Transcript Family Presence During Resuscitation

Shannon King, Leslee Johnson, Cydney Chomel, Amanda
Lengerich, Kaitlyn Burke, Brooke Delay, Lindsey Gamrat,
Nora Melvin, Hannah Crist, Kayelene Linkenheld
Background
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 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)
Background
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 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)
PICO Question
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 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
Literature Review
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 “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)
Literature Review
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 “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)
Literature Review
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 “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)
Literature Review
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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:
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Single region (Ball Memorial Hospital Muncie, Indiana)
more than 95% were women
more than 90% were white
used convenience sampling
(Twibell et al , 2008)
Literature Review
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 “Creating Advocates for Family Presence During Resuscitation”
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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)
Literature Review
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 “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)
Implementations
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 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
AACN Audit of Family
Presence During Resuscitation
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(Martin, 2010)
AACN Audit of Family
Presence During Resuscitation
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(Martin, 2010)
References
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 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
References
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 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/famil
y%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.