Family presence during cardiopulmonary resuscitation and invasive procedures: a meta-synthesis

Barreto, Mayckel da Silva; Peruzzo, Hellen Emília; Garcia-Vivar, Cristina; Marcon, Sonia Silva

doi:10.1590/S1980-220X2018001303435

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REVIEW • Rev. esc. enferm. USP 53 • 2019 • https://doi.org/10.1590/S1980-220X2018001303435 copy

Family presence during cardiopulmonary resuscitation and invasive procedures: a meta-synthesis

Presencia de la familia durante resucitación cardiopulmonar y procedimientos invasivos: una metasíntesis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To synthesize the best qualitative evidence regarding the perception of family members, patients and health professionals about family presence during cardiopulmonary resuscitation and invasive procedures.

Method:

Systematic review with meta-synthesis performed in the databases of Web of Science, Scopus, CINAHL, PsycINFO, LILACS, MEDLINE, Embase and VHL. Articles published between 2010 and 2017 were included and evaluated with use of the Qualitative Data Extraction Instrument.

Results:

In total, were found 2,391 articles, out of which 26 were selected, and 24 were analyzed. The identified meta-theme was ‘A pendular perspective: different views on family presence during cardiopulmonary resuscitation and invasive procedures’, which is supported by the following themes: Benefits resulting from family presence; Disadvantages and/or limiting factors of family presence; and Context: environmental, sociocultural and care factors influencing the perception of family presence.

Conclusion:

The perception of family members, patients and professionals about family presence is still controversial. The sensitization of these subjects can potentiate the practice by making it more systematized and qualified.

DESCRIPTORS:
Cardiopulmonary Resuscitation; Emergency Medical Services; Family relations; Professional-Family Relations; Emergency Nursing; Review

