Family Presence During Resuscitation and Invasive Procedures

Transcription

1 Family Presence During Resuscitation and Invasive Procedures Kathleen Ohman, EdD, MS, RN, CCRN Joyce Simones, EdD, MS, RN Roberta Basol, MA, RN, CNA,BC Kirsten Skillings, MA, RN, CCNS, CCRN

2 Research Grant This research is partially supported by a research grant from the American Association of Critical Care Nurses and a private donation.

3 Recommendations from National Guidelines & Professional Organizations Health-care professionals consider allowing family members to be present during resuscitation & bedside invasive procedures (AACN, 2005; ENA, 2000; McClenathan, Torrington & Uyehara, 2002; Meyers et al, 2000; Moreland, 2005)

4 Historical Perspective of Family Presence During Resuscitation 1982: First U.S. Exploration --Foote Hospital in Michigan Two instances in which family members demanded to be present 18 family members of recently deceased patients surveyed to determine whether they felt the need or desire to be present during resuscitation 13 of the 18 individuals surveyed (72%) wished they had been present during resuscitation (Hanson & Strawser, 1992)

5 1985: Program Development by Foote Hospital Relatives given information about the patient s condition Asked if they wished to be present If desired, escorted to room Trained hospital chaplain or other support person stays with the relatives

6 1985: Second Survey Completed by Hanson & Strawser 47 bereaved family members present during resuscitation responded 66% felt that their adjustment to the death of a loved one was made easier by their presence during resuscitation 64% felt their presence was beneficial to the dying person

7 1993: U.S. Emergency Nurses Association (ENA) First to develop a resolution to support the option of allowing a patient s family to be present during CPR and invasive procedures

8 2000: The American Heart Association (AHA) Announced revised international guidelines for CPR and ACLS which included considering family members presence during resuscitation efforts Guidelines were developed over two years of rigorous scientific debate and evaluation by the world s top resuscitation research experts from Australia, Europe, Canada, Japan, New Zealand, Latin America, Saudi Arabia, South Africa, & Thailand

9 2005: The American Heart Association (AHA) According to the 2005 AHA Guidelines for CPR and ECC: "in the absence of data documenting harm and in light of data suggesting that it may be helptul, offering select family members the opportunity to be present during a resuscitation seems reasonable and desirable" "resuscitation team members should be sensitive to the presence of family members during resuscitative efforts, assigning a team member to the family to answer questions, clarify information and otherwise offer comfort"

10 2002: American Association of Critical Care Nurses Established guidelines for expected practice during CPR and invasive procedures The expected practice recommends that health care organizations have an approved written policy for presenting the option of family presence during CPR and bedside invasive procedures

11 Literature Perceived Benefits of Family Presence during CPR Meets family and patient s emotional and spiritual needs Fosters greater appreciation for code efforts Enhances family understanding of patient s condition Reduces family guilt and anxiety Allows family to be with the dying person (Ardley, 2003; Bauchner, Waring, & Vinci, 1991; Guzetta, Taliaferro, & Proehl, 2000; Meyers, Eichhorn, & Guzzetta, 1998; Meyers, Eichhorn, Guzzetta et al, 2000; Robinson, Mackenzie- Ross, Hewson, et al, 1998; Timmermans, 1997)

12 Perceived Benefits Continued Helps staff provide more holistic care Opportunity to educate the family Conveys a sense of personhood Encourages more professional behavior More apt to consider dignity, privacy, and pain management (Ardley, 2003; Bauchner, Waring, & Vinci, 1991; Guzetta, Taliaferro, & Proehl, 2000; Meyers, Eichhorn, & Guzzetta, 1998; Meyers, Eichhorn, Guzzetta et al, 2000; Robinson, Mackenzie-Ross, Hewson, et al, 1998; Timmermans, 1997)

13 Registered Nurses and Physicians Literature Concerns Family members may interfere Observe poor performance by staff Observe uncaring attitudes or inappropriate staff remarks Hamper staff s performance by making staff lose concentration Impair staff function due to distractions Might cause more harm than good (Adams, Whitlock, Higgs, et al, 1994; Helmer, Smith, Dort, et al, 2000; Meyers, Eichhorn, Guzzetta, et al, 2000; Martinez, 2001; Mitchell & Lynch, 1997; Redley, & Hood, 1996)

14 Concerns of Registered Nurses and Physicians Continued Family more likely to complain that not enough was done/too much was done or resuscitation stopped too soon or not carried on for long enough Staff feelings dealing with bereaved relatives in the resuscitation room while trying to care for the patient (Adams, Whitlock, Higgs, et al, 1994; Helmer, Smith, Dort, et al, 2000; Meyers, Eichhorn, Guzzetta, et al, 2000; Martinez, 2001; Mitchell & Lynch, 1997; Redley, & Hood, 1996)

15 Current Research Registered Nurses, Physicians and Other Health Care Personnel Attitudes, Concerns, and Beliefs toward Family Presence during Cardiopulmonary Resuscitation and Bedside Invasive Procedures by Kathleen Ohman, Principle Investigator and Roberta Basol, Joyce Simones and Kirsten Skillings Co-Investigators. Started May 8, 2005 Completed Analysis Fall 2006 Site: St. Cloud Hospital a Magnet designated hospital

