Running head: FAMILY PRESENCE DURING RESUSCITATION
Family Presence during Resuscitation
Pamela Green, MSN, APRN, FNP-C
Linda Roussel, PhD, RN, NEA-BC, CNL
University of Alabama at Birmingham (UAB) School of Nursing
1
FAMILY PRESENCE DURING RESUSCITATION
2
Family Presence during Resuscitation
Introduction
Background
The last few moments of life are often marked by heroic efforts to restore
cardiopulmonary function. Varying opinion surround the issue of family presence in the
resuscitation room while these efforts are underway. Family members and healthcare providers
are at odds regarding what is best in those critical moments.
With trained medical personnel immediately available to implement cardiopulmonary
resuscitation (CPR), 44% of patients will die within the first 20 minutes post CPR (Peberdy et
al., 2003). Of the 56% who survive, less than 17% will survive to discharge from the hospital
(Weissman & Ramenofsky, 2009). Although CPR is often the terminal life event, less than five
percent of acute care facilities across the United States have policies and protocols to allow for
family presence in the resuscitation room (MacLean et al., 2003).
The purpose of this quality improvement project is to determine if awareness of the
benefits of and guidelines for family presence in the resuscitation room has a positive impact on
physician opinion.
Literature Search Strategy
A search of the literature surrounding family presence during resuscitation was
undertaken. Database, citation and hand searching methods were used. Database searches
included Cochrane Library, CINAHL, Scopus, Medline Plus, Ovid and PubMed. Hand searches
of journals included Journal of Emergency Nursing, BMJ Supportive and Palliative Care,
Centers to Advance Palliative Care, and the American Journal of Critical Care. Key search
FAMILY PRESENCE DURING RESUSCITATION
3
words included: family presence, cardiopulmonary resuscitation, healthcare provider stress,
family grieving, and family in resuscitation room.
Literature Synthesis
In December, 2012, the Emergency Nurses Association (ENA) revised their guidelines
recommending family members be included during invasive procedures and resuscitation
(Emergency Nurses Association [ENA], 2012). The American Heart Association recommended
family members be offered the opportunity to be present during resuscitation (American Heart
Association [AHA], 2000). These guidelines and recommendations were followed by a practice
alert from the American Association of Critical Care Nurses stating all family members should
be given the option of family presence during resuscitation (American Association of Critical
Care Nurses [AACN], 2010).
Healthcare consumers are a driving force calling for change in organizational culture to
include family presence during resuscitation. When allowed to be present, family members
perceive the experience to have a positive effect on grieving and adjusting to loss (Doyle et al.,
1987; Meyers et al., 2000; Meyers, Eichhorn, & Guzzetta, 1998).
The Emergency Nurses Association (ENA) conducted a review of the literature
surrounding family presence during resuscitation and invasive procedures. The first
retrospective study to examine family presence during resuscitation was performed in 1985 at
Foote Hospital in Jackson, Michigan. This study indicated family presence during resuscitation
had a benefit in family member grieving and that family members perceived they helped the
person undergoing resuscitation (Doyle et al., 1987). Since 1987, family presence has been
studied from the family member and healthcare provider perspective. Of the 37 articles
reviewed, only one qualitative study was found to have been conducted of resuscitation
FAMILY PRESENCE DURING RESUSCITATION
4
survivors. This study found all survivors were content with family presence during resuscitation
(Robinson, Mackenzie-Ross, Hewson, Egleston, & Prevost, 1998). Hospitalized patients with
life threatening illness indicated they would prefer family to be present during CPR (Mortelmans
et al., 2009).
No studies indicated decrease in family member satisfaction or increase in stress when
present during resuscitation. From the family member perspective, many expressed they not
only wanted to be present, but felt it was their right (Tinsley et al., 2008; Mortelmans et al.,
2009; Piira, Sugiura, Champion, Donnelly, & Cole, 2005; Dingeman, Mitchell, Meyer, &
Curley, 2007; Dudley et al., 2009; McGahey-Oakland, Lieder, Young, & Jefferson, 2007).
