In written protocol for family presence during resuscitation

In an emergency setting, how does family presence compare to no family present during resuscitation benefit or harm nurses and families after the visit?   Although there is a growing number of healthcare facilities that are initiating this protocol, many others are reluctant to do so out of concern for family members, staff, and legal implications.   The research article “It’s Just What We Do”: A Qualitative Study of Emergency Nurses Working with Well-Established Family Presence Protocol provides more insight into this persistent question.  By studying this topic in a facility that has an established protocol, Elinar Lowery, Ph.D., RN, and author, gathered qualitative data supporting the presence of family members during resuscitation.  Without reluctance or fear, nurses providing quality care should invite family members to attend resuscitation efforts to save loved ones. 

BACKGROUND OF STUDY

            Many hospitals remain hesitant to allow family presence during resuscitation due to concerns regarding the quality and outcome of the event.  Fear that presence could directly or inadvertently have undesirable results are a concern.  Further apprehensions include the thoughts that families may interrupt treatment, there is an absence of space to accommodate the family and a supposed greater risk of lawsuits. (Goldberger, 2015) The purpose of this study was to gather data and determine nurse perceptions of this procedure. This study was conducted in a healthcare facility that has recognized and written protocol for family presence during resuscitation since 1992.  The researcher contacted all seventy-six registered nurses that had experienced a resuscitation with family in attendance via letters and direct contact for sampling purposes. 

 

METHODS OF STUDY

Nineteen nurses responded initially.  Only fourteen nurses joined in the research. Nurses voluntarily participated after informed consent was attained.  Demographics were obtained and an interview with open-ended questions answered. An example included, “Can you tell me about a family presence experience you had that was positive?  Can you tell about one that did not go so well?”  Interviews were audiotaped and copied verbatim.  The researcher kept a journal and had a second person help to create categories and establish tendencies.  Throughout the research, the author references qualitative methods borrowed from others to gather data, including consistent guidelines offered by Lincoln and Guba.  (Lowry, 2012).  A total of thirty-two references were utilized ranging from 1985 to 2010 for this study. The author and helper checked each other’s work and held one another accountable to achieve dependability, reproducibility, and eighty percent accurateness of the interpretation.  Results were recorded.  The author developed a perspective that family presence should be allowed during resuscitation efforts based on the findings from this study.  The researcher used the phenomenology method to gather data as described through interviews with nurses that have experienced family presence during resuscitation. 

In addition, one may state that a grounded theory method of qualitative inquiry was utilized as evidenced by the framework and diagram created to display the results of the study.  The grounded theory is conducted to discover problems (should family be present) that exist in a scene (in this study it is the resuscitation room) and the process that is utilized to handle it (protocol for this procedure). The author formulated the perspective that family should be allowed in the room during resuscitation.  The study was conducted and she redeveloped the proposition supporting her theory.  (Grove, 2014)

RESULTS OF STUDY

            Every nurse that participated in the study described an experience in which family was present during resuscitation.  The nurses discussed how there was always an invitation for family during resuscitation, but not all families accepted it.  Benefits of family presences was themed.  All nurses described how family was incorporated into the resuscitation efforts.  Descriptions explained how members could see progression of patient status changes and provided a sense of reality. Finally, family members were given the opportunity to observe the efforts put forth for resuscitation of their loved one.  Only one nurse described family presence as not going well.  None stated they had seen actual harm to a family member when following this protocol.  Some nurses did describe this process as difficult to watch the family member hurt, but good that the family could see what was going on.  Two nurses explained feeling situationally uneasy due to family members not comprehending the events taking place.  They feared misinterpretation of actions as errors, but could not recall any legal implications from this procedure.  Some nurses expressed concern for “harm” being that the family member may have a bad memory or the event may be traumatic involving blood and exposure of the body.  (Lowry, 2012)

The author addresses weakness of the study including how nurses were vague when determining roles of staff during resuscitation and family presence.  The nurses constantly recognized the need for a chaplain, but acknowledged that one was not always available.  It was reported that other healthcare team members accepted this protocol.  The study notes that the nurses participating were not found to have specific demographic connections.  Ten of the fourteen nurses participating reported that 75% of resuscitations they participated in had family present.  Finally, all nurses were in favor of family presence during resuscitation without regard to nurse age, sex, location, education level, or experience.  (Lowry, 2012)

Limitations included no control over or evaluation of consistency for following protocol.  It was determined that the family presence procedure was more accepted by modeling rather than by being familiar with the specifics of the protocol.  This was evidenced by some descriptions that did not consistently follow protocol.  Nurses were unable to determine when and how family presence during each event was decided when it did not occur in the resuscitation room.  The author notes that more research needs to be completed regarding family member presence and timing of the invitation into the room.  Further research should include all the emergency staff, physicians. and assimilation of this protocol for new nurses.  (Lowry, 2012)

After collecting data, results suggest that family presence during resuscitation is accepted and positively affected through participation and modeling.  All nurses reported this practice as being the right thing to do and providing compassionate care.  Supplementary support in emergency units for staff would increase this positive impact and acceptance.  (Lowry, 2012)

ETHNICAL CONSIDERATIONS

The study was accepted by the proper institutional review boards and permissions were obtained prior.  Nurse involvement was voluntary.  The author does not suggest any ethical bias.  The participants had no demographic connections.  There were no regards to age, sex, education, or experience for nurses participating in the survey.  Strict confidentiality was preserved.  Participants were identified with unique identification numbers on data gathering tools. (Lowry, 2012) There were no ethical concerns regarding the lack of treatment.

Conclusion

            Nurses work first hand with the family during a resuscitation effort.  This study suggests that family presence during resuscitation has positive benefits for all involved.  The nurses who are favorable to this practice provide compassionate care and support for the families involved.  The family finds comfort in knowing the staff worked hard in their efforts to save a loved one.  A sense of appreciation is expressed and the nurse builds confidence in his or her performance. The author suggests that continued studies and presentation of this evidenced-based practice could lead to a greater acceptance of this process while decreasing fears and legal concerns for nurses.  The development of protocols and procedures could make the family presence during resuscitation a standard in nursing care.