The healthcare professionals' perspectives and experiences with family presence during resuscitation: A qualitative evidence synthesis.

INTRODUCTION: Family presence during resuscitation (FPDR) is a growing hospital praxis despite lack of high-quality evidence. The aim of this qualitative evidence synthesis review was to synthesize current evidence regarding healthcare professionals (HCP) perspectives on barriers and facilitating factors of FPDR and the potential impact of FPDR on HCP performance. METHODS: We conducted a systematic literature search May 17, 2023 including primary studies with qualitative study designs. We applied NVivo for data analysis. Data was coded with line-by-line coding and organized into themes and categories following the method for thematic synthesis described by Thomas and Harden to analyse data. The studies underwent quality appraisal by Critical Appraisal Skills Program. We used GRADE CERQual to assess the confidence in the evidence. RESULTS: We identified 8241 articles suitable for screening, 141 articles were full text screened, and nine studies included from Australia, UK and USA. In total, 134 HCP participated, between 2005 and 2019. Most studies lacked sufficiently rigorous data analysis and findings were appraised to have moderate GRADE CERQual confidence. We identified three analytical themes ("Facilitating factors for FPDR", "Barriers for FPDR" and "How staff are affected by FPDR") with eight descriptive subthemes. One finding was of high GRADE CERQual confidence: a belief that FPDR is "the right thing to do" which was a "Facilitating factor of FPDR." CONCLUSION: The evidence on HCP perspectives is of low to moderate confidence. The interviewed consent that FPDR is the "right thing to do", and an ethical principle of beneficence is dominant, especially regarding children.

A survey of emergency medical service providers' perspectives regarding relatives influence on acute prehospital treatment of adult patients.

BACKGROUND: In the field of prehospital emergency medicine, specialized emergency medical service (EMS) providers interact with acutely ill patients and their relatives. The influence of family presence during in-hospital resuscitation is well described. However, no studies have previously assessed the influence of relatives' presence in the acute prehospital setting. The aim of this study was to investigate EMS providers' perspectives on relatives' impact on the acute prehospital treatment of adult patients. METHODS: An online anonymous survey was distributed to all prehospital EMS providers in the Capital Region of Denmark. The survey included 25 research questions on a 5-point Likert scale, investigating relatives' influence on treatment in three different domains: positive, negative, and resuscitation. A higher domain score indicates a high level of agreement or frequency. RESULTS: Two hundred forty-six EMS providers completed the survey (84 ambulance technicians, 87 paramedics, and 75 physicians). There were no significant differences in the positive domain across professions (p = .175). Physicians had a statistically significant lower median score in the negative domain, compared with ambulance technicians and paramedics (2.50 vs. 2.63 and 2.63, p = .024). In the resuscitation domain, paramedics and physicians had a significant lower median score compared with ambulance technicians (3.00 and 3.00 vs. 3.14, p = .003). CONCLUSION: All professions were equally positive towards the relatives' presence and involvement in the acute prehospital setting. Physicians were less likely to be negatively influenced by the presence of relatives compared with ambulance technicians and paramedics. In all professions, increased experience led to improved comfort with handling relatives.

Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey.

AIMS AND OBJECTIVES: (I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model. BACKGROUND: Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. DESIGN: Observational, descriptive, cross-sectional study. METHODS: Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. RESULTS: A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. CONCLUSIONS: The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. RELEVANCE TO CLINICAL PRACTICE: The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.

Reliability and validity of the Chinese version of the family presence risk-benefit and self-confidence scales in Chinese nurses.

