EBN: Family Presence During Resuscitation in Acute Care Settings

This report explores the contentious issue of family presence during resuscitation in acute care settings, addressing the research question: "should family members be allowed to be present during the resuscitation of a loved one?" The student begins by identifying key concepts such as family members, resuscitation, and acute care, and then selects relevant databases like Embase, PubMed, CINAHL, and others to gather evidence. The report synthesizes findings from several studies, including research on nurses' and physicians' perceptions, family experiences, and potential impacts on both patients and healthcare professionals. The evidence presented considers both the benefits, such as providing comfort to the patient and allowing for a final farewell, and the drawbacks, such as potential for distress and disruption. The report concludes by supporting the presence of family members, emphasizing the importance of prioritizing patient needs and the potential for family presence to provide courage and comfort during the healing process. References are provided to support the findings.

EVIDENCE BASED NURSING 1
Evidence Based Nursing
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EVIDENCE BASED NURSING 2
Evidence Based Nursing
Introduction
Resuscitation is one of the common techniques that are performed during emergence in
hospital settings. The event always results in stress for physicians, nurses, and people who are
near. As a result of its advanced effects, questions have been raised on whether relatives and
friends should be allowed to witness the resuscitation of their loved ones.
Based on the search question, “should family members be allowed to be present during the
resuscitation of a loved one in the acute care settings?” I had to find out the best strategy to get
high relevance evidence from both qualitative and quantitative articles. I had to follow step by
step to get high-quality evidence. My first step was to identify the key concepts and key terms
within my chosen research question in the clinical scenario. In this case, the primary search
concept that I identified includes
Search concept 1 Search concept 2 Search concept 3 Search concept 4
Family members Resuscitation Acute care Present
Family centered
care
Resuscitation
techniques
Hospital settings Family presence
After determining the key concepts in my research question, the next step was to select the
most relevant databases and resources. In this research question scenario, I choose to include
approved health science databases such as Embase, PubMed, CINAHL, Cochrane Library,
Scopus and Google Scholar. The next research strategy step was to combine the key search terms

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and concepts together with the Boolean operator. The next stage was running the searches in the
selected databases, reviewing, and then refining my search results.
Findings
One of the articles that I found in my research strategy is (Fridh, Forsberg and Bergbom,
2009). The primary aim of the study was to find out the experience of nurses and physicians in
their perception of caring of patients who are in critical conditions in the presence of their family
members. The research allowed relatives of the patient whose aim was to provide an enduring
memory of their loved ones. According to the article, the patients who died with the absence of
their relatives and friends were comsidered as tragic (Oczkowski et al. 2015).
According to (Hung and Pang, 2011), the concept of inviting family members or a relative to
witness the resuscitation of their patients is not common. The findings from the study show that
many nurses and physicians fears for the psychological trauma to relatives, medicolegal issues,
possible disruptions by family members and performance anxiety among the health care
professionals.
A survey to find out whether the presence of family and relatives should be allowed during
cardiovascular resuscitation was conducted (James, Cottle and Hodge, 2011). According to the
results of the findings, 64 percent of the families believed that if they had been allowed to
witness the cardiovascular resuscitation of their patient, it would have relieved their distress.
Also, 76 percent of families and relatives who were allowed to witness resuscitation believed
that their presence relieved their sorrow. Additionally, 64 percent of the families that were
allowed to witness believed that their presence strengthened their patient.

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Most recently, 570 relatives of patients were undergoing cardiovascular pulmonary
resuscitation practice. The standard practice was that the relatives of these 570 patients were
taken outside for the resuscitation to procedure to take place. After three months of
cardiovascular pulmonary resuscitation, psychologists were administered a questionnaire.
According to the results of the survey, 27 percent of the group had a fewer symptom of PSTSB
and 15 percent has anxiety than the control group (Porter, Cooper and Sellick, 2014). One year
later, follow up activity was carried out which exhibited that the control group had increased
episodes of major depressive and complicated grief.
Presence of any outsiders who is not part of the professional team during resuscitation
process may result to potential harm to the patient (Köberich et al. 2010). This is because
resuscitation is a delicate procedure that may make the outsider to interrupt the process. This
may then lead to the increased stress of the health care professionals whom may find themselves
unable to handle the situation. This may thereby hinder the chance for open communication
between the patient, family members, and even the nurses. For instance, according to a study that
included simulated codes, the presence of family members were seen as disruptive as they led to
a delay in resuscitation process in health care settings (Doolin et al. 2011). In a research of about
42000 in a patient with FPDR policy, the findings were that over 60 percent of the patients had
experienced delays in obtaining of vascular airway access and there were many medication
errors. This medication error was as a result of the presence of relatives and friends who could
disrupt the process as they cared for their loved one. This could cause potential harm to the
patient as resuscitation procedures need to be carried safely without any disruption.
As a result of growing debates on whether resuscitation should be carried out with the
presence of their relatives, a randomized research study was carried out to determine the

