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Comparison of Physicians and Nurses' Attitudes toward Family Presence during Cardiopulmonary Resuscitation

Jeong Lim Cho1, Eun Nam Lee1, Sang Hee Sim2, Na Youn Lee3
Korean Journal of Adult Nursing 2013;25(1):41-52.
Published online: February 18, 2013

1Department of Nursing, Dong-A University, Busan

2Pusan National University Hospital, Yangsan

3Graduate College of Nursing, Seoul National University, Seoul, Korea

Corresponding author: Lee, Eun Nam Department of Nursing, Dong-A University, 3 Ga-1, Tongdaesin-dong, Seo-gu, Busan 602-714, Korea Tel: +82-51-240-2864, Fax: +82-51-240-2947, E-mail: enlee@dau.ac.kr
• Received: August 14, 2012   • Accepted: February 19, 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to compare the attitude of physicians and nurses toward family presence during cardiopulmonary resuscitation (CPR).
  • Methods
    100 physicians and 100 nurses from five hospitals with than 500 beds in B city were surveyed using a Family Presence During Resuscitation (FPDR) Inventory. The data were analyzed by t-test, ANOVA and Duncan's multiple range test using SPSS/WIN 19.0 version.
  • Results
    Nurses showed more positive attitudes toward family presence during CPR but reported more concerns about the problem of confidentiality, arguing with family members, and emotional distress of family members than physicians did.
  • Conclusion
    On the basis of results from this study, we recommend that educational program be developed within the hospitals to change the negative perception of health care providers for the family presence during CPR.
  • Key Words: Health personnel; Family; Attitude; Cardiopulmonary resuscitation
Table 1.
Differences between Physicians and Nurses in Perceived Score for Family Presence during CPR (N=197)
Subjects Variables Categories n (%) M±SD t or F p
Physicians (n=98) Gender Male 66 (67.3) 2.76±0.34 -1.57 .119
Female 32 (32.7) 2.88±0.35
Age (year) ＜30 60 (61.2) 2.87±0.35 2.18 .031
≥30 38 (38.8) 2.72±0.33
Marital status Married 29 (29.6) 2.73±0.33 -1.15 .252
Single 69 (70.4) 2.82±0.35
Religion Yes 56 (57.1) 2.77±0.37 -0.73 .467
No 42 (42.9) 2.83±0.31
Educational level University 82 (83.7) 2.82±0.36 1.68 .097
≥Master 16 (16.3) 2.67±0.27
Position† Intern 34 (34.7) 2.95±0.29a 5.22 .007
Resident 43 (43.9) 2.71±0.38b
Fellow 21 (21.4) 2.73±0.29b
Area of practice Medical 51 (52.1) 2.78±0.34 -0.50 .618
Surgical 47 (47.9) 2.81±0.36
Experience of permission for FP during CPR Yes 64 (65.3) 2.84±0.29 1.62 .112
No 34 (34.7) 2.71±0.46
Experience of invitation for FP during CPR Yes 43 (43.8) 2.90±0.26 2.69 .009
No 55 (56.2) 2.72±0.38
Experience of being requested for FP from family members Yes 51 (52.0) 2.83±0.28 0.89 .379
No 47 (48.0) 2.76±0.41
Nurses (n=99) Gender Male 0 (0.0)      
Female 99 (100)      
Age (year) ≤25 31 (31.3) 2.80±0.28 1.69 .190
26~30 40 (40.4) 2.66±0.29
≥31 28 (28.3) 2.72±0.39
Marital status Married 19 (19.2) 2.76±0.42 0.53 .600
Single 80 (80.8) 2.71±0.29
Religion Yes 59 (59.6) 2.71±0.35 -0.35 .725
No 40 (40.4) 2.74±0.28
Educational level College 68 (68.7) 2.72±0.30 -0.03 .977
≥Bachelor 31 (31.3) 2.72±0.37
Position Staff nurse 81 (81.8) 2.71±0.30 -0.97 .391
≥Charge nurse 18 (18.2) 2.79±0.41
Experience in nursing (month) ≤24 20 (20.2) 2.75±0.30 0.11 .899
25~60 42 (42.4) 2.72±0.26
≥61 37 (37.4) 2.71±0.39
Area of practice ICU, ER 39 (39.4) 2.70±0.30 0.45 .636
Medical 39 (39.4) 2.76±0.35
Surgical 21 (21.2) 2.69±0.32
Experience of permission for FP during CPR Yes 34 (34.4) 2.80±0.22 2.12 .037
No 55 (55.6) 2.68±0.35
Experience of invitation for FP during CPR Yes 17 (17.2) 2.79±0.20 1.27 .212
No 82 (82.8) 2.71±0.34
Experience of being requested for FP from family members Yes 45 (45.5) 2.71±0.32 -0.25 .807
No 54 (54.5) 2.73±0.32

ICU=intensive care unit; ER=emergency room; CPR=cardiopulmonary resuscitation; FP=family presence.

