Historically, family members are separated from patients during the course of cardiopulmonary resuscitation (CPR). More recently, the practice of allowing family members to remain during such events, known as "Family Presence" (FP) has become more commonplace. This integrated literature review examined the opinions and experiences of nurses, physicians, families, and patients involved in FP. Results suggest that FP, when properly facilitated, offers positive benefits to participating families, patients, health care personnel, and hospitals. Additionally, nurses tend to be more accepting of FP than physicians. The findings from this review provide rationale to guide the development of evidence-based guidelines related to FP. Subsequently, these guidelines will promote development of nursing interventions and institutional policies that improve outcomes for families during a particularly stressful time.

Family Presence During Resuscitation (FPDR) remains controversial and is not consistently implemented during resuscitation events or invasive procedures. Evidence has demonstrated positive outcomes produced by implementation of FPDR; such as, decreased rates of post-traumatic stress symptoms, decreased symptoms of anxiety, and depressive symptoms were not significantly different. Unfortunately, use of FPDR in the acute care setting is not widely accepted or readily implemented. The primary purpose of this integrative literature review is to evaluate the use of FPDR in the acute care setting. The secondary purpose is to evaluate the health care professional's level of perceived value associated with the outcome of having family present during resuscitation. A systematic literature search was conducted using multiple databases for relevant articles in the English language between 2006 to 2017, including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Elton B. Stephens Co. Host (Ebsco Host), Medical Literature On-line (Medline), Psychological Information Database (PsychINFO), and PubMed. Search terms included 'family presence during resuscitation', 'family presence', 'pediatrics', 'nurse perceptions', and 'perceptions'. Ten of the nineteen articles suggest the use of FPDR leads to positive outcomes such as decreased post-traumatic symptoms, and decreased anxiety for family members. The use of FPDR can enhance family members' understanding of resuscitation efforts and involves them in their loved one's care. This integrative review indicates the implementation of FPDR can provide benefits for family members of those undergoing CPR and invasive procedures; although the perceptions of the healthcare team remain the barrier to its use.

Bakgrund: Hos sjuksköterskor på akutmottagning råder delade meningar om närståendes närvaro vid hjärt-lungräddning. Detta kan bero på om sjuksköterskan har positiva eller negativa upplevelser av situationen. Sedan flera år finns internationella riktlinjer skrivna som förespråkar närståendes närvaro, dessa används generellt inte i någon större utsträckning. Syfte: Att belysa sjuksköterskans upplevelse av närståendes närvaro vid hjärt-lungräddning på akutmottagning. Metod: En litteraturstudie har genomförts med 12 kvalitativa och kvantitativa vetenskapliga artiklar. Resultat: Under senare år har majoriteten av sjuksköterskorna gått från negativ inställning till positiv för närståendes närvaro vid HLR. Att närstående varit närvarande i de fall där HLR inte varit lyckad trodde sjuksköterskorna kunde underlätta det kommande sorgarbetet. Sjuksköterskorna trodde att närstående lättare kunde acceptera det plötsliga dödsfallet om de fick beröra, ta farväl och vara ett stöd den sista stunden i livet för sin familjemedlem. Slutsats: För att sjuksköterskan ska kunna behålla sin positiva upplevelse till närståendes närvaro vid HLR på akutmottagning krävs utvecklings–och förbättringsarbete. I detta arbete krävs både teoretisk och praktisk utbildning inom området. Samt etablering av de internationella riktlinjerna till lokala riktlinjer. / Background: Among nurses in emergency department is a difference of opinion regarding the issue of relatives being present during cardiopulmonary resuscitation. This can depend on the nurse have positive or negative experience of the situation. Since several years international guidelines are written to recommend relatives being present but in general they are not used. The aim: Of this study was to explain nurse’s experiences of relative’s presence during cardiopulmonary resuscitation in emergency department. Method: A literature review in which 12 qualitative and quantitative scientific papers have been reviewed. Results: During the last years most parts of the nurses changed their opinion from negative to positive regarding to relatives being present at CPR. If relatives been present when CPR wasn´t successful the nurses believed could help the coming grieving process. Nurses believed that relatives easier could accept the sudden death if they were able to touch, to say goodbye and share the last moments in life with their family member. Conclusion: To maintain the nurse positive experience of relative presence during CPR in emergency department needs development- and improvement work. This work needs both theoretical and practical education. And also there are needs to establish the international guidelines to local guidelines.