Findings	Subtheme	Themes	Meta-theme
I held my grandfather’s hand firmly and told him I was there to be with him. I hope he felt my presence even though he was unconscious (Mr L - family member)²²22 Hung MSY, Pang SMC. Family presence preference when patients are receiving resuscitation in an accident and emergency department. J Adv Nurs. 2011;67(1):56-67. DOI: 10.1111/j.1365-2648.2010.05441.x https://doi.org/10.1111/j.1365-2648.2010... .	Promoting physical and emotional contact between the family and the patient	Benefits resulting from family presence during cardiopulmonary resuscitation and invasive procedures	A pendular perspective: different views on family presence during cardiopulmonary resuscitation and invasive procedures
He (brother) helped me with the ventilation. So, he was inflating the AMBU for me and I was telling him when to do it (prehospital care professional)¹³13 Walker WM. Emergency care staff experiences of lay presence during adult cardiopulmonary resuscitation: a phenomenological study. Emerg Med J. 2014;31(6):453-8.DOI: 10.1136/emermed-2012-201984. https://doi.org/10.1136/emermed-2012-201... .	Allowing family participation in the care process
If the patient awakened from unconsciousness, he would not be scared if the family were there. I could provide psychological and emotional support to him as well as to myself (Mr L - family member)²²22 Hung MSY, Pang SMC. Family presence preference when patients are receiving resuscitation in an accident and emergency department. J Adv Nurs. 2011;67(1):56-67. DOI: 10.1111/j.1365-2648.2010.05441.x https://doi.org/10.1111/j.1365-2648.2010... .	Promoting patient and family support
After witnessing a resuscitation, a family realized their family member could not be saved, that is, they saw that in the end, the team was exhausted, and that all that could be done had been done (professional)²³23 Chapman R, Bushby A, Watkins R, Combs S. Australian Emergency Department health professionals' reasons to invite or not invite family witnessed resuscitation: a qualitative perspective. Int Emerg Nurs. 2014;22(1):18-24. DOI: 10.1016/j.ienj.2013.03.008. https://doi.org/10.1016/j.ienj.2013.03.0... .	Offering the family a better understanding of the patient’s case and the care provided
We are just passing briefly by the lives of these people, and the family has been present throughout their lives, they have far more rights. We’re just a team trying to avoid death. Sometimes we win, sometimes not. I think our role is not just to resuscitate the person, but to help the grief of the family throughout this process (Darren - nurse)²⁴24 Giles T, Lacey S, Muir-Cochrane E. Factors influencing decision-making around family presence during resuscitation: a Grounded Theory study. J Adv Nurs. 2016;72(11):2706-17. DOI: 10.1111/jan.13046 https://doi.org/10.1111/jan.13046... .	Facilitating the family’s grief process
Praying is not just next to a patient. But it is confirmed by the Prophet Muhammad, when he was visiting his mother’s grave and wept, even though his mother had died 40 or 50 years before. Hence, being close to the place gives the feeling of emotional closeness, being near increases the power of prayer and encourages something to happen (Abu Yassin - family member)²2 Masa'Deh R, Saifan A, Timmons S, Nairn S. Families' stressors and needs at time of cardio-pulmonary resuscitation: Jordanian perspective. Glob J Health Sci [Internet]. 2013 [cited 2017 Jan 25];6(2):72-85. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825218/ https://www.ncbi.nlm.nih.gov/pmc/article... .	Meeting the cultural and religious needs of family and patients
I felt that the patient’s family was satisfied with the team’s efforts (in the face of the patient’s death) because they witnessed the scene and followed the efforts. This can calm families and make them happy with the hospital staff (N3 - nurse)¹⁵15 Hassankhani H, Zamanzadeh V, Rahmani A, Haririan H, Porter JE. Family presence during resuscitation: a double-edged sword. J Nurs Scholarsh. 2017;49(2):127-34. DOI: 10.1111/jnu.12273 https://doi.org/10.1111/jnu.12273... .	Promoting greater family satisfaction with care