†a＞b.

Table 2.
Differences of Perception for the Decision Making regrading Family Presence during CPR (N=197)
Items Physicians (n=98) Nurses (n=99) t p
M±SD M±SD
Family members should always be offered the opportunity to be with the patient during CPR 2.53±0.83 2.35±0.70 1.62 1.08
Physicians want relatives to be present during CPR 2.46±0.83 2.14±0.80† 2.75 .007
Nurses do not want relatives to be present during CPR 3.29±0.87 3.51±0.86 -1.77 .078
Physicians are responsible for deciding if family members are allowed to be present during CPR 3.54±0.86 2.92±0.89 4.98 ＜.001
Nurses should have the responsibility for deciding if family members should be present during CPR 2.50±0.79 2.57±0.67 -0.63 .530
It should be the joint responsibility of all members of the procedure team to decide whether (or not) family members are allowed to be present during CPR 3.31±0.83 3.96±0.75 -5.78 ＜.001
There may be a problem of confidentiality in discussing details about the patient if family members are present during CPR 3.32±0.89 3.63±0.84 -2.51 .013
Because family members do not understand the need for specific intervention they are more likely to argue with the procedure team 3.62±0.89 3.95±0.71 -2.86 .005
Family members should be present during CPR so that they can be involved in decisions 3.07±0.86 3.30±0.73 -2.03 .044
If present during CPR, family members are more likely to accept decisions to withdraw treatment 3.38±0.96 3.67±0.77 -2.33 .021
Total 2.79±0.40 2.69±0.36 1.71 .089

CPR=cardiopulmonary resuscitation.

†n=98.

Table 3.
Differences of Perception for the Effect of Family Presence on Health Care Providers and Family Members (N=197)
Items Physicians (n=98) Nurses (n=99) t p
M±SD M±SD
Family members are very likely to interfere with CPR process 3.28±0.94 3.44±0.80 -1.36 .175
Family members should not be present during CPR because it is too distressing for them 3.21±0.84 3.43±0.80 -1.89 .061
Nursing and medical staff find it difficult to concentrate when relatives are watching 3.22±0.94 3.44±0.97† -1.62 .107
The performance of the team will be positively affected due to the presence of family members 2.64±0.74 2.51±0.73 1.32 .190
During CPR, team may say things that are upsetting to family members 3.39±0.87 3.33±0.85 0.45 .656
There are enough nursing staff to provide emotional support and remain with the family member during CPR 2.60±0.94 2.21±1.04 2.76 .006
Most bed area are too small to have a family member present during CPR 3.34±0.88 3.64±0.87 -2.39 .018
It should not be normal practice for family members to witness CPR procedure of a family member 3.47±0.83 3.78±0.71 -2.81 .005
If family members are present during CPR, there should be a member of the procedure team whose only role is to look after the family 3.20±0.90 3.46±0.92 -2.02 .045
Family presence during CPR is beneficial to the patient's outcome 2.71±0.92 2.70±0.78 0.14 .886
Total 2.68±0.47 2.48±0.43 3.08 .002

CPR=cardiopulmonary resuscitation.

†n=97.

Table 4.
Differences of Perception for the Influence of Family Presence on CPR Outcomes (N=197)
Items Physicians (n=98) Nurses (n=99) t p
M±SD M±SD
Family presence during invasive procedure prevents family members developing distorted images or wrong ideas of CPR process 2.98±0.90 3.24±0.82 -2.15 .033
Family members will suffer negative long-term emotional effects if they are present during CPR 3.52±0.78 3.85±0.58 -3.36 .001
Rates of legal action against staff will increase because family members may misunderstand the actions of procedure team 3.28±0.85 3.40±0.77 -1.12 .266
Family presence during CPR helps family members to know that everything is being done for the patient 3.27±0.79 3.61±0.57 -3.46 .001
The procedure team are likely to perform more carefully CPR if a family member present 3.02±0.77 3.14±0.80† -1.08 .280
Family presence during CPR creates a stronger bond between family and nursing team 2.96±0.72 2.87±0.65 0.93 .354
Family presence during CPR is not beneficial to the patient‘s outcome 3.20±0.91 2.97±0.73 1.99 .048
Family presence during CPR helps the family member with the grieving process, if the patient does not survive 2.94±0.87 2.79±0.91 1.19 .235
Family presence during CPR prolongs emotional readjustment at the loss of family member 3.19±0.73 2.96±0.89 2.02 .045
Family presence during unsuccessful CPR is important because it enables family members to share the last moments with patient 3.21±0.88 3.35±0.79 -1.17 .242
Total 2.92±0.34 2.98±0.39 -1.22 .225

CPR=cardiopulmonary resuscitation.

