Narratives about Resuscitation—Family Members Differ about Presence

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

Family presence during resuscitation

BACKGROUND

Patients and their relatives often expect to be actively involved in decisions of treatment. Even during resuscitation and acute medical care, patients may want to have their relatives nearby, and relatives may want to be present if offered the possibility. The principle of family presence during resuscitation (FPDR) is a triangular relationship where the intervention of family presence affects the healthcare professionals, the relatives present, and the care of the patient involved. All needs and well-being must be balanced in the context of FPDR as the actions involving all three groups can impact the others.

OBJECTIVES

The primary aim of this review was to investigate how offering relatives the option to be present during resuscitation of patients affects the occurrence of post-traumatic stress disorder (PTSD)-related symptoms in the relatives. The secondary aim was to investigate how offering relatives the option to be present during resuscitation of patients affects the occurrence of other psychological outcomes in the relatives and what effect family presence compared to no family presence during resuscitation of patients has on patient morbidity and mortality. We also wanted to investigate the effect of FPDR on medical treatment and care during resuscitation. Furthermore, we wanted to investigate and report the personal stress seen in healthcare professionals and if possible describe their attitudes toward the FPDR initiative.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL from inception to 22 March 2022 without any language limits. We also checked references and citations of eligible studies using Scopus, and searched for relevant systematic reviews using Epistomonikos. Furthermore, we searched ClinicalTrials.gov, WHO ICTRP, and ISRCTN registry for ongoing trials; OpenGrey for grey literature; and Google Scholar for additional trials (all on 22 March 2022).

SELECTION CRITERIA

We included randomized controlled trials of adults who have witnessed a resuscitation attempt of a patient (who was their relative) at the emergency department or in the pre-hospital emergency medical service.  The participants of this review included relatives, patients, and healthcare professionals during resuscitation.  We included relatives aged 18 years or older who have witnessed a resuscitation attempt of a patient (who is their relative) in the emergency department or pre-hospital. We defined relatives as siblings, parents, spouses, children, or close friends of the patient, or any other descriptions used by the study authors. There were no limitations on adult age or gender. We defined patient as a patient with cardiac arrest in need of cardiopulmonary resuscitation (CPR), a patient with a critical medical or traumatic life-threatening condition, an unconscious patient, or a patient in any other way at risk of sudden death. We included all types of healthcare professionals as described in the included studies. There were no limitations on age or gender.

DATA COLLECTION AND ANALYSIS

We checked titles and abstracts of studies identified by the search, and obtained the full reports of those studies deemed potentially relevant. Two review authors independently extracted data. As it was not possible to conduct meta-analyses, we synthesized data narratively.

MAIN RESULTS

The electronic searches yielded a total of 7292 records after deduplication. We included 2 trials (3 papers) involving a total of 595 participants: a cluster-randomized trial from 2013 involving pre-hospital emergency medical services units in France, comparing systematic offer for a relative to witness CPR with the traditional practice, and its 1-year assessment; and a small pilot study from 1998 of FPDR in an emergency department in the UK. Participants were 19 to 78 years old, and between 56% and 64% were women. PTSD was measured with the Impact of Event Scale, and the median score ranged from 0 to 21 (range 0 to 75; higher scores correspond to more severe disease). In the trial that accounted for most of the included participants (570/595), the frequency of PTSD-related symptoms was significantly higher in the control group after 3 and 12 months, and in the per-protocol analyses a significant statistical difference was found in favor of FPDR when looking at PTSD, anxiety and depression, and complicated grief after 1 year.  One of the included studies also measured duration of patient resuscitation and personal stress in healthcare professionals during FPDR and found no difference between groups. Both studies had high risk of bias, and the evidence for all outcomes except one was assessed as very low certainty.

AUTHORS' CONCLUSIONS

There was insufficient evidence to draw any firm conclusions on the effects of FPDR on relatives' psychological outcomes.   Sufficiently powered and well-designed randomized controlled trials may change the conclusions of the review in future.

Family presence during adult resuscitation from cardiac arrest: A systematic review

AIM

Objective: To conduct a systematic review of the published evidence related to family presence during adult resuscitation from cardiac arrest.

METHODS

This review, registered with PROSPERO (CRD42021242384) and reported according to PRISMA guidelines, included studies of adult cardiac arrest with family presence during resuscitation that reported one or more patient, family or provider outcomes. Three databases (Medline, CINAHL and EMBASE) were searched from inception to 10/05/2022. Two investigators screened the studies, extracted data, and assessed risks of bias using the Mixed Method Appraisal Tool (MMAT). The synthesis approach was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines and a narrative synthesis method.