The patient’s dignity is not maintained during a resuscitation, clothes are removed (professional)²³23 Chapman R, Bushby A, Watkins R, Combs S. Australian Emergency Department health professionals' reasons to invite or not invite family witnessed resuscitation: a qualitative perspective. Int Emerg Nurs. 2014;22(1):18-24. DOI: 10.1016/j.ienj.2013.03.008. https://doi.org/10.1016/j.ienj.2013.03.0... .	Patient protection	Disadvantages and/or limiting factors of family presence during emergency care
Our actions are aggressive, we intubate, perform cardiac massage and others, all of which evoke bad experience in the family and affect their psyche. Sometimes, we have to stop treating the patient and attend his family. For example, we had a case where the patient’s family member entered the resuscitation room and fainted while observing the patient and our actions (doctor 4)¹⁵15 Hassankhani H, Zamanzadeh V, Rahmani A, Haririan H, Porter JE. Family presence during resuscitation: a double-edged sword. J Nurs Scholarsh. 2017;49(2):127-34. DOI: 10.1111/jnu.12273 https://doi.org/10.1111/jnu.12273... .	Family protection
As health professionals, we cannot feel comfortable when we are performing a procedure and another person is watching the team. We do not feel well, we want close relatives to stay away from the resuscitation room, so that we can perform our procedures more calmly (Kalisa - professional)²⁵25 Havugitanga P, Brysiewicz P. Exploring healthcare professionals' perceptions regarding family-witnessed resuscitation in a hospital in Kigali, Rwanda. South Afr J Crit Care. 2014;30(1):18-21. DOI: http://dx.doi.org/10.7196/sajcc.174 https://doi.org/http://dx.doi.org/10.719... .	Professional protection
It depends on your own set of beliefs and your own professional clinical experience. If it is your belief that if you were the patient you would want someone there or if you were the family member, you would like to be there for your loved one, then, I think you would obviously try to overcome the barriers to implement it [family presence] for another person (Jane - nurse)²⁴24 Giles T, Lacey S, Muir-Cochrane E. Factors influencing decision-making around family presence during resuscitation: a Grounded Theory study. J Adv Nurs. 2016;72(11):2706-17. DOI: 10.1111/jan.13046 https://doi.org/10.1111/jan.13046... .	Personal beliefs and previous experiences	Context: environmental, sociocultural and care factors influencing the perception of family presence during emergency care
Nine times out of ten, family members are the ones who are there when their loved one feels malaise or find their child drowned in a bathtub or start resuscitating at home and suddenly, they get to the hospital and are told, “No, you cannot enter”. I think this is really rude and shows a lack of understanding from our side (Bella - nurse)²⁴24 Giles T, Lacey S, Muir-Cochrane E. Factors influencing decision-making around family presence during resuscitation: a Grounded Theory study. J Adv Nurs. 2016;72(11):2706-17. DOI: 10.1111/jan.13046 https://doi.org/10.1111/jan.13046... .	Legitimate professional power and authority
We hear them, but we are very busy with what we are doing to care about them [family members], because we have to focus on what we are doing (AS7 - prehospital care professional)¹³13 Walker WM. Emergency care staff experiences of lay presence during adult cardiopulmonary resuscitation: a phenomenological study. Emerg Med J. 2014;31(6):453-8.DOI: 10.1136/emermed-2012-201984. https://doi.org/10.1136/emermed-2012-201... .	Patient-centered health care model
The rooms are cramped, and since our resuscitation team consists of two nurses and a doctor, there will not always be enough time to support the family members (nurse 15)¹¹11 Koberich S, Kaltwasser A, Rothaug O, Albarran J. Family witnessed resuscitation - experience and attitudes of German intensive care nurses. Nurs Crit Care. 2010;15(5):241-50. DOI: 10.1111/j.1478-5153.2010.00405.x https://doi.org/10.1111/j.1478-5153.2010... .	Space and personnel inadequacies
They interrupt a lot, because of the level of education. They do not know what you are doing, because they always think you can do more than what you are doing (Ghawar - nurse)²⁶26 Bashayreh I, Saifan A, Batiha AM, Timmons S, Nairn S. Health professionals' perceptions regarding family witnessed resuscitation in adult critical care settings. J Clin Nurs. 2015;24(17-18):2611-9. DOI: 10.1111/jocn.12875 https://doi.org/10.1111/jocn.12875... .	Cultural and educational aspects

