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Family Presence During CPR

Family members report that being at the beside during resuscitation helped them cope with their loss.

Whether or not a hospital should allow family presence during cardiopulmonary resuscitation remains a difficult question for many healthcare stakeholders to answer.

Many studies show witnessing a resuscitation can help families cope in knowing everything that could have been was done to save their loved one's life. Other studies reveal long-lasting negative impacts in family members who've witness a resuscitation, such as anxiety, depression and PTSD, among others.

As a group, nurses generally are not in favor of family presence during CPR, surveys show. Many cite issues such as a lack of space at the beside and increased stress for staff caring for sometimes hysterical family members. Still, nurses need to make certain they follow their facility's guidelines, policies and procedures regarding family presence during CPR to handle a situation when it occurs.


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Sometimes It Helps

Allowing family presence during CPR has several benefits. Family members that remain at the beside during resuscitation "indicate that the experience is beneficial in helping them come to terms with unsuccessful resuscitation attempt, thus contributing to a healthier bereavement."1

Another benefit that is clearly stated from the literature is the reduction of occurrence of post-traumatic stress disorder of those witnessing the resuscitation, thus making presence during a loved one's CPR significant in reducing anxiety in family members.2

Family presence also helps families comprehend the seriousness of the patient's condition or situation. According to Terzi (2008), "many family members report that witnessing resuscitation helps them to see that everything that could be done was done."1

Another benefit is having the patients' relatives close to them during the resuscitation effort, "there is evidence that most people would want to have their close relatives with them when they die."1

Not for Everyone

There are also negative aspects for allowing families to witness CPR of their loved ones.

One study, "Experience of Families During Cardiopulmonary Resuscitation in a Pediatric Intensive Care Unit," reported 29% of parents interviewed believed witnessing the resuscitation did not help them cope with their child's death and felt terrified during the entire event.3

Another study, "Post-Traumatic Stress Disorder Symptomology Associated with Witnessing Unsuccessful Out-of-Hospital Cardiopulmonary Resuscitation," showed clinically significant PTSD symptoms in witnesses of a failed attempt at resuscitation with the use of a PTSD Symptom Scale-Interview (PSS-I). They recorded witnesses of a failed attempt during CPR had a significant increase in their PTSD scores compared to those of non-witnesses.4

A third study, by Isoardi, et al., "Witnessing Invasive Pediatric Procedures, Including Resuscitation, in the Emergency Department: A Parental Perspective," showed 15% of people did not want to be present during a resuscitation where the possibility existed their child may die, 22% didn't want to see their child in pain, and 33% were afraid they would get in the way.5

Nursing Implications Family presence during CPR can be a positive experience not only for the family members but also for nurses and other healthcare providers. Family presence promotes open communication between family and healthcare providers.6 Sharing the experience allows a bond to form between both parties that makes the healthcare team feel they made a difference.

Through family presence, the healthcare team is able to satisfy the needs of both patient and family. It is also suggested family presence reduces the stress of the situation by providing positive feelings, therefore enhancing the care provided.6

Healthcare providers also believe family presence allows family members to have a better understanding of the situation, resulting in decreased symptoms of grief compared to those who were not present.

In addition, due to the therapeutic bond formed, it is proposed family members are less likely to bring litigious action toward healthcare providers in relation to those who did not witness the experience.6

When family witnesses CPR, it also can have negative effects on nurses and the entire healthcare team. Knott and Kee (2005) conducted a descriptive qualitative study to display opinions nurses had about family presence during CPR. Barriers included lack of space at the bedside for grieving family members, hysterical family members that turn the focus on nurses rather than the patient, increased stress for staff, and lack of medical knowledge from family, which may increase danger for the patient.7

The researchers used an open-ended interview questionnaire to obtain participants' opinions on family presence and used the constant comparative method to analyze the answers. Quotes from the participants gave insight on the different aspects of family presence. The fact that nurses spoke for families without family members being part of the study decreased its credibility. Scholarly references were utilized and one out of 15 references was from the past 10 years. Conclusions from the study indicated nurses see barriers in family presence during CPR.

Comfort vs. Change

There are ways for a hospital to implement successful policies on family presence during CPR.

One study, "Family Presence During Cardiopulmonary Resuscitation: Using Evidence Based Knowledge to Guide the Advanced Practice Nurse in Developing Formal Policy and Practice Guidelines," focused on the steps needed to successfully have a family present during resuscitation policy. The authors used both Kolcaba's Theory of Comfort and Lewin's Change Theory to set the policy.8

The theory of comfort states nurses who are more comfortable have better patient outcomes.

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Change theory requires three essential steps to be completed for change to take place.

The first step is "unfreezing," which is when a hospital's administrators start to look at the pros and cons, gather data, identify the problem, decide if change is needed and make others aware change is in fact needed.8

The second step is "change/transition," which is when you develop a plan, establish goals and objectives, and set due dates. It is very important to keep open communication between the staff because this is the time when they are getting trained about family presence during resuscitation.8 The third and final step is "freezing/re-freezing" where the main objective is "supporting others so that change remains."8

When It Happens

There are many different views regarding family presence during CPR. Some clinicians feel it is important to encourage family to witness resuscitation efforts made by healthcare professionals to save their loved one. The available literature shows the issue impacts both families and nursing staff in both positive and negative ways, depending almost entirely upon the perspective of the individual witnessing the resuscitation. To be prepared, nurses need to make certain their facility's guidelines, policies and procedures for family presence during CPR.

References for this article can be accessed here.

Jacqueline Arce is a nursing student at California State University, San Bernardino.

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Hi I am a student nurse in Ireland and am doing an assignment on family witnessed resuscitation. I would love to use this article as a reference, I am also looking for your permission to use this image for academic purposes only for my assignment. I would really appreciate a speedy response.

Kind Regards,

Joanne Breegan,  nurseAugust 02, 2016

The article is interesting but it does not deal with the long term psychological effects of families witnessing the CPR on their family member.

Rowena del Castillo,  RNFebruary 10, 2013
Eastchester, NY

As a nurse I've been allowed to be at the bedside although ethically not to participate in the code of a close family member. I'll never do that again! :( I also know personally of a case in which a distraught family member barrelled into the room and through staff and threw herself on top of the patient being coded just as the paddles were discharged leaving us with an additional person to rescuscitate without knowing her medical history of open heart sugery or that she had an internal pacemaker although we suspected based upon her surgical scars. Based upon those two experiences alone I have great reservations. Besides the fact that staff barely have enough room as is within the confines of a small patient room. Rooms are somewhat larger now but so are the beds and equipment thus negating the increased size. They'd have to completely redesign the rooms and also assign an additonal person to code teams just to remain with and focused only upon the family present.

TJ February 08, 2013

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