Problem Statement Recent Trends in Term Paper

Excerpt from Term Paper :


The participation of the staff is entirely voluntary and while staff will
be encouraged to participate it will not be mandatory and staff members
will only be approached once with the survey placed in their mailboxes at
work. Staff members will be allowed to return the surveys in a locked box
placed off the unit and in an unobserved area for maximum anonymity. It
would be our goal to receive completed surveys from at least fifty percent
of the nursing staff and at least fifty percent of the medical provider
staff for the staff element of the study to be valid. For medical provider
staff, we will only request surveys from individual who manage patients at
least 3 days out of the week on the intensive care units. Consultants,
dieticians, laboratory or radiology staff will not be polled, since their
involvement in resuscitation would be unlikely and minimal. For nursing
staff, we will ask for anyone who works at least 20 hours per pay period
with experience in intensive care for greater than one year, or at least
participation in five resuscitative events, no matter what the outcome.
This is primarily because we want survey results to be based upon previous
resuscitative experience and not simply on personal opinion without the
benefit of experience.

For the patients we interview we will focus primarily on those patients
preparing for elective surgery which none-the-less will likely require
intensivist intervention after the procedure. Every member of the staff as
well as intensivists and anesthetists will be provided with a written,
anonymous questionnaire and asked to return the same within twenty-four
hours. Patients between the age of 18 and 85 will also be recruited. The
patients will be those who have been scheduled to perform elective cardiac
or vascular surgery where the patient would have to spend a period of post-
operative recovery in the intensive care unit. Each patient will be asked
to complete the questionnaire in the presence of one of the researchers.
This will be a questionnaire with specific questions but will also allow
the patient space to make comments. Only patients who have next of kin
willing to participate will be allowed to participate, since a
questionnaire will also be provided to the family members and paired
responses will be analyzed.

In order to increase the likelihood of compliance with the survey, it will
be short in nature (something that can be completed in five minutes or
less). The patients will have to be English speaking. The survey will
consist of 7-10 questions regarding CPR experience, feelings about the
presence of family members in the room during resuscitative efforts and
demographic data to determine experience, age and education. The data will
be complied and transferred to a standard worksheet. A standard analysis
tool such as x2 or the Future will be used.

The procedure for the survey, and all tools used within the survey will be
reviewed and approved by the local ethics committee. Patients and staff
member demographic information will be blinded and identifying information
will not be collected. Patients will be asked to complete an informed
consent form, however, consent for participation in the survey is
considered implied by the completion of the survey. The patient's
impressions on the survey would not be considered enough to change existing
advanced directives or code situations, or local protocols and procedures.
This will be outlined clearly in the informed consent, and should patients
wish to speak to someone about code status or advance directives, then
referral will be made according to local protocols. Patients who are
considered "No Code" or have Do Not Resuscitate orders in the chart will be
approached for or included in the survey. All surveys will be hand
written. No remuneration or gift will be given for completing the survey.

Outline for Research Study

1. Research Questions -
. What are the desires of patients surrounding the presence of
family members at resuscitative events?
. What is the desire of staff members who have family members
present during resuscitative events?
2. Review of literature -
. Previous literature shows there is a lack of data surrounding
the subject, at least in as far as hard data.
. Existing studies are small scale and primarily retrospective in
nature. Patients and staff need to be surveyed as to feelings.

3. Design Research study
. The study will be using mixed methodology.
. Assessment tools include surveys provided to patients and staff
members.
. The dependent variable in this project is the opinion of staff
members and patients regarding the presence of family members at
resuscitative events.
. Independent variables include the
1. desires of family members, previous experience of resuscitative
events by staff and patients,
2. previous legal issues surrounding resuscitative events effecting
staff members,
3. incorrect media information surrounding resuscitative events and
procedures,
4. adverse outcomes from resuscitative events including liver
laceration, rib fractures or death,
5. Preconception on the part of family regarding actual
resuscitation process and procedure versus real life process and
procedure.
4. Sample selection
. Staff members who have worked more than 20 hours per week for
greater than one year, or have participated in 5 resuscitative
events.
. Patients who are scheduled for elective cardiovascular thoracic
events which will require post-surgical intensive care
management
5. Data Collection
. Data collection will be done via survey
. No identifying information will be collected.
. Staff members will receive surveys via mailboxes and will return
them to a locked, unobserved box.
6. Data Analysis
. A standard analysis tool such as x2 or the Future will be used.

7. Result interpretation
. Depending upon the results, protocols and procedures surrounding
the presence of the family members at resuscitation may change,
as may the attitudes of staff members. Staff member feelings
should be considered in the development of protocols.
8. Finding will be presented at the next conference and published if
possible.

Materials and Staffing
. 2 laptop computers (data analysis and report writing)
. One principle researcher and one research assistant
. Copy/Fax machine
. 2 cellular phones
. Copy paper for the printing of surveys

References:

Hanson C, Strawser D. Family Presence during cardiopulmonary
resuscitation: Foote Hospital emergency department's nine-year
perspective. J Emerg Nurs. 1992 Apr; 18(2):104-6

Axelsson AB, Zettergren M, Axelsson C. Good and bad experiences of family
presence during acute care and resuscitation. What makes the difference?
Eur J Cardiovasc Nurs. 2005 Jun; 4(2):161-9.
Redley B, Hood K Staff attitudes towards family presence during
resuscitation. Accid Emerg Nurs. 1996 Jul;…

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