|Year : 2017 | Volume
| Issue : 4 | Page : 113-117
Saudi family perceptions of family-witnessed resuscitation in the adult critical care setting
Abdulaziz Alshaer, Khalid Alfaraidy, Florence Morcom, Wasaif Alqahtani, Zahra Alsadah, Atheer Almutairi
King Fahad Military Medical Complex, Dhahran, Saudi Arabia
|Date of Web Publication||18-Jun-2018|
Director of Intensive Care and Respiratory Department, P. O. Box 946, Dhahran 31932
Source of Support: None, Conflict of Interest: None
Background: During cardiopulmonary resuscitation, family members are usually pushed out of the resuscitation room. However, growing literature implies that family presence during resuscitation could be beneficial. Some health organizations worldwide such as American Heart Association and the Resuscitation Council in the UK supports family-witnessed resuscitation (FWR) and urge hospitals to develop policies to ease this process. The opinions on FWR vary widely among various cultures, and some hospitals are not applying such polices yet. This is the first study which explores the Saudi family members' opinion for family witness resuscitation in adult critical care setting. Objectives: To investigate whether patient's next of kin would like to have been present in the resuscitation room during attempted cardiopulmonary resuscitation (CPR) of their relative and their experience or knowledge of what is involved in CPR. Subjects and Methods: A retrospective, descriptive telephone survey of families of patients who had admitted in critical cares areas from January 2016 to June 2016. A family presence survey was developed to determine the desires, beliefs, and concerns about FWR. Results: Out of the 235 respondents, 143 (60.9%) wanted to be present in the room of their loved one just before death while CPR was going on. One hundred and eighty-two (77.4%) of the respondents believed that the family members should be with their loved one before death. More than half, i.e., 141 (60.0%) of the respondents believed that their presence might have eased the suffering of the deceased. One hundred and fifty-seven (66.8%) of the family members thought that their presence with the deceased in their last moments could have helped their sorrows and sadness. Conclusion: Most relatives of patients requiring CPR would like to be offered the possibility of being in the resuscitation room; this could have several benefits, so this study suggests that institutions should consider establishing programs of witnessed cardiopulmonary resuscitation for family members.
Keywords: Cardiopulmonary resuscitation, critical care, family-witnessed resuscitation, Saudi Arabia
|How to cite this article:|
Alshaer A, Alfaraidy K, Morcom F, Alqahtani W, Alsadah Z, Almutairi A. Saudi family perceptions of family-witnessed resuscitation in the adult critical care setting. Saudi Crit Care J 2017;1:113-7
|How to cite this URL:|
Alshaer A, Alfaraidy K, Morcom F, Alqahtani W, Alsadah Z, Almutairi A. Saudi family perceptions of family-witnessed resuscitation in the adult critical care setting. Saudi Crit Care J [serial online] 2017 [cited 2018 Jul 18];1:113-7. Available from: http://www.sccj-sa.org/text.asp?2017/1/4/113/234635
| Introduction|| |
Resuscitation is defined as “the act of reviving someone who seems to be dead, by making him or her breathe again and restarting the heart.”
Family members were defined as people who were relatives or significant others with whom the patient shared an established relationship.
Family presence was defined as the attendance of one or more family members in a location that afforded visual or physical contact with a patient during an invasive procedure or cardiopulmonary resuscitation.
Resuscitation of critically ill or injured patients occurs daily in AICU, CCU, and CICU. Resuscitation involves the simultaneous integration of multiple tasks to save a critical patient's life and may seem to be a frantic procedure for those not actively involved. Consequently, the medical team may request family members to wait outside the resuscitation room to isolate them from such events. The practice of family-witnessed resuscitation (FWR) has been explored since the late 1980s. FWR entails inviting a family member of the critical patient into the resuscitation room to witness the resuscitative process.
The family members want to witness cardiopulmonary resuscitation (CPR), but the common practice is that they are not allowed; as their presence and anxiety distracts health-care providers. They cause undue hindrance during the process. It is also possible that the doctors and nurses do not want the relatives to know about their mistakes in the procedure or the nonfunctioning of equipment.
In Saudi Arabia, family members are not encouraged to witness resuscitation events due to concerns about the potential traumatic and distressing impact of resuscitation on the family, the possibility that a family member might hinder the resuscitation process, the limited space at the bedside, and the possibility for a breach of patient confidentiality.
