Factors influencing decision‐making around family presence during resuscitation: a grounded theory study

Abstract

Aim The aim of this study was to examine factors impacting family presence during resuscitation practices in the acute care setting. Background Family presence during resuscitation was introduced in the 1980s, so family members/significant others could be with their loved ones during life‐threatening events. Evidence demonstrates important benefits; yet despite growing support from the public and endorsement from professional groups, family presence is practiced inconsistently and rationales for poor uptake are unclear. Design Constructivist grounded theory design. Methods Twenty‐five health professionals, family members and patients informed the study. In‐depth interviews were undertaken between October 2013–November 2014 to interpret and explain their meanings and actions when deciding whether to practice or participate in FPDR. Findings The Social Construction of Conditional Permission explains the social processes at work when deciding to adopt or reject family presence during resuscitation. These processes included claiming ownership, prioritizing preferences and rights, assessing suitability, setting boundaries and protecting others/self. In the absence of formal policies, decision‐making was influenced primarily by peoples’ values, preferences and pre‐existing expectations around societal roles and associated status between health professionals and consumers. As a result, practices were sporadic, inconsistent and often paternalistic rather than collaborative. Conclusion An increased awareness of the important benefits of family presence and the implementation of clinical protocols are recommended as an important starting point to address current variations and inconsistencies in practice. These measures would ensure future practice is guided by evidence and standards for health consumer safety and welfare rather than personal values and preferences of the individuals ‘in charge’ of permissions.

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

“…Data were drawn from a larger constructivist grounded theory study that examined factors and perceptions impacting decision‐making around FPDR (Giles, de Lacey & Muir‐Cochrane, ). In that study, we used an inductive process to develop a new theory of decision‐making entitled “The social construction of conditional permission.” We noted multiple examples of clinicians (nurses, doctors, paramedics) trying to act in the best interests of patients and families with mixed outcomes, and one theme that emerged during analysis was clinicians “doing what's best” for patients and their families.…”

“…The entire participant population included 17 women and eight men aged 26–61 comprising one resuscitation patient, four family members, 15 registered nurses, two doctors and three paramedics. Participant details have been presented in full elsewhere (Giles, de Lacey & Muir‐Cochrane, ). The principal author (TG) undertook 28 in‐depth interviews (25 initial and three follow‐up) between October 2013–November 2014.…”

“…The principal author (TG) undertook 28 in‐depth interviews (25 initial and three follow‐up) between October 2013–November 2014. Each interview began with a demographic questionnaire to establish geographical, cultural and social context and then used a flexible interview guide to explore individual experiences (Giles, de Lacey & Muir‐Cochrane, ). During the interviews, participants were asked about their social and organisational practices around FPDR, their personal beliefs about those practices and their individual participation in FPDR.…”

“…Decisions that impact the welfare of patients and families usually involve an ethical lens, where the benefits and harms of such decisions are weighed by clinicians and the action with the best‐predicted outcome is chosen (Kerridge, Lowe, & Stewart, ). However, decisions to deny access for families during resuscitation events seem based on anecdotal experience and personal preferences rather than on sound rationales, and do not appear to reflect current evidence (Agard & Lomborg, ; Davidson et al., ; Giles, de Lacey, & Muir‐Cochrane, ).…”

“…More recently, Vincent and Lederman (, p1) argued that the “ethical norm” of allowing FPDR for paediatric patients should also be extended to adult patients. However, we could only locate two primary studies that had undertaken an in‐depth exploration into decision‐making around FPDR (Giles et al., ; Twibell, Siela, Riwitis, Neal, & Waters, ), and we could not locate any studies specifically exploring the role of beneficence in decision‐making around FPDR.…”