Running Head: FAMILY PRESENCE DURING RESUSCITATION 1

Family Presence during Resuscitation

Jese Broersma

GNRS 507: Scientific Writing

Diana Amaya Rodriguez, PhD., M.S., C.N.S., R.N.

Azusa Pacific University

July 30, 2017

FAMILY PRESENCE DURING RESUSCITATION 2

Family Present during Resuscitation: A Literature Review

Family presence during resuscitation (FPDR) is a growing topic of interest, and there is

variation in the way hospitals handle this sensitive situation. Many hospitals have generated

policies surrounding FPDR in order to adhere to patient- and family-centered care models.

Despite having established policies in place, hospitals are not consistently implementing FPDR;

however, family- and patient-centered care practice models reveal family grieving is positively

impacted when FPDR is implemented because families are able to be part of the resuscitation

(Leske, McAndrew, & Brasel, 2013). Nurses play a key role in the successful implementation of

this practice (Jensen, & Kosowan, 2011). The perceived barriers among health care professionals

and psychological benefit for families have been investigated in depth in order to fully

understand this dynamic topic. This paper will critique and synthesize the information in the

several pieces of literature surrounding family presence during resuscitation in the critical care

setting in order to gain a greater understanding of the issue. This paper will address methods,

findings, areas for change, and future research.

Background

The idea of having family present during resuscitation (FPDR) in the critical care setting

was introduced in 1982 after family members refused to leave the bedside of their loved ones on

two separate occasions at Foote Hospital in Jackson, MI (Boehm, 2008). Family presence during

resuscitation is defined as one or more family member present in the care area during

cardiopulmonary resuscitation where they have visual or physical contact with their family

member (Boehm, 2008). Research has been conducted addressing the perceptions of health care

providers and family members, along with the psychological benefits afforded to family in FPDR

situations. There is a lack of consistency in practice of FPDR in the critical care setting (Jensen,
FAMILY PRESENCE DURING RESUSCITATION 3

& Kosowan, 201; Wolf, Storer, & Brim, 2012). There are multiple professional nursing

organizations that support the concept of FPDR such as Emergency Nurses Association (ENA),

American Heart Association (AHA), and American Academy of Critical-Care Nurses (AACN).

The ENA released a position statement in 2009 indicating that there are no apparent detrimental

effects to the patient, family, or health care team when the family is present during resuscitation

(ENA, 2012). The ENA recommends policies be created to allow for families to have the option

of being present (ENA, 2012). Literature will be investigated and analyzed to answer the

question: 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?

Literature Review

Methods

Research design. The quantitative data is primarily non-nursing research which allows

for a multidisciplinary assessment of the topic. Jabre et al. (2014) conducted a prospective,

randomized control study that assessed psychological effects one-year after witnessing

resuscitation. Goldberger, et al. (2015) conducted a cohort study that focused on the impact of a

written FPDR policy on resuscitation outcomes. Despite there being limited quantitative data

available, it is an important to consider the data when analyzing the depth of the topic because

this provides a quantifiable strength that qualitative data is unable to produce. The available

qualitative data primarily addresses the effects of witnessing resuscitation on family and staff

perception of having family present through surveys, interviews, and field notes taken by the

researchers (Leske, McAndrew, & Brasel, 2013; Powers, & Candela, 2017; Davidson et al.,
FAMILY PRESENCE DURING RESUSCITATION 4

2011; Lowry, 2012; Jensen, & Kosowan, 2011). The considerable amount of qualitative data,

along with recurrent themes amongst available sources, provides strength to the suggestion of the

development and implementation of policies surrounding FPDR. The primary means of

gathering data in the descriptive studies is multi-dimensional surveys, questionnaires, and direct

interviews (Leske, McAndrew, & Brasel, 2013; Powers, & Candela, 2017; Davidson et al., 2011;

Lowry, 2012; Jensen, & Kosowan, 2011). The ENA explored and analyzed qualitative and

quantitative data to create a Clinical Practice Guideline that focused on the practice of FPDR and

associated policies (Wolf, Storer, & Brim, 2012).

