Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses

Abstract

• Background Increasingly, patients’ families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices of critical care and emergency nurses related to family presence. • Objective To identify the policies, preferences, and practices of critical care and emergency nurses for having patients’ families present during resuscitation and invasive procedures. • Methods A 30-item survey was mailed to a random sample of 1500 members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association. • Results Among the 984 respondents, 5% worked on units with written policies allowing family presence during both resuscitation and invasive procedures and 45% and 51%, respectively, worked on units that allowed it without written policies during resuscitation or during invasive procedures. Some respondents preferred written policies allowing family presence (37% for resuscitation, 35% for invasive procedures), whereas others preferred unwritten policies allowing it (39% for resuscitation, 41% for invasive procedures). Many respondents had taken family members to the bedside (36% for resuscitation, 44% for invasive procedure) or would do so in the future (21% for resuscitation, 18% for invasive procedures), and family members often asked to be present (31% for resuscitation, 61% for invasive procedures). • Conclusions Nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended.

Nursing staff attitudes and behaviours regarding family presence in the hospital setting

“…The challenge is that nurses are expected to perform patient care and support families during these traumatic events (Emergency Nurses Association 1994). However, providers who have experienced family presence tend to support this practice and were the most important predictor of acceptance among emergency care providers in a study by MacLean et al (2003).…”

“…The instrument was developed by the research team, drawing on several published family-centred care surveys (Bruce 1993, Daneman et al 2003, Ellison 2003, MacLean et al 2003, Mangurten et al 2005. The 22-item questionnaire included nine items that assessed attitude about family presence during routine nursing care measured on a four-point Likert scale (strongly agree = 4, agree = 3, disagree = 2, strongly disagree = 1 and no opinion = 0), nine items that assessed behaviours related to family presence on a five-point Likert scale (always = 5, usually = 4, sometimes = 3, rarely = 2, never = 1 and not applicable = 0), two open-ended items (describe if job performance hampered by family presence; preferences for handling family presence within department), and two demographic items (job title; years of patient care experience).…”

Family presence preference when patients are receiving resuscitation in an accident and emergency department

“…Numerous recent studies have supported the option of family presence, showing that there are potential benefits to both patients and family members (Doyle et al 1987, Meyers et al 2000, Eichhorn et al 2001, Tsai 2002, Ellison 2003, Grice et al 2003, MacLean et al 2003, Marrone & Fogg 2003, Benjamin et al 2004, Mangurten et al 2005, Duran et al 2007, Fulbrook et al 2007a, Mian et al 2007, Mcmahon-Parkes et al 2009). The benefits include reassuring them that everything was being done for the patient (MacLean et al 2003, Fulbrook et al 2007a); providing emotional support for patients and families (Ellison 2003, MacLean et al 2003; helping families to make decisions about resuscitation (MacLean et al 2003); providing a positive experience for patients, families and staff; and facilitating closure and the grieving process (MacLean et al 2003). Guidelines from professional bodies (American Heart Association 2005, Emergency Nurses Association 2005, Fulbrook et al 2007b) recommend that healthcare providers offer the option of family presence during resuscitation and invasive procedures.…”

Family presence during cardiopulmonary resuscitation: Using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines

“…Briguglio (2007) found that from the patient's perspective, having family members present provided comfort, increased feelings of safety, and eased fears. MacLean et al (2003) conducted a descriptive study to identify policies, preferences, and practices of FPDR among nurses in the critical care and emergency room areas. The target population was 3000 nurses with a final sample size of 984, including 473 AACN nurses, 456 ENA nurses, and 55 nurses who were members of both organizations.…”

“…While the trend during the last 25 years has promoted a more family-centered care environment, scenes such as the one described above continue to take place in hospitals across the nation. According to one study (MacLean et al, 2003), only 5% (n = 51) of the respondents worked in hospitals with formal written policies regarding FPDR and 45% (n = 422) of the respondents worked in hospitals without formal policies and procedures in place yet still permitted families to witness resuscitative efforts of their loved ones. Of the remaining respondents in the MacLean et al study, 29% (n = 260) worked in hospitals that prohibited FPDR and there was no information offered on the final 25% (n = 224).…”