Background: The new guidelines for cardiopulmonary resuscitation states that the family should be given the opportunity to be present at the resuscitation of a close relative. A cardiac arrest is an emotional experience for the family. In addition to being part of the resuscitation effort, the nurse also needs to take care of the family. Aim: The aim of this study was to describe nurses' experiences of family presence during resuscitation. Method: A literature review has been made of 13 studies where differences and similarities were analyzed. The articles were published between the years of 2009 – 2013 Result: The nurses' experiences were divided into three categories; Factors that affect family presence, The nurse' experience surrounding the presence of the family, Factors affecting family presence in the resuscitation room. The result showed that, the feeling of confidence, the ability to work under stressful conditions, the reactions of the family and external prerequisites and the presences of a family support person were important. All nurses had unique experiences that influenced their attitudes towards family presence during resuscitation. Conclusion: Every resuscitation is unique and the family's presence should be evaluated. The need for a family support person was identified as an important factor to ease the family's presence. Local protocols should be created that clearly states the decision process and whom become the family support person. Travelbee's nursing theory facilitates the comprehension of the interactions between the family and the nurse.

Familjecentrerad vård har visat sig leda till bättre hälsoresultat och tillfredsställelse hos patienten och dess familj. Inom familjecentrerad vård ska familjen ses som en helhet och där barnet, familjen och sjukvårdsteamet bildar ett partnerskap där alla parter ska känna sig respekterade och arbeta tillsammans. Många familjer ser det som deras rätt att vara närvarande vid återupplivning och invasiva procedurer. Därför behöver sjuksköterskor vara förberedda på att stödja familjen i dessa akuta situationer. Syftet var att beskriva vilken betydelse familjecentrerad vård har för vårdkvaliteten inom akutsjukvården för barn. En litteraturstudie med en strukturerad litteratursökning utfördes som metod. Studier som belyste familjecentrerad vård inom akutsjukvård för barn inkluderades med avsikt att svara på syftet. Studier med kvalitativ och kvantitativ ansats samt med mixad metod som integrerar både kvalitativ och kvantitativ data inkluderades. Datainsamlingen gjordes i databaserna PubMed och CINAHL och dataanalysen gjordes utifrån Whittemore och Knafls (2005) integrativa översiktsmetod. I denna studie identifierades två teman, partnerskap samt familjenärvaro. Delaktighet i vården och respekt för familjen utformades som underkategorier till partnerskap. Påverkan på vården skapades som underkategori till familjenärvaro. Resultatet i föreliggande studie visar på att familjemedlemmars delaktighet i barnets vård är en viktig faktor för familjecentrerad vård. Detta genom att familjemedlemmarna deltar aktivt, närvarar vid invasiva procedurer och återupplivning, är med och planerar och utför omvårdnad samt bidrar med information om barnet. Inom familjecentrerad vård är sjuksköterskans roll att finnas där och lyssna till familjen. Familjecentrerad vård kan vara en strategi för att förbättra akutsjukvården för barn. Denna studie visar på att ett partnerskap mellan sjukvårdspersonal och familjemedlemmar och familjenärvaro vid invasiva procedurer och återupplivning är betydelsefulla faktorer för familjecentrerad vård. Familjemedlemmars delaktighet i barnets vård och att familjen är närvarande i alla situationer och finns där för sitt barn hjälper både dem och barnet i dess akuta tillstånd. Sjuksköterskors inställning om att föräldrar har rätt att finnas där och att tid finns för sjuksköterskorna att stötta familjen spelar också roll inom den familjecentrerade vården. / Family-centered care has been shown to lead to better health results and satisfaction for the patient and their family. In family-centered care the family is seen as a whole unit and where the child, the family and the health care team form a partnership where all parties feel respected and work together. Many families see it as their right to be present during resuscitation and invasive procedures. Therefore nurses should be prepared to support the family in these acute situations. The aim was to describe which importance family-centered care has for the quality of care in the emergency care for children. A literature review with a structured literature research was conducted as a method. Studies which elucidated family-centered care in emergency care for children were included with the intention to answer the aim. Studies using qualitative and quantitative approach and the mixed method that integrates both qualitative and quantitative data were included. The data was collected in the databases PubMed and CINAHL, and the data analysis was based on Whittemore and Knafls (2005) integrative review method. In this study two themes, partnership and family presence were identified. Participation in the care and respect for the family were conceived as subcategories of partnership. Impact on health care was created as a subcategory of family presence. The results of the present study show that family members’ involvement in the child’s care is an important element of family-centered care. This is achieved by the family members being participating actively, being present during invasive procedures and resuscitation, being involved in planning and nursing and contributing with information about the child. In family-centered care the nurse’s role is to be there and listen to the family. Family-centered care can be a strategy to improve emergency care for children. This study shows that a partnership between medical staff and family members and family presence during invasive procedures and resuscitation are significant factors for family-centered care. Family members’ involvement in the child’s care and that the family is present in all situations and are there for their children helps both them and the child in its acute condition. Nurses’ attitude that parents have the right to be there and that time is available for the nurses to support the family also plays a role in family-centered care.

