American Journal of Critical Care. 2007;16: 281-282
Evidence-Based Review (EBR) is the journal club feature in the American Journal of Critical Care. In a journal club, attendees review and critique published research articles: an important first step toward integrating evidence-based practice into patient care. General and specific questions such as those outlined in the "Discussion Points" box aid journal club participants in probing the quality of the research study, the appropriateness of the study design and methods, the validity of the conclusions, and the implications of the article for clinical practice. When critically appraising this issue’s EBR article, found on pp 270–279, consider the questions and discussion points outlined in the "Discussion Points" box. Visit www.ajcconline.org to discuss the article online.
Evidence-Based Review and Discussion Points
By
Ruth Kleinpell, RN, PhD.
Ruth Kleinpell is contributing editor of the Evidence-Based Review section. She is a professor in the Rush University College of Nursing, a teacher-practitioner at the Rush University Medical Center, and a nurse practitioner with Our Lady of the Resurrection Medical Center, Chicago, Ill.
The topic of family presence has distinct application for patients in high acuity and critical care settings. The purpose of this study, "Attitudes Toward and Beliefs About Family Presence: A Survey of Healthcare Providers, Patients’ Families, and Patients," by Duran and colleagues, was to describe and compare clinicians’, patients’, and families’ beliefs and attitudes regarding family presence during resuscitation and/or invasive procedures.
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Study Synopsis
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A descriptive survey methodology was used to assess clinician, family member, and patient perceptions in several settings in an academic hospital including the emergency department and adult and neonatal intensive care units (ICUs). A total of 202 clinicians, 72 family members, and 62 patients completed a survey that was adapted from previous research conducted on family presence.
The survey generated both quantitative and qualitative data. The study results revealed that clinicians, family members, and patients had positive attitudes about family presence. Respiratory therapists had the highest scores on the survey, indicating favorable attitudes, and nurses had more favorable attitudes toward family presence than did physicians. Most healthcare providers supported family presence during resuscitation (54%) and invasive procedures (69%). Clinicians indicated some concerns about safety, the emotional response of the family, and performance anxiety. This study serves to extend the evidence base on the use of family presence, especially as it relates to attitudes and beliefs about family presence.
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Information From the Authors
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Christine Duran, APRN-BC, DNP, CNS, CCTN, lead author of this EBR article, provided additional information about the study. She explains that the survey was distributed to hospital staff via the interhospital mail system. The survey was completed by a large number of healthcare providers in the institution. She notes that "we did not do a second mailing as it was too costly and we had no funding. We did have people on our research team remind staff to complete surveys."
Enlisting the participation of family members in the study required a team effort. Dr Duran explains: "Consistent with HIPAA [Health Insurance Portablity and Accountability Act] regulations, the bedside nurse taking care of the patient and family approached the subjects initially. The nurse asked the patient and family if we [the investigators] could speak with them about a study we were conducting. If the patient and family agreed, the investigators then went in, explained the study, and asked if the patient and family would like to take the survey."
The response rate to the survey was good owing to several strategies. Dr Duran explains: "We had such a good response rate because we were able to approach each patient and family individually. The initial approach by the bedside nurse was not considered part of the response rate because they did not actually hand out the survey; they simply asked if an investigator could come to speak with them about the study. If we based response rate on the RN approach, we would have had a poorer response rate."
Inclusion in the study was not dependent on having had prior experience with family presence. However, Dr Duran notes that clinicians who had previous experience did express more positive attitudes toward family presence. "There was a significant difference in attitudes among those care providers who had been involved when a family witnessed resuscitation compared to those who had not," she says. "A significant difference in attitudes also was found between those providers who had been involved with a family witnessing invasive procedures and those who had not.
"Providers had a more positive attitude if they already had been involved in a family presence situation. There also was a significant difference among family members who previously had participated in a loved one’s resuscitation or invasive procedure versus those who had not. However, there was not a significant difference between those patients who previously had had family members present during their resuscitation or invasive procedure."
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Implications for Practice
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According to the study results, clinicians, family members, and patients had positive attitudes about family presence. Dr Duran adds: "I think the results show that patients and families at least want the option, and it seems that most providers are willing to give it a try. We need to be leaders not only in the area of family presence, but in patient- and family-centered care as well. As nurses in acute and critical care settings, we need to continue to advocate for family presence."
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Investigator Spotlight
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This feature briefly describes the personal journey and background story of the EBR article’s lead investigator, discussing the circumstances that led him or her to undertake the line of inquiry represented in the research article featured in this issue.
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Christine Duran
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What led these investigators to conduct their research on family presence in the intensive care unit (ICU)? Christine Duran explains that it was her coinvestigator, Kathleen Oman, RN, PhD, CNS, from the division of Professional Resources at the University of Colorado Hospital, who encouraged her to pursue their mutual interest in the issue. "There had been interest in performing a study like ours," says Duran, "but other projects took precedence for some time. I was actually interested in the subject as a new ICU nurse, and Kathy suggested that I take on the project. In fact, she was quite excited that the topic would be revisited. We then proceeded to put a multidisciplinary team together to work on it."
Oman and Duran are conducting additional research along the same lines as those in this study. "We implemented a family presence policy last fall," says Duran. "Now we are in the process of surveying healthcare providers. We want to explore whether attitudes about family presence have changed and examine things we can do to improve the experience for everyone involved. In addition, the hospital medical board, though supportive of the overall practice of having family members present during CPR and/or invasive procedures, wants to see follow-up data since implementation of the policy."
In Duran’s view, readers of the American Journal of Critical Care can best use the information in this issue’s EBR source article to help support the practice of family presence as well as to advocate for family presence where they work. "I would like readers to use the data to add to the arsenal of evidence supporting family presence," she notes. "I hope that the more research that is out there, the easier it will be to implement the practice in other hospitals. I hope this article encourages providers in other hospitals to write their own policies on family presence, or at least to open up the discussion about family presence with colleagues."
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Discussion Points
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- Description of the Study
What was the purpose of the research?
- Why is the problem significant for those working in critical and high acuity care?
- Literature Evaluation
- What previous research on family presence has been conducted?
- Where are there gaps in the research evidence on the use of family presence?
- Sample
- What were the study’s inclusion and exclusion criteria?
- Methods and Design
- How were the data collected?
- What measures were used to assess the soundness of the survey instrument, which was adapted from previous research on the topic of family presence?
- Results
- What were the findings of the research?
- What themes emerged from the qualitative data?
- Clinical Significance
- What are the implications of this study for clinical practice?
- How does the study extend the evidence base for family presence during resuscitation and invasive procedures?
eLetters
Now that you’ve read the EBR article and accompanying features, discuss them with colleagues. To begin an online discussion using eLetters, just visit www.ajcconline.org, select the article in its full-text or .pdf form from the table of contents, and click "Respond to This Article" from the list on the right side of the screen. All eLetters must be approved by the journal’s coeditors prior to publication.
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Study Synopsis
Information From the Authors
