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

https://doi.org/10.1016/j.ijnurstu.2015.03.004Get rights and content

Abstract

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.

Introduction

In the context of emergency care, there is a growing body of literature and practical interest in, examining the benefits for family involvement and presence when emergency measures are being initiated (Ganz and Yoffe, 2012, Lowry, 2012, Porter et al., 2013). This family involvement sometimes extends to family being present if cardiopulmonary resuscitation (CPR) is initiated (hereafter the term ‘resuscitation’ refers only to CPR). Patients, family members and professional groups report positively on the benefits of family presence during CPR (Axelsson et al., 2010, Hung and Pang, 2011, Porter et al., 2013). Relatives explain that being with their loved one during their last moments of life was meaningful as they believed they were able to provide comfort, appreciate that a life was over and commence grieving (Fulbrook et al., 2007, Holzhauser and Finucane, 2008, MacLean et al., 2003, Meyers et al., 2000). Some studies indicate that witnessing this intervention was not always a positive experience with some families reporting regret at having witnessed the event and ongoing stress recalling the experience (Fulbrook et al., 2005, Mian et al., 2007, Van der Woning, 1999).

Of the few studies examining the experiences of patients who have survived CPR (described in this paper as survivors), individuals express feelings of being safe, supported and comforted, and less afraid when family were present (Eichhorn et al., 2001, McMahon-Parkes et al., 2009, Robinson et al., 1998). Further, patients believed that family acted as an advocate and their presence served to remind the staff of their personhood and promote quality care. Families who were not present, tended to report more intrusive images, depression, anxiety and reduced acceptance that the death had occurred (Clarke and Carter, 2002, Doyle et al., 1987, Eichhorn et al., 2001, Hansen and Strawser, 1998, MacLean et al., 2003, Meyers et al., 2000, Oman and Duran, 2010, Robinson et al., 1998). A recent experimental study conducted in the pre-hospital environment randomised assigned family member to either family presence during CPR (n = 211) or standard practice (n = 131) groups (Jabre et al., 2013). Families in the intervention group reported less post-traumatic stress disorder. Having the family present does not interfere with the health teams’ delivery of care (Dwyer, 2009, Jabre et al., 2013). Further, being together is evidently important for family members in this crisis with family members expressing relief at just being with them [patients] to offer emotional support, to know that everything was done or to make sense of the situation (Maxton, 2008, McGahey-Oakland et al., 2007).

Studies of family members’ level of support for being present during resuscitation varies from 49 to 73 per cent (Berger et al., 2004, Ersoy and Yanturali, 2006, Mazer et al., 2006, Ong et al., 2007). This variation in the levels of support may reflect unique aspects about the cohort and the use of the term ‘resuscitation’. For example, families report higher levels of support for being present during invasive procedures (Anantha et al., 2014), when compared to being present specifically during CPR. Clarification of the term when reporting family preference is important as families’ perception of the severity of the illness and whether the intervention is ‘life-saving’ could influence the individual's desire to be present (Schmidt, 2010).

Studies of patients and relatives presenting to hospitals generally report high levels of support for family presence. Ong et al. (2007), approached the family support person (n = 155) of patients presenting to the emergency department, reported high levels of support (73.1%) for witnessing resuscitation (Ong et al., 2007). These participants believed that being present aided the grieving process (68.8%; n = 99) and offered them a measure of assurance that everything possible was being done for their family member (85.3%; n = 122) (Ong et al., 2007). These findings mirror the high levels of support observed when participants are recruited as they present to emergency departments (Duran et al., 2007, Meyers et al., 2004, Wagner, 2004). Where the benefits for survivors and families are becoming clear, attitudes and opinions of the general public about their involvement, and the decisions they may make should it happen to them, have not been widely reported. Knowledge about public opinion is largely limited to family in emergency departments and there is need for more diverse studies of the views of the general public attitudes towards being present when a family member requires CPR. Greater knowledge about public perceptions is imperative to inform the development of culturally appropriate policy and guidelines to support this practice.

The aim of this population based study was to identify factors that predict general public support for having family present during CPR. Secondary aims were to: determine if individual attitudes vary for family presence during CPR of; an adult, child or the individual themselves and identify factors that influence and individuals preference for wanting to be present.