BACKGROUND: Controversy surrounding Family Presence during Resuscitation (FPDR) continues internationally. The attitudes of medical professionals toward FPDR are particularly important for its clinical implementation. Currently, there is a lack of validated tools to evaluate medical professionals' perceptions of FPDR in China. The study aimed to: (1) Cross-culturally adapt and validate the Family Presence Risk-Benefit Scale (FPR-BS) and the Self-Confidence Scale (FPS-CS) for use in China; and (2) investigate the nurses' perceptions of FPDR and explore the relationships between the nurses' perceptual variables and demographic variables. METHODS: The English version of the FPR-BS and FPS-CS underwent a rigorous process of translation, back-translation, proofreading, and cultural adaptation to create the Chinese versions. In the first stage, a sample of 200 nurses were recruited to evaluate the reliability and validity of the scales. In the second stage, a larger cohort 519 nurses were invited to assess their perceptions of FPDR and the relationships between these perceptual variables and demographic variables. RESULTS: Exploratory factorial analysis identified a single dimension for both the FPR-BS and FPS-CS, explaining 43.84% and 48.43% of the variance, respectively. The Scale-level content validity index (S-CVI) of the FPR-BS and the FPS-CS was 0.98 and 0.97, respectively. Reliability assessments yielded Cronbach's alpha coefficients of 0.933 for the FPR-BS and 0.930 for the FPS-CS. The split-half reliability coefficients were 0.832 for the FPR-BS and 0.835 for the FPS-CS, while the retest reliability coefficients were 0.742 and 0.927, respectively. The average scores obtained were 2.76 (SD = 0.52) for the FPR-BS and 3.43 (SD = 0.58) for the FPS-CS. Statistical analyses revealed that factors such as patient type, family members' prior experience with resuscitation, and the number of times nurses invited family members during resuscitation significantly influenced perceptions of the benefits and risks associated with FPDR (P < 0.05). Furthermore, obtaining certification as an intensive care specialist was positively associated with nurses' self-confidence in managing FPDR (P < 0.05). CONCLUSIONS: The FPR-BS and FPS-CS were validated as effective instruments for measuring nurses' perceptions of PFDR, demonstrating acceptable levels of validity and reliability. While nurses reported fewer benefits and greater risks of FPDR, they exhibited increased self-confidence in managing family presence during resuscitation.

Attitudes and Barriers of Emergency Nurses and Physicians Toward Family Presence During Resuscitation in Iran: A Cross-Sectional Study.

INTRODUCTION: Implementing family presence during resuscitation poses many challenges in developing countries, especially in developing countries like Iran, where cultural and contextual factors play significant roles. This study examined the attitudes and barriers of Muslim emergency nurses and physicians toward family presence during resuscitation in Iran. METHODS: A cross-sectional study included 300 physicians and 500 nurses. Data were analyzed using descriptive and analytic statistics. RESULTS: The overall score of physicians' attitudes toward family presence during resuscitation was higher than nurses' (P = .001). Female nurses had a higher attitude score than male nurses (P = .001). Other demographic variables were not significant with nurses' attitudes toward family presence during resuscitation. The most significant barriers to family presence during resuscitation included increased stress on staff and unwanted events during cardiopulmonary resuscitation. The attitude of Iranian physicians and nurses toward family presence during resuscitation is becoming more positive, with more than half of them agreeing with both the concept and the practice. DISCUSSION: The findings suggest that hospitals should develop and adopt policies to ensure consistent performance when implementing family presence during resuscitation and that the procedure is safe and effective.

Family presence during resuscitation: Perceptions and confidence of intensive care nurses in an Australian metropolitan hospital.