RESULTS

The search retrieved 9,459 citations of which 31 were included: 18 quantitative studies (including two RCTs), 12 qualitative studies, and one mixed methods study. The evidence was of very low or low certainty. There were four major findings. High-certainty evidence regarding the effect of family presence during resuscitation on patient outcomes is lacking. Family members had mixed outcomes in terms of depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and experience of witnessing resuscitation. Provider experience was variable and resuscitation setting, provider education, and provider experience were major influences on family presence during resuscitation. Finally, providers reported that a family support person and organisational guidelines were important for facilitating family presence during resuscitation.

CONCLUSION

The effect of family presence during resuscitation varies between individuals. There was variability in the effect of family presence during resuscitation on patient outcomes, family and provider outcomes and perceptions.

Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology

BACKGROUND AND OBJECTIVES

Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives.

METHODS

Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present.

RESULTS

Thirty-one participants' videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations >9 out of 10 and were all ranked top 10 communicators.

CONCLUSIONS

During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication.

Owner-witnessed cardiopulmonary resuscitation in small animal emergency veterinary medicine

OBJECTIVE To determine opinions of veterinary emergency health-care providers on the topic of owner-witnessed CPR in small animal emergency medicine and to identify reasons for opposition or support of owner-witnessed CPR. DESIGN Cross-sectional survey. SAMPLE 358 surveys completed by American College of Veterinary Emergency and Critical Care diplomates and residents as well as other emergency-care veterinarians and veterinary technicians between August 14, 2016, and September 14, 2016. PROCEDURES An internet-based survey was used to collect data on respondent demographics, CPR experience, and opinions about owner-witnessed CPR. Responses were collected, and the Fisher exact test or χ² test was used to compare distributions of various opinions toward owner-witnessed CPR among certain respondent groups. RESULTS Owner presence during CPR was opposed by 277 of 356 (77.8%) respondents, with no substantial differences among demographic groups. Respondents with ≤ 10 years of experience were less willing to allow owner presence during CPR, compared with respondents with > 10 years of experience. Respondents who worked at practices that allowed owner presence during CPR were more likely to report emotional benefit for owners. CONCLUSIONS AND CLINICAL RELEVANCE Veterinary professionals surveyed had similar concerns about owner-witnessed CPR, as has been reported by human health-care providers about family-witnessed resuscitation. However, emotional benefits from family-witnessed resuscitation in human health care have been reported, and emotional impacts of owner-witnessed CPR could be an area of research in veterinary medicine. In addition, investigation is needed to obtain more information about pet owner wishes in regard to witnessing CPR performed on their pets.

Family Presence During Resuscitation After Trauma

The purpose of this study was to examine the effects of family presence during resuscitation (FPDR) in patients who survived trauma from motor vehicle crashes (MVC) and gunshot wounds (GSW). A convenience sample of family members participated within three days of admission to critical care. Family members of 140 trauma patients (MVC n = 110, 79%; GSW n = 30, 21%) participated. Family members ranged in age from 20-84 years (M = 46, SD = 15, Mdn = 47). The majority were female (n = 112, 80%) and related to the patient as spouse (n = 46, 33%). Participating in the FPDR option reduced anxiety (t = -2.43, p =.04), reduced stress (t = -2.86, p = .005), and fostered well-being (t = 3.46, p = .001). Results demonstrate the positive initial effects of FPDR on family members of patients surviving trauma injury.

Family presence during resuscitation: Validation of the risk–benefit and self-confidence scales for student nurses

Background. There is increasing debate about the advantages and disadvantages of family-witnessed resuscitation. Research about the views of healthcare providers depends upon reliable tools to measure their perceptions. Two tools have been developed for use with nurses (26-item cost-benefit tool, 17-item self-confidence tool). Objectives. Firstly, to validate these tools for use with student nurses in the UK. Secondly, to report on the perceived risks and benefits reported by student nurses, and their self-confidence in dealing with this situation. Methods. A sample of 79 student nurses were invited to complete the tools. Item-total correlations and Cronbach’s α were used to determine internal consistency. Factor analysis was computed to assess construct validity. The correlation between the two scales was explored. Results. 69 students completed a questionnaire. Very few had experience of family-witnessed resuscitation. Mean total scores were 3.16 (standard deviation 0.37; range 2.04–4.12) on the risk-benefit scale and 3.14 (standard deviation 0.66; range 1.94–4.82) on the self-confidence scale. Four of the original items were removed from the risk-benefit scale (Cronbach's α 0.86; 95% confidence interval ≥0.82). None were removed from the self-confidence scale (Cronbach's α 0.93; 95% confidence interval ≥0.91). There was a significant correlation between the two scales ( r = 0.37, p = 0.002). Conclusions. There is growing evidence that these tools are valid and reliable for measuring student nurses’ perceptions about family-witnessed resuscitation.

