Family Presence During Resuscitation

SECTION 4: Discussion and consequences

Introduction

There was no policy in place when this project was started. The project team included: the emergency nursing department, nursing education, chairman of the emergency room, the clinical nurse specialist, legal department plus the quality assurance department. The team developed an accepted recorded practice document that would give the patients family members a choice on whether to be present or not at the bedside at the time of resuscitation. The team was able to develop guiding principles for the health care practitioners to enable the presence of family at the time of resuscitation. The guiding principles were established centred on the commendations by emergency nurses association (ENA). (Gold berger Z. D et al., 2015)

The family presence during resuscitation (FPDR) Implementation Plan (see Appendix B), was established through the project team on the basis of ENA commendations. This strategy requires that all participants who are involved in the family presence during resuscitation (FPDR) process comprehend their responsibilities and safety strategies. The participants include: the healthcare practitioners, the chosen facilitator and the family members. The project team developed programmes for the distribution of the FPDR plan and practice through informal education meetings and staff gatherings.

The project team created the FPDR Evaluation Form (see Appendix C). The form was aimed at generating quantitative data. The form is made up of 10 questions along with answers that comprise yes or no. This questions permit the family members to have an opportunity to communicate feedback concerning their experience throughout the FPDR process. The feedback will then be gathered, recorded and revised for upcoming recommendations. (Strasen J et al., 2015)

Evaluation of the Project

Studies shows that the family presence especially during resuscitation has positive effects and is useful to the present family members. The project team will assess the achievement of this project on the basis of the patient contentment scores for the emergency department (ED). The project team will also make a comparison of the patient contentment surveys in the ED pre-policy application stage and post-policy application stage. I will take part in gathering and recording the findings from these surveys, which will give data as regards to the differences in the satisfaction scores between the two stages. The ENA gives the recommended standards to successfully evaluate the procedure.

Evaluation of the Policy

Evaluation of the policy will be conducted by the project team. This will be done by conducting a research study in the Facility’s emergency department so as to analyse the achievements of this procedure. We will use the FPDR Evaluation Form to gather data to determine the rate at which a patient’s family members choose to take part in the resuscitation procedure and evaluate their experiences. The project team will then record the findings. The findings will give information on areas such as the advantages of implementing policy versus the disadvantages of having no implemented policy. The ENA gives recommended procedure for successful evaluation of the procedure.

Evaluation plan

The evaluation plan is a secondary product of this project. The plan will play an important role in coming up with recommendations for the PFDR policy. The evaluation strategy consist of the programs organisation as well as the procedures and timelines of this project. I was able to direct the strategies alongside the complete participation and support from every team members of this project. The process of data collection will take a period of 8 weeks. The data analysis will take 4 weeks.

The evaluation plan was designed by the project team. (Hassankhani et al. , 2017) It was created to guide the health care practitioners on how they will move forward throughout the program. The guidelines will help determine the experiences of the participant family members. The program guidelines give the outline to assist in the distribution of the questions and any additional activities for the participants as required. The strategies are precise concerning the objectives of the program. The strategies should ensure to give the health care practitioners with definite instructions to be followed. Files containing the program instructions and doings will be made each of the participants and the medical staff to instruct them during the practice.

The head of the hospital and its health care practitioners will employ the instructions and the set evaluation plan to evaluate the progress of every participants. They are also used to give the accepted level of support for the participant family members. The health care practitioners will fill official evaluation by making us of the evaluations document at the conclusion of the FPDR session. This is done to classify any areas that would need extra resources or further interventions from the team in the project.

The evaluation strategy is useful in coming up with the goal of promoting family presence during resuscitation and ensuring that they get a positive experience. The plan was created to assist influence the following- up and evaluating of the program. It comprises short- term as well long-term goals that involve examining the participants’ experiences during FPDR. Questions in this survey place emphasis on the experiences of the participants. Participants will fill the survey after the resuscitation sessions and answer a sequence of questions which are in the format of yes or no. The desired outcome is to increase positive experiences of family members during FPDR.