Sample. The samples and inclusion/exclusion criteria varied among all literature

reviewed. Small sample sizes that ranged between 14 and 124 were used and were primarily

convenience samples (Leske, McAndrew, & Brasel, 2013; Powers, & Candela, 2017; Davidson

et al., 2011; Lowry, 2012; Jensen, & Kosowan, 2011). The effects of a small sample size and

convenience sampling are: lack of diversity (gender, age, ethnicity/racial) and potential threats to

transferability and generalizability (Leske, McAndrew, & Brasel, 2013; Powers, & Candela,

2017; Davidson et al., 2011; Lowry, 2012; Jensen, & Kosowan, 2011). The qualitative data had

clearly defined inclusion/exclusion criteria which refined the results and narrowed the focus of

the studies. Inclusion criteria utilized were: nurses that had previous experience with FPDR

practices (Lowry, 2012) and patients 18 and older admitted to the SICU requiring resuscitation

(Leske, McAndrew, & Brasel, 2013). Reasons for exclusion from the sample included: patients

under 18 years old, a fatality in the same accident, multiple family members as patients in a

critical care setting (Leske, McAndrew, & Brasel, 2013) and families that didn't answer the

phone for follow-up interview after 15 attempts (Jabre et al., 2014). The quantitative data yielded

a significantly larger sample sizes (4,608 family members and 41,568 patients) that allow for
FAMILY PRESENCE DURING RESUSCITATION 5

more practical and realistic generalizability and transferability of themes (Wolf, Storer, & Brim,

2012; Jabre et al., 2014; Goldberger et al., 2015). Because of the larger sample sizes, the

quantitative studies were able to analyze the impact of a FPDR policy on resuscitation outcomes

(Goldberger et al., 2015) and the long-term impact of implementing FPDR practices on families

(Jabre et al., 2014) because their result are easily generalized and transferred.

Findings

Family and patient perceptions. The findings revealed commonalities that included:

family member is part of the team or a voice for the patient (Lowry, 2012; Davidson et al., 2011;

Leske, McAndrew, & Brasel, 2013; Wolf, Storer, & Brim, 2012), sense of comfort for the family

members (Powers, & Candela, 2017; Jabre et al., 2014; Leske, McAndrew, & Brasel, 2013;

Wolf, Storer, & Brim, 2012; Lowry, 2012; Jensen, & Kosowan, 2011), and increased sense of

closure (Powers, & Candela, 2017; Wolf, Storer, & Brim, 2012; Jensen, & Kosowan, 2011; Jabre

et al., 2014; Davidson et al., 2011 Lowry, 2012). These themes reflect the importance and

positive benefits of consistently practicing FPDR. Families reported an increased level of

satisfaction with the care their loved one received and decreased distress when they were present

during resuscitation which had positive psychological benefits and facilitated grieving (Wolf,

Storer, & Brim, 2012). An increased sense of closure was conveyed in family members that were

able to view and participate in the resuscitation efforts which is an important component of the

grieving process (Jabre et al., 2014; Powers, & Candela, 2017; Jensen, & Kosowan, 2011;

Lowry, 2012). Current promotion of a patient and family centered models care suggest that

family should be a critical decision maker and an active member of the health care team (Jabre et

al., 2014; Powers, & Candela, 2017; Jensen, & Kosowan, 2011; Lowry, 2012). Critical events,
FAMILY PRESENCE DURING RESUSCITATION 6

like resuscitation, can be challenging for all parties involved but it is important to evaluate and

consider the benefits of FPDR to the family when considering resuscitating a patient.

Staff perceptions and perceived barriers. Staff perceptions and perceived barriers

were other areas addressed in the literature that provided insight as to why FPDR is not

commonly practiced. Family interfering with efforts was a commonality revealed that is

important because families may not be offered the option to be present if they interrupt the

efforts of the health care team (Jensen, & Kosowan, 2011; Goldberger et al., 2015; Goldberger et

al., 2015; Wolf, Storer, & Brim, 2012). Another commonality was health care providers feeling

uneasy with family present which may impact the effectiveness of their treatments and

interventions (Jensen, & Kosowan, 2011; Davidson et al., 2011; Wolf, Storer, & Brim, 2012).

Concern for misinterpretation of interventions resulting in legal action was a common finding

that could create significant financial cost to the hospital or physician (Jensen, & Kosowan,

2011; Lowry, 2012; Wolf, Storer, & Brim, 2012). Understanding barriers to implementation will

allow for FPDR to be more widely practiced.

