Family Presence during Resuscitation Pamela Green, MSN, FNP-C Linda Roussel, PhD, RN, NEA-BC, CNL University of Alabama at Birmingham School of Nursing Background

Cardiopulmonary resuscitation frequently marks end of life. Less than 17% of successful resuscitations survive to discharge.

Current healthcare practice does not allow for family members to be with their loved ones during resuscitation. Family Presence in the Resuscitation Room is endorsed by - The Emergency Nurses Association - The American Heart Association - The American Association of Critical Care Nurses Less than 5% of critical care areas in the U.S. have a policy allowing family presence during resuscitation.

Significance

Literature review demonstrates differing opinion between patients, family members and medical staff.

Patient: 72% want family present Family member: 75% want to be present Presence perceived as a right Healthcare provider: 83% disagree with family presence fearing: -interference with resuscitation efforts -trauma to family members -stress on the healthcare team - medical/legal concerns.

Purpose

Align clinical practice with evidence regarding family presence during resuscitation. PICO Question: For medical staff in an acute care setting, does knowledge of evidence change opinion regarding family presence in the resuscitation room?

Methods

Active and courtesy medical staff members of Baylor Medical Center at Carrollton were asked to participate in a two part study to include an initial survey followed by a ten slide Family Presence presentation with references and repeat survey. Step 1: Review of literature and guidelines Identify target population Step 4: Distribute education slides and second survey to target population Step 2: Develop survey Develop education slides IRB approval Step 5: Analyze survey results using SPSS statistical program Evaluate effect of education on medical staff opinion.

Step 3: Distribute initial survey to target population

Goal

Identify barriers to family presence in the resuscitation room.

Reinforce the benefit of family presence in the resuscitation room.

Dispel false perceptions of risk to family presence in the resuscitation room.

Encourage a culture of patient and family centered care.

Results

Family Presence during Resuscitation Percentages based on Gender and Practice Area

(n= 32, response rate 13.4%)

87.5%

Male

12.5%

Female

21.9%

ED

25%

ICU

46.9%

GIP

3.1%

Womens Service

3.1%

Pedi

Indicator

Family members should have the option to be present during CPR Family members present for CPR have fewer psychological difficulties during bereavement FPDR results in higher rates of family satisfaction with care Witnessing CPR causes emotional trauma to family members Family members who witness CPR are more likely to file lawsuit FPDR inhibits code team communication FPDR interferes or interrupts care Comfort with providing psycho-social spiritual support for family members during CPR

% Agree and Somewhat Agree Survey #1 % Agree and Somewhat Agree Survey #2

55.6% 50.0% 55.6% 72.2% 41.2% 61.1% 61.1% 66.6% 69.2% 53.9% 69.2% 53.8% 7.7% 46.2% 38.5% 76.9%

Outcome

13.6% increase 3.9% increase 13.6% increase 18.4% decrease 33.5% decrease 22.6% decrease 19.4% decrease 10.3% increase

Conclusion:

Physician opinion is impacted by the presentation of evidence in support of practice change. Based on the comparison, it would be beneficial to provide education across the Baylor Health Care System prior to formal policy and procedure for family presence during resuscitation.

References

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Doyle, C. J., Post, H., Burney, R. E., Maino, J., Keefe, M., & Rhee, K. J. (1987, February 3). Family participation during resuscitation: an option.

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Jabre, P., Belpomme, V., Azoulay, E., Jacob, L., Bertrand, L., Lapostolle, F., ... Bouilleau, G. (2013, March 14). Family presence during cardiopulmonary resuscitation.

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MacLean, S. L., Guzzetta, C. E., White, C., Fontaine, D., Eichhorn, D.J., Meyers, T. A., & Desy, P. (2003, June). Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses.

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29:3

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