T-Test for independent samples

t -Test for independent samples relates two independent samples and seeks to determine whether there is statistical evidence that the associated population means have a significant difference. The project team will make a comparison of the patient contentment surveys in the emergency department pre-policy application stage and post-policy application stage. The data collected is quantitative and continuous. The independent variables used in this tests are: pre-policy application stage and post policy application stage. In this study, the t-test will be used in testing the statistical differences between the average of the two scores.

The null and alternative hypothesis of the independent variables in t-test can be expressed in two different ways:

HO: µ1=µ2 the two means are equal

HA: µ1=µ2 the two means are not equal

Strengths and Limitations

The family presence during resuscitation (FPDR) Policy had not been set in the emergency department before the application of this project. The strength of this project is the capacity to change the attention from the attitudes and insights of the health care workers’ towards FPDR to dealing with the results of having family members present at the time of resuscitation.

Even though we have argued the strengths of this project, there are some limitations that are necessary to recognize. There are delays to be deliberated upon when data is not recorded correctly. Delays can also occur when data is not made accessible to the project team for reviewing within the time frame that was agreed upon so as to assess the necessary commendations or adjustments. In addition, it is not possible to give an explanation for the preconceived attitudes regarding FPDR of people filling the evaluation form. Negative attitudes towards the FPDR may affect the way these people respond. (Porter J. E et al, 2014)

Recommendations

The recommendations that have been made to make sure that this policy will support the presence of a patient’s family members during resuscitation are:

1. Education and in-service to support staff so that they remain abreast of policy and procedure.
2. Develop a plan to determine compliance with policy and improve compliance.
3. Develop communication strategies to remind staff of the policy.
4. Develop a plan to incorporate competency verification tool.

Conclusion

Presence of family during resuscitation of the patient is of importance to the patients and their family members who desire to be there during a crisis incident so as provide the needed support and comfort. The knowledge gained throughout this project has been helpful to the development and implementation of policy to promote a patient and family centred approach to care. The policy aims at providing documented strategies that will improve the patient and family experience.

Definition of terms

 Family Member: Relative related by blood or significant others with whom patient has an established relationship

 Family Presence: The presence of one member of the family at the patients’ bedside during resuscitation.

 Resuscitation: The restoration of breathing, circulation and/or normal heart rhythm with the use of chest compressions, medications, invasive procedure, and/or electrical shock.

 Invasive Procedure: Medical procedures that may involve penetrating the body through the skin or body cavity and manipulating and/or interrupting body functions. Some procedures may not be appropriate for family member’s presence.

 Healthcare Team Member: Healthcare worker who is directly concerned in the care of the patient before, during and after resuscitation.

 Family Facilitator: A healthcare team member who facilitates the presence of family members by providing support before, during and after the resuscitation interventions. The family facilitator includes patient representative, registered nurse, physician, respiratory therapist, child life specialist, social worker, or pastoral care.

SECTION 5

Abstract

Presence of the patient’s family during resuscitation has come out as a practice that is important. The practice of FPDR has sparked substantial controversy all over the world. Over the years a number of studies have been done to support this idea. Qualitative researchers explored the experiences of the members of the family present at any particular time during the resuscitation. They also looked into the perspectives of the family member as well as the attitudes and perspectives of the health care practitioners.

The aim of the study was to help understand the experience of the members of the family who are offered the privilege of being present during the process of resuscitation. The participants were given questionnaires to fill with the answers of yes or no. The chosen theme was the patient and family member’s contentment of surveys in the emergency department pre-policy application stage and post-policy application stage. The findings were collected, recorded and analysed and used to develop recommendations for the implementation the FPDR policy. A survey was used to collect data and the data for this study is quantitative and continuous. Analysis will be done using t-test for independent variables.

In conclusion, family presence during resuscitation (FPDR) gives an opportunity for family members to show their support to their loved ones during the period of crisis. When FPDR choice is offered, family members are able to observe and take part in the decision making process concerning the life sustaining measures.

Introduction

The practice of allowing the presence of family members during the presence of resuscitation of their loved ones has currently grown as an important practice. However, the practice has sparked significant controversies all over the world. Researchers have examined the experiences of the members of the family present during the resuscitation process. They have also examined the perspectives of the patients and family members as well as the attitudes and perspectives of the health care practitioners (Powers et al, 2017) ENA (Emergency Nurses Association) reacted to the increasing demands arising from the position of family presence during resuscitation and on invasive procedures.