Allowing family presence during the resuscitation was felt to create transparency. Family
members who had witnessed a resuscitation event felt everything had been attempted to save
their loved one (McGahey-Oakland et al., 2007; Tinsley et al., 2008; Emergency Nurses
Association [ENA], 2007).
Healthcare providers have varying opinion regarding family presence during resuscitation
(FPDR). Many providers have held to the belief that witnessing resuscitation efforts would be
too stressful for family members or family presence would hinder the delivery of care. Increased
risks of litigation and increased stress to healthcare providers have also been cited as compelling
reasons to separate patient and family during resuscitation efforts (Critchell & Marik, 2007).
One study of healthcare providers in the emergency and critical care areas revealed
providers were 82% in favor of family presence during resuscitation despite the fact they had no
prior knowledge of the benefit and were not aware of guidelines surrounding family presence
(Demir, 2008). Healthcare providers identify family presence allows the family the opportunity
to say goodbye when resuscitation efforts are unsuccessful, promotes family acceptance of their
FAMILY PRESENCE DURING RESUSCITATION
5
loved one’s death, and facilitates grieving (Dingeman et al., 2007; Demir, 2008; McClement,
Fallis, & Pereira, 2009; Walker, 2008). Many healthcare providers perceive untoward
repercussions when family members are allowed to be present in the resuscitation room. Many
providers believe family members would interfere with resuscitation efforts (Basol, Ohman,
Simones, & Skillings, 2009; Demir, 2008; Dingeman et al., 2007; Fernandez, Compton, Jones, &
Vilella, 2009; McClement et al., 2009; Walker, 2008; Madden & Condon, 2007). Healthcare
providers experience increased stress and performance anxiety when family members are
witnessing the resuscitation efforts (Basol et al., 2009; Demir, 2008; Dingeman et al., 2007;
Fernandez et al., 2009; Madden & Condon, 2007; McClement et al., 2009; Walker, 2008).
Although there is no evidence to support the perception, many providers fear increased litigation
when family members are present in the resuscitation room (Walker, 2008; Madden & Condon,
2007; McClement et al., 2009; Dingeman et al., 2007; Demir, 2008; Fernandez et al., 2009).
Approximately 95% of acute care facilities in the United States do not have policies in
place to support family presence during resuscitation (MacLean et al., 2003). Three studies
indicated hospital policy surrounding family presence would have a positive impact on provider
attitude regarding family presence (Basol et al., 2009; Madden & Condon, 2007; Howlett,
Alexander, & Tsuchiya, 2010).
Based on review of the literature, it is the recommendation of the ENA that family
members should be offered the option for presence in the resuscitation room. The ENA further
recommends that institutional policy should be written to support the recommendation of family
presence during resuscitation. There is evidence to support a designated health care professional
being assigned to family members present in the resuscitation room to provide explanation and
comfort (Emergency Nurses Association [ENA], 2012).
FAMILY PRESENCE DURING RESUSCITATION
6
Microsystem Analysis
Baylor Health Care System does not have a written policy for family presence during
resuscitation. Interviews with physicians and staff members in the Emergency Department and
Critical Care areas reveal variation in practice between departments and providers. Provider
opinion regarding family presence in the resuscitation room ranges from “never” to “always”.
Of those providers allowing family presence, no clear criteria could be elicited. Decisions
appear to be subjective based on the opinion of the provider. One provider who reported he
never allowed family members to be present in the resuscitation room commented, “I know I am
going to have to change my practice. Evidence is mounting in support of family member
presence”.
Study Question
For physicians in the acute care setting, does education on recommendations and best
practice related to family presence in the resuscitation room change physician opinion regarding
family presence?
Purpose and Objectives
The purpose of this project is to determine if awareness of the benefits of and guidelines
for family presence in the resuscitation room has a positive impact on physician opinion. The
objectives of this project include: 1) identify current practice related to family presence in the
resuscitation room, 2) identify medical staff opinion regarding family presence in the
resuscitation room, and 3) determine if education regarding guidelines and best practice for
family presence during resuscitation has a positive impact on medical staff opinion.