Discussion

Limitations. Limitations in the literature are sample size and a limited amount of

quantitative data surrounding the topic because. Opportunities to obtain relevant data may be

affected if the physician is not experienced with FPDR because family presence is ultimately the

physician's decision. With the expanded practice of FPDR, sufficient data may be available to

strengthen the driving forces behind creation and implementation of policies. Due to the sensitive

nature surrounding FPDR, quantitative data is often difficult to obtain (Leske, McAndrew, &

Brasel, 2013; Lowry, 2013; Jensen, & Kosowan, 2011). This may require nurses to develop
FAMILY PRESENCE DURING RESUSCITATION 7

additional intervention-based studies to gather data that supports the implementation of FPDR

practice on a more consistent basis.

Gaps in the literature. Gaps in the literature are evident when analyzing reliability,

validity, and trustworthiness of the study designs and results. The majority of the literature fails

to comment on measures taken to ensure reliability, validity, and trustworthiness are met. This

creates challenges and uncertainty surrounding the strength, usefulness, and generalizability of

the results and preceding recommendations. Leske, McAndrew, & Brasel (2013) addressed these

measures by indicating researchers provided a thorough description about the setting and

analysis of findings, practiced peer debriefings, utilized a systematic approach to data analysis,

and maintained an adult trial. Lowry (2012) also comments on having data analyzed and cross-

monitored by coding staff to ensure reliability.

Future research and education. Future research surrounding FPDR is recommended

throughout the literature and focuses on addressing barriers, gaining quantitative data, and

understanding long-term benefits of FPDR (Leske, McAndrew, & Brasel, 2013; Jensen, &

Kosowan, 2011; Lowry, 2012; Wolf, Storer, & Brim, 2012; Davidson et al., 2011; Goldberger et

al., 2015). Additional research is needed to understand the acceptance of FPDR policies, staffs

willingness to implement the practice, and multi-disciplinary considerations (Lowry, 2012;

Powers, & Candela, 2017) Additional educational efforts are also proposed in an attempt to

bridge the gap between acceptance of FPDR and its practice. Recommendations include:

education provided to staff surrounding policies, the practice of FPDR, and psychological effects

on family (Powers, & Candela, 2017; Lowry, 2012; Leske, McAndrew, & Brasel, 2013).

Professional organizations like ENA, AACN, and AHA have created clinical practice guidelines
FAMILY PRESENCE DURING RESUSCITATION 8

that should be used as a framework for the implementation FPDR (Leske, McAndrew, & Brasel,

2013; Wolf, Storer, & Brim (2012).

Conclusion

This paper sought to critique and synthesize information from several pieces of literature

surrounding family presence during resuscitation in the critical care setting. Areas addressed

were methods, findings, areas for change, and future research. Additional research is needed to

answer the question: 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? Collaborating findings and suggestions from all sources will add to the data

encouraging development and wide-spread implementation of FPDR policies.

FAMILY PRESENCE DURING RESUSCITATION 9

Clinical Implications

This section will discuss clinical implications related to the PICOT question: 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?

Key Findings

Despite hospitals having policies surrounding FPDR, the practice is inconsistent (Jensen,

& Kosowan, 201; Wolf, Storer, & Brim, 2012). Multiple professional nursing organizations such

as the Emergency Nurses Association (ENA), American Heart Association (AHA), and

American Academy of Critical-Care Nurses (AACN) recommend the creation of a FPDR policy

and offering family members the option of being present during resuscitation (AACN, 2016;

AHA, 2010; ENA, 2012). Having a family member act as a voice for the patient and active

member of the health care team during resuscitation efforts was a commonality amongst the

research (Lowry, 2012; Davidson et al., 2011; Leske, McAndrew, & Brasel, 2013; Wolf, Storer,

& Brim, 2012). Research also showed an increased sense of closure when families were present

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

2014; Davidson et al., 2011; Lowry, 2012). Families reported an increased level of satisfaction

with the care their loved one received and decreased distress when present during resuscitation

which facilitated grieving (Wolf, Storer, & Brim, 2012). Research indicates that implementation

of policies, a family facilitator, and education programs will help with implementing the practice

of FPDR (Powers, & Candela, 2017; Wolf, Storer, & Brim, 2012; Jensen, & Kosowan, 2011;

Jabre et al., 2014; Davidson et al., 2011; Lowry, 2012).