The option of FPDR (Family Presence during Resuscitation) offers the members of the family with an opportunity to be present with their lovers during ongoing measures of saving life. The literature has shown that FPDR has facilitated and supported the grieving family members. However, in spite of the benefits of FPDR, there is a lack in the implementation of policy. Healthcare facilities need implementation of FPDR policy so families are provided with an option to be present during resuscitation

There was no policy in place when this project was started. The project team included: the emergency nursing department, nursing education, chairman of the emergency room, the clinical nurse specialist, legal department as well as the quality assurance department. The team developed an accepted recorded practice document that would give the patients family members a choice on whether to be present or not at the bedside at the time of resuscitation. The team was able to develop guiding principles for the health care practitioners to enable the presence of family at the time of resuscitation. The guiding principles were established centered on the commendations by emergency nurses association (ENA).

Problem Statement

In the early years, about 100 years ago, the symbol of worry for extremely sick patients has been misleading. In the past, patients used to be treated in their homes with the instructions of the members of their family. When hospitals begun, specific visiting hours were introduced together with other hospital restrictions on the presence of family in the patients rooms.

At the moment, in the Emergency Department, many of the family members have opinions about the option for family presence during resuscitation. Their views involve being at the patient’s room through the period of crisis. FPDR is reinforced by a number of organizations including the emergency nurses association. Despite these, the attitudes and the perspectives of many medical practitioners remain mixed as many hospitals are beginning to support this practice.

Purpose Statement/Project Objective

Despite the recommendations that allow Family Presence During Resuscitation, there still persists attitudes and perceptions that vary in the normal clinical practice of today. In a research done in USA by Miller and Stiles in 2009, when a medical crisis is happening, most family members are requested to move away from the rooms of the patient who is their loved one. Family Presence During Resuscitation gets endorsement from health care organizations nationwide. However, there still exist different opinions from family members, patients themselves, and nurses about this matter of patient’s family witnessing resuscitation attempts.

The emphasis of this DNP project will be based on the available literature on FPDR attempts. The DNP project looks into development of policies expressing the practice of family presence during the process of resuscitation, re-training of medical staff on the practice of family presence and coming up with a plan for implementing and evaluating plan for the policy.

Objectives and Outcomes

The objective is for the facility to develop and implement a policy (see Appendix A), implementation plan (see Appendix B) and evaluation plan (see Appendix C). Literature suggests that allowing the presence of the members of the family during the process of resuscitation demonstrates a family-centred approach. The outcome of this DNP project was the implementation of policy.

Literature review

Burgeoning consumerism could be said to have been a major force which is pushing for the presence of family members during the resuscitation process. The force arising from the increasing knowledge gained by the patients and their family members in the process of seeking for healthcare. From the early founding works, subjective explanations have been complemented with a lot of research about the effects of FPDR on the patient’s family members and medical staff.

Recent studies show that most of the families would want to be given the choice of being present in the resuscitation room. Those who have had the experience say that they would make the choice again. Critics of FPDR indicate that there is fear that since most family members want to be present in the patient rooms, the protocols may be disrupted and the family members can be anguished by the severe psychological trauma. There is also risk of lawsuits by the family members in case of things go wrong and they feel there was malpractice by the health care practitioners (Tudor K et al, 2014).

In the United States, standards of how to deliver resuscitation have changed radically. This was after the American Heart Association recommended offering resuscitation based on the associations guidelines on cardiopulmonary resuscitation. Despite the changes, the nurses and healthcare professionals are reluctant to fulfil their obligation to meet the patients’ needs for FPDR. And this practice still remains controversial among the health care professional and is therefore far from being the norm in a practice setting.

Supporters of this practice argue that protecting family members by preventing them from being in the resuscitation room is no longer necessary. (Giles, T. et al. , 2016) This is because individuals witness critical crisis events in the field many times. There are also television shows that have given many individuals the exposure of what happens during resuscitation. Being able to see your loved one, witnessing the efforts that the medical team are implementing to bring them back to life and communicating with them helps the family members to understand and accept the death in case in happens.

