ABSTRACT
BACKGROUND: Public support in favour of family presence during an adult cardiopulmonary resuscitation (CPR) attempt is a contentious issue among providers of emergency care. Researchers have mostly relied on attitudinal surveys to elicit staff views, leaving the life-world of those who have experienced this phenomenon, largely unexplored. OBJECTIVE: To explore the lived experience of lay presence during an adult CPR attempt in primary (out-of-hospital) and secondary (inhospital) environments of care. DESIGN: Hermeneutical phenomenological study. METHODS: Semistructured, face-to-face interviews with 8 ambulance staff and 12 registered nurses. The interviews were audio-recorded and subjected to thematic analysis. RESULTS: Participants provided insight into situations where lay presence during adult CPR came about either spontaneously or as a planned event. Their accounts portrayed a mixture of benefits and concerns. Familiarity of working in the presence of lay people, practical experience in emergency care and personal confidence were important antecedents. Divergent practices within and across the contexts of care were revealed. The concept of exposure emerged as the essence of this phenomenon. Overall, the study findings serve to challenge some of the previously reported attitudes and opinions of emergency care staff. CONCLUSIONS: Improved intraprofessional and interprofessional collaboration is essential to overcoming the barriers associated with lay presence during adult CPR. The future of this practice is dependent on initiatives that seek to bring about attitudinal change. Priority should be given to further exploring this phenomenon in the context of patient and family centred end-of-life care.
Subject(s)
Attitude of Health Personnel , Cardiopulmonary Resuscitation/psychology , Critical Care/psychology , Emergency Medical Services , Family , Adult , Clinical Protocols , Critical Care/organization & administration , England , Humans , Personal Autonomy , Professional-Family RelationsABSTRACT
This paper reports on the process and outcomes of a study, designed to pilot the use of interprofessional, simulation-based training in end of life care communication. Participants comprised 50 final year medicine, nursing, physiotherapy and pharmacy students. Learning methods included observation of role play and facilitated, interactive group discussion. A Likert scale rating questionnaire was used to evaluate the impact of the learning experience. Evaluation data revealed that students were supportive of interprofessional learning and could recognise its benefits. The results indicated self-perceived improvements in knowledge, skills, confidence and competence when dealing with challenging end of life care communication situations. Comparison of pre- and post-intervention scores revealed a statistically significant positive change in the students' perceptions about their level of knowledge (Z = -5.887, p = 0.000). The reported benefits need to be balanced against design and delivery issues that proved labour and resource intensive. Economic evaluation is worthy of further consideration.
Subject(s)
Interdisciplinary Communication , Interdisciplinary Studies , Problem-Based Learning/organization & administration , Terminal Care , Adult , Curriculum , England , Female , Humans , Male , Pilot Projects , Professional Competence , Students, Health Occupations/psychology , Young AdultABSTRACT
Many nurses will be familiar with the unexpected death of an adult patient following a sudden, life-threatening cardiac event. It is a situation that demands sensitive nursing care and skilled interventions to provide a foundation for recovery and promote healthy bereavement. This article examines the causes and incidence of sudden cardiac death in adults. Possible reactions of those who are suddenly bereaved are described and immediate care interventions aimed at dealing with the grief process are discussed. The article concludes by identifying ways in which the incidence of sudden cardiac death may be reduced.
Subject(s)
Bereavement , Death, Sudden, Cardiac , Family/psychology , Nurse's Role , Professional-Family Relations , Adult , Causality , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Health Promotion , Humans , Incidence , Nurse's Role/psychology , Resuscitation/nursing , Resuscitation/psychology , Social Support , Truth Disclosure , United Kingdom/epidemiology , Visitors to Patients/psychologyABSTRACT
The science and practice of resuscitation is recognised and endorsed on an international level, yet for more than a decade it has appeared in the literature alongside words such as witnessing or witnessed to signify the practice of family presence during a resuscitation attempt. This paper explores the meaning of witnessed resuscitation using the process for concept analysis proposed by Rodgers. The term resuscitation is explored, followed by identification of relevant uses of the concept of witnessed resuscitation. The reader is introduced to conceptual variations that challenge the way in which the concept has become associated with family or relatives presence in the resuscitation room of an accident and emergency department. Conceptual clarity is further enhanced through the identification of references, antecedents and consequences of witnessed resuscitation and by providing a model case of the concept that includes its defining attributes.