FAMILY PRESENCE DURING RESUSCITATION
7
Conceptual Framework
Medical practice struggles to keep up with medical knowledge. It is estimated to
take as long as twenty years to incorporate evidence into practice (Agency for Healthcare
Research and Quality [AHRQ], 2001). Donabedian’s model for healthcare quality (Appendix A)
identifies three fundamental elements of healthcare when seeking to incorporate evidence into
practice: 1. Structure – characteristics of the organization where care occurs, 2. Process – the
focus of the care delivered to the patient, and 3. Outcome – effect of care on the patient
(Donabedian, 1988). Applied to family presence during resuscitation, the structure may include
available staff, the physical environment where resuscitations occur, equipment available and the
organization philosophy regarding family presence. Based on the location of the patient within
the facility when a cardiopulmonary resuscitation occurs, some variables within the structure
may change. The process for family presence must view the patient/family unit as the focus of
care. Not only will measures continue to surround patient outcome in terms of survival,
outcomes for family members must be developed to capture the outcome of cardiopulmonary
resuscitation.
The Model for Improvement identifies that improvement comes from the application of
knowledge. The Model for Improvement (Appendix B) provides a framework for change. This
model is based on three questions that form the basis for improvement:

What are we trying to accomplish?

How will we know that a change is an improvement?

What changes can we make that will result in improvement?
Addressing why improvement is necessary, establishing and incorporating a means to
identify when improvement is happening, developing a change resulting in improvement, testing
FAMILY PRESENCE DURING RESUSCITATION
8
the change before implementation and knowing when and how to make change permanent are
the principles guiding the Model for Improvement (Langley et al., 2009). The methodological
framework of the Model for Improvement (MFI) will be used to determine the effectiveness of
education. The three fundamental questions from MFI will guide the improvement project
through Plan-Do-Study-Act (PDSA) (Langley et al., 2009).
1. What are we trying to accomplish? The goal of this project is to determine if
awareness of current guidelines and best practice have an impact on medical staff
opinion regarding family presence in the resuscitation room.
2. How will we know a change is an improvement? To assess improvement in
physician opinion regarding family presence during resuscitation, the following
aims will be developed:
a. Baseline assessment to determine current medical staff opinion regarding
family presence in the resuscitation room.
b. Evidence based education regarding guidelines, recommendations, and
benefits of family presence during resuscitation.
c. Comparative analysis of pre- and post-education provider opinion of
family presence during resuscitation.
3. What change can we implement that will result in an improvement? Medical staff
education to support the practice of family presence during resuscitation will be
developed and implemented.
Setting
Baylor Medical Center at Carrollton (Baylor Carrollton) is a non-profit organization in
the Dallas/Ft.Worth, Texas area. Joining Baylor Health Care System (BHCS) in June, 2009, the
FAMILY PRESENCE DURING RESUSCITATION
9
organization is one of 31 care facilities owned, operated, joint ventured or affiliated with BHCS.
Baylor Carrollton maintains 232 licensed acute care beds. Five hundred six physicians are on the
medical staff that provides full services to the community of Carrollton and Farmers Branch,
Texas.
IRB
The Clinical Ethics and Supportive and Palliative Care Committee identified an
opportunity to facilitate change in the Baylor Health Care System (BHCS) approach to family
presence in the resuscitation room. The Advanced Practice Registered Nurse (APRN) for
Supportive and Palliative Care at Baylor Medical Center at Carrollton acted as lead facilitator for
this project. Approval from BHCS and the University of Alabama at Birmingham (UAB)
institutional review boards was obtained prior to the initiation of this project.
Population
Active and courtesy medical staff members from Baylor Carrollton were asked to
complete two electronic surveys. The purpose of the surveys was to identify medical staff
opinion regarding family presence during resuscitation before and after review of the evidence
surrounding family presence during resuscitation. A total of 239 surveys were sent.
