Family Presence During Resuscitation

1. Family Presence During Resuscitation Shannon King, Leslee Johnson, Cydney Chomel, Amanda Lengerich, Kaitlyn Burke, Brooke Delay, Lindsey Gamrat, Nora Melvin, Hannah Crist, Kayelene Linkenheld

2. Background • In the past family members are taken to a waiting room during resuscitation (Boehm J., 2008)  • If and when a nurse becomes available, the family may be updated on the patient’s status (Boehm J., 2008) • Recent debate has come up on inviting families in during resuscitation  • Of families who have been apart of a code, 94% said they would do it again (Martin B., 2010)

3. Background • Nurses who invited families into the code were found to have increased self confidence (Twibell R., Siela D., Riwitis C., Wheatley J., Riegle T., Bousman D., & … Neal A., 2008) • In pediatric patients, families biggest stressor during a code was being separated from them (Maxton F. J. C., 2008) • Only 5% of Critical Care Units in the US have written policies about family presence during resuscitations (Martin B., 2010)

4. PICO Question • P- For families of Code Blue Patients • I- is being present during a resuscitation • C- compared to not being present • O- help the family cope with the event

5. Literature Review • “Family Presence During Resuscitation” • Level of evidence E: Evidence From Expert Opinions • Institutions need guidelines and should provide a support personal if family chooses to stay during resuscitation • Used several expert opinions and demonstrated the need for more research • Weaknesses of study: no actual experiment or study actually performed and there is limited knowledge regarding details of the practice (Engelhardt E., 2008)

6. Literature Review • “Should Families Be Present During Resuscitation?” • Level of evidence C: Systematic Review • Families should have the option to be present if appropriate • Looks at both the advantages and disadvantages • Looks at the family perspective and views, not just the patient • Weaknesses of the study: • No written policies • Hard to know if the patient wants family present (Fitzgerald K., 2008)

7. Literature Review • “Nurses' perceptions of their self-confidence and the benefits and risks of family presence during resuscitation” • Level of Evidence C: Qualitative • Majority agreed that family presence was a right of the family and the patient • Certified nurses and members of professional organizations perceived more benefits and fewer risks • Reluctance to family presence stems from • Unpleasantness of what the family sees • Fear that the team will not function as well • Anxiety that the family members will become disruptive • Family can see that everything was done to the patient to save the patient • Family can comfort the patient during resuscitation (Twibell et al, 2008)

8. Literature Review • 375 nurses participated in this qualitative study • 75% of the nurses had a least 6 yrs of experience • half of the study participants held a BSN degree • They used extensive statistical analysis on the survey responses • developed a tool that will allow the study to be repeated • Weaknesses of the study: • Single region (Ball Memorial Hospital Muncie, Indiana) • more than 95% were women • more than 90% were white • used convenience sampling (Twibell et al , 2008)

9. Literature Review • “Creating Advocates for Family Presence During Resuscitation” • Level of Evidence D: Peer Review • Uses different perspectives • Used national guidelines • Author has experience in codes • Medical Attitudes • Feel that family gets in the way, lack of knowledge, increased stress for both parties • Family Attitudes • Fear of the unknown, provide comfort, last chance to say goodbye • Weaknesses of the study: • Low level of evidence • Did not conduct own study (Agard, 2008)

10. Literature Review • “Parental Presence During Resuscitation in the PICU: The Parent’s Experience” • Level of evidence C: Qualitative Study • Being present lead to increased support from staff • Biggest stressor was being separated from their children • Parents felt “their role” was to be present • Purposive sampling was used • Worked with social workers to interview at appropriate times • Weaknesses of the study: • Small sample size • Study was voluntary (Maxton, 2008)

11. Implementations • Form a written policy • During admission, have a “Family Presence” form • Committee dedicated to family presence • Provide education (such as ELMS) to the staff • Assign role of facilitator for the family members • Evaluation post-implementation on all floors

12. AACN Audit of Family Presence During Resuscitation (Martin, 2010)

13. AACN Audit of Family Presence During Resuscitation (Martin, 2010)

14. References • Agard, M. (2008). Creating advocates for family presence during resuscitation.MEDSURG Nursing 17(3), 155-160. • Engelhardt, E. (2008). Family presence during resuscitation. The Journal of Continuing Education in Nursing, 39(12), 530. • Fitzgerald, K. (2008). Should families be present during resuscitation? MEDSURG Nursing, 7(16), 431-433. • Martin, B. (2010). Audit of family presence during resuscitation and invasive procedures, American Association of Critical Care Nurses. Retrieved from http://www.aacn.org/wd/practice/docs/practicealerts/family%20presence%20audit%20tool%204-2010%20final.pdf

15. References • Martin, B. (2010). Family presence during resuscitation and invasive procedures, American Association of Critical Care Nurses. Retrieved http://www.aacn.org/wd/practice/docs/practicealerts/family%20presence%2004-2010%20final.pdf • Maxton, F. J. C. (2008). Parental presence during resuscitation in the picu: the parents' experience. Journal of Clinical Nursing, 17, 3168-3176. doi: 10.1111/j.1365-2702.2008.02525.x • Twibell, R., Siela, D., Riwitis, C., Wheatley, J., Riegle, T., Bousman, D., & ... Neal, A. (2008). Nurses' perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. American Journal Of Critical Care, 17(2), 101-112.