NTI 2016: Family Presence During Resuscitation?!

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    Family presence during resuscitation is a hot topic. We are all faced with a better-informed public then ever before. allnurses recently discussed this topic with the expert: Dr Cathie Guzzetta.

    NTI 2016:  Family Presence During Resuscitation?!

    AACN Pioneering Spirit Award

    Cathie Guzzetta, PhD, RN, FAAN, is a nursing mentor, consultant and award-winning researcher who is focused on the importance of holistic care. She has served on the clinical faculty at George Washington University School of Nursing, Washington since 2007.

    Dr. Guzzetta received the AACN Pioneering Spirit Award on May 16, 2016, at NTI 2016 as the preeminent nurse expert on family presence — and as the consummate mentor of pediatric patient care research by nurses at the bedside.

    Allnurses.com was fortunate to have the privilege of interviewing Dr. Guzzettaon the same day that she received her prestigious award. “I've worked on adult and pediatric family presence during resuscitation since 1994, “ she stated to Mary, allnurses Community Manager during the interview. Nurses at that time questioned why families were not present during resuscitation. She related a story from earlier in her nursing career where family presence during resuscitation of a fourteen year old boy was honored, but the nurse was admonished and almost lost her job for doing so. She went on to reiterate the importance of family integrity during these very stressful situations.

    Holistic Nursing

    Holistic nursing is the framework for family presence and spans birth to death and emphasizes family involvement in every patient care unit. ICU is frequently the location where end of life decisions are made. Nurses that staff these units want to be the best of the best. So, utilizing family presence fits this goal of being at the top of their game.

    Some holistic nursing techniques include:

    • Visualization
    • Guided imagery
    • Distraction

    Partnering with the patient to meet the outcome that the patient wants is also extremely important. This is relevant to both adult and pediatric patients and families. Nowadays patients and families demand family presence and shared decision making. With the advent of information readily available on the Internet, patients and families are better informed than ever before.

    Family Presence During Resuscitation

    Dr. Guzzetta relates that in pediatric resuscitation research shows that 97-99% of parents want to be present. In adult resuscitation the numbers are approximately 87%. However, in all instances the families’ wishes must be honored and respected. Families often feel the need to be present but also experience some ambivalence during the event. Research has also proven that despite the fact that families wish they didn't have to make the decision about family presence, they are universally positive that they made the decision to be present. Sometimes this is the last act they can give their family members.

    The Emergency Nurses Association has well established practice guidelines for family presence. AACN has also recently updated their guidelines as to family presence. These are all based on the latest research and provide much information for nurses.

    We want to publicly thank Dr. Guzzetta for her time. Her research and authorship of many books on the subject of family presence have elevated nursing professionalism and brought this topic to the forefront of many discussions in the medical community.

    What has been your experience with family presence?
    Does your facility promote family presence and shared decision-making?

    NTI Interview with Dr. Cathie Guzetta


    References

    - AACN Family Presence Guidelines
    - Clinical Pediatric Emergency Medicine. Family Presence in Emergency Medical Services for Children
    - ENA Family Presence
    - Journal of Emergency Nursing. Family Presence During Cardiopulmonary Resuscitation
    Last edit by Joe V on Nov 3, '16
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    27 Comments

  3. by   Nurse Beth
    I am loving these tidbits and insights into current nursing topics at NTI 2016! Thanks for interviewing nurse leaders and sharing.
  4. by   sirI
    Excellent Article on this topic. Thank you.
  5. by   emtb2rn
    I believe families should have the option to observe the code. My facility ask the family if they wish to observe. If the answer is yes, an experienced rn with excellent communication skills (generally one of the charges) stays with the family and explains everything that is happening. It seems to give a sense of closure when the code is unsuccessful and has led to hugs from the family when rosc is attained.
  6. by   traumaRUs
    You are so right EMTb2RN. It is important that families are given the choice and that their choice is respected
  7. by   Boomer MS, RN
    Quote from emtb2rn
    I believe families should have the option to observe the code. My facility ask the family if they wish to observe. If the answer is yes, an experienced rn with excellent communication skills (generally one of the charges) stays with the family and explains everything that is happening. It seems to give a sense of closure when the code is unsuccessful and has led to hugs from the family when rosc is attained.
    The scenario described above is ideal. There has been a great deal of literature published on "Family Presence During Resuscitation", much which began to surface in the late 1990s and instigated by the Emergency Nurses Association. Kudos to AACN for following suit with their own guidelines.
  8. by   traumaRUs
    Agree - with the coming of age of the boomers, and more information available on the internet, families expect more (we all are experiencing this!) and they don't want to leave their loved ones.

