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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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family presence during resuscitation

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
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)
background1
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)
pico question
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
literature review
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)

literature review1
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)

literature review2
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)

literature review3
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)

literature review4
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)

literature review5
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)

implementations
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
references
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
references1
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.