1. Family Presence During Resuscitation (FPDR)
Jessica Berlin
University of Central Florida
College of Nursing

2. Background
The first reported practice of FPDR occurred at Foote Hospital in Michigan in 1982 (Demir, 2008).
Not until the later part of the 1990's were research articles published on FPDR (Boehm, 2008).
Professional organizations (the Emergency Nurses Association (ENA), the American Association of Critical-Care Nurses (AACN), and the American Heart Association (AHA)) have influenced the increase in efforts to create awareness of and policies supporting FPDR (Demir, 2008; Doolin et al., 2011; ENA, 2010).
Despite the support of professional organizations, only 5% of critical care areas have written policies governing practice supportive of FPDR (Martin, 2010).

3. Problem
Development of a policy in support of FPDR in the hospital setting is crucial to supporting evidence-based practices, allowing for family closure, and creating a supportive environment for staff and families during a stressful time. Despite these benefits and current research support, there continues to be poor policy development in many critical care areas backing FPDR.

4. Significance
Patients who survive cardiac arrest, generally reported comfort during family presence as did families, since their doubt and anxiety were alleviated (Martin, 2010).
Reasons for opposition are:
fear of psychological trauma, distraction, family interference, litigation, performance anxiety, appearing incompetent and confidentiality risks during resuscitation.
The majority of health systems still have no FPDR policy in place
leading to misunderstandings by families and in turn veering away from a family-centered approach (Dougal et al., 2011).
Importance of having policies supporting FPDR:
to not leave the visitation rights of patient's families solely up to the either the physician's discretion or the nursing supervisor.
Healthcare staff can be encouraged to engage in the promotion of change directed towards a FPDR policy
Through the use of staff meetings, open discussions and policy development in unit based councils

5. Aims of Policy Creation
Without written policies, practicing FPDR can become inconsistent and some families may feel excluded from care during a patient’s end of life (ENA, 2010).
Policies should
be flexible to keep up with current standards and to allow for FPDR (Salladay, 2006).
include benefits, assessment criteria, and the roles of family facilitators (Martin, 2010).
aid healthcare providers in the inclusion of families during resuscitation efforts and alleviate the stress of the decision making process.
be clear that the hospital is supportive of FPDR and discuss the benefits surrounding these practices.

6. Theoretical Framework
Kolcaba’s Theory of Comfort
Lewin’s Change Model
Supports the desire for a peaceful death
Describes positive outcomes to encourage desirable outcomes
Utilizes approaches of unfreezing, changing and re-freezing to implement change

7. Kolcaba’s Theory of Comfort
Application of Theory
Kolcaba’s Theory of Comfort
Lewin’s Change Model
Bases the need for the change on the issue of poor policy backing, despite research on family presence
Uses unfreezing as it pertains to the pros and cons of FPDR (Doolin et al., 2009)
Looks at the actual change, and the communication of goals and objectives needing to be addressed
Uses re-freezing to state that the changes must be accepted as the new way of practice (Lewin, 2011)
Allows for families to be present during resuscitation and obtain closure
Supports the idea that patient and family-focused outcomes, like timely responses to needs, and family inclusion in treatment plans, are also addressed (Doolin et al., 2009).

8. Implementation in Literature
Doolin et al. (2009)
discuss the use of evidence-based knowledge to guide the development of policy and practice guidelines for FPDR.
Novak, Kolcaba, Steiner, and Dowd (2001)
discuss comfort in caregivers and patients during end-of-life care and the goal to reduce the anxiety and fear that might be displayed by families, by supporting and educating families on the processes taking place.
While several national organizations have suggested that families be present during resuscitation, only a small amount of facilities have written policies dedicated to this (Oman & Duran, 2010).

9. Summary
FPDR is a nurse driven practice that must be supported by policy, and the policy change must continuously be reinforced during orientation, nursing rounding, and through discussions (Mian et al., 2007).
The concept of families wishing to remain at the bedside during resuscitation, and the desire of healthcare workers to shield them from it, due to their own fears of family response and pre-established problems with family presence, is an issue that stands to benefit from policy development in support of FPDR (Nibert, 2005).
Guided by the theoretical framework of comfort and change, the concept of FPDR not only supports the desire for patient and family comfort, but maintains its foundation in evidence-based practice.

10. Martin, B. (2010, April). AACN practice alert family presence during resuscitation and invasive procedures. American Association of Critical-Care Nurses. Retrieved from presence final.pdf Mian, P., Warchal, S., Whitney, S., Fitzmaurice, J., & Tancredi, D. (2007). Impact of a multifaceted intervention on nurses' and physicians' attitudes and behaviors toward family presence during resuscitation. Critical Care Nurse, 27(1), Retrieved from Nibert, A. T. (2005). Teaching clinical ethics using a case study family presence during cardiopulmonary resuscitation. Critical Care Nurse, 25(1), Retrieved from Novak, B., Kolcaba, K., Steiner, R., & Dowd, T. (2001). Measuring comfort in caregivers and patients during late end-of-life care. American Journal of Hospice & Palliative Care, 18(3), doi: / Oman, K. S., & Duran, C. R. (2010). Health care providers' evaluations of family presence during resuscitation. Journal of Emergency Nursing, 36(6), Salladay, S. (2006). Ethical problems: Family presence code controversy. Nursing2006, 36(1), 26.
References
Boehm, J. (2008, May). FPDR. Code Communications. Retrieved from Demir, F. (2008). Presence of patients' families during cardiopulmonary resuscitation: Physicians' and nurses' opinions. Journal of Advanced Nursing, 63(4), Doolin, C. T., Quinn, L. D., Bryant, L. G., Lyons, A. A., & Kleinpell, R. M. (2011). Family presence during cardiopulmonary resuscitation: Using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines. Journal of the Academy of Nurse Practitioners, 23(1), Dougal, R. L., Anderson, J. H., Reavy, K., & Shirazi, C. C. (2011). Family presence during resuscitation and/or invasive procedures in the emergency department: One size does not fit all. Journal of Emergency Nursing, 32(2), Emergency Nurses Association. (2010). Family presence during invasive procedures and resuscitation in the emergency department. Retrieved from Lewin, K. (2011). Change theory. Retrieved from