"It's just what we do": a qualitative study of emergency nurses working with well-established family presence protocol.

INTRODUCTION: ENA has supported family presence at the bedside during resuscitation of a loved one since 1993. Limited support from health care institutions has resulted in research that includes few data from hospitals with long-term family presence experience. The study objectives were to (1) describe the benefit and harm of being present during resuscitation to family members, using perceptions of nurses who work in an emergency department with a well-established family presence protocol; and (2) define family presence using perceptions of nurse participants. METHODS: A descriptive qualitative study was conducted in an emergency department that has had a written family presence protocol since 1992. Fourteen emergency nurses described their experience with family presence in face-to-face interviews using an investigator-developed, open-ended tool. Transcribed interviews were evaluated using conceptual content analysis. RESULTS: Nurses perceived benefits to family members in that 1) the family is able to see evolving events, described as a family member's ability to see a loved one's condition change over time, and 2) is able to validate efforts to save the life of their loved one. Nurses also indicated that family members' appreciation that everything possible was done increased nurses' confidence that they did everything they could during the resuscitation event. No nurses described observing actual harm to family members who were present during resuscitation. DISCUSSION: Emergency nurses can embrace family presence and influence benefits for family members when the practice is well established. Behavior modeling rather than written protocol may affect acceptance of family presence during resuscitation efforts among emergency nurses.

Promoting a good death for persons with dementia in nursing facilities: family caregivers' perspectives.

The experience of dying from Alzheimer's disease (AD) in a nursing home setting is a poorly understood phenomenon. Fifty-seven family member caregivers of persons with Alzheimer's disease, who had died as a resident in a national nursing home chain, participated in a structured telephone interview. Despite the belief that their loved one had died with dignity, 16 out of 57 (28%) family member caregivers believed that their loved one had not experienced a good death. This article reviews the definition of a good death and the six themes of a good death found in the literature: pain and symptom management; clear decision making; preparation for death; completion; contributing to others; and affirmation of the whole person. Five standards for evaluating the quality of an anticipated death are discussed in relation to the experiences of the persons with AD. Finally, recommendations for how nurse administrators and other members of the healthcare team can promote a positive death experience for a person with AD are proposed.