This study was carried out to find out the desires, beliefs, and concerns of the family members about the option of their presence during CPR by using a questionnaire pro forma.
| Subjects and Methods|| |
We studied the attitudes of families of patients who had admitted in critical care areas, for 6 months from January 2016 to June 2016 at KFMMC, to interview Saudi Families who had experienced critical illness/death of a loved one to determine their desires, beliefs, and concerns about FWR. This was a retrospective descriptive study using a questionnaire based on themes from the literature review. The questionnaire was divided into 2 sections with a total of 16 items. Section 1 consisted of eleven demographic items. Section 2 consisted of 5 survey questions with one question related to the desires, three to the beliefs, and one question related to the concerns about the family presence. These questions were adapted from the evaluative and retrospective studies conducted at the Foote Hospital in Michigan.
Questions were both open ended and close ended and included basic demographics, awareness of the practice of FWR, actual practice of FWR, and consequences of allowing family to witness resuscitation*.
Ethical clearance was obtained from the Human Research Ethics Committee of the KFMMC, and permission was obtained from the administration of the hospital. The total study group canvassed comprised 235 patient relatives.
Qualitative and quantitative data were analyzed using IBM SPSS ver. 22. Responses were tabulated and compared. Data analysis was conducted using descriptive statistics.
| Results|| |
Of the 235 respondents, 80 (34.0%) were females and 155 (66.0%) were males, ages of 228 respondents ranged from 15 to 94 years (mean 48.48 ± 15.33). The average age of the women was 49.88 ± 49.88 years and the men was 47.71 ± 15.50 years.
Seventy-eight (33.2%) of the patients died, 157 (66.8%) survived at KFMMC, during the 6-month study period.
The relationship of the respondent to the patient included parent (father, mother, grandmother) n = 29 (12.3%), child (son, daughter) n = 159 (67.7%), sibling (brother, sister) n = 25 (10.6%), spouse (husband, wife) n = 17 (7.2%), and others n = 5 (2.1%).
The response of family members is given in [Table 1]. Out of the 235 respondents, 128 (54.5%) had witnessed the CPR of their relatives' patients, 143 (60.9%) wanted to be present in the resuscitation room of their loved one just before death while CPR was going on; reasons for that were 39.3% of relatives felt this would provide support, 16.1% wished to see that everything possible was done, 14.3% did not wish the patient to die alone and 1.8% wished to participate in deciding when to discontinue resuscitation, and 28.6% to pronunciation of martyrdom at death and the commandment; reasons for against were out of the 39.1% relatives that did not wish to be present, the most common reason cited was that they felt it would be too distressing (72.2%), 10.2% of relatives were concerned they may impede resuscitation, 13.6% of relatives felt they would be too frightened, and 3.4% of relatives felt they would be unable to help. One hundred and eighty-two (77.4%) of the respondents believed that the family members should be with their loved one before death; reasons for that were 64.7% of relatives felt this would provide support, 17.6% wished to see that everything possible was done, 1.5% wished to participate in deciding when to discontinue resuscitation, 16.2% to pronunciation of martyrdom at death and the commandment; reasons for against were out of the 22.6% relatives that did not wish to be present, the most common reason cited was that they felt it would be too distressing (93.3%), 6.7% of relatives declined as felt they would be unable to help. More than half, i.e., 141 (60.0%) of the respondents believed that their presence might have eased the suffering of the deceased; reasons for that were 76.9% of relatives felt this would provide support, 19.2% wished to see that everything possible was done, and 3.8% did not wish the patient to die alone; reasons for against were out of the 40.0% relatives that did not wish to be present, the most common reason cited was that they felt it would be too distressing (13.3%), 20.0% of relatives felt they would be too frightened, and 66.7% of relatives declined as felt they would be unable to help. 157 (66.8%) of the family members thought that their presence with the deceased in their last moments could have helped their sorrows and sadness; reasons for that were 74.2% of relatives felt this would provide support, 25.8% wished to see that everything possible was done; reasons for against were out of the 33.2% relatives that did not wish to be present, the most common reason cited was that they felt it would be too distressing (31.3%), 56.3% of relatives felt they would be too frightened, and 12.5% of relatives declined as felt they would be unable to help.
In the last question, family was asked about their concerns. The major themes that emerged, included the outcome of the procedure and to get information about the CPR = 50.0%, seriousness of the condition and concern that everything possible is being done = 15.0%. Others said no need to be present = 35.0%.