Implementation Plan
FAMILY PRESENCE DURING RESUSCITATION 10

The research evaluated to determine the implementation process was primarily level VI

according to the Hierarchy of Evidence for Interventional Studies adopted from Bernadette

Melnyk (Stillwell, et al., 2010). The proposed practice change will occur at Sharp Memorial

Hospital Emergency Department (SMHED).

Policy and procedure. SMHED has a policy and procedure titled Family Presence

During Resuscitation (Appendix A) that was written in 2011 and revised in 2015 (SMMC, 2012).

This policy has as a framework for implementation but is infrequently practiced. This policy

defines the terms: family, resuscitation, family facilitator (FF), family presence, acute phase, and

transition phase in order to establish guidelines for the implementation of the practice. Family is

defined as a relative, significant other, or any person the patient has an established relationship

(SMMC, 2012). Resuscitation is defined as a sequence of life-saving measures (SMMC, 2012).

The family facilitator is a member of the health care team that facilitates family presence,

remains with family for the duration of their presence, answers questions, and provides support

(SMMC, 2012). During the acute phase, the time where the patient is undergoing life-saving

treatment, the FF will be a registered nurse who is familiar with the progression of resuscitation

(SMMC, 2012). During the transition phase, the time where the patient has been stabilized or

has expired, the FF can be a chaplain, social worker, or any other support person that can

advocate for and provide assistance to the family (SMMC, 2012). The policy outlines family

expectations (Appendix B) that will be reviewed with the family prior to being escorted to the

patient care area (SMMC, 2012).

The proposed change will be as follows: When radio room notifies Charge RN that CPR

is inbound, the resuscitation team will gather in trauma/resuscitation room and a pre-brief will be

initiated. During the pre-brief, the charge nurse will delegate one bedside RN to act as the
FAMILY PRESENCE DURING RESUSCITATION 11

FF. Once family arrives in the ED lobby, they will be escorted to a private area where the charge

nurse and assigned FF will greet family. At this time, guidelines and behavior expectations will

be discussed with the family and they will be escorted to the treatment area, if indicated and

appropriate. The rest of the procedure will be followed as outlined by the policy. If nursing staff

is unavailable, the Administrative Liaison (AL) may fill the role of FF (SMMC, 2012). The FF

will accompany the family to the patient care area and remain with them until the resuscitation is

complete (SMMC, 2012). Finally, the family will be escorted to an area of the ED where they

can discuss the events and be supported. At this time, the family will be informed of what to

expect and the decisions they will make in the near future (SMMC, 2012).

Data collection and evaluation. The charts of all patients who received cardiopulmonary

resuscitation at Sharp Memorial Emergency Department (SMHED) will be audited

retrospectively. Internal data will be accessed in order to determine the current level of

compliance with practicing FPDR. Provider education will be presented to all nursing staff

during the annual skills and competency testing and to physicians during their monthly meeting.

Once all staff has received the education, FPDR practice change will be initiated. Families

invited to be present during resuscitation and those not present will all be included to ensure both

groups are represented. All of the charts of patients who receive cardiopulmonary resuscitation

between August 2017 and December 2017 we be included. The emotional status will be

evaluated in the families that were present and will be compared to those not present during the

same time period. Methods used by Jabre et al. (2014) will be utilized to evaluate familys

emotional status. Families of all resuscitations will be contacted at the 3-month mark and

questioned by a trained psychologist to complete the complete the impact of event scale (IES),

the hospital anxiety and depression scale (HADS), the inventory of complicated grief (ICG), and
FAMILY PRESENCE DURING RESUSCITATION 12

the structured diagnosis of a major depressive episode (MINI) to determine if they fall within the

DSM-IV criteria for major depressive episode. These tools have been used internationally and

have been validated and compared to tools used for DSM criteria in the US (Jabre et al., 2014).

Families that refuse to complete the follow-up interview and/or are unreachable after five

attempts will be removed from the analysis.

Barriers to implementation. Family interfering with efforts was a commonality that was

revealed and is important because families are less likely to be offered the option of being

present during resuscitation if the staff feels they may interfere with care (Jensen, & Kosowan,

2011; Goldberger et al., 2015; Wolf, Storer, & Brim, 2012). Another barrier to implementation

is the concern that having family present may increase stress and anxiety among health care

providers (Jensen, & Kosowan, 2011; Wolf, Storer, & Brim, 2012). Providing education to the

health care team on the benefits of FPDR for the family is a way to overcome these barriers

(Davidson et al., 2011; Jensen, & Kosowan, 2011). Implementing a policy surrounding FPDR

will create structure and a framework for implementing the practice (Leske, McAndrew, &

Brasel, 2013; Jensen, & Kosowan, 2011; Lowry, 2012; Wolf, Storer, & Brim, 2012; Davidson et

al., 2011; Goldberger et al., 2015).