BACKGROUND: While literature supporting family presence during resuscitation (FPDR) was first published over three decades ago, the practice remains controversial. Benefits have been confirmed, and barriers to practice identified through international research. The extent that FPDR is practised in Australian intensive care units (ICUs) is currently unknown. OBJECTIVES: To examine ICU nurses' previous exposure and experiences with FPDR To establish their perceptions of the risks and benefits of the practice, as well as their confidence participating. METHODS: A descriptive, cross-sectional study design, using validated FPDR risk-benefits and confidence scales, was distributed electronically to registered nurses working within a single adult ICU in Australia. RESULTS: Fifty-six percent (n = 45) of respondents had never witnessed FPDR. Respondents were divided on whether families had the right to be present or should be given the option. ICU nurses perceived benefits for families but not for the patients involved or for the nurses participating. Nurses indicated they felt conflicted between the needs of the family, preserving the quality of the care delivered to a deteriorating patient, and protecting the safety of all stakeholders. Support for FPDR was often dependent on the availability of resources such as a family-support person. CONCLUSION: This research establishes that ICU nurses lacked exposure to FPDR but were confident in their ability to perform, be observed, and support families during a resuscitation event. Therefore, confidence is likely not a factor in a decision to reject the practice. Further education is indicated as there remained a reluctance to adopt FPDR practice, despite many of the barriers reported having already been largely disproven by the available literature. Institutions have a role in policy development, ensuring adequate resources, and education.

Relatives' influence on the treatment of acutely critically ill patients in prehospital emergency medicine: a qualitative study of healthcare professionals' experiences and attitudes.

BACKGROUND: Family presence during resuscitation is a growing topic in the field of prehospital emergency medicine. Emergency medicine service (EMS) providers interact with the relatives of acutely critically ill patients daily. Previous studies have found varying preferences towards family presence during resuscitation. Some EMS providers experience family presence affects patient treatment. The study aimed to gain insight into how EMS providers experience relatives of critically ill patients influence patient treatment. METHODS: We used semi-structured individual interviews of specially trained paramedics and anaesthetists specialised in prehospital emergency medicine. A total of 11 interviews were conducted at a University Hospital in Copenhagen. Inductive qualitative contents analysis was used to analyse the data. RESULTS: Relatives were defined as family, spouses, children, partners, close friends or colleagues, and, for some participants, more peripheral relationships such as schoolmates or acquaintances. We identified four themes, describing how EMS providers experience relatives' influence on patient treatment: 'supporting optimal patient treatment', 'futile resuscitation', 'negative impact on patient treatment', and 'the paediatric patient'. CONCLUSIONS: Our study illustrates how EMS providers experience that treatment is influenced by relatives of acutely critically ill patients in the prehospital emergency medicine setting. Relatives can help or challenge treatment, and also influence EMS providers' clinical decision-making. Our findings can guide those working in prehospital emergency medicine towards utilising relatives of critically ill patients and increasing our understanding of how relatives can influence EMS providers' treatment and their clinical decision-making. Future studies should seek to quantify relatives' effect on treatment and investigate the clinical and ethical aspects of futile resuscitation.

Family caregivers as essential partners in care: examining the impacts of restrictive acute care visiting policies during the COVID-19 pandemic in Canada.

INTRODUCTION: During the pandemic many Canadian hospitals made significant changes to their 'open family presence' and 'visitor policies' to reduce the spread of COVID-19 by instituting restrictive or 'zero visiting' policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. METHODS: A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. RESULTS: Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. CONCLUSIONS: The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no "one-size-fits-all" caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.

Family support person role during resuscitation: A qualitative exploration.

AIMS AND OBJECTIVES: To provide guidance to nurses by examining how critical care nurses perceive and perform the family support person role during resuscitation. BACKGROUND: Nurses can serve as family support person when families witness a loved one's resuscitation. However, few studies have examined the role of family support person to provide nurses with sufficient knowledge to enact the role. DESIGN: An exploratory-descriptive qualitative design with individual, semi-structured interviews. METHODS: Sixteen critical care nurses who had served as family support person completed interviews. The data were analysed by thematic analysis. COREQ guidelines were followed. RESULTS: Six themes were identified: Hard but Rewarding Role, Be With, Assess, First Moments, Explain and Support. Findings explicated nurses' perceptions of the role and key role activities. CONCLUSIONS: Nurses perceived the role as hard but rewarding. Role challenges included the need for quick, accurate assessments and interventions to keep family members safe, informed and supported, while allowing them to witness resuscitation. Key role activities included: being fully present and compassionately attentive to family, continuously assessing family members, coordinating the first moments when family presence during resuscitation commences, explaining in simple, tailored terms the resuscitation activities, and supporting the family emotionally and psychologically through a variety of strategies. Nurses noted the high variability in how families respond and the complexity of simultaneously performing the multi-faceted role activities. RELEVANCE TO CLINICAL PRACTICE: To effectively support the growing global trend of family presence during resuscitation, nurses need the knowledge this study provides about how to fulfil the family support person role. Identifying the role activities may facilitate development of clinical guidelines and educational preparation for the role. Nurses can refine the many skills this role requires, building their competence and confidence, to increase opportunities for family members to experience family presence during resuscitation in a safe, and high-quality manner.

