To the editor
Cardiac arrest followed by cardiopulmonary resuscitation (CPR) is a stressful situation that is frequently faced by healthcare providers (HCPs) and patient's family. During CPR, nurses are challenged by a controversy of either allowing the family members to attend the resuscitation or to leave the room.
Literature about HCPs’ positions regarding family presence during resuscitation (FPDR) is inconsistent and ambiguous. Healthcare professionals are generally less supportive of FPDR than patients’ families, and levels of support vary by geographic region and culture”.
1Tíscar-González et al.,
- Flanders S.A.
- Strasen J.H.
Review of evidence about family presence during resuscitation.
Crit Care Nurs Clin. 2014; 26: 533-550
2asserted that CPR with FPDR is influenced by socio-cultural contexts, as a uniquely individual case within its context.
- Tíscar-González V.
- Gastaldo D.
- Moreno-Casbas M.T.
- Peter E.
- Rodriguez-Molinuevo A.
- Gea-Sánchez M.
Presence of relatives during cardiopulmonary resuscitation: perspectives of health professionals, patients and family in the Basque Country.
Atencion Primaria. 2018; 51: 269-277
In the Middle East, and within a contextual and cultural reference, we argue that the extended family engagement and the strong family ties are factors that impede family members to stay dispassionate during a CPR. Accordingly, most HCPs in this region dismiss FPDR as an option in claim of protecting patients’ privacy and avoiding adverse emotional effects on the family.
- Badir A.
- Sepit D.
Family presence during CPR: a study of the experiences and opinions of Turkish critical care nurses.
Int J Nurs Stud. 2007; 44: 83-92
In a collective societal structure as in the Arabic Islamic culture, family members usually support each other in times of leisure and in times of grief.
4In Islam, visiting a patient has a religious value. In the context of critical illness and dying, it is a religious duty that a close family member stay at the patient's bedside to prompt the dying patient to recite the “Shahadah” by saying “La Ilaha Illa’llah” (God is the only Allah). It is commonplace to see a kin sitting besides a dying patient reciting verses from the Qur’an or playing an audio of the holy book of Islam. Rituals of spirituality like these make it easier for the family to perceive CPR as imminent, peaceful, and comforting.
- Dars B.A.
- Indhar S.A.
Islamic creed: relevance, sources and chronology.
The Scholar: Islamic Acad Res J. 2016; 28: 1-5
Recommendations for introducing FPDR
Permitting or prohibiting family members from attending CPR should be justified and based on evidence rather than on personal judgment. Healthcare institutions should assess patients’ and families’ needs and preferences by maintaining open communication with patients and their families.
Recommendations to address FPDR implemetation: educating HCPs about FPDR; creating an environment of privacy and communication; considering patients’ preferences; having a family liaison; assessing the cultural and religious beliefs of patients and families
5; initiating a multidisciplinary collaboration
- Leung N.
- Chow S.
Attitudes of healthcare staff and patients’ family members towards family presence during resuscitation in adult critical care units.
J Clin Nurs. 2012; 21: 2083-2093
6; and developing a culturally accepted policy.
- Breach J.
Exploring the implementation of family-witnessed resuscitation.
Nurs Stand. 2018; 33: 76-81
Assessing the attitudes and cultural beliefs of HCPs, and providing them with the appropriate training and emotional councelling is another cornerstone. Training may include assessment of transcultural competence, emotional preparedness, and arrangements that help family members get prepared for what they will witness.
In cases of anticipated CPR, HCPs should assess the expectations, perceptions, values, and beliefs of the family members regarding attending CPR. One staff member should stay with family to console them, give support, and allow those who are willing to attend. Allowing a family member to witness CPR provides a successful way of communicating the event to other family members.
7When a patient survives CPR, the family witness will relay the heroic performance of HCPs to the patient and the family.
- Porter J.E.
- Miller N.
- Giannis A.
- Coombs N.
Family presence during resuscitation (FPDR): observational case studies of emergency personnel in Victoria, Australia.
Int Emerg Nurs. 2017; 33: 37-42
Conflict of interest
The researchers thank: Valerie Swigart, Ph.D., RN, Professor, University of Pittsburgh, School of Nursing and Rafat Safady, Ph.D., Curriculum and instruction, TESOL.
- Review of evidence about family presence during resuscitation.Crit Care Nurs Clin. 2014; 26: 533-550
- Presence of relatives during cardiopulmonary resuscitation: perspectives of health professionals, patients and family in the Basque Country.Atencion Primaria. 2018; 51: 269-277
- Family presence during CPR: a study of the experiences and opinions of Turkish critical care nurses.Int J Nurs Stud. 2007; 44: 83-92
- Islamic creed: relevance, sources and chronology.The Scholar: Islamic Acad Res J. 2016; 28: 1-5
- Attitudes of healthcare staff and patients’ family members towards family presence during resuscitation in adult critical care units.J Clin Nurs. 2012; 21: 2083-2093
- Exploring the implementation of family-witnessed resuscitation.Nurs Stand. 2018; 33: 76-81
- Family presence during resuscitation (FPDR): observational case studies of emergency personnel in Victoria, Australia.Int Emerg Nurs. 2017; 33: 37-42
Published online: April 15, 2020
Received: February 18, 2020
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