Inclusion criteria:

Baylor Carrollton active or courtesy medical staff with an email address on file in
the Medical Staff Office.

Participants must be able to read English.

Participants must hold a license as a physician in the state of Texas.

Physicians in practice residency programs were asked to participate.
Exclusion criteria:
FAMILY PRESENCE DURING RESUSCITATION

Retired members of the Baylor Carrollton medical staff.

Baylor Carrollton medical staff members in nonclinical positions.

Baylor Carrollton medical staff members in research positions.

Active and courtesy staff members with no email address on file in the Medical
10
Staff Office.
Plan
The plan for this improvement project began with a literature review of the evidence
surrounding family presence. The target population was clearly identified with defined inclusion
and exclusion criteria. The project cover letter, survey and education information was
developed. Consent to survey the target population was granted through the Institutional Review
Boards for Baylor Health Care System and the University of Alabama at Birmingham.
The survey utilized a 4-point Likert scale. Participants were asked to rate their agreement
with 12 statements. These statements were designed to capture the participant’s opinion
regarding family presence in the resuscitation room. Answers ranged from strongly disagree to
strongly agree. The survey was adopted from the Emergency Nurses Association (ENA, 2007)
study developed and published by Lori M. Feagan. Internal validity of the survey was
established by a panel of three masters and doctoral prepared nurses (Feagan & Fisher, 2011).
The survey identified eight project variables of provider support of family presence
during resuscitation. The overall internal reliability of the variables was established with a
Cronbach a value of .884. The variables included participant opinion regarding:
1. family member emotional trauma with witnessed resuscitation efforts
2. family member likelihood to file lawsuit with witnessed resuscitation efforts
3. family member satisfaction in care with witnessed resuscitation efforts
FAMILY PRESENCE DURING RESUSCITATION
11
4. family member interference or interruption of care with witnessed resuscitation
efforts
5. anxiety of health care provider with family members witnessing resuscitation
efforts
6. family member presence inhibiting code team member communication
7. family members should be given the option to be present during resuscitation
efforts
8. family members have the right to be present during resuscitation efforts
(Feagan & Fisher, 2011).
Demographic questions captured data to include gender, practice area, and prior
education related to family presence during resuscitation. Additional data elements identified
participant’s years in practice, number of resuscitation efforts performed in the past year, and
number of resuscitation efforts with family members present.
Do
Two hundred and thirty nine members of the Baylor Carrollton medical staff received
information via email regarding the study and a link to complete the first on line survey. The
survey link was available for 14 days. On day 15, a ten slide Family Presence presentation along
with four slides of references was sent to the same 239 members of the Baylor Carrollton
medical staff via email with instructions to review the presentation prior to completing the
second on line survey. The second survey link was available for 14 days. Completed survey
results were restricted to the project leader. Survey results were entered by the project leader
into an IBM Statistical Package for the Social Sciences data analysis program. No participant
identifiers were collected.
FAMILY PRESENCE DURING RESUSCITATION
12
Study
Thirteen percent of medical staff participated in the study (n = 32). Percentage based on
gender and practice area are provided in Figure 1.
Family Presence during Resuscitation
Demographics
87.5%
46.9%
12.5%
Male
Female
21.9%
25%
3.1%
ED
ICU
GIP Womens Service Pedi
3.1%
Figure 1 – Participant demographics
Fifty-nine percent of participants participated in five or less resuscitations over the previous year.
Providers in the Emergency department were more likely to participate in CPR events than those
in the Intensive Care Unit or General In Patient areas, as seen in Figure 2. Based on the results
from the initial survey, 88% of participants had little or no experience with family presence in
the resuscitation room, 79% had received no training regarding family presence and 68% felt the
healthcare system had a policy in place to address family presence during resuscitation.