Parental presence at the bedside of critically ill children in the pediatric intensive care unit: A scoping review.

Parental presence at the bedside (PPB) of critically ill children in the pediatric intensive care unit (PICU) is necessary for operationalizing family-centred care. Previous evidence syntheses emphasize parent-healthcare provider interactions at rounds and resuscitation; our focus is the parent-child dyad. Prior to embarking on further study, we performed a scoping review to determine the breadth and scope of the literature addressing PPB of critically ill children in the PICU. We searched five online databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and PSYCHINFO) and the grey literature to identify English and French reports from January 1960 to June 2020 addressing physical parental presence with children (birth to 18 years) in intensive care units, without limitation by methodology. Screening, reference selection, and data extraction were performed by two independent reviewers. Data were extracted into a researcher-designed tool. We identified 204 publications (81 quantitative, 68 qualitative, 22 mixed methods, and 9 descriptive case or practice change studies, and a further 24 non-study reports). PPB was directly assessed in 78 (38%) reports, and was the primary objective in 64 (31%). Amount or quality of presence was addressed by 114 reports, barriers and enablers by 152 sources, and impacts and outcomes by 134 sources. While only 6 reports were published in the first two decades of our search (1960-1980), 17 reports were published in 2019 alone. Conclusions: A relatively large body of literature exists addressing PPB of critically ill children. Separate systematic evidence syntheses to assess each element of PPB are warranted. Scoping review protocol registration: Open science framework, protocol nx6v3, registered 9-September-2019. What is Known: • Parental presence at the bedside of critically ill children must be enabled to facilitate family centeredness in care. • Systematic evidence syntheses have focused on parental presence at rounds or resuscitation, rather than with the child throughout the intensive care journey. What is New: • Many reports (n=204) address parental presence at the bedside in the pediatric intensive care unit, though most do as incidental findings • Identifies studies addressing key elements of parental presence in the PICU including barriers and enablers to, amount and quality of, and impact and outcomes of parental presence, and demonstrates trends over time and geography.

Family involvement in the intensive care unit in four Nordic countries.

BACKGROUND: Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement. AIMS AND OBJECTIVES: To describe family involvement, communication practices and visiting policies in adult ICUs. DESIGN: A cross-sectional survey. METHOD: A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries. RESULTS: The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments. CONCLUSIONS: The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement.

Patients' Family Satisfaction in Intensive Care Unit: A Leap Forward.

Garg SK. Patients' Family Satisfaction in Intensive Care Unit: A Leap Forward. Indian J Crit Care Med 2022;26(2):161-163.

Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review.

BACKGROUND: Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals. METHODS: We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. RESULTS: Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). CONCLUSIONS: Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. TRIAL REGISTRATION: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction.

Family presence during resuscitation: a needs assessment of education, policy, and opinion in Canada.