16 Methodology Survey methodology: Questionnaire published from the American Emergency Nurses Association: Likert scaled questions with some openended questions Researcher developed demographic questionnaire

17 Primary Results. 625 respondents total Open ended questions were coded Data currently being analyzed Descriptive statistics Correlations ANOVA

18 Gender Presence 0% 19% Gender Male % Gender Female Gender No Answer 502 2

19 3, 0% 1, 0% 7, 2% 3, 0% 3, 0% Ethnicity Ethnicity Caucasion Ethnicity Hispanic Ethnicity African American Ethnicity Asian Ethnicity Other Ethnicity No Answer 608, 98%

20 Profession 9, 1% 4, 1% 17, 3% 88, 14% 17, 3% Physican CRNA RN Respiratory Therapy Orderly / Spiritual Care No Answer 490, 78%

21 Years in Position 8, 1% 25, 4% 119, 19% 195, 32% >20 No Answer 121, 19% 157, 25%

22 Highest Level of Education 5, 1% 1, 0% 1, 0% 86, 14% 144, 23% 4, 1% 44, 7% MD/DO Doctorate Masters Baccalaureate Diploma Associate High School Other 106, 17% No Answer 234, 37%

23 Clinical Management 45.1 (14%) 282 (86%)

24 Nursing Specialty 21, 4% Anesthesia Critical Care, PICU,NICU Emergency 153, 29% 83, 15% Float pool Med/Surg 33, 6% Pediatrics Practice Nurse OutPatient 32, 6% Surgery 45, 8% Tele/PCU/CPRU Other 39, 7% 85, 16% 23, 4% 11, 2% 19, 3%

25 Physician Specialty 8, 6% Anesthesia 30, 20% 14, 10% Cardiologist Emergency 4, 3% Family Practice Hospitalist 9, 6% 4, 3% 18, 12% Intensivist Internal Medicine Neonatal/Pediatrics OB/Gyn Oncology Resident Surgery 9, 6% 8, 6% Other 7, 5% 5, 4% 18, 13% 8, 6%

26 Involvement in Resuscitation Events During Career 6, 1% 80, 13% , 14% >10 316, 50% No Answer 135, 22%

27 Member of Code Blue Team 6, 1% 181, 29% Yes No No Answer 438, 70%

28 National Certification 77, 12% Yes 261, 42% No No Answer 287, 46%

29 Work Hours 19, 3% 4, 1% Full Time 173, 28% Part Time Casual No Answer 429, 68%

30 Direct Care of Patients ( % of Time ) 56, 9% 78, 12% , 62% 104, 17% >90

31 Likert Responses n= Mean 1. Providing psychosocial and/or emotional support to family members is part of my job/practice. Sd I feel comfortable providing psychosocial/emotional support to family members during treatment situations 3. I feel appropriate psychosocial/emotional care is provided to patients and their families when patients are undergoing invasive procedures. 4. I feel appropriate psychosocial/emotional care is provided for family members of patients undergoing resuscitations. 5. I believe family members should have the option to be present during invasive procedures. 6. I believe family members should have the option to be present during resuscitation situations. 15. How well informed do you think you are about the impact of family presence during invasive procedures or resuscitation?

32 Variables Correlations of Age Pearson Correlation Strength of Relationship (Significance Level) Nature of Relationship (Likert-scale item 2) (n = 453) As the age of the health care provider increased, subjects agreed with feeling comfortable providing support to family members.

33 Correlations of Highest Level of Education Variables (Likertscale item 5) (n = 554) (Likertscale item 6) (n = 554) (Likertscale item 15) (n = 554) Pearson Correlation Strength of Relationship (Significance Level) Nature of Relationship As the level of education increased, subjects agreed that family members should have the option to be present during invasive procedures As the level of education increased, subjects agreed that family members should have the option to be present during resuscitation As the level of education increased, subjects felt less informed about the impact of family presence during invasive procedures or resuscitation

34 Correlations on National Certification (Likert-scale item 1) (n = 490) Pearson Correlation Significance (2-tailed) Those with national certification believed less than those not certifiedthat providing psychosocial and/or emotional support to family members is part of the subject s job/practice. (Likert-scale item 5) (n = 490) (Likert-scale item 6) (n = 490) (Likert-scale item 15) (n = 490) Those with national certification believed less than those not certified that family members should have the option to be present during invasive procedures The correlation was negative when comparing those with national certification to those without national certification Those with national certification believed less than those not certified that family members should have the option to be present during resuscitation Those with national certification felt more informed than those not certified about the impact of family presence during invasive procedures or resuscitation.

