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.     

Nurses' knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature

AIM: This paper reports a literature review examining factors that enhance retention of knowledge and skills during and after resuscitation training, in order to identify educational strategies that will optimize survival for victims of cardiopulmonary arrest. BACKGROUND: Poor knowledge and skill retention following cardiopulmonary resuscitation training for nursing and medical staff has been documented over the past 20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is important as nurses often discover the victims of in-hospital cardiac arrest. Many different methods of improving this retention have been devised and evaluated. However, the content and style of this training lack standardization. METHOD: A literature review was undertaken using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and British Nursing Index databases and the keywords 'cardiopulmonary resuscitation', 'basic life support', 'advanced life support' and 'training'. Papers published between 1992 and 2002 were obtained and their reference lists scrutinized to identify secondary references, of these the ones published within the same 10-year period were also included. Those published in the English language that identified strategies to enhance the acquisition or retention of Cardiopulmonary resuscitation skills and knowledge were included in the review. RESULTS: One hundred and five primary and 157 secondary references were identified. Of these, 24 met the criteria and were included in the final literature sample. Four studies were found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-instruction, three to the use of different resuscitation guidelines, three to computer-based learning programmes, two to voice-activated manikins, two to automated external defibrillators, one to self-instruction, one to gaming and the one to the use of action cards. CONCLUSIONS: Resuscitation training should be based on in-hospital scenarios and current evidence-based guidelines, including recognition of sick patients, and should be taught using simulations of a variety of cardiac arrest scenarios. This will ensure that the training reflects the potential situations that nurses may face in practice. Nurses in clinical areas, who rarely see cardiac arrests, should receive automated external defibrillation training and have access to defibrillators to prevent delays in resuscitation. Staff should be formally assessed using a manikin with a feedback mechanism or an expert instructor to ensure that chest compressions and ventilations are adequate at the time of training. Remedial training must be provided as often as required. Resuscitation training equipment should be made available at ward/unit level to allow self-study and practice to prevent deterioration between updates. Video self-instruction has been shown to improve competence in resuscitation. An in-hospital scenario-based video should be devised and tested to assess the efficacy of this medium in resuscitation training for nurses.     

Family member presence during resuscitation in the emergency department: An Australian perspective

Objective: The practice of family member presence during resuscitation in the ED has attracted widespread attention over the last few decades. Despite the recommendations of international organizations, clinical staff remain reluctant to engage in this practice in many EDs. This paper separates the evidence from opinion to determine the current state of knowledge about this practice. Methods: A search strategy was developed and used to locate research based publications, which were subsequently reviewed for the strength of evidence providing the basis for recommendations. Results: The literature was examined to reveal what patients and their family members want; the outcomes of family presence during resuscitation for patients and their family members; staff views and practices regarding family presence during resuscitation. Findings suggest that providing the opportunity to be with their critically ill family member is both important to and beneficial for families, however, disparity in staff views has been identified as a major obstacle to family presence during resuscitation. Examination of published guidelines and staff practices described in the literature revealed consistent elements. Conclusion: Although critics point to the lack of rigour in this body of literature, the current state of knowledge suggests merit in pursuing future research to examine and measure effects of family member presence during resuscitation on patients, family members and healthcare providers.     

The effect of medical emergency teams on patient outcome: a review of the literature

This paper presents a review of literature on the impact of the medical emergency team (MET) on inpatient mortality, cardiopulmonary arrests or unscheduled intensive care unit (ICU) admissions. A total of 14,172 abstracts and 98 full text papers were reviewed. In total, 24 met the inclusion criteria, 2 used a cluster-randomized controlled trial, 11 before and after, 6 retrospective analyses, 4 prospective cohorts and 1 not reported. There is moderate to strong evidence that METs are associated with decreased mortality and cardiac arrest rates, and weak evidence on its impact on ICU admission rate reductions. This evidence suffers from the flaws with only two randomized controlled trials examining differing outcome measures with differing results. Poor methodology and failure to report both quality improvement co-interventions and time response rates of METs, limit the strength of the evidence that METs are effective interventions for preventing mortality, code rates or unscheduled ICU admissions. Studies with improved implementation practices and evaluation of the efficacy of MET is warranted.     

