A qualitative study of factors in nurses' and physicians' decision‐making related to family presence during resuscitation

Abstract

Aims and objectives To explore the similarities and differences in factors that influence nurses' and physicians' decision‐making related to family presence during resuscitation. Background Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision‐making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision‐making about family presence. Design Qualitative exploratory‐descriptive. Methods Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open‐ended questions about family presence. Through thematic analysis, decision‐making factors for physicians and nurses were identified and compared. Results Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life‐saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit. Conclusions Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team. Relevance to clinical practice Knowledge of factors that influence the decision‐making of interprofessional colleagues can improve collaboration and communication in crisis events of family presence during resuscitation.

Family presence during resuscitation in emergency departments: professionals’ attitudes in Brazil

“…; Twibell et al. ). There is a tension produced in the belief of most families that accompanying their relative is a right, and professionals who believe they must have total control over care.…”

“…As a result, FPDR remains inconsistently implemented by emergency staff (Twibell et al. ), thus, highlighting a research/practice disparity (Bashayreh et al. ; Giles et al.…”

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

“…More recently, Vincent and Lederman (, p1) argued that the “ethical norm” of allowing FPDR for paediatric patients should also be extended to adult patients. However, we could only locate two primary studies that had undertaken an in‐depth exploration into decision‐making around FPDR (Giles et al., ; Twibell, Siela, Riwitis, Neal, & Waters, ), and we could not locate any studies specifically exploring the role of beneficence in decision‐making around FPDR.…”

Decidindo “caso a caso” a presença familiar no serviço de atendimento emergencial

“…(2) In this sense, studies demonstrate potential disadvantages of this practice from the professionals' perspectives (7,8) or, at the most, dichotomize the understanding of the phenomenon into benefi ts versus limitations/losses. (9) Th e multifaceted perceptions and experiences of professionals who experienced emergency care, witnessed by the relative of an adult patient, are minimally explored (1,10) Th is limits the understanding of the reasons why physicians and nurses invite/allow families to accompany the patient during the care provided.…”

“…As nurses and physicians work collaboratively in emergency care, both can benefi t from a better understanding of this phenomenon. (1,10) Based on the evidence presented, the objective of the study was to understand how physicians and nurses ex-perience and perceive family presence in the emergency care service.…”