Some family members say that being in the resuscitation room for their loved one was a good experience. The live saving actions by the health care professional give them a chance to participate in decision making about the health of their loved one. The family members who express satisfaction report having been treated appropriately the medical team during the resuscitation. Those that report bad experiences and dissatisfaction, they claim that there was no understanding and luck of proper organisation of the crowd during the intervention. They also report poor communication and lack of interaction with the medical team. (Twibell R S et al, 2015)

The purpose for this study is to evaluate the success of the FPDR project based on the patient satisfaction scores for the emergency department (ED). The project team will then compare the satisfaction of the patients prior to the implementation of the policy phase and after the implementation. Data from the results of these surveys will be collected and documented the data will be used to provide information regarding the difference in satisfaction scores between the both phases. The emergency nurses association (ENA) provides the recommended criteria for successful evaluation of FPDR procedure.

It is important to identify the ethical theoretical perspectives as they assist the nurses to understand the FPDR process better based on the literature and promote critical-thinking in clinical practice. Further studies are needed to provide information on the gaps left by our current knowledge of FPDR. (Hassankhani H, et al , 2017)

Dissemination Plan of Policy

The first phase in the dissemination process will be to partner with the Clinical Nurse Educator, Quality Improvement and Legal Team to present the policy to the key stakeholders which includes the Nursing Clinical Practice Committee, ER Medical Directors Committee and the RRT committee. It is crucial to give all key stakeholders an opportunity to give their feedbacks on the FPDR policy and procedure and this should be done on the basis of organizational culture and evidence. The following are some of the recommendations relating the dissemination of FPDR guidelines:

1. There will be sharing of the FPDR guidelines at huddles and staff meetings.

2. Education programs would be provided to all multidisciplinary staff-members in the Emergency Department on matters relating the current policy and purpose.

3. Efforts would be made towards establishing a comprehensive education and training programs for the family facilitator roles.

4. The implementation of the policy will involve the multi-disciplinary staff members.

5. Progressive work aimed at supporting institutions that allows staffing of FPDR advocates during every shift.

Analysis of Self

In the event of a medical crisis, the patient’s family members are often put away from the loved one. According to professor McMahon, there exists the fear that the actual presence of the patient’s family members at the time of their resuscitation may cause an interference in the process of resuscitation. There is also the probability that present family members could be mentally affected by the trauma of this experience.

As a DNP prepared student I was able to initiate and participate in the process of establishing the policy and the procedure. The procedure was to provide guidelines for health care practitioners to refer from. This would ensure that we are always offering the best care to patients and families and placing their needs first. The development and implementation of this policy has enhanced the departments’ approach to a family-centred care concept.

One of the greatest challenges of this project was creating schedules to meet with the project team and staff in the planning stages of the process. Although there were many obstacles to get over during this scholarly journey, I have learnt that it is not only important to discover what is lacking in our nursing processes but it is more important to develop, implement and evaluate a plan to address the need through evidence based practice.

Project designs and methods.

The DNP project was about the presence of family members during resuscitation. The presence of the members of the family during resuscitation of FPDR guidelines and evaluation plans were planned to be offered as a way of ensuring patient satisfaction while in the health facility. As an improvement to the FPDR policy, the project paid attention to the numerous methodologies that helped the participant in ensuring positive experiences during FPDR. The project focused primarily evaluating the success of this project on the basis of patient satisfaction scores for the emergency department. His will involve a comparison of the patient satisfaction scores of the surveys conducted on pre-policy implementation stage and the post-policy implementation stage. From these surveys data will be collected, recorded and analysed. Information regarding the found differences in the satisfaction scores between the two stages will be provided. (Porter et al. , 2017) Below are phases were essential to the progress of the program.

• • • 1. Assembling of the project group
      2. Leading the group through a thorough review of literature.
      3. Developing guidelines and an evaluation plan.
      4. Validating of subjects.
      5. Developing a plan for projects implementation.
      6. Developing a plan for projects evaluation.