Family Presence during Resuscitation
CPR in the Past Year
83%
67%
20%
ED
ICU
GIP
Figure 2- CPR events
Responses from the first survey (n = 19) were compared to the responses from the second
survey (n = 13). There was no change in provider opinion between the two surveys related to
FAMILY PRESENCE DURING RESUSCITATION
13
providers wanting to be present during CPR of a loved one and caregiver anxiety and/or stress
with family members present. When responding to the statement regarding advocating for
family presence during resuscitation, 22.2% of survey one respondents were in agreement, as
opposed to 53.8% in survey two. Other indicators reflecting change between first and second
survey are provided in Table 1.
Indicator
Family members should have the
option to be present during CPR
Family members present for CPR
have fewer psychological
difficulties during bereavement
FPDR results in higher rates of
family satisfaction with care
Witnessing CPR causes emotional
trauma to family members
Family members who witness
CPR are more likely to file
lawsuit
FPDR inhibits code team
communication
FPDR interferes or interrupts care
Comfort with providing psychosocial-spiritual support for family
members during CPR
Table 1 – Comparison data
% Agree and
Somewhat
Agree Survey
#1
% Agree and
Somewhat
Agree Survey
#2
55.6%
69.2%
13.6% increase
50.0%
53.9%
3.9% increase
55.6%
69.2%
13.6% increase
72.2%
53.8%
18.4% decrease
41.2%
7.7%
33.5% decrease
61.1%
46.2%
22.6% decrease
61.1%
38.5%
19.4% decrease
66.6%
76.9%
10.3% increase
Outcome
A stepwise linear regression analysis was performed to determine predictors of family
presence during resuscitation as an option. The dependent variable was family member option
for presence during resuscitation. There were eleven independent variables included in the
analysis. All variables satisfied the level of measurement requirements for stepwise multiple
FAMILY PRESENCE DURING RESUSCITATION
14
regression analysis. Survey respondents who viewed family presence as an option did not
identify family presence as interfering with care (p <.001), viewed family presence as a right (p
<.001), and felt there was a positive psychological effect for family members being present (p
=.044).
A parsimonious subset of independent variables was identified to be statistically
significant in predicting agreement with family presence as an option. These included, in order
of importance:
1. Advocacy for family presence.
2. Family presence does not interfere with care.
3. Right of family presence.
4. Psychological benefit of grieving with family presence (when advocacy for family
presence removed).
These four predictors accounted for 86% of the variance for the option of family presence during
resuscitation. F (3, 24) = 14.05, p < .001, R2 = .856, 95% CI
Limitations of this study include sample size. The design of the study did not control for
participant consistence between the survey groups. There was no means to verify education
slides were reviewed prior to completing the second survey. Fifty-four percent (54%) of
participants completing the second survey denied having education or training on family
presence, suggesting an alternate form of education may have had a greater influence on second
survey outcomes.
Conclusion
Based on this limited study, physician opinion does appear to be impacted by the
presentation of evidence supporting practice change. Participants completing the post education
FAMILY PRESENCE DURING RESUSCITATION
15
survey were more supportive of family presence in the resuscitation room, indicating education
across the healthcare system would be beneficial prior to developing a policy for family presence
during resuscitation.
The next phase in the implementation of family presence during resuscitation will be the
development of a team focused on family presence during resuscitation. Healthcare provider
champions for change will be identified. This team should include all stakeholders involved in a
resuscitation event. Including a patient or family member who has experienced or witnessed
cardiopulmonary resuscitation as a member of the team should be strongly considered. It will be
the responsibility of this team to develop a protocol for family presence with the goal of piloting
the process in the critical care and emergency department areas within three acute care facilities
across the system. Identifying healthcare provider champions at each facility will be invaluable
to the transition of Baylor Health Care System from family exclusion to family inclusion during
resuscitation.
.
FAMILY PRESENCE DURING RESUSCITATION
16
References
Agency for Healthcare Research and Quality. (2001). Translating research into practice (TRIP) II. Retrieved from
http://www.ahrq.gov/research/findings/factsheets/translatnig/tripfac/trip2fac.pdf
American Association of Critical Care Nurses. (2010). American Association of Critical Care
Nurses Practice Alert: Family presence during resuscitation and invasive procedures.
