Family presence during resuscitation (FPDR): searching for evidence of implementation and practice in the emergency department

BACKGROUND. A resuscitation event involves a team of emergency personnel who attempt to ensure that the patient receives the best possible chance of survival. The team comprises of both doctors and nurses who work in a variety of resuscitation roles and hold a number of responsibilities during the event. There is a growing movement among practitioners to involve family members during resuscitation events. Family presence during resuscitation (FPDR) in both adult and paediatric resuscitations was formally endorsed in the year 2000 by leading Emergency Associations and Resuscitation Councils (American Heart Association, 2000; Association, 2000) who were responsible for releasing practice guidelines. The debate continues with little known about FPDR implementation and practice in emergency departments. This study aimed to investigate the implementation and practice of FPDR with the objective of identifying the benefits, barriers and enablers, evaluating the role of the family support person, and assessing the level of education and training in rural and metropolitan emergency departments. METHOD. A mixed methods approach with a sequential explanatory design was utilised for this research study. The study was predominately quantitative (QUAN) followed by an interpretative qualitative component (qual). Phase One involved a ten page questionnaire which was distributed to 18 emergency departments in the state of Victoria, Australia. Phase Two of the study incorporated a two week period of observation in a single rural and single metropolitan emergency department. A combination of field notes, resuscitation event template and semi-structured interviews were used. RESULTS. A total of 347 questionnaires were included in the final data set with a 27% response rate representing emergency personnel from rural and metropolitan emergency departments. Descriptive and inferential statistics were used to describe the Family Presence During Resuscitation (FPDR): Searching for Evidence 6 of Implementation and Practice in the Emergency Department population followed by a factor analysis of the 26 statements on FPDR. A total of 65 doctors and 282 nurses completed the questionnaire, with a mean age of 37.2 years and a mean of 7.8 years working emergency care. A total of 61% (n=173) of the nurses and 65% (n=42) of the doctors had a post graduate qualification and approximately 50% of the doctors and 80% of the nurses had completed adult and paediatric advanced life support training. The staff believed that FPDR occurred 0-20% of the time with adult resuscitations and 80-100% of the time for paediatric resuscitations. The doctors (77%, n=50) and nurses (79%, n=222) believed that family had a right to be present during resuscitation events and that it helped with the grieving process (54% of doctors and 62% of nurses). The staff greatly agreed that a designated support person was essential when allowing family to be present (89% of doctors and 92% of nurses). It was considered important that family members be given the opportunity to say good bye (83% of doctors and 93% of nurses). The perceived benefits, barriers and enablers for the implementation and practice of FPDR were discussed. Following a content analysis of the open ended responses the acronym ER-DRIP was developed which helped to define the essential information that family required during a resuscitation event. The acronym stands for E-emergency personnel, R-reassurance, D-diagnosis, R-regular updates, P-prognosis. During the observations in Phase Two of the study a total of 29 interviews were conducted together with observation of six rural and 18 metropolitan resuscitations. The interviews were audiotaped and later transcribed for analysis. A content analysis was conducted and six major themes emerged including; the importance of the care coordinator, balance of power, delivering bad news, life experience generates confidence, allocating roles and family centre care in action. CONCLUSION. Although not a new research topic, FPDR continues to invoke debate among emergency personnel. This research study aimed to develop an understanding of staff training and education, and to explore the perceived benefits, barriers and enablers to FPDR implementation and practice. In addition comparisons were made between adult and paediatric FPDR practice across both rural and metropolitan emergency departments. Further research is warranted in order to develop an understanding of the impact FPDR has on the patient and the family members. It is the Family Presence During Resuscitation (FPDR): Searching for Evidence 7 of Implementation and Practice in the Emergency Department recommendation of this study that a comprehensive training program be developed which incorporates the acronym ER-DRIP to ensure emergency personnel develop the necessary skills and communication techniques required to feel confident with family presence during adult and paediatric resuscitations.