Cathie E. Guzzetta

Do families want to be present during CPR? A retrospective survey

INTRODUCTION The purpose of this study was to interview families who had experienced the death of a loved one to determine their desires, beliefs, and concerns about family presence during CPR. METHODS A retrospective, descriptive telephone survey of families of patients who had died because of traumatic injuries while in an emergency department was used. A family presence survey was developed to determine the desires, beliefs, and concerns about family presence during CPR. RESULTS Of the 25 family members surveyed, 80% said they would have wanted to have been in the room during CPR had they been given the option (desires), 96% believed that families should be able to be with their loved ones (beliefs), 68% believed that their presence might have helped their family member (beliefs), and 64% believed that their presence would have helped their sorrow following the death (beliefs). Major themes from family concerns were worry about the seriousness of the patients condition and whether the patient would survive the resuscitation. DISCUSSION Family members strongly support having the option of being present during CPR. Health care providers should explore ways to implement this program to best meet the needs of families.

Family Presence During Invasive Procedures and Resuscitation: Hearing the Voice of the Patient

How do patients react to the presence of family during invasive procedures (IPs) or cardiopulmonary resuscitation (CPR)? Until recently, surprisingly little research had addressed the issue of family presence at all, and to our knowledge, no other studies have been published that delineate patients’ perspectives.In February 2000, we first reported in this journal findings from our pioneering study, which demonstrated numerous benefits that bedside visitation confers on the families of patients undergoing these procedures. This article presents our further investigation—aimed at describing the experiences of the patients—using a qualitative research approach to analyzing data collected during that study.The study took place in the emergency department (ED) of a university-affiliated, regional, level-I trauma center. The protocol for family presence was adapted from guidelines developed by the Emergency Nurses Association (ENA). Nine patients (eight who had IPs and one who underwent CPR) were also interviewed approximately two months after the emergency event. A semistructured questionnaire was used to determine their perceptions of the family presence experience.Seven themes emerged from the data. Three of these relate to the positive effects that family presence had on patients: it comforted them; provided help; and served, the patients believed, to remind providers of a patient’s “personhood”—he wasn’t just a patient; he was a person and had a family. Two themes involve how family presence reflects the reciprocal nature of patient–family bonds and the patient’s right to have family members present. The remaining two themes characterize how patients perceived the effects of the experience on their family members and on the health care environment. Patients saw both positive and negative effects on those who were present but believed the benefits to families outweighed the potential problems. Although further study is needed, family presence indeed appears to deliver many benefits, with apparently few drawbacks or adverse effects, to patients, their families, and their providers. In 1999, our institution, Parkland Health & Hospital System, approved a hospital-wide protocol for family presence during IPs and CPR.Corresponding author:Theresa MeyersPresbyterian Hospital of Dallas, Emergency Department8200 Walnut Hill LaneDallas, TX 75231TheresaMeyers@texashealth.org

Opening the Doors: Family Presence During Resuscitation

In most hospitals, family members are prohibited from being present during resuscitation because it is believed that they would be unable to cope with the crisis or that litigation might be fostered. This article challenges traditional thinking and proposes that a movement is underway fostering family presence during resuscitation because of nursings moral imperative to preserve the wholeness, integrity, and dignity of the family unit from birth to death. An overview of the family presence movement is presented that synthesizes current literature and research, examines risks and benefits, suggests guidelines for practice, shares experience, and proposes implications for the future.

Family presence: making room.