†n=98.

  • Badir A., Sepit D.. 2007;Family presence during CPR: A study of the experiences and opinions of Turkish critical care nurses. International Journal of Nursing Studies. 44(1):83-92. http://dx.doi.org/10.1016/j.ijnurstu.2005.11.023.
  • Duran C. R., Oman K. S., Abel J. J., Koziel V. M., Szymanski D.. 2007;Attitudes toward and beliefs about family presence: A survey of healthcare providers, patients' families, and patients. American Journal of Critical Care. 16:270-282.
  • Eichhorn D. J., Meyer T. A., Guzzetta C. E., Clark A. P., Klein J. D., Taliaferro E., et al. 2001;Family presence during invasive procedures and resuscitation: Hearing the voice of the patient. American Journal of Nursing. 101(5):26-33.
  • Emergency Nurses Association. 2005;Emergency nurses association position statement: Family presence at the bedside during invasive procedures and resuscitation Retrieved March 1, 2007, from.http://www.ena.org/SiteCollectionDocuments/Position%20Statements/FamilyPresence.pdf.
  • Fulbrook P., Albarran J. W., Latour J. M.. 2005;A European survey of critical care nurses attitudes and experiences of having family members present during cardiopulmonary resuscitation. International Journal of Nursing Studies. 42:557-568. http://dx.doi.org/10.1016/j.ijnurstu.2004.09.012.
  • Halm M. A.. 2005;Family presence during resuscitation: A critical review of the literature. American Journal of Critical Care. 14:494-511.
  • Helmer S. D., Smith R. S., Dort J. M., Shapiro W. M., Katan B. S.. 2000;Family presence during trauma resuscitation: A survey of AAST and ENA members. The Journal of Trauma: Injury, Infection, and Critical Care. 48:1015-1024.
  • Knott A., Kee C. C.. 2005;Nurses' beliefs about family presence during resuscitation. Applied Nursing Research. 18:192-198.
  • Koo H. J.. 2011;Perception and attitude of emergency medical staff to family presence during cardiopulmonary resuscitation Unpublished master's thesis, The Catholic University of Korea, Seoul..
  • Mangurten J. A., Scott S. H., Guzzetta C. E., Sperry J. S., Vinson L. A., Hicks B. A., et al. 2005;Family presence: Making room. American Journal of Nursing. 105(5):40-48.
  • Mason D. J.. 2003;Family presence: Evidence versus tradition. American Journal of Nursing. 12:190-192.
  • McClenathan B. M., Torrington K. G., Uyehara C. F.. 2002;Family member presence during cardiopulmonary resuscitation: A survey of us and international critical care professionals. Chest. 122:2204-2211. http://dx.doi.org/10.1378/chest.122.6.2204.
  • Meyers T. A., Eichhorn D. J., Guzzetta C. E., Clark A. P., Klein J. D., Taliaferro E., et al. 2000;Family presence during invasive procedures and resuscitation: The experience of family members, nurses, and physicians. American Journal of Nursing. 100(2):32-42.
  • Mortelmans L. J. M., Cas W. M. F., van Hellemond P. L. A., de Cauwer H. G.. 2009;Should relatives witness resuscitation in the emergency department? The point of view of the Belgian Emergency Department staff. European Journal of Emergency Medicine. 16:87-91.
  • Sanford M., Pugh D., Warren N. A.. 2002;Family presence during CPR: New decisions in the twenty-first century. Critical Care Nursing Quarterly. 25(2):61-66.
  • Sim S. H.. 2007;Recognition of physicians, nurses, and family members on the family presence during invasive procedure Unpublished master's thesis, Dong-A University, Busan..
  • Walker W.. 2008;Accident and emergency staff opinion on the effects of family presence during adult resuscitation: Critical literature review. Journal of Advanced Nursing. 61:348-362.