The Project group

The project group was selected on the basis of on the knowledge they have as well as their dedication to the support of patients to ensure they get quality care. The team consisted of the emergency nursing department, chairman of the emergency room, clinical nurse specialist, nursing education, the legal department, the quality assurance department and myself. The total wealth of knowledge of the team members, their years of nursing experience, and their qualifications in a number of specialties made them valued resources to the project. Their specialties comprised of attending Stanford emergency nursing education and obtaining certification, working with patients at the emergency department and invasive procedures. All of the team members were able to attend an 8-week conference centred on family presence during resuscitation. The responsibilities of the group members comprised of the following:

1. The Student: I wrote the project and served as project leader and facilitator.
2. Emergency nursing department: nurse practitioners working with patients at the emergency department.
3. Chairman of the emergency room: Instructor of the practices and procedures for family presence during resuscitation.
4. Clinical nurse specialist: a nurse with the experience of working at the emergency department.
5. The legal department: to ensure that the policy was implemented within the legal guidelines.
6. The quality assurance department: to ensure quality of services in the emergency department and in the implementation of FPDR
7. Nursing education : Provided classes on good practices of FPDR

I used the logic model to direct the development of the project in terms of the timeline and plan. The project team was able have a meeting weekly for 3 months to discuss and come up with the projects strategic plans. The goal was to evaluate the success of the FPDR project by creating a turnkey program with an effective implementation and evaluation plan. The project was based on my findings from literature review on family presence during resuscitation.

Products of the DNP Project

Program strategies with Objective

The program strategies offers a background of the FPDR program. I defined the several projects aims, various duties carried by the group members and participants, and finally the weekly activities and aims in the program strategies. The first week emphasized good practices which are part of the normal clinical activities.

At the beginning of the program, participants will receive instructs on the importance giving the patients family a choice of being present during the life- saving measures. The educational sessions were planned for a collective interaction which will give the participants the opportunity to ask their questions and facilitate discussions. Participants were taught on how to identify the attitudes and the perspectives of the respondents with regards to PFDR. The participants were also to complete the given curriculum subject, reviewing the focuses in the team setting, and discussing potential or actual barriers. The participants were expected to collect a selected task for the following week before the end of the conferences.

Standardized Evaluation Rubric

The group members created the uniform evaluation rubric utilizing the Lewin’s change theory. In this theory, Lewin theorised that changes often take place in three phases: unfreezing phase, moving phase and refreezing phase Unfreezing includes motivating people by making them ready for change, moving involves inspiring the people to agree to the new ideas that would empower them to agree that the present condition can be made better. Refreezing phase involves supporting new forms new systems of behaviour. The objective of the project is to assess the important changes of the FPDR project. There were discussion sessions every week when the participants would gather to talk concerning the experiences they encountered either positive or negative.

Validation of the Product

To validate this product, the group made for this project created a process to use in validation. Peer review was the standard method of use to advocate the legitimacy of any product. Peer review is thought to be part of specific practice. It combines the procedures of specialist in a particular field. The procedures are for evaluation of distinction, production, and the contributions of other persons specialized in the same field. The procedure was important to this project. It gives response that are of value to the project team. Peer review done for this project provided the chance for the analysis of the products in an all-inclusive exercise. At the same time it allowed for valuable response to the project team.

Project Implementation Plan

The project group created a plan for implementation for this project. The plan for implementation required planning harmonization together with the emergency department at the hospital faculty. The content specialists also helped in the process of coming up the plan. The implementation strategy was on the basis of putting more emphasis on evaluating the success of the project based on the contentment scores for the emergency department. It was essential to ensure that participants will be able to have positive experiences during FPDR.

Project evaluation plan

The evaluation plan was designed by the group in charge of the project. It was planned indicate how the health care practitioners will develop throughout the project program and to identify the experiences of the participant family members. The program guidelines give the outline to the distribution of questions as well as any additional practices by the participants as required. The strategies are precise about the objectives of the program and should ensure to give the health care practitioners definite guidelines to be followed. Files containing the program rules and practices will be made for the participants and the medical staff to offer guidance throughout this process.

The evaluation plan sets the goal of promoting family presence during resuscitation and ensuring that they get a positive experience. The plan was created to assist influence follow up and evaluation process of this program. It has short-term and long-term objectives that include following up the participants’ experiences during FPDR. Questions of this survey emphasis on the experiences of the participants. They will fill the survey after the resuscitation sessions and answer questions in the format of yes or no. The desired outcome is to increase positive experiences of family members during FPDR.