Predictors of public support for family presence during cardiopulmonary resuscitation: A population based study

BACKGROUND

The debate on whether individuals want their family to be present during cardiopulmonary resuscitation continues to be a contentious issue, but there is little analysis of the predictors of the general public's opinion. The aim of this population based study was to identify factors that predict public support for having family present during cardiopulmonary resuscitation.

DESIGN

Data for this cross-sectional population based study were collected via computer-assisted-telephone-interviews of people (n=1208) residing in Central Queensland, Australia.

RESULTS

Participants supported family members being present should their child (75%), an adult relative (52%) or they themselves (51%) require cardiopulmonary resuscitation. Reasons cited for not wanting to be present were; distraction for the medical team (30.4%), too distressing (30%) or not known/not considered the option (19%). Sex and prior exposure to being present during the resuscitation of adults and children were both predictors of support (p<0.05). Reasons for not wanting to be present differed significantly for males and females (p=0.001).

CONCLUSION

Individual support for being present during cardiopulmonary resuscitation varies according to; sex, prior exposure and if the family member who is being resuscitated is a family member, their child or the person themselves. A considerable proportion of the public have not considered nor planned for the option of being present during a cardiac arrest of an adult relative. Clinicians may find it useful to explain the experiences of other people who have been present when supporting families to make informed decisions about their involvement in emergency interventions.

Families' stressors and needs at time of cardio-pulmonary resuscitation: a Jordanian perspective

Background:

During cardio-pulmonary resuscitation, family members, in some hospitals, are usually pushed to stay out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Previous literature shows controversial belief whether or not a family member should be present during resuscitation of their relative. Some worldwide association such as the American Heart Association supports family-witnessed resuscitation and urge hospitals to develop policies to ease this process. The opinions on family-witnessed resuscitation vary widely among various cultures, and some hospitals are not applying such polices yet. This study explores family members’ needs during resuscitation in adult critical care settings.

Methods:

This is a part of larger study. The study was conducted in six hospitals in two major Jordanian cities. A purposive sample of seven family members, who had experience of having a resuscitated relative, was recruited over a period of six months. Semi-structured interview was utilised as the main data collection method in the study.

Findings:

The study findings revealed three main categories: families’ need for reassurance; families’ need for proximity; and families’ need for support. The need for information about patient’s condition was the most important need. Updating family members about patient’s condition would reduce their tension and improve their acceptance for the end result of resuscitation. All interviewed family members wanted the option to stay beside their loved one at end stage of their life. Distinctively, most of family members want this option for some religious and cultural reasons such as praying and supplicating to support their loved one.

Conclusions:

This study emphasizes the importance of considering the cultural and religious dimensions in any family-witnessed resuscitation programs. The study recommends that family members of resuscitated patients should be treated properly by professional communication and involving them in the treatment process. The implications concentrate on producing specific guidelines for allowing family-witnessed resuscitation in the Jordanian context. Finally, attaining these needs will in turn decrease stress of those witnessing resuscitation of their relative.

How Families and Health Care Practitioners Experience Family Presence during Resuscitation and Invasive Procedures

BACKGROUND

The presence of family members during resuscitation and invasive procedures has been, and continues to be debated in the literature.

OBJECTIVE

To synthesize the best available research evidence on how families and health care practitioners experience family presence during resuscitation and invasive procedures.

INCLUSION CRITERIA

Studies about families and health care practitioners experiencing family presence during resuscitation and invasive procedures were considered.This review considered family members and health care practitioners who had experienced the phenomena of family presence during resuscitation or invasive procedures.Family members and health care practitioners experience of family presence during resuscitation or invasive procedures.Qualitative evidence consisting of, but not limited to, designs such as interpretive, descriptive-exploratory, observational, phenomenology, ethnography, grounded theory, hermeneutics, participatory action research, and critical theory were included in the review.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished research articles from 1985 to 2009. The review was limited to papers written in English.

METHODOLOGICAL QUALITY

Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised tools developed by the Joanna Briggs Institute.

DATA COLLECTION

Data were using standardized data extraction tools developed by the Joanna Briggs Institute.

DATA SYNTHESIS

The Joanna Briggs Institute' approach for meta-synthesis by meta-aggregation was used.

RESULTS

25 studies were included in the review. 154 findings were extracted and synthesized into 14 categories and 5 synthesized findings.

