Nursing Considerations for Family Members Presence during Cardiac Resuscitations

The Role of Family Presence in Cardiopulmonary Resuscitation

Annotated Bibliography

De Stefano, C., Normand, D., Jabre, P., Azoulay, E., Kentish-Barnes, N., Lapostolle, F., Baubet, T., Reuter, P.-G., Javaud, N., Borron, S. W., Vicaut, E., & Adnet, F. (2016). Family Presence during Resuscitation: A Qualitative Analysis from a National Multicenter Randomized Clinical Trial. PLoS ONE, 11(6), 1–12.

The purpose of this qualitative study was to analyze a series of interviews to characterize experiences of family members offered the choice to observe CPR on a loved one, within a multicenter randomized trial. Researchers interviewed 30 relatives at home 3 months after the cardiac arrest to understand their perspective. Analysis identified four main themes: 1) opting for active involvement; 2) communication with providers; 3) perceiving reality of death; 4) reactions based on witnessing or not. Twelve sub-themes provided further details. Findings highlighted communication\'s pivotal role in facilitating acceptance. Witnessing helped support the patient’s passage and gain closure. An evaluation indicates that although the findings are not entirely generalizable, they were consistent in showing that family presence can ameliorate grief through togetherness, humanization, and comprehension during resuscitation events. Taken together, this study underscored impacts of clinician communication and family presence on coping and meaning-making after tragic loss of life. These findings are also highly congruent with NMBA Registered Nurse Standards that require nurses to engage in therapeutic and professional relationships as well as to provides safe, appropriate and responsive quality nursing practice.

Mureau-Haines, R. M., Boes-Rossi, M., & Casperson, S. C. (2017). Family Support During Resuscitation: A Quality Improvement Initiative. Critical Care Nurse, 37(6), 14–23.

In the past, family members have been barred from observing hospital CPR on loved ones due to factors such as provider preference, perceived interference, psychological impact concerns, hospital norms, and lack of patient-centric models. Over the past 20 years, however, a body of literature has emerged supporting family presence during resuscitation (FPDR). Nevertheless, implementation varies, highlighting the need for evidence-based policies and training to actualize FPDR\'s benefits for families and patients. This study developed and evaluated a curriculum to train dedicated staff in a new role supporting families during hospital resuscitations in response to increasing advocacy for family presence yet lack of implementation protocols. An interdisciplinary team created a 4-hour session covering clinical aspects, integration and support steps, distress responses, and self-care. Before and after, 59 social workers and 8 spiritual providers completed surveys rating knowledge and attitudes. The results showed significant increases across all knowledge aspects related to the family support role and self-care strategies. This study demonstrates that through tailored curricular offerings, healthcare institutions can effectively train resuscitation team member who are dedicated solely to providing family support. These findings facilitate safer implementation of family presence protocols during codes which conform to NMBA Registered Nurse Standards for providing safe, appropriate and responsive quality nursing practice as well as evaluating outcomes to inform nursing practice.

Powers, K., Duncan, J. M. & Twibell, R. K. (2023). Family support person role during resuscitation: A qualitative exploration. Journal of Clinical Nursing, 32, 409-421.

While family presence during resuscitation of hospitalized loved ones has been controversial, evidence now supports associated benefits, contributing to family presence during resuscitation’s (FPDR\'s) increasing adoption as family-centered care. In these settings, trained family support staff play a vital role helping families navigate witnessing resuscitation. As FPDR expands based on recognized merits, dedicated family support persons emerge as crucial for ensuring beneficial experiences. The purpose of this qualitative study was to provide guidance for nurses on performing the family support person role during resuscitation. Though nurses increasingly serve in this role when families witness resuscitation, few studies have examined it to inform nurses. Using individual interviews, researchers explored how 16 critical care nurses perceived the role and key activities. An evaluation of this study indicates that it provides valuable insights concerning the complexity of simultaneously assessing and supporting distraught families while coordinating their presence, a role that nurses found challenging but meaningful. Upon reflection, this study provides insights to facilitate developing guidelines and training to perform this role effectively, allowing more families to safely experience presence during resuscitation which are consistent with the NMBA Registered Nurse Standards for engaging in therapeutic and professional relationships as well as evaluating outcomes to inform nursing practice.

Wang, C.-H., Chang, W.-T., Huang, C.-H., Tsai, M.-S., Yu, P.-H., Wu, Y.-W., & Chen, W.-J. (2019). Factors associated with the decision to terminate resuscitation early for adult in-hospital cardiac arrest: Influence of family in an East Asian society. PloS One, 14(3), e0213168.

Cardiopulmonary resuscitation is crucial for cardiac arrest patients; however, the ideal duration is debated. While some research on out-of-hospital cardiac arrest has linked longer CPR to worse outcomes overall, certain subgroups like those with initial shockable rhythms have shown greater resilience for favorable results with prolonged efforts. More study is needed to determine optimal CPR duration based on individual patient factors and characteristics. This retrospective study analyzed factors associated with in-hospital CPR termination decisions and the role of family presence. Researchers reviewed 1525 cardiac arrest cases from 2006-2014 at one Taiwanese hospital. Multivariate survival analysis identified variables linked to CPR duration and outcome. Median CPR time was shorter when family was present at start versus absent (23.5 vs 30 mins). Factors such as age, comorbidities, and baseline deficits correlated with earlier termination. Adjusted analysis showed family presence associated with shorter CPR duration before stopping (Hazard Ratio 1.25). An evaluation of this study shows that although the findings were specific to one East Asian hospital, family presence at CPR start was associated with shorter resuscitation duration. In addition, the researchers also concluded that clinicians’ decisions concerning when to terminate CPR seemed to be based on outcome prognosticators because family presence at the beginning of CPR was associated with shorter duration of CPR. These findings have significant implications for developing cross-cultural competencies which are mandated by the NMBA Registered Nurse Standards for maintaining the capability for practice as well as developing a plan for nursing practice.

Implications and Recommendations for Clinical Practice

Reflect on the current literature and Intensive Care environment/practices or guidelines

While historically controversial, an emerging body of evidence now supports family presence during cardiac resuscitations as an aspect of patient-centered care that can provide comfort, facilitate coping, and bring closure to loved ones during difficult moments. Further, family presence during these critical events provides them with the opportunity to offer their incensory prayers on behalf of their loved one. Thoughtfully coordinating family presence during this emotion-charged events, though, requires dedicated training and protocols to ensure supportive communication and appropriate duration tailored to the sensitivities of each case.

The literature reviewed for the annotated bibliography provides valuable insights on family presence during resuscitation (FPDR), underscoring the benefits of enabling families to be present while conforming to professional standards. The current evidence reflected in the reviewed literature indicates FPDR improves coping, closure and care experiences for families during tragic circumstances; translating these findings into practice, though, requires concerted training and policies to facilitate effective family support.