Figure & Data

References

    Citations

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    Comparison of Physicians and Nurses' Attitudes toward Family Presence during Cardiopulmonary Resuscitation
    Korean J Adult Nurs. 2013;25(1):41-52.   Published online February 28, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.1.41
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    Comparison of Physicians and Nurses' Attitudes toward Family Presence during Cardiopulmonary Resuscitation
    Korean J Adult Nurs. 2013;25(1):41-52.   Published online February 28, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.1.41
    Close
    Comparison of Physicians and Nurses' Attitudes toward Family Presence during Cardiopulmonary Resuscitation
    Comparison of Physicians and Nurses' Attitudes toward Family Presence during Cardiopulmonary Resuscitation

    Differences between Physicians and Nurses in Perceived Score for Family Presence during CPR (N=197)

    Subjects Variables Categories n (%) M±SD t or F p
    Physicians (n=98) Gender Male 66 (67.3) 2.76±0.34 -1.57 .119
    Female 32 (32.7) 2.88±0.35
    Age (year) ＜30 60 (61.2) 2.87±0.35 2.18 .031
    ≥30 38 (38.8) 2.72±0.33
    Marital status Married 29 (29.6) 2.73±0.33 -1.15 .252
    Single 69 (70.4) 2.82±0.35
    Religion Yes 56 (57.1) 2.77±0.37 -0.73 .467
    No 42 (42.9) 2.83±0.31
    Educational level University 82 (83.7) 2.82±0.36 1.68 .097
    ≥Master 16 (16.3) 2.67±0.27
    Position† Intern 34 (34.7) 2.95±0.29a 5.22 .007
    Resident 43 (43.9) 2.71±0.38b
    Fellow 21 (21.4) 2.73±0.29b
    Area of practice Medical 51 (52.1) 2.78±0.34 -0.50 .618
    Surgical 47 (47.9) 2.81±0.36
    Experience of permission for FP during CPR Yes 64 (65.3) 2.84±0.29 1.62 .112
    No 34 (34.7) 2.71±0.46
    Experience of invitation for FP during CPR Yes 43 (43.8) 2.90±0.26 2.69 .009
    No 55 (56.2) 2.72±0.38
    Experience of being requested for FP from family members Yes 51 (52.0) 2.83±0.28 0.89 .379
    No 47 (48.0) 2.76±0.41
    Nurses (n=99) Gender Male 0 (0.0)      
    Female 99 (100)      
    Age (year) ≤25 31 (31.3) 2.80±0.28 1.69 .190
    26~30 40 (40.4) 2.66±0.29
    ≥31 28 (28.3) 2.72±0.39
    Marital status Married 19 (19.2) 2.76±0.42 0.53 .600
    Single 80 (80.8) 2.71±0.29
    Religion Yes 59 (59.6) 2.71±0.35 -0.35 .725
    No 40 (40.4) 2.74±0.28
    Educational level College 68 (68.7) 2.72±0.30 -0.03 .977
    ≥Bachelor 31 (31.3) 2.72±0.37
    Position Staff nurse 81 (81.8) 2.71±0.30 -0.97 .391
    ≥Charge nurse 18 (18.2) 2.79±0.41
    Experience in nursing (month) ≤24 20 (20.2) 2.75±0.30 0.11 .899
    25~60 42 (42.4) 2.72±0.26
    ≥61 37 (37.4) 2.71±0.39
    Area of practice ICU, ER 39 (39.4) 2.70±0.30 0.45 .636
    Medical 39 (39.4) 2.76±0.35
    Surgical 21 (21.2) 2.69±0.32
    Experience of permission for FP during CPR Yes 34 (34.4) 2.80±0.22 2.12 .037
    No 55 (55.6) 2.68±0.35
    Experience of invitation for FP during CPR Yes 17 (17.2) 2.79±0.20 1.27 .212
    No 82 (82.8) 2.71±0.34
    Experience of being requested for FP from family members Yes 45 (45.5) 2.71±0.32 -0.25 .807
    No 54 (54.5) 2.73±0.32

    ICU=intensive care unit; ER=emergency room; CPR=cardiopulmonary resuscitation; FP=family presence.

    †a＞b.

    Differences of Perception for the Decision Making regrading Family Presence during CPR (N=197)

    Items Physicians (n=98) Nurses (n=99) t p
    M±SD M±SD
    Family members should always be offered the opportunity to be with the patient during CPR 2.53±0.83 2.35±0.70 1.62 1.08
    Physicians want relatives to be present during CPR 2.46±0.83 2.14±0.80† 2.75 .007
    Nurses do not want relatives to be present during CPR 3.29±0.87 3.51±0.86 -1.77 .078
    Physicians are responsible for deciding if family members are allowed to be present during CPR 3.54±0.86 2.92±0.89 4.98 ＜.001
    Nurses should have the responsibility for deciding if family members should be present during CPR 2.50±0.79 2.57±0.67 -0.63 .530
    It should be the joint responsibility of all members of the procedure team to decide whether (or not) family members are allowed to be present during CPR 3.31±0.83 3.96±0.75 -5.78 ＜.001
    There may be a problem of confidentiality in discussing details about the patient if family members are present during CPR 3.32±0.89 3.63±0.84 -2.51 .013
    Because family members do not understand the need for specific intervention they are more likely to argue with the procedure team 3.62±0.89 3.95±0.71 -2.86 .005
    Family members should be present during CPR so that they can be involved in decisions 3.07±0.86 3.30±0.73 -2.03 .044
    If present during CPR, family members are more likely to accept decisions to withdraw treatment 3.38±0.96 3.67±0.77 -2.33 .021
    Total 2.79±0.40 2.69±0.36 1.71 .089

