Family Presence During Resuscitation

Julie K. Kuzin RN, CPNP-AC/PC Shino S. Thomas RN, NNP-BC

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Objectives 1) Identify the perceived risk and reward received by families present during resuscitation of infants and children. 2) Discuss interventions that provide support to families during resuscitation events. 3) Discuss the desired outcomes of family presence during resuscitation.

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Family Centered Care is the 3

rd

of 6 central aims to improve healthcare

Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

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Historical Timeline Family Centered Care (FCC)

History of Family Visitation in Hospitals

• 1894 Boston Children’s Hospital •Visit 2 days per week • 1910 Massachusetts General Hospital •Crying children moved into isolation • 1959 Platt Report •Advocated for open visitation (Markel 2008, Ismail & Mulley 2007) Page 6 AM

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History of Family Centered Care

(Kuo, et al. 2012 ) 1980s • Maternal and Child Health Bureau and Surgeon General offices advocated for family centered care 2001 • Institute of Medicine named patient centered care as crucial for health care quality • AAP had incorporated FCC into multiple policy statements and affirmed FCC as the standard of health care for all children 2003 xxx00.#####.ppt 1/2/2014 11:50:4 AM

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History of Family Presence During Resuscitation (FPDR)

(Boehm 2008) 1982 Foote Hospital in Michigan • 2 family member requested to be present during resuscitation • Survey showed 13 of 18 family members wished they had been present 1985 Program Developed by Foote Hospital • 47 bereaved family members responded to survey • 76% stated being present helped them grieve • 64% felt their presence helped dying family member xxx00.#####.ppt 1/2/2014 11:50:4 AM

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History of FPDR

Dingeman, et al. 2007, Henderson and Knapp 2005 1993 Emergency Nurses Association • First to develop a resolution supporting family presence 2000 & 2005 American Heart Association • Resolution supporting families be given option • Presence of support personnel for family member 2002 American Association of Critical Care Nurses • Health care organizations have written policy regarding FPDR 2004 American Academy of Pediatrics Consensus • 18 organizations convened to develop recommendations for FPDR xxx00.#####.ppt 1/2/2014 11:50:4 AM

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Current Literature

• Institutional Support •About 9% of hospitals have written policy (Dingeman, et al 2007) •One of three nurses surveyed offered families the option (Halm, 2005) •Increasing demand •1991 survey reported half of families would choose to be present •About a decade later 87% would be present •86% felt it was their parental

Right

(Dingeman et al 2007) 10 AM

Patient Perspective

Adult patient data •Endorsed their humanity •Benefit to family members outweighed risks •Did not create embarrassment •Wanted family members present, even if it was traumatizing (Mortelmans, 2009) •3 survivors were content that family present (Dudley, 2009 ) Page (ENA 2009, Dingeman 2007, McGahey, 2007; Meyers, 2000; Pirra, 2005; Tinsley, 2008 ; 11 AM

Family Perspective

• Decreased anxiety, Increased satisfaction • Improved Coping “Everything could be done was done” • Helpful, comforting to their child during trauma resuscitation • 72% of pts & family wanted family present (Benjamin, 2004) • 94% would repeat their decision to be present during invasive procedure (Powers & Rubenstein, 1999) • Family “Right” & should have the option, 100% said it was helpful (Meyers, 2000) • 11% were asked, 69% would have wanted the opportunity, 62% would have chosen to be present (Barrett & Wallis, 1998) Page (Dingeman 2007, Dudley 2009, ENA CPG 2009, Mortelmans 2009, Piira 2005, Tinsley 2008) 12 AM

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Provider Perspective

Violation of patient confidentiality Adult patient perspective in support of FPDR Parents key to providing medical information Supported patient dignity Increased stress on staff RNs and senior physicians support FPDR 79% felt residents should be trained in FDPR (Gold, 2006) Increased risk of litigation No literature to support Provider performance Too traumatic for families to witness No delay in care Improved grieving process No difference in procedure success rate No delay in stopping resuscitation Less depression, PTSD and anxiety long term follow-up Humanized the patient Promoted family acceptance of death, know everything was done (Halm 2005; Dingeman et al 2007, ENA CPG 2009) xxx00.#####.ppt 1/2/2014 11:50:4 AM

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Randomized Control Trial Jabre et al (France) New England Journal of Medicine 2013

570 relatives 15 EMS units (driver, RN, MD) Randomized to offer FPDR or follow standard practice Experimental group 79% present for CPR Control group 43% present for CPR PTSD higher in the control group and higher in those who did not witness CPR FPDR did not affect resuscitation, patient survival, staff stress, or medicolegal claims xxx00.#####.ppt 1/2/2014 11:50:4 AM

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Cultural Perspective

Singapore - 75% of physicians and 78% of nurses families should not be present United Kingdom - 62% of families would have chosen to be present if given the chance United Kingdom – 63% did not favor FPDR -mostly physician Scotland – 13% supported FPDR, 48% were unsure, 71% wanted a policy Sweden – Nurses and physicians thought few families would want FPDR, more nurses than physicians would always respect families wishes. Australia – 62% would consider FPDR, 70% would want it for themselves, 76% procedure offensive to family Turkey, Saudi Arabia, Germany, Hong Kong (guarded or negative attitudes) (Dingeman et al 2007, ENA 2009, Halm 2005) xxx00.#####.ppt 1/2/2014 11:50:4 AM

In summary

• No negative effect on delivery of care • Not evidence of harm in the literature • Improves psychological impact on families • Patients and families want the option • Healthcare providers hold unfounded fears • FPDR is a key component of Family Centered Care Page xxx00.#####.ppt 1/2/2014 11:50:4 AM

Family Panel

Nalah Deonc Griffin & Grayson Harper Jenna

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Where do we go from here?