Cultural, Ethical, and Spiritual Considerations

Though grief and bereavement are universal, some cultural differences and preferences

may be factors in families and health care providers practicing FPDR (Jabre et al., 2014; Wolf,

Storer, & Brim, 2012). Studies conducted in Turkey, Germany, and Hong Kong revealed that

there was a guarded attitude toward FPDR among health care providers despite family members

being in favor of the practice (Wolf, Storer, & Brim, 2012). Nurses indicate that providing

emotional, psycho-social, and spiritual support to patients and family members is an important
FAMILY PRESENCE DURING RESUSCITATION 13

aspect of their job and most feel comfortable in doing so (Jensen, & Kosowan, 2011). A

significant ethical considerations surrounding FPDR is that of beneficence, or providing health

benefits to others (Beauchamp & Childress, 2013). FPDR has the ability to fulfill the principle of

beneficence by reassuring family that everything is being done and to facilitate closure if

attempts are unsuccessful (Halm, 2005).

Gaps in the Literature

Additional research is needed to understand the acceptance of FPDR policies, staffs

willingness to implement the practice, and multi-disciplinary considerations (Lowry, 2012;

Powers, & Candela, 2017). Educational efforts are also proposed in an attempt to bridge the gap

between acceptance of FPDR and its practice. Recommendations include: education provided to

staff surrounding policies, the practice of FPDR, and psychological effects on family (Powers, &

Candela, 2017; Lowry, 2012; Leske, McAndrew, & Brasel, 2013). Due to the sensitive nature

surrounding FPDR, quantitative data is often difficult to obtain (Leske, McAndrew, & Brasel,

2013; Lowry, 2013; Jensen, & Kosowan, 2011).

Conclusion

Framework has been created to aid in the implementation and consistent FPDR practice.

Minimal additional cost will be endured by the ED to create a team to include a family

facilitator, a psychologist to conduct follow-up interviews, a data collector and analyzers, and

someone to evaluate the effectiveness of FPDR on families. Collaborating findings and

suggestions from all sources will add to the data encouraging development and wide-spread

implementation of FPDR policies (Powers, & Candela, 2017; Wolf, Storer, & Brim, 2012;

Jensen, & Kosowan, 2011; Jabre et al., 2014).

FAMILY PRESENCE DURING RESUSCITATION 14

References

American Association of Critical-Care Nurses (2016). Family presence during resuscitation and

invasive procedures. Retrieved from: https://www.aacn.org/~/media/aacn-

website/clincial-resources/practice-alerts/fampresresuscpafeb2016ccnpages.pdf

American Heart Association (2010). Family presence during resuscitation. Retrieved from:

https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-

pediatric-advanced-life-support/intra-arrest-care-updates/family-presence-during-

resuscitation/

Boehm, J. (2008). Family presence during resuscitation. Code Communications Newsletter.

Retrieved from:

http://www.zoll.com/CodeCommunicationsNewsletter/CCNL05_08/CodeCommunicatio

ns05_08.pd

Beauchamp, T., & Childress, J. F. (2013). Principles of biomedical ethics. Oxford University

Press, USA.

Davidson, J., Buenavista, R., Hobbs, K., & Kracht, K. (2011). Identifying factors inhibiting or

enhancing family presence during resuscitation in the emergency department. Advanced

Emergency Nursing Journal, 33(4), 336-343.

Emergency Nurses Association (2012). Emergency nursing resource: Family presence during

resuscitation in the emergency department. Retrieved from

http://ena.org/IENR/ENR/Documents/FamilyPresneceENR.pdf

Goldberger, Z., Nallamothu, B., Nichol, G., Chan, P., Curtis, J., & Cooke, C. (2015). Policies

allowing family presence during resuscitation and patterns of care during in-hospital

cardiac arrest. Circulation: Cardiovascular quality and outcomes (114).

FAMILY PRESENCE DURING RESUSCITATION 15

Halm, M. (2005). Family presence during resuscitation: a critical review of the

literature. American Journal of Critical Care, 14(6), 494-511.