AJN t May 2005 t Vol. 105, No. 5 http://www.nursingcenter.com U ntil April 2002, in the ED of Children’s Medical Center in Dallas, we sometimes allowed families to be present at patients’ bedsides during invasive procedures (IPs, such as central line placement, lumbar puncture, and chest tube insertion) and resuscitation interventions (RIs, including emergency endotracheal intubation and cardiopulmonary resuscitation). However, we had no guidelines or policies on the presence of family—defined as relatives or significant others with whom the patient shares an established relationship— during such interventions, nor did we have any formal support from our ED administrators. In practice, we drew the line on certain procedures that we deemed too painful for families to witness. In 1995 the Emergency Nurses Association (ENA) developed clinical guidelines to support the option of family presence during IPs and RIs. Other health organizations, including the American Heart Association (AHA) and the American Association of Critical-Care Nurses, have since followed suit. In addition, advanced training programs such as the AHA’s Advanced Cardiac Life Support Course and Pediatric Advanced Life Support Course and the ENA’s Trauma Nursing Core Course and Emergency Nursing Pediatric Course have been incorporating family presence recommendations into their curricula. We decided that our ED should have a written policy regarding family presence. First we examined recent surveys, many of which found that the majority of family members

Parents’ Positioning and Distracting Children During Venipuncture Effects on Children’s Pain, Fear, and Distress

The purpose of this study was to determine the effectiveness of parental positioning and distraction on the pain, fear, and distress of pediatric patients undergoing venipuncture. An experimental-comparison group design was used to evaluate 43 patients (20 experimental and 23 comparison) who were 4 to 11 years old. Experimental participants used parental positioning and distraction. All participants rated their pain and fear; parents and child life specialists (CLS) rated the child’s fear, and CLS rated the child’s distress. Self-reported pain and fear were highly correlated (p < .001) but not significantly different between the two groups. Fear rated by CLS (p < .001) and parents (p = .003) was significantly lower in experimental participants. Although no difference was found in distress between the two groups, a significant time trend was discovered (p < .001). The parental positioning-distraction intervention has the potential to enhance positive clinical outcomes with a primary benefit of decreased fear. Further research is warranted.

National survey of hospital nursing research, part 2. Facilitators and hindrances.

OBJECTIVE: The aim of this study was to describe the facilitators and hindrances associated with the conduct of registered nurse–led research in US hospitals. BACKGROUND: Hospital-based nursing research programs are growing in response to increasing emphasis on evidence-based practice. Concerns existed about institutional regulations prohibiting staff nurses’ ability to be principal investigators of their research studies. METHODS: Comments from the Hospital-Based Nursing Research Requirements and Outcomes national survey regarding facilitators and hindrances of conducting nursing research in hospitals were analyzed using content analysis. RESULTS: Comments from 95% of surveys were classified into 24 facilitator and hindrance codes. Both Magnet® and non-Magnet hospitals identified the presence of a research mentor as the top facilitator. In non-Magnet hospitals, the top hindrance was a lack of a research mentor as compared with Magnet hospitals, which reported lack of time. CONCLUSIONS: The presence of a research mentor is the most important facilitator for hospital nursing research. Findings provide data to inform research program development.

Family Presence During Trauma Activations and Medical Resuscitations in a Pediatric Emergency Department: An Evidence-based Practice Project

INTRODUCTION The existing family presence literature indicates that implementation of a family presence policy can result in positive outcomes. The purpose of our evidence-based practice project was to evaluate a family presence intervention using the 6 As of the evidence cycle (ask, acquire, appraise, apply, analyze, and adopt/adapt). For step 1 (ask), we propose the following question: Is it feasible to implement a family presence intervention during trauma team activations and medical resuscitations in a pediatric emergency department using national guidelines to ensure appropriate family member behavior and uninterrupted patient care? METHODS Regarding steps 2 through 4 (acquire, appraise, and apply), our demonstration project was conducted in a pediatric emergency department during the implementation of a new family presence policy. Our family presence intervention incorporated current appraisal of literature and national guidelines including family screening, family preparation, and use of family presence facilitators. We evaluated whether it was feasible to implement the steps of our intervention and whether the intervention was safe in ensuring uninterrupted patient care. RESULTS With regard to step 5 (analyze), family presence was evaluated in 106 events, in which 96 families were deemed appropriate and chose to be present. Nearly all families (96%) were screened before entering the room, and all were deemed appropriate candidates. Facilitators guided the family during all events. One family presence event was terminated. In all cases patient care was not interrupted. DISCUSSION Regarding step 6 (adopt/adapt), our findings document the feasibility of implementing a family presence intervention in a pediatric emergency department while ensuring uninterrupted patient care. We have adopted family presence as a standard practice. This project can serve as the prototype for others.