Retrieved from
http://www.aacn.org/wd/practice/docs/practicealerts/family%20presence%20042010%20final.pdf
American Heart Association. (2000). Guidelines 2000 for cardiopulmonary resuscitation and
emergency cardiovascular care, part 2: ethical aspects of CPR and ECC. Circulation, 102,
112-121. http://dx.doi.org/Retrieved from
Basol, R., Ohman, K., Simones, J., & Skillings, K. (2009). Using research to determine support
for a policy on family presence during resuscitation. Dimensions in Critical Care
Nursing, 28, 237-247.
Chelluri, L. P. (2008, April-June). Quality and performance improvement in critical care. Indian
Journal of Critical Care , 12, 67-73. Retrieved from
http://www.bioline.org.br/pdf?cm08016
Critchell, C. D., & Marik, P. E. (2007). Should family members be present during
cardiopulmonary resuscitation? A review of the literature. American Journal of Hospice
and Palliative Medicine, 24, 311-317.
Demir, F. (2008, August). Presence of patients’ families during cardiopulmonary resuscitation:
physicians’ and nurses’ opinions. Journal of Advanced Nursing, 63, 409-416.
FAMILY PRESENCE DURING RESUSCITATION
17
Dingeman, R. S., Mitchell, E. A., Meyer, E. C., & Curley, M. A. (2007, October). Parent
presence during complex invasive procedures and cardiopulmonary resuscitation: A
systematic review of literature. Pediatrics, 120, 842-854.
Donabedian, A. (1988). The quality of care: how can it be assessed? JAMA, 206(12), 1743-1748.
Doyle, C. J., Post, H., Burney, R. E., Maino, J., Keefe, M., & Rhee, K. J. (1987, February 3).
Family participation during resuscitation: an option. Annals of Emergency Medicine,
16:6, 673-675.
Dudley, N. C., Hansen, K. W., Furnival, R. A., Donaldson, A. E., Van Wagenen, K. L., & Scaife,
E. R. (2009). The effect of family presence on the efficiency of pediatric trauma
resuscitations. Annals of Emergency Medicine, 53, 777-784.
Emergency Nurses Association. (2007). Presenting the Option for Family Presence. Des Plains,
IL: Emergency Nurse Association.
Emergency Nurses Association. (2012). Clinical Practice Guideline: Family presence during
invasive procedures and resuscitation . Retrieved from https://www.ena.org/practiceresearch/research/CPG/Documents/FamilyPresenceCPG.pdf
Feagan, L. M., & Fisher, N. J. (2011, May). The impact of education on provider attitudes
toward family witnessed resuscitation. Journal of Emergency Nursing, 37, 231-239.
Retrieved from http://www.nursingconsult.com/nursing/journals/0099-1767/fulltext/PDF/s0099176710001108.pdf?issn=00991767&full_text=pdf&pdfName=s0099176710001108.pdf&spid=24209537&article_id=8
12771
FAMILY PRESENCE DURING RESUSCITATION
18
Fernandez, R., Compton, S., Jones, K. A., & Vilella, M. A. (2009). The presence of a family
witness impacts physician performance during simulated medical codes. Critical Care
Medicine, 37, 1956-1960.
Howlett, M. S., Alexander, G. A., & Tsuchiya, B. (2010). Health care providers’ attitudes
regarding family presence during resuscitation of adults: An integrated review of the
Literature. Clinical Nurse Specialist, 24, 161-174.
Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence
based practice: A conceptual framework. Quality in Health Care, 7, 149-158. Retrieved
from http://qualitysafety.bmj.com/content/7/3/149.full.pdf+html
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P.
(2009). The improvement guide: A practical approach to enhancing organizational
performance (2nd ed.). San Francisco, CA: Jossey-Bass.