Jabre, P., Tazarourte, K., Azoulay, E., Borron, S. W., Belpomme, V., Jacob, L., & ... Adnet, F.

(2014). Offering the opportunity for family to be present during cardiopulmonary

resuscitation: 1-year assessment. Intensive Care Medicine, 40(7), 981-987.

doi:10.1007/s00134-014-3337-1

Jensen, L., & Kosowan, S. (2011). Family presence during cardiopulmonary resuscitation:

Cardiac health care professionals' perspectives. Canadian Journal of Cardiovascular

Nursing, 21(3), 23-29.

Leske, J. S., McAndrew, N. S., & Brasel, K. J. (2013). Experiences of families when present

during resuscitation in the emergency department after trauma. Journal of Trauma

Nursing, 20(2), 77-85. doi:10.1097/JTN.0b013e31829600a8

Lowry, E. (2012). It's Just What We Do: A qualitative study of emergency nurses working

with well-established family presence protocol. Journal of Emergency Nursing, 38(4),

329-334. doi:10.1016/j.jen.2010.12.016

Powers, K. A., & Candela, L. (2017). Nursing practices and policies related to family presence

during resuscitation. Dimensions of Critical Care Nursing, 36(1), 53-59.

Sharp Metropolitan Medical Campus. 2012. Family presence during resuscitation, 35091.99.

Retrieved from: https://sharp-all.policystat.com/policy/3520684/latest/

Wolf, L., Storer, A., & Brim, C., (2012). Clinical practice guideline: Family presence during

invasive procedures and resuscitation.

FAMILY PRESENCE DURING RESUSCITATION 16

Appendix A

PAGE 16 OF 4 REFERENCE

ORIGINAL CURRENT CATE/DIV SECT. # SECT.CODE POLICY

ISSUE DATE EFFECT DATE /PROCEDURE/PLAN #
11/12 11/15 D/I 35 ES 35091.99

TITLE:
[ ] POLICY
[ ] PROCEDURE
FAMILY PRESENCE DURING RESUSCITATION
[X] POLICY & PROCEDURE
[ ] PLAN
SUBJECT:
Patient Care
KEYWORD(S): CPR
.[ ] All Sharp HealthCare AFFECTED DEPARTMENTS: ACCREDITATION:

[ ] System Services Surgery Centers:

[ ] SRS [ ] CV-OPS Emergency Department
[ ] SCMG [ ]
GPSC
[ ] SHP [ ] SMH-OPP

Hospitals (check all that apply): ORIGINATOR: LEGAL REFERENCES:

[ ] SCOR [X] SMH
Emergency Nurses Association
[X] SCVMC [ ] SMBHWN
[X] SGH [ ] SMV Emergency Department American College of Emergency
[ ] SMC Physicians
American Association of Critical Care
Nurses

I. PURPOSE:
The purpose of this document is to outline and explain the process of Family Presence During Resuscitation.
This process will be followed when appropriate based on staffing and patient circumstances.

II. DEFINITIONS:

A. Family: A relative or significant other with whom the patient shares an established relationship.

B. Resuscitation: A sequence of lifesaving measures.

C. Family Facilitator (FF): A member of the healthcare team who facilitates family presence while offering
support and supervision of the family before, during, and after resuscitation. The FF shall assess the
family for appropriateness prior to their invitation into the patient care area and during resuscitation,
answer questions during resuscitation, and offer support for the family. The FF is a vital role and should
be this team members only responsibility during resuscitation. During the acute phase (see below) the
FF will be an experienced emergency department registered nurse (RN) so that questions about the
patients medical care can be answered. Family members will not be present without escort by the FF.

D. Family Presence: The presence of one or more family members in the patient care area.

E. Acute Phase: The phase of resuscitation in which the patient is undergoing life-saving treatment.

F. Transition Phase: The phase of resuscitation in which the patient has been stabilized or has expired.
During this phase the FF can be a chaplain or other support staff to advocate and provide assistance for
the family.
FAMILY PRESENCE DURING RESUSCITATION 17

III. TEXT:
Family Presence During Resuscitation has been shown to allow for the following:
A. Enhanced family understanding of patient condition
B. Opportunities for family members to support the patient or obtain closure in case of death
C. Family appreciation of resuscitation efforts
D. Staff attention to dignity of the patient
E. Enhanced professional behavior among staff members
F. A more holistic approach to care, utilizing medical, nursing, auxiliary, and chaplain staff to ensure
maximum quality in patient care

