resuscitation

Are policies allowing family into the trauma room humane and necessary--or just asking for trouble?     

Family presence during resuscitation

The concept of allowing families in during invasive procedures and resuscitation is rapidly growing and receiving more attention and acceptance. Health care organizations that have been traditionally bound by the practice of family exclusion are now being challenged by the increasing volume of research and public attention surrounding the family presence movement. In an ironic turn of practice, the health care arena that long ago permitted fathers and family members to be present at the beginning of life, is now beginning to recognize the value of family presence at the end of it. Allowing family members to be present validates the unique personhood of the patient while recognizing his integral position within a larger family unit. The documented benefits have exceeded the perceived risks for families permitted to be present during resuscitation. Families as well as patients view family presence during resuscitation as a right. In addition, health care providers who initially had resisted permitting families in during resuscitation are now conceding to families this opportunity and, not surprisingly, an opportunity that they would choose for themselves. The family presence program will continue to evolve as new research is conducted and variables are examined to assess their impact on patients, families and health care providers. With increased knowledge and awareness of the benefits and limitations of family presence, the practice of allowing families in to comfort and support loved ones at the end of life can only enhance and strengthen the hallowed bond between patients and health care providers.     

Family presence during cardiopulmonary resuscitation

A recent phenomenon in emergency and critical care settings is the presence of family members during resuscitation events. It remains controversial in most institutions, but evidence is increasing that the experience has positive benefits for family members. In this article, the origin of family presence is described and research evidence about the experience is presented. Three case studies are presented to illustrate typical events, including the potential role of the hospital chaplain. Recommendations for implementation are included.