PURPOSE: Family presence during resuscitation (FPDR) has been widely endorsed. Nevertheless, there is limited information available on current education and training used to support FPDR implementation, including that of relevant policy. Understanding the current state of FPDR educational opportunities, policies, and practices across Canadian hospitals is crucial to advancing and standardizing these within our medical community. Our objective was to identify the current and desired state of education and policy on FPDR, as well as current practices and opinions of Canadian healthcare professionals. METHODS: We selected questionnaire topics and employed a modified Delphi consensus technique using a group of subject matter experts in resuscitation. We contacted a stratified sample of Canadian healthcare professionals via select listservs and surveyed the cohort using RedCAP™. We used descriptive statistics and conducted quantitative analyses to describe and test for significant differences among groups. RESULTS: In total, 635 surveys were completed. Only 46.3% of participants reported ever attending an educational opportunity involving learning how to manage FPDR; however, 92% wanted training. Only 11% knew if they had an official FPDR policy in their current hospital but 62.9% indicated they wanted one. In support of FPDR, 88% agreed that family members should be allowed to be present during a resuscitation. CONCLUSION: While opinions are mostly positive towards FPDR, there exists a gap between the current and desired state of education and policy supporting it within Canada.

RéSUMé: OBJECTIF: La présence de la famille pendant la réanimation est largement appuyée. Néanmoins, il existe peu d'informations disponibles sur l'éducation et la formation actuelles utilisées pour soutenir la mise en œuvre de la présence de la famille pendant la réanimation, y compris l'information touchant les politiques pertinentes. Il est essentiel de comprendre l'état actuel des opportunités de formation, des politiques et des pratiques en matière de présence familiale pendant la réanimation dans l'ensemble des hôpitaux canadiens afin de les faire progresser et de les standardiser au sein de la communauté médicale. Notre objectif était de déterminer l'état actuel et souhaité de la formation et des politiques en matière de présence familiale pendant la réanimation, ainsi que les pratiques et les opinions actuelles des professionnels de la santé canadiens. MéTHODE: Nous avons sélectionné un questionnaire et utilisé une technique de consensus Delphi modifiée afin d'obtenir les réponses d'un groupe d'experts en matière de réanimation. Nous avons communiqué avec un échantillon stratifié de professionnels de la santé canadiens par l'entremise de gestionnaires de liste sélectionnés et avons sondé notre cohorte à l'aide de l'application RedCAP™. Nous avons utilisé des statistiques descriptives et effectué des analyses quantitatives pour décrire et tester les différences significatives entre les groupes. RéSULTATS: Au total, 635 sondages ont été complétés. Seuls 46,3 % des participants ont déclaré avoir déjà assisté à une opportunité de formation portant sur l'apprentissage de la gestion de la présence familiale pendant la réanimation; toutefois, 92 % des répondants ont déclaré désirer une formation. Seulement 11 % des répondants savaient s'il existait une politique officielle de présence de la famille pendant la réanimation dans leur hôpital, mais 62,9 % ont indiqué qu'ils souhaitaient en avoir une. En faveur de la présence familiale, 88 % étaient d'avis que les membres de la famille devraient être autorisés à être présents lors d'une réanimation. CONCLUSION: Bien que les opinions soient pour la plupart positives à l'égard de la présence familiale pendant la réanimation, il existe un écart entre l'état actuel et souhaité de la formation et des politiques qui l'appuient au Canada.

Family presence during resuscitation: adaptation and validation into Spanish of the Family Presence Risk-Benefit scale and the Self-Confidence scale instrument.