IV. PROCEDURE: RESPONSIBILITY

A. Designate Family Facilitator A. Intake RN and Charge

When family arrives, the charge nurse should be called. The RN
charge nurse will either act as the Family Facilitator or assign
someone for this role. The FF shall be an RN. In the event,
there is insufficient staff to fulfill this role, the Administrative
Liaison, can be paged to serve as the FF during the acute
phase (see definition below). During the transition phase
(see definition below) the role of FF may be delegated to
auxiliary hospital staff (chaplain or social worker)

B. Decision to offer family presence: Family Assessment B. Family Facilitator

If the patient is able to convey his/her wishes for or against
family presence, these wishes should be honored.
The healthcare team will be made aware that family is present
and shall reach a consensus on the appropriateness of family
presence for the patient.

The FF will assess the family to determine if they are

appropriate to invite into the patient care area. Family that
should be excluded are those who are: unattended minors,
belligerent, intoxicated, extremely emotional, or otherwise
inappropriate for presence in the clinical setting.
C. Discuss expectations with family C. Family Facilitator

The FF shall prepare the family for what they are about to see,
where they should sit in the room, and how they should behave.
The FF may review the Family Expectations During
Resuscitation agreement prior to entering the patient care area
(refer to Attachment A herein).

D. Escort Family Members to Treatment Area D. Family Facilitator

Acute phase:
Family members will not be in the treatment area at any time
without the presence of the Family Facilitator. The FF will be a
bedside RN, but the Administrative Liaison will serve as the FF
during the acute phase should staffing be inadequate to fill the
role of FF. The FF should announce the family when they are
brought into the treatment area. The FF will provide comfort
measures for the family if needed such as chairs or tissue, answer
questions, and explain treatments. The FF shall seek
opportunities for family to touch or speak to the patient if desired
when it will not interfere with medical treatment. If family
FAMILY PRESENCE DURING RESUSCITATION 18

IV. PROCEDURE: RESPONSIBILITY

members become disruptive, faint, or otherwise inappropriate,

they will be immediately escorted out of the treatment area.

Transition phase:
Once acute measures have been discontinued (expiration or return
of stability), a FF remains to aid the family in the transition period
until the patient is moved to the ICU or the expired patient is
moved to its destination. During this time, the role of FF may be
delegated to the hospital staff chaplain.

E. Complete the Visit

Family should be taken to a place where they can comfortably
discuss the circumstances. They will be given the opportunity to
ask questions. If death has occurred, the FF will offer a Chaplain,
alone time, or emotional support. The family shall be informed
of what to expect and what decisions they will have to make
regarding the body.

V. REFERENCES:
Basol, R., Ohman, K., Simones, J., & Skillings, K. (2009). Using research to determine
support for a policy on family presence during resuscitation. Dimensions of Critical Care
Nursing, 28(5), 237-247.
Meyers, T., Eichhorn, D., Guzzetta, C., Clark, A., & Taliaferro, E. (2004). Family
presence during invasive procedures and resuscitation: the experience of family
members, nurses, and physicians. Topics in Emergency Medicine, 26(1), 61-73.
Mian, P., Warchal, S., Whitney, S., Fitzmaurice, J., & Tancredi, D. (2007). Impact of a
multifaceted intervention on nurses' and physicians' attitudes and behaviors
toward family presence during resuscitation. Critical Care Nurse, 27(1), 52-61.
Oman, K., & Duran, C. (2010). Health care providers' evaluations of family presence
during resuscitation. Journal of Emergency Nursing, 36(6), 524-533.

VI. CROSS REFERENCES: None

VII. ATTACHMENTS: (Click on attachment name to access)

A. Family Expectations During Resuscitation

VIII. APPROVALS:
A. Sharp Grossmont Emergency Department Administration
B. Sharp Grossmont Emergency Medical Group
C. MEC Approvals: CV GH 7/12 SMH
D. ED Supervisory Approvals: CV GH 7/12 SMH 12/12
E. Nursing Policy & Procedure Committee 10/12
F. The System Policy & Procedure Steering Committee 11/12
G. SMH Emergency Services Committee 12/12
H. SMH Emergency Nurse Practice Council - 12/12
I. SMH Emergency Department Leadership - 01/13, 11/15
J. System ED Collaborative 11/15

IX. REPLACES: None

X. HISTORY: System #35091.99; originally dated 11/12

Reviewed/Revised: 11/15
FAMILY PRESENCE DURING RESUSCITATION 19

Appendix B

FAMILY EXPECTATIONS DURING RESUSCITATION

Because our main priority is the care of your loved

one, you may only be able to stay a few minutes. If
there is any interference with medical care, you will
be asked to leave.

