Family Presence During Resuscitation

Julie K. Kuzin RN, CPNP-AC/PC

Shino S. Thomas RN, NNP-BC

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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.

Historical Timeline Family Centered Care (FCC)

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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)

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History of Family Presence During Resuscitation (FPDR) (Boehm 2008)

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History of FPDR Dingeman, et al. 2007, Henderson and Knapp 2005

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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 PerspectiveAdult 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

(Halm 2005; Dingeman et al 2007, ENA CPG 2009)

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Randomized Control Trial

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Cultural PerspectiveSingapore - 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

Family Panel

Nalah

Deonc

Griffin & Grayson

Harper

Jenna

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Where do we go from here?

• 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 ListAmerican Academy of Pediatrics Committee on Hospital Care Family-centered care and the pediatrician’s role. Pediatrics. 2003;112:691–697. doi: 10.1542/peds.112.3.691.

Barrett F., Wallis, DN (1998). relatives in the resuscitation room: Their point of view. Journal of Accident and Emergency Medicine 15(2), 109-111.

Boehm, J., (2008) Family presence during resuscitation. Code Communications, 3(5). Available at http://www.zoll.com/CodeCommunicationsNewsletter/CCNL05_08/CodeCommunications05_08.pdf. Accessed 23 Dec 2013

Curley, M.A., Meyer, E.C., Scoppettuolo, L.A., McGann, E.A., Trainor, B.P., et al. (2012) Parent presence during invasive procedures and resuscitation: Evaluating a clinical practice change. American Journal of Respiratory and Critical Care Medicine, 186(11), 1133-1139

Dingeman, R.S., Mitchell, E.A., Meyer, E.C., & Curley, M.A. (2007). Parent presence during complex invasive procedures and cardiopulmonary resuscitation: A systematic review of literature. Pediatrics, 120(4), 842-854.

Dudley, N.C., Hansen, K.W., Furnival, R.A., Donaldson, A.E., Van Wagene, K.L., & Saife, E.R. (2009). The effect of family presence on the efficiency of pediatric trauma resuscitations. Annals of Emergency Medicine, 53(6), 777-784e3.

Emergency Nursing Resources Development Committee. (2009, revised 2012). Clinical practice guideline: Family presence during invasive procedures and resuscitation. Emergency Nurses Association. Available at http://www.ena.org/practice-research/research/CPG/Documents/FamilyPresenceCPG.pdf. Accessed 23 Dec 2013

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Reference ListHalm, M. A. (2005) Family presence during resuscitation: A critical review of the literature. American Journal of Critical Care, 14(6) 494-511

Henderson, D.P., Knapp, J.F. (2005). Report of the national consensus conference on family presence during pediatric cardiopulmonary resuscitation and procedures. Pediatric Emergency Care, 21(11), 787-791

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001. Available at http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed 29 Dec 2013.

Institute for Patient- and Family-Centered Care. Patient- and Family-Centered Care Core Concepts. http://www.ipfcc.org/faq.html. Accessed Dec 29 2013.

Ismail, S., Mulley, G. (2007) Visiting times. British Medical Journal, 335, 1316

Jabre, P. et al. (2013) Family presence during cardiopulmonary resuscitation. The New England Journal of Medicine, 368, 1008-1018.

Kuo, D.Z., Houtrow, A.J., Arango, p., Kuhlthau, K.A., Simmons, J.M., Neff, J.M., (2012) . Family centered Care: Current applications and future directions in pediatric health care. Maternal and Child Health Journal, 16(2), 297-305.

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Reference ListMarkel, H., (2008) .When hospitals kept children from parents. The New York Times. Available at http://www.nytimes.com/2008/01/01/health/01visi.html?_r=0. Accessed 7 Nov 2013.

Maternal and Child Health Bureau. Definition of Family-Centered Care: www.familyvoices.org/admin/work_family_centered/files/FCCare.pdf. 2005. Accessed Dec 29 2013. McGahey-Oakland PR, Lieder HS, Young A, Jefferson LS.

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 Healthcare, 21(4), 217-225.

Mortelmans, L.J.M., Van Broeckhoven, V., Van Boxstael, S., De Cauwer, H.G., Verfaillie, L., Van Hellemond, P.L.A., et al. (2009). Patients’ and relatives’ view on witnessed resuscitation in the emergency department: A prospective study. European Journal of Emergency Medicine, 00, 000-000. (Ahead-of-print publication).

Piira, T., Sugiura, T., Champion, G.D., Donnelly, N., & Cole, A.S.J. (2005). The role of parental presence in the context of children’s medical procedures: A systematic review. Child: Care, Health & Development, 31(2), 233-243.

Tinsley, C., Hill, J.B., Shar, J., Zimmerman, G., Wilson, M., Freier, K., & Abd-Allah, S. (2008). Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics, 122(4), e799-e804.