Family Presence
During Resuscitation
Julie K. Kuzin RN, CPNP-AC/PC
Shino S. Thomas RN, NNP-BC
Objectives
1) Identify the perceived risk and reward received by families
present during resuscitation of infants and children.
2) Discuss interventions that provide support to families during
resuscitation events.
3) Discuss the desired outcomes of family presence during
resuscitation.
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Family Centered Care is the 3rd of 6
central aims to improve healthcare
Providing care that is respectful of and responsive to
individual patient preferences, needs, and values and
ensuring that patient values guide all clinical decisions.
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Historical Timeline
Family Centered Care (FCC)
History of Family Visitation in Hospitals
• 1894 Boston Children’s Hospital
•Visit 2 days per week
• 1910 Massachusetts General Hospital
•Crying children moved into isolation
• 1959 Platt Report
•Advocated for open visitation
(Markel 2008, Ismail & Mulley 2007)
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History of Family Centered Care
(Kuo, et al. 2012)
1980s
2001
2003
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• Maternal and Child Health Bureau and Surgeon General offices
advocated for family centered care
• Institute of Medicine named patient centered care as crucial for health
care quality
• AAP had incorporated FCC into multiple policy statements and
affirmed FCC as the standard of health care for all children
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History of Family Presence During
Resuscitation (FPDR)
1982 Foote Hospital in Michigan
• 2 family member requested to be present during
resuscitation
• Survey showed 13 of 18 family members wished they
had been present
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(Boehm 2008)
1985 Program Developed by Foote
Hospital
• 47 bereaved family members responded to survey
• 76% stated being present helped them grieve
• 64% felt their presence helped dying family member
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History of FPDR
Dingeman, et al. 2007, Henderson and Knapp 2005
1993 Emergency
Nurses Association
• First to develop a
resolution supporting
family presence
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2000 & 2005 American
Heart Association
• Resolution
supporting families
be given option
• Presence of support
personnel for family
member
2002 American
Association of Critical
Care Nurses
• Health care
organizations have
written policy
regarding FPDR
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2004 American
Academy of Pediatrics
Consensus
• 18 organizations
convened to develop
recommendations for
FPDR
Current Literature
• Institutional Support
•About 9% of hospitals have written policy (Dingeman, et al 2007)
•One of three nurses surveyed offered families the option (Halm, 2005)
•Increasing demand
•1991 survey reported half of families would choose to be present
•About a decade later 87% would be present
•86% felt it was their parental Right
(Dingeman et al 2007)
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Patient Perspective
Adult patient data
•Endorsed their humanity
•Benefit to family members outweighed risks
•Did not create embarrassment
•Wanted family members present, even if it was traumatizing (Mortelmans, 2009)
•3 survivors were content that family present (Dudley, 2009)
(ENA 2009, Dingeman 2007, McGahey, 2007; Meyers, 2000; Pirra, 2005; Tinsley, 2008;
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Family Perspective
• Decreased anxiety, Increased satisfaction
• Improved Coping “Everything could be done was done”
• Helpful, comforting to their child during trauma resuscitation
• 72% of pts & family wanted family present (Benjamin, 2004)
• 94% would repeat their decision to be present during invasive procedure (Powers &
Rubenstein, 1999)
• Family “Right” & should have the option, 100% said it was helpful (Meyers, 2000)
• 11% were asked, 69% would have wanted the opportunity, 62% would have chosen to
be present (Barrett & Wallis, 1998)
(Dingeman 2007, Dudley 2009, ENA CPG 2009, Mortelmans 2009, Piira 2005, Tinsley 2008)
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Provider Perspective
Violation of
patient
confidentiality
Adult patient
perspective in support
of FPDR
Increased
stress on
staff
Provider
performance
No delay in care
RNs and senior
physicians support
FPDR
Parents key to
providing medical
information
Supported patient
dignity
Increased
risk of
litigation
No literature to
support
No difference in
procedure success
rate
No delay in stopping
resuscitation
79% felt residents
should be trained in
FDPR (Gold, 2006)
Humanized the patient
Too traumatic
for families to
witness
Improved grieving
process
Less depression,
PTSD and anxiety
long term follow-up
Promoted family
acceptance of death,
know everything was
done
(Halm 2005; Dingeman et al 2007, ENA CPG 2009)
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Randomized Control Trial
Jabre et al (France)
New England Journal of Medicine 2013
570 relatives
15 EMS units
(driver, RN,
MD)
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Randomized
to offer FPDR
or follow
standard
practice
FPDR did not
Experimental
PTSD higher
affect
group 79%
in the control resuscitation,
present for
patient
group and
CPR
higher in those survival, staff
Control group
who did not
stress, or
43% present
medicolegal
witness CPR
for CPR
claims
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Cultural Perspective
Singapore - 75% of physicians and 78% of nurses families should not be present
United Kingdom - 62% of families would have chosen to be present if given the chance
United Kingdom – 63% did not favor FPDR -mostly physician
Scotland – 13% supported FPDR, 48% were unsure, 71% wanted a policy
Sweden – Nurses and physicians thought few families would want FPDR, more nurses than physicians would always
respect families wishes.
Australia – 62% would consider FPDR, 70% would want it for themselves, 76% procedure offensive to family
Turkey, Saudi Arabia, Germany, Hong Kong (guarded or negative attitudes)
(Dingeman et al 2007, ENA 2009, Halm 2005)
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In summary
• No negative effect on delivery of care
• Not evidence of harm in the literature
• Improves psychological impact on families
• Patients and families want the option
• Healthcare providers hold unfounded fears
• FPDR is a key component of Family Centered Care
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Family Panel
Deonc
Jenna
Nalah
Griffin & Grayson
Harper
Where do we go from here?
•
•
•
•
•
Page
Institutional policy
Healthcare provider education
Family support person
What is the patient’s voice?
Ongoing evaluation of effect on families?
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Reference List
American Academy of Pediatrics Committee on Hospital Care Family-centered care and the pediatrician’s role. Pediatrics. 2003;112:691–
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Curley, M.A., Meyer, E.C., Scoppettuolo, L.A., McGann, E.A., Trainor, B.P., et al. (2012) Parent presence during invasive procedures and
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Reference List
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