Family Presence During Resuscitation (FPDR) Jessica Berlin University of Central Florida College of Nursing

Background The first reported practice of FPDR occurred at Foote Hospital in Michigan in 1982 (Demir, 2008). Not until the later part of the 1990's were research articles published on FPDR (Boehm, 2008). Professional organizations (the Emergency Nurses Association (ENA), the American Association of Critical-Care Nurses (AACN), and the American Heart Association (AHA)) have influenced the increase in efforts to create awareness of and policies supporting FPDR (Demir, 2008; Doolin et al., 2011; ENA, 2010). Despite the support of professional organizations, only 5% of critical care areas have written policies governing practice supportive of FPDR (Martin, 2010).

Problem Development of a policy in support of FPDR in the hospital setting is crucial to supporting evidence-based practices, allowing for family closure, and creating a supportive environment for staff and families during a stressful time. Despite these benefits and current research support, there continues to be poor policy development in many critical care areas backing FPDR.

Significance Patients who survive cardiac arrest, generally reported comfort during family presence as did families, since their doubt and anxiety were alleviated (Martin, 2010). Reasons for opposition are: fear of psychological trauma, distraction, family interference, litigation, performance anxiety, appearing incompetent and confidentiality risks during resuscitation. The majority of health systems still have no FPDR policy in place leading to misunderstandings by families and in turn veering away from a family-centered approach (Dougal et al., 2011). Importance of having policies supporting FPDR: to not leave the visitation rights of patient's families solely up to the either the physician's discretion or the nursing supervisor. Healthcare staff can be encouraged to engage in the promotion of change directed towards a FPDR policy Through the use of staff meetings, open discussions and policy development in unit based councils

Aims of Policy Creation Without written policies, practicing FPDR can become inconsistent and some families may feel excluded from care during a patient’s end of life (ENA, 2010). Policies should be flexible to keep up with current standards and to allow for FPDR (Salladay, 2006). include benefits, assessment criteria, and the roles of family facilitators (Martin, 2010). aid healthcare providers in the inclusion of families during resuscitation efforts and alleviate the stress of the decision making process. be clear that the hospital is supportive of FPDR and discuss the benefits surrounding these practices.

Theoretical Framework Kolcaba’s Theory of Comfort Lewin’s Change Model Supports the desire for a peaceful death Describes positive outcomes to encourage desirable outcomes Utilizes approaches of unfreezing, changing and re-freezing to implement change

Kolcaba’s Theory of Comfort Application of Theory Kolcaba’s Theory of Comfort Lewin’s Change Model Bases the need for the change on the issue of poor policy backing, despite research on family presence Uses unfreezing as it pertains to the pros and cons of FPDR (Doolin et al., 2009) Looks at the actual change, and the communication of goals and objectives needing to be addressed Uses re-freezing to state that the changes must be accepted as the new way of practice (Lewin, 2011) Allows for families to be present during resuscitation and obtain closure Supports the idea that patient and family-focused outcomes, like timely responses to needs, and family inclusion in treatment plans, are also addressed (Doolin et al., 2009).

Implementation in Literature Doolin et al. (2009) discuss the use of evidence-based knowledge to guide the development of policy and practice guidelines for FPDR. Novak, Kolcaba, Steiner, and Dowd (2001) discuss comfort in caregivers and patients during end-of-life care and the goal to reduce the anxiety and fear that might be displayed by families, by supporting and educating families on the processes taking place. While several national organizations have suggested that families be present during resuscitation, only a small amount of facilities have written policies dedicated to this (Oman & Duran, 2010).

Summary FPDR is a nurse driven practice that must be supported by policy, and the policy change must continuously be reinforced during orientation, nursing rounding, and through discussions (Mian et al., 2007). The concept of families wishing to remain at the bedside during resuscitation, and the desire of healthcare workers to shield them from it, due to their own fears of family response and pre-established problems with family presence, is an issue that stands to benefit from policy development in support of FPDR (Nibert, 2005). Guided by the theoretical framework of comfort and change, the concept of FPDR not only supports the desire for patient and family comfort, but maintains its foundation in evidence-based practice.

Martin, B. (2010, April). AACN practice alert family presence during resuscitation and invasive procedures. American Association of Critical-Care Nurses. Retrieved from http://www.aacn.org/wd/practice/docs/practicealerts/family presence 04-2010 final.pdf 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), Retrieved from http://ccn.aacnjournals.org/content/27/1/52.long Nibert, A. T. (2005). Teaching clinical ethics using a case study family presence during cardiopulmonary resuscitation. Critical Care Nurse, 25(1), 38-44. Retrieved from http://ccn.aacnjournals.org/content/25/1/38.full.pdf&embedded=true Novak, B., Kolcaba, K., Steiner, R., & Dowd, T. (2001). Measuring comfort in caregivers and patients during late end-of-life care. American Journal of Hospice & Palliative Care, 18(3), 170-180. doi:10.1177/104990910101800308 Oman, K. S., & Duran, C. R. (2010). Health care providers' evaluations of family presence during resuscitation. Journal of Emergency Nursing, 36(6), 524-533. Salladay, S. (2006). Ethical problems: Family presence code controversy. Nursing2006, 36(1), 26. References Boehm, J. (2008, May). FPDR. Code Communications. Retrieved from http://www.zoll.com/CodeCommunicationsNewsletter/CCNL05_08/CodeCommunications05_08.pdf Demir, F. (2008). Presence of patients' families during cardiopulmonary resuscitation: Physicians' and nurses' opinions. Journal of Advanced Nursing, 63(4), 409-416. Doolin, C. T., Quinn, L. D., Bryant, L. G., Lyons, A. A., & Kleinpell, R. M. (2011). Family presence during cardiopulmonary resuscitation: Using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines. Journal of the Academy of Nurse Practitioners, 23(1), 8-14. Dougal, R. L., Anderson, J. H., Reavy, K., & Shirazi, C. C. (2011). Family presence during resuscitation and/or invasive procedures in the emergency department: One size does not fit all. Journal of Emergency Nursing, 32(2), 152-157. Emergency Nurses Association. (2010). Family presence during invasive procedures and resuscitation in the emergency department. Retrieved from https://www.ena.org/SiteCollectionDocuments/Position%20Statements/FamilyPresence.pdf Lewin, K. (2011). Change theory. Retrieved from http://currentnursing.com/nursing_theory/change_theory.htm