Langley, G. J., Moen, R., Nolen, K. M., Norman, C. L., & Provost, L. P. (2009). The
Improvement Guide: A practical approach to enhancing organizational performance (2
ed.). San Francisco, CA: Jossey-Bass.
MacLean, S. L., Guzzetta, C. E., White, C., Fontaine, D., Eichhorn, D. J., Meyers, T. A., &
Desy, P. (2003, June). Family presence during cardiopulmonary resuscitation and
invasive procedures: practices of critical care and emergency nurses. Journal of
Emergency Nursing, 29:3, 208-221.
Madden, E., & Condon, C. (2007). Emergency nurses’ current practices and understanding of
family presence during CPR. Journal of Emergency Nursing, 33, 433-440.
McClement, S. E., Fallis, W. M., & Pereira, A. (2009). Family presence during resuscitation:
Canadian critical care nurses perspectives. Journal of Nursing Scholarship, 41, 233-240.
FAMILY PRESENCE DURING RESUSCITATION
19
McGahey-Oakland, P. R., Lieder, H. S., Young, A., & Jefferson, L. S. (2007). Family
experiences during resuscitation at a children’s hospital emergency department. Journal
of Pediatric Health Care, 21, 217-225.
Meyers, T. A., Eichhorn, D. J., & Guzzetta, C. E. (1998, October). Do families want to be
present during CPR? A retrospective survey. Journal of Emergency Nursing, 24:5, 400405.
Meyers, T. A., Eichhorn, D. J., Guzzetta, C. E., Clark, A. P., Taliaferro, E., Klein, J. D., &
Calvin, A. (2000). Family presence during invasive procedures and resuscitation.
American Journal of Nursing, 100:2, 32-42.
Mortelmans, L. J., VanBroeckhoven, V., Van Boxstael, S., De Cauwer, H. G., Verfaillie, L., Van
Hellemond, P. L., ... Cas, W. M. (2009, August). Patients’ and relatives’ view on
witnessed resuscitation in the emergency department: A prospective study. European
Journal of Emergency Medicine, 17, 203-207.
http://dx.doi.org/10.1097/MEJ.0b013e328331477e
Peberdy, M. A., Kaye, W., Ornato, J. P., Larkin, G. L., Nadkami, V., & Mancini, M. E. (2003).
Cardiopulmonary resuscitation of adults in the hospital: A report of 14,720 cardiac arrests
from the National Registry of Cardiopulmonary Resuscitation. Resuscitation, 58 (3), 297308.
Piira, T., Sugiura, T., Champion, G. D., Donnelly, N., & Cole, A. S. (2005). The role of parental
presence in the context of children’s medical procedures: A systematic review. Child:
Care, Health & Development, 31, 233-243.
FAMILY PRESENCE DURING RESUSCITATION
20
Robinson, S. M., Mackenzie-Ross, S., Hewson, G. L., Egleston, C. V., & Prevost, A. T. (1998).
Psychological effects of witnessed resuscitation on bereaved relatives. Lancet, 352, 614619.
Rycroft-Malone, J. (2004). The PARIHS framework - A framework for guiding the
implementation of evidence based practice. Journal of Nursing Care Quality, 19, 297304.
Tinsley, C., Hill, J. B., Shar, J., Zimmerman, G., Wilson, M., Feier, K., & Abd-Allah, S. (2008).
Experience of families during cardiopulmonary resuscitation in a pediatric intensive care
unit. Pediatrics, 122, 799-804.
Walker, W. (2008). Accident and emergency staff opinion on the effects of family presence
during adult resuscitation: Critical literature review. Journal of Advanced Nursing, 61,
348-362.
Weissman, D. E., & Ramenofsky, D. H. (2009). Fast Facts and Concepts #179. Retrieved from
Medical College of Wisconsin End of Life/Palliative Education Resource Center:
http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_179.htm
FAMILY PRESENCE DURING RESUSCITATION
Appendix A
Donabedian’s Model
For Health Care Quality
21
FAMILY PRESENCE DURING RESUSCITATION
Appendix B
22