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), 112.

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 patients 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), 1423.

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...…requires concerted training and policies to facilitate effective family support.

Compare and contrast the evidence to current practice in your work setting

In many ICU settings, restricted visitation limits family presence in general and during cardiac resuscitation events in particular, a reality that contrasts with the literature's endorsements for greater FPDR accessibility given the broad range of benefits that accrue to the practice. In order to better align practice with standards emphasizing responsive, compassionate care, ICUs should develop FPDR protocols and trained, dedicated support roles. Implementing FPDR would enhance conformance with NMBA Standards requiring therapeutic relationships and quality, responsive care.

Recommendations for practice

It is recommended that appropriate protocols should be implemented that allow family member presence during resuscitations. Dedicated support roles that receive training like the curriculum analyzed in Mureau-Haines et al. (2017) should be instituted. With proper preparation, staff can provide supportive communication and coordinate family presence to humanize the situation, as De Stefano et al. (2016) found. Aligning practices with evidence promoting FPDR will enable delivering more patient-and-family centered care. Moreover, facilitating family presence is in line with current NMBA Standards, including most especially the requirements to engage in therapeutic and professional relationships as well as evaluating outcomes to inform nursing practice.

In sum, FPDR's benefits warrant translating current evidence into protocols through trained support roles. With careful implementation, families can gain closure while patients receive holistic care respecting preferences. Supporting loved ones aligns with ethical, compassionate practice. As Wang et al. (2019) concluded, effective clinician communication is key to ensuring appropriate FPDR duration. Finally, notwithstanding the challenges that are involved, the research was consistent…