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Family Presence

During
Resuscitation

Jese Broersma
Background
1982- Foote Hospital in Jackson, Michigan
Family members refused to leave the bedside on 2 separate occasions

Research has been conducted to determine the impact of family and health care
workers as well as resuscitation outcomes

Support from multiple professional organizations:


ENA
AHA
CCNA
Joint Commission
IOM
PICOT:
In the family of patients undergoing resuscitation in the critical care
setting, does being present during resuscitation compared to not
being present, result in more family members stating they were glad
they were present when attempts were unsuccessful 3-months post-
resuscitation?

(Boehm, 2008; AACN, 2016; AHA, 2010; ENA, 2012)


Clinical Implications
ENA, AHA, CCNA recommend:
Development of a FPDR policy
Offering family the option of being present

For successful implementation, an experienced nurse


should act as a family facilitator

Family Facilitator will remain with family member for


duration of their time in treatment area

Sharp Memorial Hospital Emergency Department


Policy/Procedure: Family Presence During
Resuscitation
Created: 2011
Revised: 2015
AACN, 2016; AHA, 2010; ENA, 2012)
Current Practice

MICN notifies charge RN inbound CPR


Room is prepared and pre-brief may or may not
occur
When patient arrives, efforts are initiated
When family member arrives, they are taken to
a private waiting area

When patient is stabilized or efforts are ceased,


MD notifies family
Coroner is consulted to determine if further
investigation is required
Patient is cleaned up and moved to separate room
Family is invited in by social worker
Practice Change
MICN notifies charge RN inbound CPR
Room is prepared and charge RN conducts a pre-
brief
FF is assigned by charge nurse
When family member arrives, they are taken to a
private waiting area and greeted by charge RN and
FF
Behavior expectations will be discussed with
Team is notified of family arrival and informed of
family
possible presence
Family is escorted to the treatment area by FF
Behavioral assessment will be conducted by FF
FF will remain with family for the duration of the
and invitation to be present will be determined
(SMMC, 2012)
resuscitation (acute vs transition)
Barriers

Staff perceptions
Traumatizing to family
Inability to perform life-saving procedures
Family interfering with care
Increased stress among staff
Humanizes patient/Raw emotion
Culture change
Staffing Needs

Leske, McAndrew, & Brasel, 2013; Jensen, & Kosowan, 2011; Lowry, 2012; Wolf, Storer, & Brim, 2012;
Davidson et al., 2011; Goldberger et al., 2015
Ethical Considerations
Cultural Considerations
Attitudes towards death differ among cultures
Spiritual Considerations
Emotional, psychosocial, and spiritual support
Most feel comfortable providing support
Ethical Considerations
Beneficence
Family should be considered
Psychological benefits for family
Everything is being done

(Jabre et al., 2014; Wolf, Storer, & Brim, 2012; Beauchamp & Childress, 2013)
Measured Outcomes
Retrospective Data Collection
Education to be provided to RN staff during annual skills testing
Education to be provided to MD staff during monthly meeting
Data will be collected 3 months after initiation of practice change
All patients that received resuscitation efforts will be included
Groups compared
Family present
Family not present
Trained psychologist perform follow-up phone interviews
DSM-IV criteria for major depressive episode
impact of event scale (IES)
hospital anxiety and depression scale (HADS)
inventory of complicated grief (ICG)
structured diagnosis of a major depressive episode (MINI)

(Jabre et al., 2014)


Conclusion
Grief and bereavement are universal
Family presence may increase sense of closure and facilitate grieving
Research is needed to understand:
acceptance of FPDR policies
staffs willingness to implement the practice
long-term effects on family and staff
Hospital-based education is needed to bridge the gap between written policies and implemented
practice
Policies can act as framework for implementation

(Powers, & Candela, 2017; Wolf, Storer, & Brim, 2012; Jensen, & Kosowan, 2011; Jabre et al., 2014)