Emergency Staff's Attitude Towards Family Present During Resuscitation

The family being present was defined as the attendance of a family member in a location that afforded visual or physical contact with the patient during invasive procedures or CPR. The practice of family member presence is a public demand ,and it is still worldwide controversial . The benefits of FP are identified as providing feelings of support, reducing anxiety, eliminating doubts about the procedure in resuscitating patients and facilitating grieving with subsequent death. Despite this,the practice of FP remains an ethical, moral and legal dilemma issue.Objective: To investigate Emergency staff's experiences of and attitudes to family presence (FP) during resuscitation of adult patients.Further to investigate relevant factors that impact the Emergency staff's attitude to FP。Methods:1.Survey methodology:A quantitative descriptive study was undertaken.From October 2008 to November 2008 ,a questionnaire was applied on a convenient sample of six hospitals in Changchun. In total about 168 questionnaires were distributed and 162 valid questionnaires were received,giving a valid response rate of 96.4%.2.The questionnaire consisted of four sections: (1) socio-demographical characteristics,including occupation, gender, employment, age, work experience, emergency work experience, education level, job and title, (2) cognitive and experiences of FP, (3) attitudes to FP ,and(4)an open question to collect the staff' recommendation .The third section was sub-divided in three parts. In section three three point Likert scales were used, which were converted to figures from one to three. The content validity of the questionnaire were tested before data collection.3.Statistical methods: Data were analyzed using the statistical package of social science(SPSS13.0).Statistical description and analysis use frequency, percentage, mean±standard deviationr.Statistical difference was determined by Rank-Sum test to analyse ordinal variables, for analysing three groups Kruskal-Wallis and Dunn's testing were used. Results:1.Cognitive of FP:Out of the sample,52.5% Emergency staff recognized that FP is medical ethics practice.only 30.2% of the respondents kown that International Guidelines 2000 for CPR and ECC give some support to FP. 71.2% doctors and 73.6% nurses agreed that staff should provide emotional and psychological support to the relatives.Only 34.6% doctors and 42.7% nurses believe that family presence during resuscitation is reflected the Biological - psychological - social medicine model.2.Experiences of FP:Out of the sample,Almost all of the respondents (95.1%)had experienced a which family members were present during resuscitation,and of these samples,78.6% of respondents allowded relatives into the rususcitaion room only after outcome is known.Of the 154 staffs who had experienced relatives'prescnce,48.7% of respondents had suffer positive and negative experience.Only 39.5% of respondents had invited a family member to be present during resuscitation.There is only one hospital had a witten policy that forbidded family member during resuscitation. Only 6.8% of respondents preferred written policies allowing family presence.3.Attitudes to FP: Nearly half of respondents (49.4%)did not agree that family members should always be offered the opportunity to be with the patient during resuscitation,with 58.6% of respondents stating that they did not want relatives to be present,in addition,most of respondents(77.8%) felt that because family members did not understand the need for specific intervention during CPR, they were likely to argue with the resuscitation team.82.1% of respondents indicated that family members are likely to interfere with the resuscitation,59.3% of respondents agree that family members should not be present during CPR because it is too distressing for them.59.3% of respondents concers that misunderstandings might lead to increased rates of legal action against members of the resuscitation team.5.Influencing factors:Cognitive and experiences of FP and self-confident have a significant impact on the attitudes to FP.General information such as occupation, title almost have no impact on attitudes to FP .The employment,emergency experience has a certain impact on attitudes to FP.Conclusion:1.This study reveals that Emergency staff in Changchun are not familiar with the concept of family presence during resuscitation.2.Almost all health care workers have experienced FP, most respondents allowded relatives into the rususcitaion room only after outcome is known,but few respondents had invited a family member to be present during resuscitation.3.Developing a written polices and guidelines on the practice of FP. These policies will help meet the needs of patients, families and staff by providing consistent, safe and caring practices for all involved in the resuscitation process.4.Emergency staff are not in faver of FP. The most frequent reasons for not wanting relatives to be present were: concern that the experience will be traumatic experience for relatives, relatives might interfere with resuscitation,and medico-legal issues might arise.5.Cognitive and experience of FP and medical staff'self-confident have a significant impact on the attitudes to FP. Recommendations is developmet educational programme on the safe implementation and practices of FP.