EXECUTIVE SUMMARY

Nurses and acute care physicians consider different factors for decision-making on family presence during resuscitation, found a recent study.

• Physicians focus primarily on the patient.

• Nurses consider the patient, family, and resuscitation team.

• A designated “family facilitator” can minimize disruption.


Nurses and acute care physicians consider different factors when making decisions on family presence during resuscitation, found a recent study.1

“Much research has explored the overall perceptions of healthcare professionals related to family presence during resuscitation. But little research has explored decision-making processes,” says K. Renee Twibell, PhD, RN, CNE, associate professor at Ball State University’s School of Nursing. Twibell also is a nurse researcher at Indiana University Health Ball Memorial Hospital in Muncie.

Previous research has shown that nurses and physicians have different perceptions about family presence.2 “We wanted to explore those interprofessional differences specifically in factors related to decision-making,” says Twibell.

Researchers surveyed 325 nurses and 193 acute care physicians on decision-making factors about family presence. “From our own clinical experiences and existing published evidence, we suspected there would be differences between physicians and nurses,” says Twibell.

Physicians focused primarily on the patient. Nurses balanced the needs of multiple stakeholders: the patient, family, and resuscitation team.

“We were surprised at how strongly the physicians spoke about not inviting family presence due to the potential for family disruption,” says Twibell. Also important to physicians is the family’s lack of knowledge about resuscitation events. In analyzing the data, it became clear that the physicians prioritized their patients’ survival. “They had little tolerance for anything that would compromise that,” says Twibell.

Better Collaboration

Most families believe it is their right to be present with loved ones when situations are life-threatening. “Not inviting families to witness the resuscitation of a loved one may appear unethical to families,” notes Twibell. However, physicians perceive a clear ethical call to save a patient’s life; they do not want anything to deter from their efforts to do so, including family presence.

Ariane Lewis, MD, assistant professor at New York City-based NYU Langone Medical Center’s department of neurology, says it can be beneficial for families to directly witness the immense efforts being made to save a person’s life. This can help them come to terms with the severity of the situation. “However, families can become overwrought with emotions and interfere with a resuscitation,” says Lewis.

Developing policies on this issue can allow institutions to take an organized, systematic approach. Lewis suggests this wording: “If families are interested in remaining in the room during resuscitation attempts, they should be given the opportunity to do so, provided that their presence will not interfere with patient care.”

Cheyn Onarecker, MD, MA, chair of the healthcare ethics council at Trinity International University’s Center for Bioethics & Human Dignity in Deerfield, IL, says the fact that families benefit from being present during resuscitation efforts on their loved ones has been recognized for some time. “The families say they experienced more meaningful closure by being present,” says Onarecker. “They feel as if they had a chance to say goodbye.” Families can see for themselves how far the medical team was willing to go to save the person rather than wondering later if the team had made a serious effort.

“Interestingly, the families do not appear to suffer serious psychological consequences from the experience,” says Onarecker. Some studies indicate that families actually experience less psychological trauma by being present.3

“Hospital leaders might worry that legal issues might arise more frequently as a result of having families present,” says Onarecker. “But that has not occurred.”

Minimize Disruption

Twibell says the ethical question is: “Whose needs, priorities, and wishes are most important?” Some hospitals appoint a member of the healthcare team as a “family facilitator” during a resuscitation, to coach and support individuals who choose to be present. This minimizes the threat of disruptions caused by families. “Such a solution allows family members to be there for a loved one in crisis, and allows physicians to focus on the patient without fear of interruption,” says Lewis.

The researchers hope to design and test a decision-making process for family presence during resuscitation so clinicians can consistently manage this aspect of end-of-life, family-centered care.

“Our hope is that nurses and physicians can collaborate better if they understand differences and similarities in decision-making preferences related to family presence,” says Twibell.

REFERENCES

1. Twibell R, Siela D, Riwitis C, et al. A qualitative study of factors in nurses’ and physicians’ decision-making related to family presence during resuscitation. J Clin Nurs 2018; 27(1-2):e320-e334.

2. Howlett MS, Alexander GA, Tsuchiya B. Health care providers’ attitudes regarding family presence during resuscitation of adults: an integrated review of the literature. Clin Nurse Spec 2010; 24(3):161-174.

3. De Stefano C, Normand D, Jabre P, et al. Family presence during resuscitation: A qualitative analysis from a national multicenter randomized clinical trial. PLoS One 2016; 11(6): e0156100.

SOURCES

• Ariane Lewis, MD, Assistant Professor, Department of Neurology, NYU Langone Medical Center, New York City. Email: ariane.kansas.lewis@gmail.com.

• Cheyn Onarecker, MD, MA, Chair, Healthcare Ethics Council, The Center for Bioethics & Human Dignity, Trinity International University, Deerfield, IL. Phone: (405) 272-7494. Email: cheyn.onarecker@ssmhealth.com.

• K. Renee Twibell, PhD, RN, CNE, Associate Professor, School of Nursing, Ball State University/Nurse Researcher, Indiana University Health Ball Memorial Hospital, Muncie, IN. Phone: (765) 751-5338. Email: rtwibell@bsu.edu.