Data and Participants

There was no data collected concurrent with this DNP Project. Data (the satisfaction scores) shall be collected by the facility undertaking the evaluation. This will be in association with this suggested quality enhancement project as well as the primary products that were used in this project. Approval to do this project was gotten from (IRB). The proposal used to develop the products listed for the project plus a condition that no collection of data or implementation the project was done by me. A plan for evaluation was formulated to give guidance on assessing the efficiency of the products.

Primary Products

The main emphasis of the project was helping the family members of the patient to have positive experiences during resuscitation. I planned this project based on evidence to help potential participants understand how interior and exterior factors play an important role in making sure patient satisfied at the emergency department.

To develop primary as well as secondary products, I formed a group led by myself and nurses working in the facility and medical staff. The group members consisted of the emergency nursing department, nursing education, clinical nurse specialist chairman of the emergency room, legal department also the quality assurance department.

Program Guidelines

The project team designed this program to complement patient care at the hospital the guides to the program were made from data on review of literature. It was based on current evidence on family presence during resuscitation. It was designed to assist the participants to get positive experiences from the practice. The FPDR policy has well-defined goals and objectives.

The curriculum (see Appendix C) will provide a formal evaluation plan. The formal evaluation plan was to be filled after FDDR session. The curriculum contents provided the following information:

1. If the FPDR option was given at the event of the emergency.
2. If the option to be present during resuscitation was accepted.
3. If the facilitator was present to support the family and if the support offered by the facilitator was helpful.
4. If at the time of resuscitation there was a spiritual care provider offered and if they were helpful to the family.
5. If the chance for the patient’s family members to be present during resuscitation provide an opportunity for the loved ones to be supportive during the period of crisis.
6. The contents should inform if there good crowd control and if the condition of the environment during resuscitation was favourable.
7. If the facilitator provided support after the resuscitation session and if the opportunity provided a better understanding of the resuscitation process.

After the participants execute the curriculum content after the resuscitation session. They should have an understanding of their individual roles in this project. There are many known factors that will influence the participant’s attitudes and perspectives about FPDR in the future. The curriculum offers an opportunity for holding discussions on the challenges and victories the participants experienced.

The group acknowledged that the health belief model proposed by Pender was the right background for the program. Various components forms the basis of this model which include supposed susceptibility, supposed severity, supposed benefits, supposed barriers and clues to practice. An understanding of Pender’s background as well as the skill to recognise which stage of the background will be experienced, correct interventions by the medical staff can be performed in a manner that is timely

Evaluation Rubric

Evaluation rubric was created by the group to give measurable features on stages 1 to 5. The review of the development of the participants by using the measurable features levels will be vital in recognizing which the stages of Lewin’s model strategies changes experienced by the participants. The process will result to the creation of personalized care strategies for every participant on the basis of his or her need. Personalized care strategies which depend on the demands of the participants demands have proven to be helpful and beneficial to all participants.

Implementation and Evaluation Plan

Implementation (see Appendix B) and evaluation plan (see Appendix D) are secondary to this program. They have an important duty in the products given to the hospital. Implementation plan entails the creation of primary product as well as giving the procedure and timelines. I guided the plans alongside the contribution from all group members. The expected that time required to execute the project would be 12 week in total.

Evaluation plan was created to assist influence monitoring and evaluation. It entails both short- term and long-term objectives involving monitoring of the participants’ experiences after FPDR. Questions in the survey focus on the experience and satisfaction of the participants. The people participating in the study are required to a survey at the termination of the resuscitation session and will answer multiple questions employing the yes or no format.

Implications

Policy

There was no policy in place when the project was started. The project team came up with guidelines for the healthcare practitioners to enable presence of family during resuscitation. The guidelines were based on the recommendations by ENA

Practice

In the past the patient’s family were asked to leave the patients room when a crisis occurred. Evidence from current studies show that the patients family want to be given the choice of FPDR. The program is organised, designed, and structured in an individual manner to satisfy the particular and various requirements if every participant. Every participant will take part in the curriculum contents that enable a conducive environment for FPDR. The choice of FPDR will enable individuals to be more knowledgeable about the process of resuscitation.

Research

The department head in the facility has set up a plan that will follow up as well as check the results from the project for a period of first one year of the study. The objective of this program is to evaluate the success of the project based on the patient satisfaction in the emergency department. Data gathered during this program could contain of the data gathered at the start of program for a period 1 to 2 years.