CONCLUSIONS

A tension is created between the belief of most family members that being present is a right and health care practitioners who believe they should have control over the circumstances of the practice. Although healthcare practitioners express concern that the practice will cause the family to experience psychological trauma the data does not suggest that this is the case. Most family members describe their presence as an opportunity to comfort and to gain closure.

IMPLICATIONS FOR PRACTICE

IMPLICATIONS FOR RESEARCH.

Family presence during resuscitation and invasive procedures: physicians' and nurses' attitudes working in pediatric departments in Greece

BACKGROUND

Family presence during resuscitation and invasive procedures (FPDRAIP) has been a frequent topic of debate among healthcare personnel worldwide. This paper determines the knowledge, experiences and views of Greek physicians and nurses on FPDRAIP and examines possible correlations and factors promoting or limiting the implementation of the issue.

METHODS

The data for this descriptive questionnaire study were collected between March and June 2009. The study population consisted of 44 physicians and 77 nurses working in neonatal-pediatric departments and intensive care units in Patras, Greece, who answered an anonymous questionnaire.

RESULTS

The majority of the participants (73.6%) were not familiar with FPDRAIP, were neither educated (72.7%) nor did they agree with the issue (71.9%). No written policy on FPDRAIP existed in the hospitals surveyed. Participants who were familiar with existing guidelines on the issue, or those who had relevant personal experience (76.9%), were positive for practising it as well. The degree of invasiveness of the medical intervention was the major determinant for healthcare personnel to consent for FPDRAIP. Finally, 43.2% of physicians believed that the decision of allowing FPDRAIP should be made only by them, whereas, 40.3% of nurses thought it should be a joint one.

CONCLUSIONS

This study reveals that healthcare personnel in Greece are not familiar with the issue of FPDRAIP. In view of the increasing evidence on the advantages of this practice, we recommend implementation of relevant educational programs and institutional guidelines and policies.

Family presence preference when patients are receiving resuscitation in an accident and emergency department

AIM

This paper is a report of a study to illuminate the experience of family members whose relatives survived the resuscitation in an accident and emergency department, and their preferences with regard to being present.

BACKGROUND

Family presence during resuscitation can offer benefits to both patient and family members, and large healthcare organizations support and recommend offering the option for their presence. However, many staff believe that this is too distressing or traumatic for families and that they would interfere with the resuscitation process.

METHODS

An interpretive phenomenological approach was used to collect data in 2007-2008 with 18 family members of patients who survived life-sustaining interventions in an accident and emergency department in Hong Kong. Audio-recorded interviews were transcribed verbatim for thematic analysis and verified with the participants in second interviews.

FINDINGS

None of the family members was present in resuscitation room during the life-sustaining interventions, and five entered the room after the patients' condition was stable. The majority indicated a strong preference to be present if given the option. Three interrelated themes emerged: (i) emotional connectedness, (ii) knowing the patient, and (iii) perceived (in)appropriateness, with 10 subthemes representing affective, rational and contextual determinants of family presence preferences. The interplay of these determinants and how they contributed to strong or weak preference for family presence was analysed.

CONCLUSION

Variations among the contributing determinants to each family member's preference to be present were revealed. Appropriate nursing interventions, policy and guidelines should be developed to meet individualized needs during such critical and life-threatening moments in accident and emergency departments.

Effects of family-witnessed resuscitation after trauma prior to hospitalization

The purpose of this study was to the examine the effects of family-witnessed resuscitation (FWR) in patients experiencing trauma from motor vehicle crashes and gunshot wounds prior to hospitalization. Family members of 33 patients (motor vehicle crashes: n = 19, 57%; gunshot wounds: n = 14, 43%) participated in this study. Within 1 to 2 days after admission to critical care, families who witnessed resuscitation and those who did not witness resuscitation were asked to participate. Reliable and valid measures for family resources, coping, problem-solving communication, and well-being were used. Results indicated that scores for family resources, coping, problem-solving communication, and well-being were no different in families who witnessed resuscitation compared with those who did not witness resuscitation prior to hospitalization in this study. The effects of FWR during the prehospital time period are not detrimental to family members. Further research needs to be conducted to examine the effects of FWR.

Family presence during resuscitation and invasive procedures

The practice of allowing family to be present during patient resuscitation or invasive procedures (Family Presence) is gaining acceptance in North America and the United Kingdom in controlled circumstances. Research into Family Presence has demonstrated multiple benefits for the patient, family and health care team. These advantages include helping the family to understand the severity of the illness/trauma and to see that appropriate attempts were undertaken to save their loved one. Family Presence can also facilitate improved communication between the health care team and family. In spite of evidence supporting Family Presence as a useful practice for patient, family and health care team, the use of Family Presence is uncommon within Australian emergency departments and hospitals. Clear expectations at organisational, governmental and professional levels are essential to effectively implement this approach. To be supported in the clinical area, the success of a Family Presence program requires an inclusive approach to program development. A critical component of a successful Family Presence program is a family facilitator who is adequately prepared for the role and committed to supporting the family during resuscitation or invasive procedures. Research exploring Family Presence in Australia is lacking and highlights the need for context specific research in this area.

Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature review

AIM

This paper is a report of a critical literature review to identify the positive and negative effects of family presence during adult resuscitation, as perceived by accident and emergency healthcare staff based in primary (out-of-hospital) and secondary (in-hospital) environments of care.

BACKGROUND

The controversial practice of family presence during resuscitation of adults has stimulated debate over the past two decades, giving rise to a growing body of literature and the development of clinical guidelines for practice.

METHODS

A search was carried out for the period 1987-2007 using the Science Direct, CINAHL, Medline, EMBASE, psychINFO and BNI databases and the search terms resuscitation, witnessed resuscitation, family presence, relatives' presence, attitudes and opinions and accident and emergency.

RESULTS

Eighteen studies were included in the critical review, primarily comprising retrospective survey research. The majority of studies were descriptive in design. A standardized approach to the appraisal process was achieved through the utilization of guidelines for critiquing self-reports. The findings revealed that accident and emergency healthcare staff perceive both positive and negative effects as a consequence of family presence during adult resuscitation and their opinions suggest that there are more risks than benefit.

CONCLUSION

Further research is essential if family presence during resuscitation of adults is to be better defined and understood. Qualitative methods of enquiry are recommended as a way of gaining a deeper insight into and understanding of this practice.

Nurses’ Perceptions of Their Self-confidence and the Benefits and Risks of Family Presence During Resuscitation

Background Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables.

Objectives To test 2 instruments used to measure nurses’ perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses’ self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence.

Methods Nurses (n = 375) completed the Family Presence Risk-Benefit Scale and the Family Presence Self-confidence Scale.

Results Nurses’ perceptions of benefits, risks, and self-confidence were significantly and strongly interrelated. Nurses who invited family presence during resuscitation were significantly more self-confident in managing it and perceived more benefits and fewer risks (P &lt; .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P &lt; .001). Data supported initial reliability and construct validity for the 2 scales.

Conclusions Nurses’ perceptions of the risks and benefits of family presence during resuscitation vary widely and are associated with how often the nurses invite family presence. After further testing, the 2 new scales may be suitable for measuring interventional outcomes, serve as self-assessment tools, and add to conceptual knowledge about family presence.

Relatives' presence in connection with cardiopulmonary resuscitation and sudden death at the intensive care unit

Within Norwegian intensive care units it is common to focus on the needs of the next of kin of patients undergoing end-of-life care. Offering emotional and practical support to relatives is regarded as assisting them in the initial stages of their grief process. It has also become usual to encourage relatives to be present at the time of death of close relatives. How can dignified end-of-life care coexist with the sometimes turbulent and dramatic character of intensive care in the highly technological environment of intensive care units? This paper describes a case study based on an incident that took place at the intensive care unit (ICU) of Trondheim University Hospital, Norway, in which the relatives of a newly deceased patient voiced unusually strong dissatisfaction with the way they were excluded in connection with cardiopulmonary resuscitation (CPR). The next of kin's criticism highlights an important paradox as well as a degree of inconsistency in lifesaving and end-of-life care at the ICU. I argue that an investigation of the multiple identities within medical practice can illuminate the potential for clashes between lifesaving and end-of-life care, as described and analysed in this paper.

Should family members be present during cardiopulmonary resuscitation? A review of the literature

During resuscitation, family members are often escorted out of the room for fear of immediate and long-term consequences to the family, the patient, and the physician. However, mounting evidence suggests that family presence during resuscitation could, in fact, be beneficial. The Emergency Nurses Association and the American Heart Association endorse family-witnessed resuscitation and the development of hospital policies to facilitate this process. However, the opinions on family-witnessed resuscitation vary widely, and few hospitals in the United States have developed formal policies on the presence of families during cardiopulmonary resuscitation. In this article, we review the current status of family-witnessed resuscitation and provide recommendations on the development of hospital policies for family-witnessed resuscitation.

The presence of family members during cardiopulmonary resuscitation: European federation of Critical Care Nursing associations, European Society of Paediatric and Neonatal Intensive Care and European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement

This paper presents the European federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement on The Presence of Family Members During Cardiopulmonary Resuscitation.