• Institutional policy • Healthcare provider education • Family support person • What is the patient’s voice?

• Ongoing evaluation of effect on families?

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Reference List

American Academy of Pediatrics Committee on Hospital Care Family centered care and the pediatrician’s role. Pediatrics. 2003;112:691– 697. doi: 10.1542/peds.112.3.691. Barrett F., Wallis, DN (1998). relatives in the resuscitation room: Their point of view. Journal of Accident and Emergency Medicine 15(2), 109-111.

Boehm, J., (2008) Family presence during resuscitation.

Code Communications, 3(5).

Available at http://www.zoll.com/CodeCommunicationsNewsletter/CCNL05_08/CodeCommunications05_08.pdf

. Accessed 23 Dec 2013 Curley, M.A., Meyer, E.C., Scoppettuolo, L.A., McGann, E.A., Trainor, B.P., et al. (2012) Parent presence during invasive procedures and resuscitation: Evaluating a clinical practice change.

American Journal of Respiratory and Critical Care Medicine, 186(11), 1133-1139

Dingeman, R.S., Mitchell, E.A., Meyer, E.C., & Curley, M.A. (2007). Parent presence during complex invasive procedures and cardiopulmonary resuscitation: A systematic review of literature.

Pediatrics, 120(4), 842-854.

Dudley, N.C., Hansen, K.W., Furnival, R.A., Donaldson, A.E., Van Wagene, K.L., & Saife, E.R. (2009). The effect of family presence on the efficiency of pediatric trauma resuscitations.

Annals of Emergency Medicine, 53(6), 777-784e3.

Emergency Nursing Resources Development Committee. (2009, revised 2012). Clinical practice guideline: Family presence during invasive procedures and resuscitation. Emergency Nurses Association. Available at http://www.ena.org/practice research/research/CPG/Documents/FamilyPresenceCPG.pdf

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Reference List

Halm, M. A. (2005) Family presence during resuscitation: A critical review of the literature.

American Journal of Critical Care, 14(6) 494-511

Henderson, D.P., Knapp, J.F. (2005). Report of the national consensus conference on family presence during pediatric cardiopulmonary resuscitation and procedures.

Pediatric Emergency Care, 21(11), 787-791

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001. Available at http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed 29 Dec 2013. Institute for Patient- and Family-Centered Care. Patient- and Family-Centered Care Core Concepts. http://www.ipfcc.org/faq.html. Accessed Dec 29 2013 .

Ismail, S., Mulley, G. (2007) Visiting times.

British Medical Journal, 335, 1316

Jabre, P. et al. (2013) Family presence during cardiopulmonary resuscitation.

The New England Journal of Medicine, 368, 1008-1018.

Kuo, D.Z., Houtrow, A.J., Arango, p., Kuhlthau, K.A., Simmons, J.M., Neff, J.M., (2012) . Family centered Care: Current applications and future directions in pediatric health care.

Maternal and Child Health Journal, 16(2), 297-305.

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Reference List

Markel, H., (2008) .When hospitals kept children from parents.

The New York Times

. Available at http://www.nytimes.com/2008/01/01/health/01visi.html?_r=0 . Accessed 7 Nov 2013.

Maternal and Child Health Bureau. Definition of Family-Centered Care: www.familyvoices.org/admin/work_family_centered/files/FCCare.pdf. 2005. Accessed Dec 29 2013. McGahey-Oakland PR , Lieder HS , Young A , Jefferson LS .

McGahey-Oakland, P.R., Lieder, H.S., Young, A., Jefferson, L.S. (2007). Family experiences during resuscitation at a children's hospital emergency department.

Journal of Pediatric Healthcare, 21(4), 217-225.

Mortelmans, L.J.M., Van Broeckhoven, V., Van Boxstael, S., De Cauwer, H.G., Verfaillie, L., Van Hellemond , P.L.A., et al. (2009). Patients’ and relatives’ view on witnessed resuscitation in the emergency department: A prospective study.

European Journal of Emergency Medicine, 00, 000-000. (Ahead-of-print publication).

Piira, T., Sugiura , T., Champion, G.D., Donnelly, N., & Cole, A.S.J. (2005). The role of parental presence in the context of children’s medical procedures: A systematic review.

Child: Care, Health & Development, 31(2), 233-243.

Tinsley, C., Hill, J.B., Shar, J., Zimmerman, G., Wilson, M., Freier, K., & Abd-Allah, S. (2008). Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit.

Pediatrics, 122(4), e799-e804.

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