A European survey of critical care nurses’ attitudes and experiences of having family members present during cardiopulmonary resuscitation

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Abstract

This paper presents the results of a survey into the experiences and attitudes of 124 European critical care nurses to the presence of family members during cardiopulmonary resuscitation (CPR). Nurses from mainland Europe were less experienced and less sure about the consequences of relatives witnessing resuscitation than United Kingdom (UK) nurses. Generally, nurses supported the presence of family members, although UK nurses held significantly more positive attitudes than their non-UK counterparts in the areas of decision-making, processes and outcomes of resuscitation. Differences in attitudes are explored in the discussion. On the basis of results from this study, it is recommended that further policy guidance is required.

Introduction

The issue of whether or not family members should be present during cardiopulmonary resuscitation (CPR) of a relative is a topic that is highly controversial. Analyses of the literature covering the past decade from both medical (Adams et al., 1994; Boyd, 2000; Tsai, 2002) and nursing journals (Connors, 1996; Mason, 2003; Rattrie, 2000; Walker, 1999) attest to the range of divided opinions. Proponents argue that distressed family members should not be denied the opportunity to be with their loved ones during their last moments. Being present provides emotional comfort and bonding, helps to reduce the period of grieving and provides closure to a life of shared experiences (Robinson et al., 1998; Meyers et al., 2000; Eichhorn et al., 2001). Evidence from these studies also indicates that family members suffer no adverse psychological effects from being present during CPR. The contrary view centres upon the possible traumatic, distressing and haunting consequences that might occur for those who are present during CPR (Osuagwu, 1991; Schilling et al., 1994). Others, particularly physicians, fear that family members will interfere or disrupt the work of the resuscitation team (McClenathan et al., 2002; Meyers et al., 2000). There are also concerns over the potential ethico-legal consequences arising from inviting family members to the resuscitation room (Fulbrook, 1998). Family witnessed resuscitation (FWR) thus embraces a set of varied and conflicting perspectives, of which many are misconceived (Boyd, 2000; Mason, 2003).

Section snippets

Background

According to the North American literature, family members and significant others are requesting and expecting to be present with their relative regardless of the clinical procedures or resuscitation being performed at the time (Meyers et al., 2000; MacClean et al., 2003). In the UK, Barratt and Wallis (1998) examined the views of 35 recently bereaved family members about whether they would have liked to have been offered the opportunity to witness resuscitation of their relative. Of these, 15

Literature review into professionals’ attitudes and experiences in Europe

Within Europe much of the research has been centred on the attitudes and experiences of accident and emergency (A&E) staff based in the UK. For example, Back and Rooke (1994) sent 25 questionnaires to nurses and doctors from two A&E units. The response rate was 80%, although it is unclear whether criteria were used in choosing participants or is there data on the composition of the sample. Accordingly, 13 participants (65%) had experience of a family member being present during CPR, but only

Methodology

The study was designed to address the following questions:

  • •

    What are the experiences and attitudes of European critical care nurses to the presence of family members during CPR of an adult relative?

  • •

    What are the differences in nurses’ attitudes to family presence with respect to (a) decisions about resuscitation, (b) processes of resuscitation, and (c) outcomes of resuscitation?

Biographical data

Of the 235 questionnaires distributed, a total of 130 (55.4%) were returned completed. Six of the respondents were from countries outside of Europe; therefore, they were excluded from the analysis, leaving a sample size of 124. Of these 124, 43.5% (n=54) were from the UK, with the remainder from 14 other European countries (n=70). The next largest groups were from Denmark (14.5%, n=18), Sweden (12.1%, n=15) and Norway (8.9%, n=11). As seen in Table 1, the majority of the respondents were women,

Discussion

To our knowledge this study is unique in that no other research has explored the experiences and attitudes of European critical care nurses to the presence of family members during resuscitation. The use of a comprehensive multi-lingual questionnaire and the nature of the sample make this study distinctive from other published international work in this area. While it was not the intention of this study to make comparisons between nations, the large number of UK-based respondents meant that

Limitations

To begin with, only conference delegates were eligible to participate, therefore, the sample is unrepresentative of the critical care nursing population. It might be argued that only those with an interest in the subject and competent in English completed the questionnaire and so generalising the results is inappropriate. Additionally, there was an inherent bias in sampling, in that most nurses were based mainly within ICUs. Other issues of concern are related to the validity of the

Conclusion

The close contact that nurses have with family members makes them an obvious target for requests to be present during the resuscitation of a relative. Our results confirm that UK nurses, rather than non-UK nurses, are most likely to be approached and have more positive attitudes to allowing family members to be present during resuscitation of an adult relative. This extends to the areas of decision-making, processes and outcomes of resuscitation. Despite this, a lack of consensus among European

Acknowledgements

The authors would like to thank Marjo Frings, registered translator, for assisting in the preparation of the questionnaire into different European languages and the European Federation of Critical Care Nursing Associations for their permission to undertake this study.

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