    I thought it was very interesting the research that Dr Guzzetta did after the fact - she polled families long after they had been afforded the opportunity to be present during resuscitation and while they all felt it was a very stressful or THE most stressful situation of their lives, they universally stated they were glad they were given the chance to be present.
  9. by   Roy Hanson
    no! family is under enough stress when a member is about to open deaths door. Beside with all the equipment in that small room...family should remain outside. We cant move if the family wants a BETTER look. They have NO idea what is going on.
    The era of dieing baby boomers is upon us. Even if one is a lawyer, doctor, etc..no admittance until I am finished my work. If the member dies, let attending break the news.
  10. by   Boomer MS, RN
    Quote from traumaRUs
    Agree - with the coming of age of the boomers, and more information available on the internet, families expect more (we all are experiencing this!) and they don't want to leave their loved ones.

    I thought it was very interesting the research that Dr Guzzetta did after the fact - she polled families long after they had been afforded the opportunity to be present during resuscitation and while they all felt it was a very stressful or THE most stressful situation of their lives, they universally stated they were glad they were given the chance to be present.
    I did a literature search on this topic for graduate school for a paper I wrote (graduated in 1999). Interestingly, the literature at that time showed the same conclusions that Dr. Guzzetta described, about families being polled after their experiences and being grateful for the opportunity and choice of being present. Obviously no family has to be there; it's a choice. Findings at that time also reviewed what the staff thought about family resuscitation, and not all were in favor for various reasons. Way back then, I had some doubts before I reviewed the articles but changed my opinion. Can we all remember when fathers were not allowed into the delivery room? It's a stimulating conversation. Can you tell I'm envious and wish I could have heard her speak?
  11. by   Catch22Personified
    When I was doing my TNCC it was taught to us that it was encouraged to give the family the option to be present during resuscitation attempts. And in my practice we always gave the family the option. Families that took that opportunity were very grateful and at times were actually afraid to be too close, due to concerns of being in the way of staff during taking care of their loved one. I think the only time we don't let family be close to watch is during central line insertions.

    Personally, I get very nervous when family is around due to pressure but I will respect their wishes. When my grandmother was ill I wasn't even allowed to visit her even when she was dying due to "flu season" visitation restrictions. I do not want any family be deprived of see in their family, sometimes seeing everyone work their hardest save their loved one gives a sense of closure.
  12. by   Here.I.Stand
    I'm having trouble picturing where they would stand...our rooms get SO crowded. The pharmacist doesn't even come inside our ICU rooms -- they stand just outside the doorway next to the crash cart.

    Families if present are allowed to stand outsidr of the room, just out of the way of staff. The chaplain is at their side to give comfort and explain in general what is happening, as clinical staff are of course focused on the rescucitation efforts.
  13. by   Boomer MS, RN
    Quote from Here.I.Stand
    I'm having trouble picturing where they would stand...our rooms get SO crowded. The pharmacist doesn't even come inside our ICU rooms -- they stand just outside the doorway next to the crash cart.

    Families if present are allowed to stand outsidr of the room, just out of the way of staff. The chaplain is at their side to give comfort and explain in general what is happening, as clinical staff are of course focused on the rescucitation efforts.
    Your points are well taken. When the early literature was published, it was focused on Emergency Department resuscitations. Ideally, a clinical person would also be with the family, but, again, is that practical staff numbers wise? I think we can all visualize what you're saying about your crowded ICU environment and how well you've accommodated family members. Too bad we all could not be at NTI and ask Dr. Guzzetta some of these questions. Sigh....
  14. by   calivianya
    We let families come in. Our rooms get crowded, too, but there's usually some space against a wall somewhere that family members can stand.

    Most are very well behaved during a code, and don't get in the way. We've only had to get one family out of the room because they were being disruptively loud, at least during the ones I've been to. We had one wife who stood at the edge of the bed and held her husband's feet the whole time once, but she was still (and a small person) so even she didn't interfere with what we were doing in any way.

    It gives families closure, and really shows them we are doing everything we can. Another benefit is the families that watch more often than not end up telling us to stop at some point, so family presence is helpful in that we don't spend forever coding someone who is a futile case but a full code.

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