BACKGROUND: Family Presence during Cardiopulmonary Resuscitation has been studied both to identify the opinions of health professionals, patients, and family members, and to identify benefits and barriers, as well as to design protocols for its implementation. R. Twibell and her team designed an instrument that measured nurses' perceptions of Risks-Benefits and Self-Confidence regarding Family Presence during Resuscitation. There are few studies in Spain on this practice. METHODS: The aim is to adapt and validate into Spanish the Family Presence Risk-Benefit scale and Family Presence Self-Confidence scale instrument. For this purpose, this instrument was translated cross-culturally, and administered in paper and online version. Statistical tests were carried out for the validity of the questionnaire. Five hundred forty-one healthcare professionals were invited to respond. The results were analyzed by the same statistical procedures as in the original scale. Ethical approvals and research permissions were obtained according to national standards. RESULTS: Two hundred thirty-seven healthcare professionals (43.8%) answered the survey (69% women), of whom 167 were nurses. Validation of instruments: Cronbach's α in Family Presence Risk-Benefit scale was 0.94. Cronbach's α in Family Presence Self-Confidence scale was 0.96. Factor Analysis Kaiser, Meyer and Olkin (KMO) was greater than 0.9. The correlation between the two measured scales, is significant and has a moderate intensity of the relationship (r = 0.65 and α < 0.001). A lower predisposition to Family Presence during Cardiopulmonary Resuscitation is observed, but the pure detractors are only 12%. Doctors are more reluctant than nurses. CONCLUSIONS: The psychometric properties of the questionnaire in Spanish indicate high validity and reliability. Risk-Benefit perception and Self-Confidence are related to the healthcare professionals who consider the Family Presence to be beneficial. More studies in different contexts are necessary to confirm the psychometric results and validity of this instrument in Spanish.

Family witnessed resuscitation and invasive procedures: Patient and family opinions.

BACKGROUND: Family presence during invasive procedures and cardiopulmonary resuscitation (FPDR) is a highly controversial issue, with divergence of opinion among health professionals, with clinical evidence in favor, and with barriers to its implementation in comprehensive patient care. Many international organizations support health policies for its implementation, but it is not a widespread practice. Little research has been conducted on this subject from the perspective of patients and families. OBJECTIVE: To learn opinions, perceptions, and desires of family members and patients in terms of family presence during invasive procedures and cardiopulmonary resuscitation. METHOD: Qualitative descriptive study, using semi-structured interviews with relatives and patients regarding their experiences and perceptions about FPDR (n = 18) from 8 October 2017 to 8 March 2018. The interviews were recorded and transcribed verbatim for later analysis using the method of content analysis. ETHICAL CONSIDERATIONS: This study has the approval of the Clinical Research Ethics Committee of the Fundació Unió Catalana d'Hospitals and ethical considerations were carefully regarded throughout the study. RESULTS: Three significant categories were identified: knowledge, respect for rights, and accompaniment of the patient, relating FPDR to courage, emotional support, and trust in professionals. CONCLUSION: FPDR is an unusual practice; it is not offered to patients or their families, and it is not considered a patient's right, although most of the interviewees support it. The desire for accompaniment is conditioned by the courage and knowledge of the accompanying persons, as well as the degree of invasiveness of the procedures. The results of this study provide information for a change of vision in patient-centered care.

"Compassion Cannot Choose:" A Call for Family-centered Critical Care during the COVID-19 Pandemic.

Compassion has been one of the greatest virtues of healthcare professionals. In the early phase of the pandemic, a lot of caution was essential, and restrictions were imposed on the hospital visitation of the COVID-19 patients by their family members. The healthcare system was overburdened, and the healthcare workers were apprehensive about the new virus and the rising mortality. Compassion and family-centered care took a step back as survival of the pandemic became the ultimate goal of mankind. "COVID-19 patients admitted to the critical care units, their loved ones and the healthcare professionals caring for these patients took the brunt of the emotional and psychological impacts of the pandemic." However, as we have moved more than a year into the pandemic, knowledge and resources we gained may be leveraged to provide family-centered critical care for COVID-19 patients. Family presence in intensive care units (ICUs) has been associated with higher satisfaction with care, collaboration with the medical team, shared decision-making, reduced delirium, and optimized end-of-life care of COVID-19 patients. The policymakers should review the restrictions, consider a holistic approach, and take appropriate actions to provide safe family-centered critical care for COVID-19 patients. HOW TO CITE THIS ARTICLE: Mohan M, Joy LF, Sivasankar A, Ali S, Meckattuparamban BV. "Compassion Cannot Choose:" A Call for Family-centered Critical Care during the COVID-19 Pandemic. Indian J Crit Care Med 2021;25(9):1049-1050.