Social Change

The presence of family during resuscitation has proven to be helpful. It gives the family members a chance to be involved in the life-saving decisions and practices of their loved one. This practice is also of psychological benefits to the patients as well as the family members. Implementation of this project will be beneficial as it will give individuals a chance to understand the practice better. It will facilitate improvement of patient care in the emergency department. Health care providers need to have a better understanding of their roles in patient care especially in the emergency department for better patient care.

Conclusion

Family Presence During Resuscitation (FPDR) provides an opportunity for families to demonstrate support to their loved ones during crisis. When FPDR is offered, family members are able to witness and participate in the decision making process regarding the life sustaining measures. A trained individual will facilitate the FPDR Process while providing an explanation of all events.

Appendix A: Primary Product Policy

Family Presence During Resuscitation: Policy

Policy

Hospital Policy and Procedure Family Presence During Resuscitation

Purpose:

1. The policy of the Hospital is to facilitate and promote a family patient and centred approach to care. The Hospital has outlined guidelines which preserves the patient’s and family members’ autonomy.

Description:

1. The family forms an integral part of the patient’s care and this is the basis of the patient and family centred approach. It is important that healthcare professionals embrace the needs of patients and family members. The family of family members during resuscitation is advantageous to patients as it allows family members to demonstrate support; satisfy the need for information and involvement; and provides an outlet for psychological, social, emotional and spiritual needs to be met. The allowance of family presence should be determined based on the individual situation to maintain a safe environment, which will require the judgment of a healthcare team member.

Policies and Procedures:

A. Criteria for Assessing Family Presence:

1. Family members will be assessed by the healthcare team to determine whether suitable, to be present at the bedside during resuscitation. Family members should display emotional stability and should not be combative, uncooperative, display extreme emotional outbursts, or present with altered mental status, suspected use of drugs or alcohol and/or suspected abuse. The allowance of family presence will remain the judgment of a healthcare team member to maintain a safe environment and is not limited to the behaviours mentioned above.

2. The presence of one family member positioned at a designated area at the patients’ bedside will be allowed. The family member may have visual contact with the patient.

3. The Family Facilitator will facilitate the needs and provide resources for family members to ensure that they are supported before, during and after the event; remain updated on developments regarding the patients’ status and handle any untoward reactions.

4. The decisions of patients’ not to have family members present during resuscitation will be supported by the healthcare team.

5. The healthcare team will support the decision of the absence of the family members during the resuscitation.

Appendix B: Secondary Product Implementation Plan

Family Presence During Resuscitation: Implementation Plan

FPDR will be implemented using the following steps:

1. The FPDR Policy guidelines will be disseminated to the nurses, physicians, and other staff involved in the FPDR process via informal educational sessions and hospital grand rounds.

2. Family Facilitator: a “family facilitator” will be given the responsibility of assessing the conditions for appropriateness and the readiness of the family members, answering of questions, attending to the necessities of the families, and providing support. APNs (Advanced practice nurses), nurses, case managers, physicians, spiritual care providers and social workers are some of the personnel which constitute the facilitators.

3. Assessment: Assess the appropriateness of the FPDR for the current situation. Firstly, it depends on the agreement of the interdisciplinary team to the FPDR. Secondly, a stable patient is expected to give his or her consent. Thirdly, the FPDR facilitator should examine the suitability of the designated members of the family to the FPDR. The facilitator should eliminate family members who are disruptive, histrionic and combative. The family members possessing required characteristics for FPDR should be given the chance to be presence in the area of resuscitation. Lastly, the staff should support the members of the family who decide to exclude themselves from the resuscitation. The staff should make the necessary efforts in meeting the informational and emotional needs of such family members even if they are not present at the bedside.

4. Number of Family Members Allowed: Only one family member is granted the permission to be present during the resuscitation process. Greater numbers of family members increase the challenges in accommodation bearing in mind that there are constraints associated with resuscitation rooms. Besides, many family members complicates the facilitator’s capability of maintaining the control of the visitors. In case of the presence of a legal decision maker, then FPDR will be preferentially offered to that person, since he or she may be asked to make decisions during the resuscitation.

