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Family Presence During Resuscitation

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Submitted By amalrajmary
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Running head: NURSES PERCEPTION OF THEIR SELF-CONFIDENCE

Nurses perception of their self-confidence and the benefits and risks of Family Presence during Resuscitation
Mary Amalraj
Grand Canyon University
Intro to Nursing Research
NRS-433V

August 7, 2011

Nurses perception of their self-confidence and the benefits and risks of Family Presence during Resuscitation The presence of family members during resuscitation is considered to be a debatable topic among healthcare professionals despite recommendations made by some of the professional organizations.
Purpose
The purpose of this research was to explore how the nurses’ perceive the presence of family during resuscitation and to develop a reliable and valid scientific instrument to measure the key variables during such situation. The title of the article is “Nurses Perception of Their Self-confidence and the Benefits and Risks of Family Presence during Resuscitation” by Twibell, et al. The study was presented concisely and at least four questions raised were about the two new psychometric property instruments used in order to measure the perceptions of nurses in relation to family presence, the relationships between their perceptions of risks, benefits and self-confidence related to during such event, the relationships among nurses’ perception of family being present during resuscitation and demographic variables and finally the differences in perception of the nurses who had invited the family during resuscitation and those who did not.
Literature Review The presence of family during resuscitation has caused mixed attitudes and practices among healthcare professionals globally, as increasing number of hospitals are following the recommendations of the professional organizations to include family members during resuscitations. (American Heart Association, 2005, Emergency Nurses Association, 1994, Henderson and Knapp, 2005, AACN). Three primary reasons have been reported in the study that prevents the nurses from inviting family that includes unpleasant situation for the family, fear of under functioning of the staff and anxiety related to disruption by family members. The less likely reasons raised are prolonging of treatment in the presence of family members, the fear of litigation and breach of confidentiality. The research article shows that the given reasons have little or no evidence to support and can be ignored, and the researchers have mentioned the advantage of family presence during resuscitation is that, it allows the family members to perceive the gravity of the situation and understand that every possible measures were attempted to revive their loved one and helps in better coping during the grief process. The article also states that there are three distinct gaps in the perceptions and decisions of nurses during the resuscitation process when the family is present. The earlier research on this topic lacks scientific back up as they were conducted based on opinion surveys that are difficult to replicate, lacked in conceptual framework and error in the sample.
Theoretical and conceptual framework More research is needed in this subject; if the nurses’ self confidence was high would the nurse invite the family to be present during resuscitation. Many concepts based on this study are in the literature, which include the risks and benefits of practice. As per diffusion of innovation theory by Roger, “new ideas are adopted in part on the basis of estimates of relative risks and benefits” and as per Bandura “people tend to perform behaviors that they feel confident in doing”.

Study design For this research the author conducted a qualitative research method by utilizing the two instruments to measure the perceptual variables that include the perceived risks and benefits and self-confidence in relation to the presence of family during resuscitation. “The (FPR-BS) family presence risk-benefit scale and the (FPS-CS) family presence self-confidence scale” were used that had five-point response options scale ranging from 1). Strongly disagree to five that states strongly agree. In order to measure the demographic variables the study used information like ethnicity, sex, age, nursing roll, and experiences. Questions like the number of times the nurses invited the family members’ presence during resuscitation were conducted using a response option of never, fewer than five times and five times or more.
Sampling
A total number of 375 nurses participated in the study that were at different levels of roles, ethnicity, age and experience and also belonged to different specialty units. The study had prior approval by the institutional review board members at “the Ball memorial hospital” in the state of Indiana. The hospital had no policy regarding the presence of family member during resuscitation.The study conducted by allowing the voluntary participants whose identity was kept anonymous to complete the 2 instruments and mail back. All data collected were kept confidential. Since the study included voluntary participants prior consent were obtained.
Data collection Of the total 375 participants, there was a 64% response rate achieved. The women out numbered the male participants and equaled to 95%. 90% of the participants were whites and there were 75% of participants who had 6 years of experience at least. The data collected showed that only 7.5% of the nurses did invite the family during resuscitation more than 5 times or more, two thirds never invited the family and 20% invited at least once, but less than 5 times. Normal distribution was not expected due to the large size of the sample. Parametric statistics were computed as there was no normality of the distribution although the graphs depicted near normalcy visually. During factor analysis the FPR-BS deleted four items due to low item-total correlation and inconsistent loading where as the FPS-CS correlation retained all of the 17 items.
Data analysis and implementation The result of the study reflects the continued controversy in relation to the presence of family during resuscitation. Research findings show that the families of critically ill patients have the desire to stay at the bed side of their loved ones during a life threatening and revival situation and many of the professional organizations do support the same, however, the nurses still seem to not agree based on their own perception of the risks and benefits. There was not enough evidence to have a clear insightful comparison of scores due to the fact that the study focused on sample that had only nurses, and the research was on resuscitation and the items used in this study were different from earlier tools used for similar studies. According to the study the score the nurses gave themselves for self- confidence was moderately high and there were no other earlier available studies for comparisons, as no other investigators had the chance of using “a multi-item tool” as this one to do the assessment of self- confidence of nurses. However, the resultant finding that nurses with high self-confidence invited the presence of family was compatible with two earlier studies. The factor analysis that was used supported “to construct validity” and reliability for the statistical measurement. There were no hidden subscales noted in the study.
Conclusion
The finding in this study suggests that the nurses have different perceptions of risks and benefits and their self-confidence related to the presence of family. The nurses who favor towards inviting family are found to be members in professional organizations, certified and or who work in emergency departments, which show that they are current with research findings and evidence based practice. Nurses with high self-confidence perceive family presence reduces risk and increases benefits and tend to invite family more. Although the two new scales, the “FPR-BS” and the “FPS-CS” showed that they were reliable and valid tools for measuring of interventional outcomes, further testing is recommended to increase the reliability and validity to enhance the evidence based practice about presence of family during resuscitation.

References
Family presence during invasive procedures and resuscitation in the emergency department. (2009). Emergency Nurses Association, , 2.
Henderson, (2005). Report of the national consensus conference on family presence during pediatric cardiopulmonary resuscitation and procedures . Pediatric Emergency Care, 21(11), 786-791. Retrieved August 6, 2011. Retrieved from http://www.aap.org/visit/NationalConsensus.pdf
Twibell, , Siela, , Riwitis, , Wheatley, , Riegle, , & Bousman, et al. (2008). Nurses perception of their self confidence and the benefits and risks of family presence during resuscitation. AJCC, 17(2), 101-111. Retrieved July 25, 2011. Retrieved from http://ajcc.aacnjournals.org

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