We ask that 1-2 family members are present in the

treatment area at a time.

Someone will stay with you the entire time you are in
the treatment area.

We ask that you remain seated while in the

treatment area.

Taking photos or videos will not be permitted while

in the patient care area.

You may leave any time.

Your healthcare team is in charge of the treatment.

Someone will be here to answer any questions and
explain treatments as they are taking place.
FAMILY PRESENCE DURING RESUSCITATION
Grading Rubric for Clinical Project: Clinical Implications Paper:
Category Exemplary
90 100%
Transition Section Problem clearly identified.
Thesis statement and focus of
Maximum the paper clear to reader.
10 points Significance to nursing
discussed.
PICOT question included
Body Plan for Appropriate findings from your
change literature review identified and
discussed.
Maximum Uses inference and reason to
35 points draw logical conclusions about
implications and consequences.
Identifies a strategy and
potential problems.
Provides support for change or
innovation.
Transitions link sections and
paragraphs well.
Content vocabulary appropriate,
used well.
Evaluation outcome clearly
discussed and supported
Clear plan developed to
implement change in practice.
Grading of Evidence, Barriers/Facilitators to change
Barriers/Facilitators identified and addressed,
to change, considered possible ethical
spiritual/cultural and implications, demonstrates
ethical considerations insight and depth in discussion.
15 points Cultural/Spiritual
Considerations included.
Summary statement of grading
of evidence with citation.
Conclusion Clear, thorough summary.
Maximum Relevance to nursing clearly
15 points stated.
Recommendations clear and
supported.
Assignment Addresses all required elements
Max. 5 points of assignment & expands them.
Grammar & Spelling No grammar or spelling errors.
Max. 10 points
APA Format for Citations include all elements of
Citations APA formatting, according
examples in APA 7.01.
Max. 5 points
*Formatting Follows all APA formatting
guidelines; uses Word functions
Max.5 points appropriately, introduction and
conclusion included
Meets Requirements
80 90%
Problem identified.
Thesis statement clear to reader
Significance to nursing
identified.
PICOT question included
Literature review incorporated
adequately.
Draws logical conclusions.
Identifies a strategy and
potential problems.
Proposed change is
understandable and has support
in literature.
Evaluation outcomes included.
Minor problems with transition
and order of paragraphs or
sections.
Content vocabulary generally
accurate.
Plan developed to implement
change in practice, but not
clear.
Minimal discussion of possible
barriers/facilitators, minimal
insight and/or depth.
Ethical, spiritual or cultural
considerations not all included.
Summary statement of grading
of evidence with citation.
Problem and findings
summarized.
Relevance to nursing
appropriate.
Recommendations supported.
Addresses all required elements
of assignment.
1-2 minor errors per page.
No more than two minor errors
in APA style formatting in all
citations. Follows examples in
APA 7.01.
Follows all formatting
guidelines; minor problems
with Word functions.
20
Needs Improvement Points
<79%
Problem unclear.
Thesis statement unclear
or missing.
Significance to nursing
not addressed.
PICOT question not
included
Literature review not
incorporated adequately.
Findings unclear.
Strategies unclear or not
logical.
No support for proposed
changes.
No evaluation outcome
or evaluation outcome
not clearly supported.
Many or significant
problems with transition
and order of paragraphs
or sections.
Significant errors in
content vocabulary.
Plan unclear for change
in practice
No discussion of possible
barriers/facilitators, no
ethical considerations, no
spiritual/cultural
considerations, no
insight/depth
demonstrated.
No summary statement of
grading of evidence with
citation.
Summary inadequate.
Relevance to nursing
unclear or missing.
Recommendations
unclear or unconnected.
Fails to address all
required elements of
assignment
3 or more errors per
page.
More than two minor
errors or one significant
error in formatting in all
citations. Does not follow
examples in APA 7.01.
Formatting errors; page
length incorrect; poor use
of Word functions.