Author (year)	Country	Participants	Context	Type of study	Method of analysis	QARI (%)
Hung, et al. (2010)²²22 Hung MSY, Pang SMC. Family presence preference when patients are receiving resuscitation in an accident and emergency department. J Adv Nurs. 2011;67(1):56-67. DOI: 10.1111/j.1365-2648.2010.05441.x https://doi.org/10.1111/j.1365-2648.2010...	Hong Kong	18 family members	Emergency department	Interpretative	Phenomenology	90
Koberich, et al. (2010)¹¹11 Koberich S, Kaltwasser A, Rothaug O, Albarran J. Family witnessed resuscitation - experience and attitudes of German intensive care nurses. Nurs Crit Care. 2010;15(5):241-50. DOI: 10.1111/j.1478-5153.2010.00405.x https://doi.org/10.1111/j.1478-5153.2010...	Germany	166 nurses	Intensive Care Units	Descriptive	Thematic analysis	80
Wacht, et al. (2010)¹⁰10 Wacht O, Dopelt K, Snir Y, Davidovitch N. Attitudes of Emergency Department staff toward family presence during resuscitation. Isr Med Assoc J. 2010;12(6):366-70.	Israel	10 professionals (nurses and doctors)	Emergency department	Descriptive	Thematic analysis	80
Davidson, et al. (2011)⁹9 Davidson JE, Buenavista R, Hobbs K, Kracht K. Identifying factors inhibiting or enhancing family presence during resuscitation in the Emergency Department. Adv Emerg Nurs J. 2011;33(4):336-43. DOI: 10.1097/TME.0b013e318234e6a0 https://doi.org/10.1097/TME.0b013e318234...	United States	12 professionals (nurses and doctors)	Emergency department	Interpretative	Grounded theory	90
James, et al. (2011)²⁷27 James J, Cottle E, Hodge RD. Registered nurse and health care Chaplains experiences of providing the family support person role during family witnessed resuscitation. Intensive Crit Care Nurs. 2011;27(1):19-26. DOI: 10.1016/j.iccn.2010.09.001 https://doi.org/10.1016/j.iccn.2010.09.0...	United Kingdom	4 nurses and 3 chaplains	Emergency department	Descriptive	Content analysis	80
Lowry, et al. (2012)¹²12 Lowry E. "It's just what we do": a qualitative study of emergency nurses working with well-established family presence protocol. J Emerg Nurs. 2012;38(4):329-34. DOI: 10.1016/j.jen.2010.12.016. https://doi.org/10.1016/j.jen.2010.12.01...	United States	14 nurses	Emergency department	Descriptive	Conceptual content analysis	90
Dall’Orso, et al. (2012)⁵5 Dall'Orso MS, Concha PJ. Presencia familiar durante la reanimación cardiopulmonar: la mirada de enfermeros y familiares. Cienc Enferm [Internet]. 2012 [citado 2017 jan. 03];18(3):83-99. Disponible en: http://www.scielo.cl/pdf/cienf/v18n3/art_09.pdf http://www.scielo.cl/pdf/cienf/v18n3/art...	Chile	33 nurses and 30 family members	Mobile emergency service	Retrospective exploratory	Thematic analysis	80
Bashayreh, et al. (2013)²⁸28 Bashayreh I, Saif A, Batiha AM, Ruz MEA. Family presence during CPR in Adult Critical Care Settings: Hearing the voice of Jordanian health professionals. Life Sci J. 2013;10(4):1738-48.	Jordan	31 professionals (nurses, doctors, anesthetists, physiotherapists)	Intensive Care Units	Descriptive	Thematic analysis	80
Leske, et al. (2013)⁶6 Leske JS, McAndrew NS, Brasel KJ. Experiences of families when present during resuscitation in the Emergency Department after trauma. J Trauma Nurs. 2013;20(2):77-85. DOI: 10.1097/JTN.0b013e31829600a8 https://doi.org/10.1097/JTN.0b013e318296...	United States	28 family members	Emergency department	Descriptive	Content analysis	100
Walker, et al. (2014)¹³13 Walker WM. Emergency care staff experiences of lay presence during adult cardiopulmonary resuscitation: a phenomenological study. Emerg Med J. 2014;31(6):453-8.DOI: 10.1136/emermed-2012-201984. https://doi.org/10.1136/emermed-2012-201...	United Kingdom	8 prehospital professionals and 12 hospital nurses	Prehospital and hospital emergency care settings	Interpretative	Hermeneutic phenomenology	90
Monks, et al. (2014)¹⁴14 Monks J, Flynn M. Care, compassion and competence in critical care: A qualitative exploration of nurses' experience of family witnessed resuscitation. Intensive Crit Care Nurs. 2014;30(6):353-9. DOI: 10.1016/j.iccn.2014.04.006. https://doi.org/10.1016/j.iccn.2014.04.0...	United Kingdom	6 nurses	Intensive Care Unit	Interpretative	Phenomenology	90
Chapman, et al. (2014)²³23 Chapman R, Bushby A, Watkins R, Combs S. Australian Emergency Department health professionals' reasons to invite or not invite family witnessed resuscitation: a qualitative perspective. Int Emerg Nurs. 2014;22(1):18-24. DOI: 10.1016/j.ienj.2013.03.008. https://doi.org/10.1016/j.ienj.2013.03.0...	Australia	77 nurses and 25 doctors	Emergency department	Descriptive	Content analysis	90