急诊医务人员实施紧急气管插管对心肺复苏疗效的探讨

目的 总结心肺复苏时及时气管插管的重要性.方法 对128例心肺复苏患者分为由急诊医护人员气管插管(即刻插管)与由麻醉科医师插管(延时插管)两组.通过观察复苏成功率与出院成活率,比较即时插管与延时插管的疗效.结果 即时插管患者的复苏成功率为43.6%,存活率为34.8%,延时插管患者的复苏成功率为10.4%,存活率为6.3%.两组相比差异有统计学意义(P＜0.01).结论 应提倡急诊医务人员在心肺复苏时紧急气管插管.     

Adolescent access to emergency contraception in A and E departments: reviewing the literature from a feminist perspective

Recent moves in parts of UK to provide opportunities for 'over the counter' purchasing at pharmacies, has meant that access to emergency oral hormonal contraception for adolescents is undergoing something of a revolution. The provision of emergency contraception (EC) to adolescents in Accident and Emergency (A and E) departments, however, is nothing new and is now an established component of the current government objective to reduce teenage pregnancy rates in this country. The tensions apparent in A and E departments related to the provision of EC, particularly to adolescents, have recently been recognized, but little attention has been paid to analysing the reasons why such tensions might exist. This article is based on a literature review carried out as part of a study of nurses' encounters with adolescents accessing EC in A and E departments in the North-west of England. It is a reappraisal of the salient issues in this arena from a feminist perspective, aiming to provide an alternative with which to view the encounter between adolescents and service providers in A and E.     

Short- and long-term impact of critical illness on relatives: literature review

Title. Short‐ and long‐term impact of critical illness on relatives: literature review. Aim. This paper is a report of a literature review undertaken to identify the short‐ and long‐term impact of critical illness on relatives. Background. Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after intensive care. Data sources. The following databases were searched for the period 1950–2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews – Cochrane Central Register of Clinical Trials. Search methods. Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. ‘relatives needs’, ‘meeting relatives’ needs’, ‘interventions’, ‘satisfaction’, ‘psychological outcomes’ and ‘coping’. Results. Studies have mainly identified relatives’ immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives’ needs and the short‐ and long‐term effects of critical illness on relatives. Conclusion. Despite widespread use of the Critical Care Family Needs Inventory, factors such as local or cultural differences may influence relatives’ needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives’ needs and the effects of critical illness on their well‐being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the illness.     

Burnout intervention studies for inpatient elderly care nursing staff: Systematic literature review

Background

Staff providing inpatient elderly and geriatric long-term care are exposed to a large number of factors that can lead to the development of burnout syndrome. Burnout is associated with an increased risk of absence from work, low work satisfaction, and an increased intention to leave. Due to the fact that the number of geriatric nursing staff is already insufficient, research on interventions aimed at reducing work-related stress in inpatient elderly care is needed.

Objective

The aim of this systematic review was to identify and analyse burnout intervention studies among nursing staff in the inpatient elderly and geriatric long-term care sector.

Methods

A systematic search of burnout intervention studies was conducted in the databases Embase, Medline and PsycNet published from 2000 to January 2012.

Results

We identified 16 intervention studies. Interventions were grouped into work-directed (n = 2), person-directed (n = 9) and combined approaches (work- and person-directed, n = 5). Seven out of 16 studies observed a reduction in staff burnout. Among them are two studies with a work-directed, two with a person-directed and three with a combined approach. Person-directed interventions reduced burnout in the short term (up to 1 month), while work-directed interventions and those with a combined approach were able to reduce burnout over a longer term (from 1 month to more than 1 year). In addition to staff burnout, three studies observed positive effects relating to the client outcomes. Only three out of ten Randomised Control Trials (RCT) found that interventions had a positive effect on staff burnout.

Conclusion

Work-directed and combined interventions are able to achieve beneficial longer-term effects on staff burnout. Person-directed interventions achieve short-term results in reducing staff burnout. However, the evidence is limited.