[Table 2] shows the relationship between sociodemographic characteristics of relatives and family member witness resuscitation. It shows that male family members witness resuscitation (64.1%) compared with female family members (35.9%). However, no statistical significance was found.
|Table 2: Relationship between sociodemographic characteristics of relatives and family member witness resuscitation (n=235)|
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It was also noticed that family member witness resuscitation was higher in child (70.3%) compared to parents (13.3%), sibling and spouse (7.0%), respectively, and others (2.3%). However, no statistical significance was found.
Family member witness resuscitation was significantly higher in witnesses of college education (50.0%) than witnesses of secondary education (33.6%) or witnesses of elementary (14.8%) and illiterate (1.6%), (P = 0.015).
Regarding the CPR results, [Table 2] shows that family member witness resuscitation was significantly higher in survived patients (74.2%) compared to died patients (25.5%), (P = 0.006).
Furthermore, [Table 2] shows that there were no significant differences in age groups or relationship characteristics between those who present the CPR and those who did not.
| Discussion|| |
This study showed that more than a half of family members (60.9%) wanted to be with their loved ones during resuscitation. In similar studies carried out by Zakaria and Siddique, Doyle et al., and Meyers, 94%, 72%, and 80% of family members, respectively, wanted to be with their loved one. Close family ties in the oriental culture may explain the difference. In our study, 77.4% of the family members believed that the individuals have the right to be with their loved ones if they desire as compared to 98% of the family members who gave a similar response in another study by Zakaria and Siddique.
The best documented programs of witnessed resuscitation in literature have been reported at the Foote Hospital and at the Parkland Health and Hospital System. There were no instances of actual interference with resuscitation activities, even when family members were overcome with grief.
Retrospectively, Meyers et al. found relatives would have wanted to be present if they had been given a choice. Meyers' research team continued their research prospectively to examine relatives' attitudes after they have been present during resuscitation. Conclusions by Meyers et al. overwhelmingly indicated that relatives want to be present that the presence of relatives had positive outcomes and that they believed it was their right to be present.
| Conclusion|| |
Several possible benefits might follow from relatives being present during CPR. They would see that everything possible was done; fantasy may often be worse than reality. They might help the medical team to decide when to discontinue resuscitation. Being present during resuscitation could help the next of kin in coming to terms with the death of a relative; just as it is now accepted good practice to offer bereaved relatives the opportunity to see the dead body.
While doctors may have concern about the presence of relatives during resuscitation, the Foote Hospital experience suggests that when appropriate support and supervision is provided, some of these fears (such as interference by the relatives in resuscitation) may be exaggerated.
Hampe, identified several family needs at end of life:
- To be kept informed of the patient's condition
- To be aware of the patient's impending death to anticipate the loss
- To be with the dying person.
In literature, three different perspectives of family are present: the patient, the patient's family, and the health-care providers or resuscitation. The research's findings are further categorized into three major content areas: benefits to the patient and family members and barriers and facilitates of family presence.
- Family presence is beneficial to patients, families, and staff.
- For family members:
- Removed doubt about the patient's condition
- Witnessing that everything possible was done
- Decreased their anxiety and fear
- Facilitated their need to be together
- Facilitated a sense of closure.
- For the health-care providers or resuscitation:
- Common themes emerged from many of the studies regarding the opinions of health professionals. Those approving that family presence thought it helped them to see the effort of the resuscitation team; and everything that could have been done, had been done, which may lower the risk of litigations surrounding the resuscitation or procedure
- Another theme was that health-care professionals felt family presence was a positive experience that it humanized the patient and supported patient dignity
- Many studies demonstrated that health-care professionals felt having family members present enhanced communication and facilitated education
- Another theme from health-care professionals was that it facilitated the grief process in the case of unsuccessful resuscitation. It gave family members the opportunity to say goodbye and promoted families' acceptance of the death of their loved one.
Surveys of Families Who Were Asked Whether They Want to Be Present
Themes from these surveys
- Majority state they “wished they had been present”
- Majority would have gone into the resuscitation room if given the option
- Believe family members should be able to be present
- Would want to be present if their loved one were to likely die.
- Offer all families the option of family presence
- Use a multidisciplinary approach including a family presence facilitator
- Develop family presence guidelines/policies
- Implement staff education
- Conduct additional research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]