Roland Harrison Brant Mahan David McAllister Jeff Struttmann

1.  Roland Harrison Brant Mahan David McAllister Jeff Struttmann

2. Family Witnessed Resuscitation Family witnessed resuscitation (FWR) is the act of allowing family members to be present during cardiopulmonary resuscitation of a loved one

3. History of Family Presence The ethical debate on whether family presence should be allowed spans over two decades, with the first study being conducted in 1987 FWR has become significantly more relevant due to the increase of family members expressing a desire to be present during their loved ones last moments

4. Evidence of Increasing Trend Dingeman (2007) systematic review of literature 1991 - <50% of parents wanted to be present 2001 - 87% of parents wanted to be present

5. Evidence of Increasing Trend Dingeman (2007): Systematic Review of Literature Meyers (1998) Descriptive Survey 96% of family stated the option should be given 80% stated they would stay if given the option Meyers (2000) Descriptive Survey 98% of patient family stated it their �right� to be present & would do it again

6. Organizations Endorsing FWR American Heart Association 2000 recommendations Emergency Nurses Association Family facilitator American Association of Critical Care Nurses

7. Problem at Hand Although research indicates a rise in family desire for presence and proposes benefits to FWR, only 5% of hospitals have implemented a written protocol/policy MacLean (2003) Survey of 1500 ENA & 1500 AACC nurses 948 respondents Only 5% worked on a unit with written policies

8. PICO Question Can having family present during cardiopulmonary resuscitation have positive benefits to both family members and nurses?

9. Family Perspective Boudreaux (2002) Review of Literature Of 47 mailed surveys of family members who remained present during resuscitation 44 (94%) stated they would participate again 36 (76%) stated benefits to adjustment to death 30 (64%) believed presence was beneficial to dying loved one

10. Family Perspective Meyers (1998) Descriptive Survey 68% believe their presence was helpful 64% said it would help them to cope Meyers (2000) Descriptive Survey 100% stated it was helpful 98% stated it helpful to family/patient

11. Benefits Proposed by Family Helps in understanding the seriousness of patient situation Decreases anxiety Witness �everything possible was done� Provides sense of closure Facilitates grieving process Chance to say �I love you� or �Goodbye� Facilitates role of �caretaker�

12. Surviving Patient Perspective Provides comfort Reminds staff of patients� �personhood� Provided reason to fight

13. Benefits Proposed by Nurses MacLean (2003) Survey of 948 ENA & AACN Nurses Provides emotional support Provides positive experience for families, staff, patients Provides guidance/increases family understanding Helps families make decisions Helps family to know �all was done for patient� Facilitates closure and healing

14. Positive Views of FWR by Nurses 92% of nurses supported FWR (Mangurten, 2006) 92% of Canadian Critical Care Nurses supported FWR (Fallis, 2008) 96% of ED nurses supported FWR (Dingeman, 2002) Ellison (2003) 13-item Survey of Nurses 56% wanted to be present if patient was a family member 87% wanted family present if they were the patient

15. Opposing View McClenathan (2002) 30-item Survey of Nurses 543 physicians, 28 nurses, 21 allied health care 78% opposed family presence Nurses showed a more positive attitude towards FWR than physicians

16. Reasons for Opposing MacLean (2003) Patient related issues Privacy Family related Issues Behaviors/Emotional Reactions Lack of Education/Understanding Family/Staff Relationships Environmental Limited Space Chaos/Confusion Legal Litigation & Family Complaints Staff related Issues Stress/Discomfort Impeding Work Inadequate Staffing

17. Evidence Disputing Opposing View Mangurten (2006) 100% of patient cases were uninterrupted 90% of clinicians believed family behavior was not disruptive 90% of clinicians stated their performance was not affected Dingeman (2007) Review of Literature 15 articles were reviewed and almost no instances of family interference were reported

18. Evidence Disputing Opposing View Dingeman (2002) Systematic Review of the Literature Meyers (2000) Survey No family members reported any traumatic memories 2 months after the event Boudreaux (2002) Critical Review of Literature Policies denying FWR may not meet the emotional/spiritual needs of family members

19. Factors Affecting Support of FWR Ellison (2003) 13-item Survey Positive Attitudes to Resuscitation Strongly Correlated with: Education Specialty Certification Professional Designation Specialty Area

21. Recommendations It is our recommendation that healthcare organizations adopt a FWR policy and a FWR education program to improve outcomes for families and nurses during cardiopulmonary resuscitation.

22. FWR Implementation Needs Need for Collaboration among specialty groups (Social, Pastoral, Physicians) to develop guidelines Involve Nurses in development and implementation Develop Educational resources for policies, practices, and programs supporting option Develop Educational resources for the public Need for continuing education to increase understanding of presence

23. Components for Policies, Procedures, and Educational Programs Policies and procedures, and educational programs for professional staff should include the following components: Benefits of family presence for the patient and family. Criteria for assessing the family to ensure uninterrupted patient care. Support for patients� or family members� decision not to have family members present. AACN (2004)

24. Components for Policies, Procedures, and Educational Programs Role of the family facilitator in preparing families for being at the bedside and supporting them before, during and after the event. Family facilitators may include nurses, physicians, social workers, chaplains, child life specialists, respiratory care practitioners, family therapists. Contraindications to family presence Family members who demonstrate combative or violent behaviors Uncontrolled emotional outbursts Altered mental state from drugs or alcohol Those suspected of abuse. AACN (2004)

25. Importance of Education Bassler (1999) Survey of Nurses to show Educational Effects on Nurses Attitudes toward FWR Before Educational Class 56% said family should be given the option to be present 11% gave the family the option to be present After Educational Class 89% said family should be given the option to be present 79% planned on giving the option to be present

26. Suggestions For Further Study Studies need to incorporate all pertinent demographics of the sample Age, race, relationship to family member, education, etc. Follow up studies regarding the experiences of adult patients who survive resuscitation while family was present and not present Programs that have protocols in place need to devise a way keep a registry of positive and negative experiences from both family and staff point of view Family interference, problematic levels of distress, need to be dismissed from the room This type of data may further play a part in allowing us to dispel health professionals fears regarding family presence.

27. New Research Questions What are the implications and beliefs of the need for family presence among individuals of different cultural backgrounds? What about individuals from various religious backgrounds?