Masa’Deh, et al. (2014)²2 Masa'Deh R, Saifan A, Timmons S, Nairn S. Families' stressors and needs at time of cardio-pulmonary resuscitation: Jordanian perspective. Glob J Health Sci [Internet]. 2013 [cited 2017 Jan 25];6(2):72-85. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825218/ https://www.ncbi.nlm.nih.gov/pmc/article...	Jordan	7 family members	Emergency department	Descriptive	Thematic analysis	80
Havugitanga, et al. (2014)²⁵25 Havugitanga P, Brysiewicz P. Exploring healthcare professionals' perceptions regarding family-witnessed resuscitation in a hospital in Kigali, Rwanda. South Afr J Crit Care. 2014;30(1):18-21. DOI: http://dx.doi.org/10.7196/sajcc.174 https://doi.org/http://dx.doi.org/10.719...	Rwanda	6 nurses and 3 doctors	Emergency Department and Intensive Care Unit	Descriptive	Content analysis	90
Bashayreh, et al. (2015)²⁶26 Bashayreh I, Saifan A, Batiha AM, Timmons S, Nairn S. Health professionals' perceptions regarding family witnessed resuscitation in adult critical care settings. J Clin Nurs. 2015;24(17-18):2611-9. DOI: 10.1111/jocn.12875 https://doi.org/10.1111/jocn.12875...	Jordan	19 nurses, 7 doctors and 5 physiotherapists	Intensive Care Unit	Exploratory	Thematic analysis	90
Twibell, et al. (2015)⁷7 Twibell RS, Craig S, Siela D, Simmonds S, Thomas C. Being There: Inpatients' perceptions of family presence during resuscitation and invasive cardiac procedures. Am J Crit Care. 2015;24(6):108-16. DOI: 10.4037/ajcc2015470. https://doi.org/10.4037/ajcc2015470...	United States	48 patients	Emergency department	Descriptive exploratory	Thematic analysis	90
Giles, et al. (2016)²⁴24 Giles T, Lacey S, Muir-Cochrane E. Factors influencing decision-making around family presence during resuscitation: a Grounded Theory study. J Adv Nurs. 2016;72(11):2706-17. DOI: 10.1111/jan.13046 https://doi.org/10.1111/jan.13046...	Australia	18 professionals, 6 family members and 1 patient	Emergency department	Interpretative	Grounded theory	90
Stefano, et al. (2016)⁴4 Stefano C, Normand D, Jabre P, Azoulay E, Kentish-Barnes N, Lapostolle F, et al. Family presence during resuscitation: qualitative analysis from a national multicenter randomized clinical trial. PloS One [Internet]. 2016 [cited 2017 Feb 10];11(6):e0156100. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890739/ https://www.ncbi.nlm.nih.gov/pmc/article...	France	30 family members	Mobile emergency service	Interpretative	Grounded theory	90
Soares, et al. (2016)⁸8 Soares JR, Martin AR, Rabelo JF, Barreto MS, Marcon SS. Presença da família durante o atendimento emergencial: percepção do paciente vítima de trauma. Aquichan [Internet]. 2016 [citado 2017 fev. 25];16(2):193-204. Disponível em: http://www.scielo.org.co/pdf/aqui/v16n2/v16n2a07.pdf http://www.scielo.org.co/pdf/aqui/v16n2/...	Brazil	29 patients	Emergency department	Descriptive	Thematic content analysis	80
Youngson, et al. (2017)²⁹29 Youngson MJ, Currey J, Considine J. Current practices related to family presence during acute deterioration in adult emergency department patients. J Clin Nurs. 2017;26(21-22):3624-35. DOI: 10.1111/jocn.13733 https://doi.org/10.1111/jocn.13733...	Australia	12 professionals, 9 family members and 5 patients	Emergency department	Descriptive	Thematic analysis	80
Hassankhani, et a.l (2017)¹⁵15 Hassankhani H, Zamanzadeh V, Rahmani A, Haririan H, Porter JE. Family presence during resuscitation: a double-edged sword. J Nurs Scholarsh. 2017;49(2):127-34. DOI: 10.1111/jnu.12273 https://doi.org/10.1111/jnu.12273...	Iran	12 nurses and 9 doctors	Emergency department	Interpretative	Hermeneutic phenomenology	90
Porter, et al. (2017)³⁰30 Porter JE, Miller N, Giannis A, Coombs N. Family Presence During Resuscitation (FPDR): observational case studies of emergency personnel in Victoria, Australia. Int Emerg Nurs. 2017;33:37-42. DOI: http://dx.doi.org/10.1016/j.ienj.2016.12.002 https://doi.org/http://dx.doi.org/10.101...	Australia	17 professionals (doctors and nurses)	Emergency department	Case study	Thematic analysis	90
San-Danskosky, et al. (2017)³¹31 Sak-Dankosky N, Andruszkiewicz P, Sherwood PR, Kvist T. Health care professionals' concerns regarding in-hospital family-witnessed cardiopulmonary resuscitation implementation into clinical practice. Nurs Crit Care. 2018;23(3):134-40.	Finland and Poland	168 doctors and nurses	Emergency Department and Intensive Care Unit	Descriptive	Inductive thematic analysis	90
Twibell, et al. (2017)³²32 Twibell R, Siela D, Riwitis C, Neal A, Waters N. A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation. J Clin Nurs. 2018;27(1-2):e320-34.	United States	325 nurses and 193 doctors	Emergency department	Descriptive exploratory	Thematic analysis	90

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[1] Corresponding author: Mayckel da Silva Barreto Rua Pioneiro Pompílio Custódio Valério, 343, Casa A, Jardim Sumaré CEP 87035-620 - Maringá, PR, Brazil mayckelbar@gmail.com