Cardiopulmonary monitors and clinically significant events in critically ill children.

Cardiopulmonary monitors (CPMs) generate false alarm rates ranging from 85%-99% with few of these alarms actually representing serious clinical events. The overabundance of clinically insignificant alarms in hospitals desensitizes the clinician to true-positive alarms and poses significant safety issues. In this IRB-approved externally funded study, we sought to assess the clinical conditions associated with true and false-positive CPM alarms and attempted to define optimal alarm parameters that would reduce false-positive alarm rates (as they relate to clinically significant events) and thus improve overall CPM performance in critically ill children. Prior to the study, clinically significant events (CSEs) were defined and validated. Over a seven-month period in 2009, critically ill children underwent evaluation of CSEs while connected to a CPM. Comparative CPM and CSE data were analyzed with an aim to estimate sensitivity, specificity, and positive and negative predictive values for CSEs. CPM and CSE data were evaluated in 98 critically ill children. Overall, 2,245 high priority alarms were recorded with 68 CSEs noted in 45 observational days. During the course of the study, the team developed a firm understanding of CPM functionality, including the pitfalls associated with aggregation and analysis of CPM alarm data. The inability to capture all levels of CPM alarms represented a significant study challenge. Selective CPM data can be easily queried with standard reporting, however the default settings with this reporting exclude critical information necessary in compiling a coherent study denominator database. Although the association between CPM alarms and CSEs could not be comprehensively evaluated, preliminary analysis reflected poor CPM alarm specificity. This study provided the necessary considerations for the proper design of a future study that improves the positive predictive value of CPM alarms. In addition, this investigation has resulted in improved awareness of CPM alarm parameter settings and associated false-positive alarms. This information has been incorporated into nursing educational programs.

Pediatric fasting times before surgical and radiologic procedures: Benchmarking institutional practices against national standards

Prolonged preoperative fasting can be associated with adverse outcomes, particularly in children. Our aims were to assess the time pediatric patients fasted prior to surgical or radiologic procedures and evaluate whether fasting (NPO) orders complied with national guidelines. We measured NPO start time, time of last intake, and time test or surgery was scheduled, took place, or was cancelled in 219 pediatric patients. Findings demonstrate that pediatric patients experienced prolonged fasting before procedures and that the majority of NPO orders were non-compliant with national guidelines. We have developed strategies to reduce fasting times and ensure compliance with recommended national fasting standards.

National survey of hospital nursing research, part 1. Research requirements and outcomes.

OBJECTIVE: The aim of this study was to describe program requirements and scholarly outcomes for registered nurse (RN)–led research in US hospitals. BACKGROUND: Magnet® recognition emphasis on evidence-based practice and research has stimulated the growth of hospital-based nursing research programs. Hospital policies stipulating whether RNs can lead studies as principal investigators (PIs) varied among members of a regional nursing research consortium. METHODS: Members of the consortium conducted a national survey of hospitals regarding their requirements for RN-led research and associated scholarly outcomes. RESULTS: Most (87.1%) of the hospitals (N = 160) reported no minimum educational requirements for nurses to be PIs. Mentoring, training, and peer review/approval requirements differed between Magnet and non-Magnet hospitals. On average, hospitals reported an annual total of 4 studies initiated, 4 disseminated via podium or poster presentation, 1 published, and 2 funded. CONCLUSIONS: Findings from this study provide a prototype and benchmark information for nursing administrators planning to establish, evaluate, and/or expand nursing research programs.