Palliative Care and End of Life Issues: Palliative Care and End of Life |

Family Presence During Resuscitation: Perceptions and Attitudes of Health-care Staff at an Inner-City Academic Hospital FREE TO VIEW

Alvaro Martin, MD; Maria Quinteros, MD; Shivanck Upadhyay, MD
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SBH Health System Bronx, Bronx, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):947A. doi:10.1016/j.chest.2016.08.1049
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SESSION TITLE: Palliative Care and End of Life

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: The concept of family presence during resuscitation (FPDR) has been controversial since its introduction. Despite evidence of its positive effects on patients’ family members, there is reluctance to universally adopt this practice. Although most studies focus on the perceptions of physicians and nurses, not much has been reported about the opinions of other CPR team members, including respiratory therapists, nursing aids and resident trainee physicians. This study aims to objectively measure the perceptions and attitudes from the entire CPR team towards FPDR, and to explore factors that influence them to perceive FPDR as beneficial or detrimental at an inner-city teaching hospital of an underserved community in New York.

METHODS: This descriptive study was conducted in a 460-bed academic hospital. It included 195 randomly selected members of the healthcare staff, including attending physicians, residents, nurses and respiratory therapists from different areas of the hospital. We used a two-part validated questionnaire with 19 multiple-choice items about demographics, experiences and attitudes towards FPDR. Data was analyzed with SAS statistical software.

RESULTS: Only 36.9% of the participants were in favor of FPDR. Attending physicians ranked the highest (47%), followed by residents (37%), nursing staff (35%) and respiratory therapists (21%). Fewer personnel from the general medical floors agreed with family presence (24%), compared to those from ICU (48%) and ED (51%). 58.7% of those against FPDR reported problems involving the patients’ families. For 85% of the surveyed, FPDR increases the levels of stress and anxiety among the staff. A significant number also felt families could potentially interfere with CPR. Concerns about increased risk of litigation and the possibility of FPDR being a traumatic experience for the families were also raised by the majority. Despite all these, 54.9% of the staff agreed that family members should be given the option to witness CPR. The staff’s level of comfort with FPDR was directly proportional to the willingness to invite families to witness CPR.

CONCLUSIONS: Overall, the attitudes towards FPDR are negative, but perceptions significantly vary among the different members of the CPR team, depending on their roles. Previous negative experiences with FPDR are associated with less positive attitudes. Most studies show a higher level of acceptance among nurses. We found that attending physicians, who work as educators, felt more comfortable with FPDR compared to the rest. Most surveyed mentioned they would benefit from FPDR training. Those who felt uncomfortable with FPDR were more amenable to the idea of training. 89.7% of the staff had no knowledge of policies regarding FPDR in our institution.

CLINICAL IMPLICATIONS: Better understanding the level of comfort and attitudes towards FPDR could help with the creation of hospital policies, guidelines and protocols and could determine successful implementation of FPDR practices. Incorporating an FPDR structured educational tool as a part of ACLS training protocol in academic hospitals could positively influence the perception and attitudes of the staff towards FPDR, decrease stress level of the team and increase their comfort level with the suggested practice.

DISCLOSURE: The following authors have nothing to disclose: Alvaro Martin, Maria Quinteros, Shivanck Upadhyay

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