    CPR=cardiopulmonary resuscitation.

    †n=98.

    Differences of Perception for the Effect of Family Presence on Health Care Providers and Family Members (N=197)

    Items Physicians (n=98) Nurses (n=99) t p
    M±SD M±SD
    Family members are very likely to interfere with CPR process 3.28±0.94 3.44±0.80 -1.36 .175
    Family members should not be present during CPR because it is too distressing for them 3.21±0.84 3.43±0.80 -1.89 .061
    Nursing and medical staff find it difficult to concentrate when relatives are watching 3.22±0.94 3.44±0.97† -1.62 .107
    The performance of the team will be positively affected due to the presence of family members 2.64±0.74 2.51±0.73 1.32 .190
    During CPR, team may say things that are upsetting to family members 3.39±0.87 3.33±0.85 0.45 .656
    There are enough nursing staff to provide emotional support and remain with the family member during CPR 2.60±0.94 2.21±1.04 2.76 .006
    Most bed area are too small to have a family member present during CPR 3.34±0.88 3.64±0.87 -2.39 .018
    It should not be normal practice for family members to witness CPR procedure of a family member 3.47±0.83 3.78±0.71 -2.81 .005
    If family members are present during CPR, there should be a member of the procedure team whose only role is to look after the family 3.20±0.90 3.46±0.92 -2.02 .045
    Family presence during CPR is beneficial to the patient's outcome 2.71±0.92 2.70±0.78 0.14 .886
    Total 2.68±0.47 2.48±0.43 3.08 .002

    CPR=cardiopulmonary resuscitation.

    †n=97.

    Differences of Perception for the Influence of Family Presence on CPR Outcomes (N=197)

    Items Physicians (n=98) Nurses (n=99) t p
    M±SD M±SD
    Family presence during invasive procedure prevents family members developing distorted images or wrong ideas of CPR process 2.98±0.90 3.24±0.82 -2.15 .033
    Family members will suffer negative long-term emotional effects if they are present during CPR 3.52±0.78 3.85±0.58 -3.36 .001
    Rates of legal action against staff will increase because family members may misunderstand the actions of procedure team 3.28±0.85 3.40±0.77 -1.12 .266
    Family presence during CPR helps family members to know that everything is being done for the patient 3.27±0.79 3.61±0.57 -3.46 .001
    The procedure team are likely to perform more carefully CPR if a family member present 3.02±0.77 3.14±0.80† -1.08 .280
    Family presence during CPR creates a stronger bond between family and nursing team 2.96±0.72 2.87±0.65 0.93 .354
    Family presence during CPR is not beneficial to the patient‘s outcome 3.20±0.91 2.97±0.73 1.99 .048
    Family presence during CPR helps the family member with the grieving process, if the patient does not survive 2.94±0.87 2.79±0.91 1.19 .235
    Family presence during CPR prolongs emotional readjustment at the loss of family member 3.19±0.73 2.96±0.89 2.02 .045
    Family presence during unsuccessful CPR is important because it enables family members to share the last moments with patient 3.21±0.88 3.35±0.79 -1.17 .242
    Total 2.92±0.34 2.98±0.39 -1.22 .225

    CPR=cardiopulmonary resuscitation.

    †n=98.
    Table 1. Differences between Physicians and Nurses in Perceived Score for Family Presence during CPR (N=197)

    ICU=intensive care unit; ER=emergency room; CPR=cardiopulmonary resuscitation; FP=family presence.

    a＞b.

    Table 2. Differences of Perception for the Decision Making regrading Family Presence during CPR (N=197)

    CPR=cardiopulmonary resuscitation.

    n=98.

    Table 3. Differences of Perception for the Effect of Family Presence on Health Care Providers and Family Members (N=197)

    CPR=cardiopulmonary resuscitation.

    n=97.

    Table 4. Differences of Perception for the Influence of Family Presence on CPR Outcomes (N=197)

    CPR=cardiopulmonary resuscitation.

    n=98.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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