35 Correlations on Member of Code Blue Team Variables (Likert-scale item 3) (n = 599) (Likert-scale item 4) (n = 576) (Likert-scale item 5) (n = 611) (Likert-scale item 15) (n = 593) Pearson Correlation Significance Level Nature of Relationship Members of the code blue team felt appropriate psychosocial/emotional care is provided to patients and their families when patients are undergoing invasive procedures more than non code blue team members Members of the code blue team felt appropriate psychosocial/emotional care is provided to patients and their families when patients are undergoing resuscitation more than non code blue team members Non members of the code blue team felt family members should have the option to be present during invasive procedures more than code blue team members Members of the code blue team felt more informed than non code blue team members about the impact of family presence during invasive procedures or resuscitation.

36 Correlations: CC, ER Nurses & Non CC, ER Nurses Variables (Likertscale item 2) (n = 614) (Likertscale item 3) (n = 605) (Likertscale item 4) (n = 581) Pearson Correlation Significance Level Nature of Relationship CC and ER nurses felt more comfortable than non CC and ER nurses about providing psychosocial/emotional support to family members during treatment situations CC and ER nurses felt appropriate psychosocial/emotional care is provided to patients and their families when patients are undergoing invasive procedures more than non CC/ER nurses CC and ER nurses felt appropriate psychosocial/emotional care is provided to patients and their families when patients are undergoing resuscitations more than non CC/ER nurses.

37 Correlations: CC, ER Nurses & Non CC, ER Nurses Variables (Likert-scale item 5) (n = 617) (Likert-scale item 6) (n = 617) (Likert-scale item 15) (n = 599) Pearson Correlation Significance Level Nature of Relationship CC and ER nurses felt family members should have the option to be present during invasive procedures more than non CC/ER nurses CC and ER nurses felt family members should have the option to be present during resuscitation situations more than non CC/ER nurses CC and ER nurses felt more informed than non CC and ER nurses about the impact of family presence during invasive procedures or resuscitation.

38 Correlations on Gender Variables Pearson Correlation Significance Level Nature of Relationship (Likert-scale item 1) (n = 617) (Likert-scale item 2) (n = 612) (Likert-scale item 5) (n = 615) (Likert-scale item 6) (n = 615) Males believed more than females that providing psychosocial and/or emotional support to family members is part of their job/practice Males felt more comfortable than females about providing psychosocial/emotional support to family members during treatment situations Males felt family members should have the option to be present during invasive procedures more than females Males felt family members should have the option to be present during resuscitation situations more than females.

39 Correlations on RNs and Non-RNs Variables (Likert-scale item 1) (n = 615) (Likert-scale item 2) (n = 610) (Likert-scale item 5) (n = 613) (Likert-scale item 6) (n = 613) Pearson Correlation Significance Level Nature of Relationship RNs believed more than non-rns that providing psychosocial and/or emotional support to family members is part of their job/practice RNs felt more comfortable than non-rns about providing psychosocial/emotional support to family members during treatment situations RNs felt family members should have the option to be present during invasive procedures more than non-rns RNs felt family members should have the option to be present during resuscitation situations more than non-rns.

40 Correlations on Physicians and RNs Variables Pearson Correlation Significance Level Nature of Relationship (Likert-scale item 1) (n = 572) RNs believed more than physicians that providing psychosocial and/or emotional support to family members is part of their job/practice. (Likert-scale item 5) (n = 570) RNs felt family members should have the option to be present during invasive procedures more than physicians. (Likert-scale item 6) (n = 571) RNs felt family members should have the option to be present during resuscitation situations more than physicians.

41 Yes/No Responses n/% yes Total Responses Physician CRNA Nurses RT Orderly Spiritual Care Have you participated in a treatment situation in which a family member was present during the invasive procedures? % % % % % % Have you participated in a treatment situation in which a family member was present during resuscitation? % % % % % % Has your job performance ever been hampered by the presence of a patient s family member? % % % % % %

42 Yes/No Responses n/% yes If your family member was ill or injured, would you (as a health care provider) want the option to be present during invasive procedures? If your family member was ill or injured, would you (as a health care provider) want the option to be present during resuscitation? Total Responses Physician CRNA Nurses RT Orderly Spiritual Care % % % % % % % % % % % %

43 Yes/No Responses n/% yes Total Responses Physician CRNA Nurses RT Orderly/ Spiritual Care If your family member was ill or injured, do you feel other members of your family (non-health care providers) should have the option to be present during invasive procedures? % % % % % % If your family member was ill or injured, do you feel other members of your family (non-health care providers) should have the option to be present during resuscitation? % % % % % %

44 Yes/No Responses n/% yes If you were critically ill/injured would you want the option to have your family present at your bedside? Total Responses % 83 Physician CRNA Nurses RT Orderly/ Spiritual Care 83.1% % % % % Do you believe there are system barriers to family presence? % % % % % %

45 Yes/No Responses n/% yes I would support a policy giving the family the option of being present during invasive procedure. Total Responses Physician CRNA Nurses RT Orderly Spiritual Care % % % % % % I would support a policy giving the family the option of being present during resuscitation % % % % % %

46 Recommendations and Implications for Practice Findings support implementation of a policy regarding family presence, although there continues to be pockets of resistance Need multidisciplinary team to work on policy and staff education Policy should detail responsibilities of healthcare providers Education should include evidence based research Further research revision of tool to reduce number of open ended questions