Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence.

BACKGROUND: Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events. OBJECTIVE: This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation. METHODS: By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale. RESULTS: Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001). DISCUSSION: These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.

Being there: inpatients' perceptions of family presence during resuscitation and invasive cardiac procedures.

BACKGROUND: Although patients' families want to be invited to the bedside of hospitalized loved ones during crisis events, little is known about patients' perceptions of family presence. OBJECTIVE: To explore adult inpatients' perceptions of family presence during resuscitation, near-resuscitation, and unplanned invasive cardiac procedures shortly after the life-threatening event. METHODS: In this qualitative study, data were collected by interviews at least 13 hours after a crisis event and before hospital discharge. Data were audio recorded, transcribed, and analyzed for themes. RESULTS: From the bedside interviews (N = 48), the overarching theme of "being there" was explained more specifically as "being there is beneficial," "being there is hard," "families in the way," and "desire for control." Most participants preferred family presence, although preferences varied with types of crisis events, patients' predictions of family members' responses, and the nature of family relationships. New perspectives emerged about patients' decision making related to family presence. CONCLUSIONS: This study extends existing knowledge about factors that influence the decision-making processes of hospitalized patients regarding family presence during a crisis event. Health care professionals can provide support as patients ponder difficult decisions about who to have present and can reduce patients' fears that families might interfere with the life-saving efforts.

Perceptions Related to Falls and Fall Prevention Among Hospitalized Adults.

BACKGROUND: Prevention of falls during hospitalization depends in part on the behaviors of alert patients to prevent falls. Research on acutely ill patients' intentions to behave in ways that help prevent falls and on the patients' perceptions related to falls is limited. OBJECTIVE: To explore hospitalized adults' perceptions related to risk for falling, fear of falling, expectations of outcomes of falling, and intention to engage in behaviors to prevent falls. METHODS: Adult, alert, acutely ill inpatients (N = 158) at risk for falling completed a survey consisting of 4 scales and 3 single items. Nurses' assessments and patients' perceptions of the risk for falling were compared. RESULTS: Decreased intentions to engage in behaviors to prevent falls were correlated with patients' increased confidence in their ability to perform high-risk behaviors without help and without falling (P < .001), decreased fear of falling (P < .001), and decreased perceived likelihood of adverse outcomes if they did fall (P < .001). Although nurses' assessments indicated a risk for falls, 55.1% of the patients did not perceive a high likelihood of falling while hospitalized. Whereas 75% of patients intended to ask for help before getting out of bed, 48% were confident that they could get out of bed without help and without falling. CONCLUSIONS: Although assessments may indicate a risk for falling, acutely ill inpatients may not perceive they are likely to fall. Patients' intentions to engage in behaviors to prevent falls vary with the patients' fall-related perceptions of confidence, outcomes, and fear related to falling.

Nurses' perceptions of their self-confidence and the benefits and risks of family presence during resuscitation.

BACKGROUND: Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables. OBJECTIVES: To test 2 instruments used to measure nurses' perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses' self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence. METHODS: Nurses (n = 375) completed the Family Presence Risk-Benefit Scale and the Family Presence Self-confidence Scale. RESULTS: Nurses' perceptions of benefits, risks, and self-confidence were significantly and strongly interrelated. Nurses who invited family presence during resuscitation were significantly more self-confident in managing it and perceived more benefits and fewer risks (P < .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P < .001). Data supported initial reliability and construct validity for the 2 scales. CONCLUSIONS: Nurses' perceptions of the risks and benefits of family presence during resuscitation vary widely and are associated with how often the nurses invite family presence. After further testing, the 2 new scales may be suitable for measuring interventional outcomes, serve as self-assessment tools, and add to conceptual knowledge about family presence.