5. Family Preparation: The facilitator is charged with the responsibility of preparing the designated member of the family through offering instructions and guidance for the presence. Some of these instructions include the place to stand, how and when to make queries, and advise him or her about interrupting medical care. The facilitator should orient the designated family member on the possible expectations, for instance, the appearance of the patient, presence of blood invasive procedures, and expedited pace at which the medical team will be working.

6. Surrogate: The designated FPDR family member might be requested to make decisions concerning the continuing resuscitative efforts. The presence of a legal decision maker which make it mandatory for the healthcare team to follow the informed decisions made by that person. However, the absence of a legal decision maker will force the healthcare provider to make decisions about the suitability of the continuing resuscitation efforts.

7. Post-Resuscitation Family Debriefing: Support and debriefing should be provided to family members after the resuscitation. In case the patient dies, then the family members will be allowed to see the body of their loved one, and staff should refer family members to a bereavement program.

8. Post-Event Staff Debriefing: The interdisciplinary team members should debrief after an emotional or traumatic FPDR event.

Appendix C: Secondary Product Formal Evaluation

Family Presence during Resuscitation: Formal Evaluation Form

Formal Evaluation Form to be completed after FPDR

FPDR Evaluation Form

Participant Name _________________________ Date_______________________

Questions

1. When the emergent event occurred, was the option given to family to be present during resuscitation/CPR? Yes ☐ No☐

2. Was the option to be present during resuscitation/CPR accepted?

Yes☐ No☐

3. Was there a facilitator or trained staff member present to provide support to family? Yes☐ No☐

4. Was the support of the facilitator or trained staff member helpful?

Yes☐ No☐

5. Was the presence of a spiritual care provider offered and was this helpful?

Yes☐ No☐

6. Did the option for family to be present during resuscitation provide an opportunity for loved ones to be supportive during crisis?

Yes ☐ No☐

7. Was there adequate crowd control?

Yes☐ No☐

8. Was the environment safe during the resuscitation/CPR process?

Yes☐ No☐

9. Did the facilitator provide support/debriefing after the resuscitation/CPR process? Yes☐ No☐

10. Do you think the option for family presence during resuscitation provided a better understanding of the resuscitation/CPR process?

Yes☐ No☐

Appendix D: The Evaluation Plan

Project

Evaluation:

The project team will evaluate the success of this project based on the patient satisfaction scores for the ED. The project team will compare the patient satisfaction surveys in the ED pre-policy implementation phase and post-policy implementation phase.

Goal:

The goal is to assess the valuable information obtained regarding the increase or decrease in patient satisfaction scores between both phases.

Policy Evaluation:

The evaluation plan will assess the benefits of the implementation of FPDR Policy by examining the frequency at which family members chose to be present during resuscitation.

Goal: The goal is to encourage a family-centred approach through the implementation of FPDR Policy.

References

Giles, T. et al. (2016). Factors influencing decision-making around family presence during resuscitation: a grounded theory study. Journal of advanced nursing, 2706 – 2717.

Gold Berger Z. D et al. (2015). Resuscitation investigators policies allowing family presence during resuscitation and patterns of care during in- hospital cardiac arrest. Circ Cardiovasc Qual Outcomes, 226-234.

Hassankhani et al. (2017). family presence during resuscitation required: required evidence based guideline development.

Hassankhani H, et al. (2017). Family Presence During Resuscitation: A Double- Edged Sword. Journal of Nursing Scholarship, 127-134.

Porter et al. (2017). Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia. International emergency nursing, 37-42.

Porter J. E et al. (2014). Family presence during resuscitation (FPDR) perceived benefits, barriers and enablers to implementation and practice. International emergency nursing, 69-74.

Powers et al. (2017). Nursing Practices and policies related to Family Presence During Resuscitation. Dimensions of Critical Care Nursing, 53-59.

Strasen J et al. (2015). Family presence during management. Nursing management, 46-50.

Tudor K et al. (2014). Nurses’ perceptions of family presence during resuscitation. American journal of Critical Care, 88-96.

Twi bell R S et al. (2015). Being there: inpatients perceptions of family during resuscitation and invasive cardiac procedures. American Journal of Critical Care, 108- 115.