Section snippets

Study design

This cross-sectional population-based study used an omnibus survey, administered by telephone interview, to explore the general public's perception of family presence during CPR. The omnibus survey was designed to create a population based representative estimate of the attitudes of the adult individual responding to the survey and the household where they live (Evans et al., 2007, Thomas and Coleman, 2004). The survey received approval from University Human Research Ethics Committee and

Participants

The survey consisted of equal representation of males (602; 49.8%) to females (606; 50.2%) (response rate 62%). Approximately 52.5% (n = 622) of the participants supported being present if one of their family members was receiving CPR while in hospital. There was no statistically significant difference in age or sex between participants who wanted to be present compared to those who did not want to be present (see Table 1). Seventy-four per cent (n = 829) had prior CPR training and when compared to

Discussion

The principal finding from this population-based study was that individual support for being present during CPR varied according to the relationship between the participant and the person that was being resuscitated. This diversity of preferences around resuscitation and the roles of patients is reported elsewhere (Eliott and Olver, 2011). If the person was an adult family member then participants reported moderate desire to be present. Similarly, if they themselves were the person requiring

Conclusion

Family presence during CPR is gaining momentum and support within the general public. People want the option of being present, especially when the family member is a child. However a considerable percentage of the population remain unaware that staying together during this traumatic event is even an option. Quality of life benefits for the patient and family are significant and include relief of the anxiety that more care could have been taken, satisfaction that their presence could be

Conflict of interest

None declared.

Funding

This research was funded by the Central Queensland University Faculty Research Grant. This paper development was financially supported through the Australian Government's Collaborative Research Networks program.

Ethical approval

Central Queensland University Human Research Ethics Committee (number: H05/08-10).

Acknowledgement

Professor Margaret McAllister assisted with the final editing of the paper. Finally, the study wouldn’t be possible without contribution of the respondents.

References (50)

  • J. Mangurten et al.

    Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department

    J. Emerg. Nurs.

    (2006)
  • P. McGahey-Oakland et al.

    Family experiences during resuscitation at a children's hospital emergency department

    J. Pediatr. Health Care

    (2007)
  • K. McMahon-Parkes et al.

    The views and preferences of resuscitated and non-resuscitated patients towards family-witnessed resuscitation: a qualitative study

    Int. J. Nurs. Stud.

    (2009)
  • K. Oman et al.

    Health care providers’ evaluations of family presence during resuscitation

    J. Emerg. Nurs.

    (2010)
  • M. Ong et al.

    Comparing attitudes of the public and medical staff towards witnessed resuscitation in an Asian population

    Resuscitation

    (2007)
  • J. Porter et al.

    Attitudes, implementation and practice of family presence during resuscitation (FPDR): a quantitative literature review

    Int. Emerg. Nurs.

    (2013)
  • J.E. Porter et al.

    Family presence during resuscitation (FPDR): perceived benefits, barriers and enablers to implementation and practice

    Int. Emerg. Nurs.

    (2014)
  • S. Robinson et al.

    Psychological effects of witnessed resuscitation on bereaved relatives

    Lancet

    (1998)
  • A. Axelsson et al.

    European cardiovascular nurses’ experiences of and attitudes towards having family members present in the resuscitation room

    Eur. J. Cardiovasc. Nurs.

    (2010)
  • J. Berger et al.

    Do potential percipients of Cardiopulmonary resuscitation want their family members to attend? A survey of preference

    J. Clin. Ethics

    (2004)
  • M. Booth et al.

    Family witness resuscitation in UK emergency departments: a survey of practice

    Eur. J. Anaesthesiol.

    (2004)
  • R. Chapman et al.

    Family-witnessed resuscitation: perceptions of nurses and doctors working in an Australian Emergency Department

    ISRN Emerg. Med.

    (2012)
  • A. Clarke et al.

    Why do nurses see families as trouble?

    Clin. Nurse Spec.

    (2002)
  • R.B. Deber et al.

    Do people want to be autonomous patients? Preferred roles in treatment decision-making in several patient populations

    Health Expect.

    (2007)
  • C. Doyle et al.

    A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

    BMJ Open

    (2013)
  • Cited by (25)

    • Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review

      2021, Resuscitation
      Citation Excerpt :

      None of the survey methods papers reported validation of the survey tools and very few included a copy of the actual survey for review so it was not possible to assess the content validity and appropriateness of the questions related to the reported findings. Eight of the papers focused on the parental or family opinion of being present (or not) during their child’s resuscitation.12–19 Five of these papers sampled parents or family members who were present during a resuscitation.14,16–19

    • Preferences of patients’ family regarding family-witnessed cardiopulmonary resuscitation: A qualitative perspective of intensive care patients’ family members

      2019, Intensive and Critical Care Nursing
      Citation Excerpt :

      Results of a randomised control trial investigating the effect of FWR on posttraumatic stress disorder symptoms show that family presence is associated with more positive psychological outcomes in families, and does not interfere with staffs’ CPR efforts, or results in conflicts between staff and family members (Jabre et al., 2013). Moreover, there is evidence suggesting that families often desire to stay by the bedside during CPR of their loved-one (Bradley et al., 2017; Chew et al., 2014; Dwyer, 2015; Leske et al., 2013; Masa’Deh et al., 2013; Twibell et al., 2015; Zali et al., 2017). There is a lack of recent studies exploring specifically intensive care unit (ICU) patients’ families’ preferences in places where this practice is not yet implemented.

    • Clinical Practice Guideline: Family Presence

      2019, Journal of Emergency Nursing
    View all citing articles on Scopus
    View full text