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characteristics of the experience of relatives whose loved ones have had cardiovascular
resuscitation while on their presence. In this context, qualitative analysis with a sequential
explanatory design was carried out. According to the findings, witnessing the resuscitation of
their loved ones led to many emotional reactions. Some had positive fear reactions whereas
others had negative fear reactions. Also, some had a feeling of relief in relation to their loved
ones distress whereas others had developed some distress. The finding suggests that the
experience of seeing your loved ones being undergoing resuscitation may be traumatizing to
some individuals. According to the survey of 800 health care professional teams, 80 percent cited
traumatization as the main reason for not allowing relatives and friend to be present at the
resuscitation (Al‐Mutair, Plummer, and Copnell, 2012).
The discussion in the involvement of relatives during resuscitation is very crucial. Many
relatives want to witness end life of their member even during resuscitation. Many suggest that
the witnessing resuscitation of their member will provide them with the opportunity to have a
farewell with their loved ones. According to a review that was done in London, (Leung and
Chow, 2012), many participants said they will want to see their friend being resuscitated. Also,
according to the same research, nurses are more supportive of family members to be present
during resuscitation than physicians. Many physicians who do not support presence of relatives
during resuscitation of their member believe that it may induce trauma and negatively affect their
life.

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Conclusion
Allowing family members and relatives to witness the resuscitation process of their patient
has both merits and demerits. From the research evidence above, we understand that the presence
of a family member may provide benefits to patient comfort as patient’s aware of relative’s
presence mean comfort and courage which can help in the healing of the patient. Also allowing
family members gives a chance to say goodbye to their loved ones. Furthermore, the presence of
a relative may increase the staff’s emotional vulnerability. On the other hand, a family presence
has may result in serious drawbacks such as distress to family members. Also, family members
may interfere with or distract resuscitation efforts thereby hindering the staffs to work
effectively.
Using the evidence from research articles, I support relatives and friends to be allowed to
witness the resuscitation of their patient as its benefits outweighs the negative ones. We must
first prioritize the needs of the patients in order to save their life. The patient takes the top
priority and also the relatives are part of the patient. The presence of a family member will
provide a word of courage and comfort to the loved ones which can help in the healing process.

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References
Al‐Mutair, A.S., Plummer, V. and Copnell, B., 2012. Family presence during resuscitation: a
descriptive study of nurses' attitudes from two Saudi hospitals. Nursing in critical
care, 17(2), pp.90-98. http://dx.doi.org/10.1155/2015/532721
Doolin, C.T., Quinn, L.D., Bryant, L.G., Lyons, A.A. and Kleinpell, R.M., 2011. Family
presence during cardiopulmonary resuscitation: Using evidence‐based knowledge to
guide the advanced practice nurse in developing formal policy and practice
guidelines. Journal of the American Academy of Nurse Practitioners, 23(1), pp.8-14.
https://doi.org/10.1111/j.1745-7599.2010.00569.x
Dougal, R.L., Anderson, J.H., Reavy, K. and Shirazi, C.C., 2011. Family presence during
resuscitation and/or invasive procedures in the emergency department: one size does not
fit all. Journal of Emergency Nursing, 37(2), pp.152-157.
https://doi.org/10.1016/j.jen.2010.02.016
Fridh, I., Forsberg, A. and Bergbom, I., 2009. Doing one's utmost: nurses’ descriptions of caring
for dying patients in an intensive care environment. Intensive and Critical Care
Nursing, 25(5), pp.233-241. https://doi.org/10.1016/j.iccn.2009.06.007
Hung, M.S. and Pang, S.M., 2011. Family presence preference when patients are receiving
resuscitation in an accident and emergency department. Journal of advanced
nursing, 67(1), pp.56-67. https://doi.org/10.1111/j.1365-2648.2010.05441.x

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James, J., Cottle, E. and Hodge, R.D., 2011. Registered nurse and health care chaplains
experiences of providing the family support person role during family witnessed
resuscitation. Intensive and Critical Care Nursing, 27(1), pp.19-26.
https://doi.org/10.1016/j.iccn.2010.09.001
Köberich, S., Kaltwasser, A., Rothaug, O. and Albarran, J., 2010. Family witnessed
resuscitation–experience and attitudes of German intensive care nurses. Nursing in
critical care, 15(5), pp.241-250. https://doi.org/10.1111/j.1478-5153.2010.00405.x
Leung, N.Y. and Chow, S.K., 2012. Attitudes of healthcare staff and patients’ family members
towards family presence during resuscitation in adult critical care units. Journal of
clinical nursing, 21(13-14), pp.2083-2093. https://doi.org/10.1111/j.1478-
5153.2010.00405.x
Oczkowski, S.J., Mazzetti, I., Cupido, C. and Fox-Robichaud, A.E., 2015. Family presence
during resuscitation: a Canadian critical care society position paper. Canadian
respiratory journal, 22(4), pp.201-205. http://dx.doi.org/10.1155/2015/532721
Porter, J.E., Cooper, S.J. and Sellick, K., 2014. Family presence during resuscitation (FPDR):
perceived benefits, barriers and enablers to implementation and practice. International
emergency nursing, 22(2), pp.69-74. https://doi.org/10.1016/j.ienj.2013.07.001