Healthcare providers' perspectives on family presence during resuscitation in the emergency departments of the Kingdom of Bahrain.

BACKGROUND: Worldwide, policies exist on family presence during resuscitation (FPDR), however, this is still lacking in the Gulf Corporation Countries (GCC) in general and in the Kingdom of Bahrain in particular. The aim of this study is to assess the perspectives of healthcare providers (HP) on FPDR among those working in the emergency departments (EDs) in the Kingdom. METHODS: A self-administered anonymous electronic survey was collected from 146 HPs (emergency physicians and nurses) working in the three major EDs in the Kingdom of Bahrain. Besides demographic data, 18 items measuring HPs' perceptions of FPDR were generated using the 5-point Likert scale. RESULTS: Surveys (n = 146) from physicians and nurses were analysed (45.9% vs. 54.1%, respectively). There were significant differences between physicians and nurses in terms of personal beliefs, FPDR enhancing professional satisfaction and behaviour, and the importance of a support person and saying goodbye (p < 0.001). However, general responses demonstrated that the majority of HPs encouraged and supported FPDR, but with greater support from physicians than nurses. CONCLUSION: The study reflects that many HPs in EDs participated in and are familiar with FPDR, with the majority of ED physicians supporting it. Further studies should investigate the reasons for the lack of support from nurses. Results may contribute to the development of hospital ED policies that allow FPDR in the region.

Doctors and nurses' views on the participation of parents in invasive procedures of hospitalized children.

OBJECTIVE: To determine health professionals' opinions toward family presence during invasive procedures in children, and to see the difference between the attitudes of physicians and nurses on the issue. METHODS: The descriptive study was conducted in June 2016 at the Paediatrics Clinic of Karadeniz Technical University Farabi Hospital, Trabzon, Turkey, and comprised health professionals working at the clinics. Data regarding attitudes of physicians and nurses on family presence during invasive procedures in children was collected using a questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 95 health professionals, 71(75%) were nurses and 24(25%) were paediatric physicians. Overall, 41(43.2%) subjects supported the idea of family presence during invasive procedures in children; 31(43.7) nurses and 10(41.7) physicians. The 54(56.8%) professionals who did not support family presence cited two major reasons; "Family gives an emotional response (p=0.001)", "It increases the stress of the healthcare provider performing the procedure" (p=0.00)". CONCLUSIONS: Healthcare professionals largely did not support the idea of family presence as they believed that the invasive procedures became more challenging..

Family Presence in the Adult ICU During Bedside Procedures.

PURPOSE: To understand perspectives of family members of adult patients admitted to the medical-surgical intensive care unit (ICU) regarding their presence during procedures. METHODS: Respondents completed a questionnaire about procedures the patient had undergone, their desire to be present, and their experience. Procedures of interest were endotracheal intubation; chest compressions; vascular catheter insertion; and gastric, chest, and rectal tubes. Impact of Events Scale-Revised (IES-R) was completed at the time of questionnaire completion and again 1 month later to evaluate the psychological impact of witnessing a procedure. RESULTS: Ninety-seven respondents completed the questionnaire on behalf of 72 patients. More than 90% patients had at least 1 procedure. Only 29 (30%) family members were present for at least 1 procedure, and 44% to 100% wished to be present. Of the 68 respondents not present for a procedure, 18 (26.5%) wanted to be present. The IES-R was completed by 52 (95%) of 55 respondents who witnessed any procedure at time 1 and 28 (51%) of 55 respondents at time 2; mean IES-R scores were 8.0 and 8.8 ( P = .68), respectively. Only 2 participants had IES-R >33, signifying the likely presence of posttraumatic stress disorder. CONCLUSION: Family members wish to be present for ICU procedures, and there are no adverse psychological effects.