Background: According to the ethical guidelines, family members of the patient should be allowed to be present during cardiopulmonary resuscitation (CPR). Nurses should be able to, besides performing CPR, decide if family presence is appropriate, support and explain the course of events to the family. Aim: The aim of this study was to illuminate nurses' experiences of family presence during resuscitation. Method: A literature study has been made of 11 qualitative studies, where differences and similarities were analysed. The studies were published between the years 2000 – 2015. Result: Two main themes were identified and five subthemes. The main themes were: "The nurse's experience of their work situation" and "The nurse's experience of the circumstances that affects the nursing". The findings showed that the nurses experienced a dilemma when they needed to decide if family presence was appropriate. The nurses experienced that a bond could be created with the families through the role of support person. They experienced that the family members could participate in the care but they could also be a distraction and a source of stress. Conclusion: Clear local guidelines would facilitate the decision if family presence is appropriate. A support person for the family would also facilitate the family's presence. More education and experience in this subject helps nurses overcome fears of difficulties often associated with family presence.

Bakgrund: Vid hjärt- och lungräddning (HLR), både hospitalt och prehospitalt, kan närståendevara närvarande. Ett av de globala hållbara målen eftersträvar en god hälsa och välbefinnandeför alla. Detta kan erhållas med personcentrerad vård som syftar bland annat på att stötta,kommunicera och visa lyhördhet till närstående. Tidigare forskning belyser att patientens vårdinte påverkas negativt av närståendes närvaro under pågående HLR och därför har riktlinjerinförts för att involvera närstående under HLR.Syfte: Att beskriva närståendes upplevelser av att närvara vid HLR.Metod: En litteraturöversikt med 15 vetenskapliga artiklar, fem kvalitativa och tio kvantitativa.Resultat: En huvudkategori identifierades, närståendes behov av information ochkommunikation. Denna huvudkategori indelades i fyra underkategorier, mentala effekter av attnärvara eller inte närvara under HLR, att vara fysiskt närvarande, förtroende tillvårdpersonalen samt stöd i sorgeprocessen. Närstående är i behov av kommunikation ochinformation i samband med HLR. Närstående kunde drabbas av psykiska besvär som PTSDoch ångest både av att närvara och att inte närvara. Närvaro under HLR kunde leda till enunderlättad sorgeprocess och ökat förtroende till vårdpersonalen.Slutsats: Ökad kunskap hos vårdpersonalen kring omhändertagandet av närstående i sambandmed HLR kan underlätta för närstående. Närstående är i stort behov av att få möjligheten attnärvara under HLR men behöver då en avsatt personal som kan stötta närstående. / Background: During cardiopulmonary resuscitation (CPR) at the hospital or prehospital thereis a posibility that relatives can be present. One of the sustainable development goals is aboutgood health and well-being for all. With a person-centred approach for communication, supportand sensitivity towards relatives the goal can be reached. Previous research shows how patientcare is not affected in the present of relatives. This has resulted in guidelines and routines forinviting relatives during CPR.Aim: To describe relatives experience of being present during CPR.Method: A literature review including 15 articles, ten quantitative articles and five qualitativearticles.Results: One theme was identified relatives' need for information and communication. Withthe main theme four sub themes were identified: psychological effects from being or not beingpresent during CPR, to be physically present, trust in healthcare personnel and support duringthe grieving period. Relatives are in need for communication and information during CPR andcould suffer from physiological effects such as PTSD and anxiety from being and not beingpresent during CPR. But being present during CPR could ease the stress during the grievingperiod and gain trust in the healthcare personnel.Conclusion: With additional training and knowledge healthcare personnel could supportrelatives during CPR. Since relatives are in need of constant communication and informationduring CPR healthcare personnel are needed to provide this to ease the stress on the relative.

SAMMANFATTNING Bakgrund: Närstående till patienter på intensivvårds avdelningar är ofta drabbade av kris och sorg. Patienten befinner sig i ett livshotande tillstånd och miljön är mycket främmande för de närstående. En väl fungerande kommunikation sjuksköterska och närstående emellan är viktig för att hjälpa de närstående bemästra den svåra situation de befinner sig i. Omvårdnadsforskning visar vikten av att de närstående finns nära patienten, men i en livshotande situation kan de närstående bli anmodade att lämna rummet. Metod: För att belysa närståendes och sjuksköterskors uppfattningar och erfarenheter gällande närståendes närvaro vid HLR på en intensivvårdsavdelning utfördes en forskningsöversikt. Sökning gjordes i databaserna Cinahl och Pubmed, med hjälp av sökorden cardiopulmonary resuscitation, resuscitation, witnessed resuscitation, nurse, nurse perspective, experience, attitude, perception, family, family presence, relative perception, och intensive care. Resultat: Sjuksköterskor i flera studier uttyckte att en personal bör utses att ta hand om de närstående vid närvaro under HLR . Sjuksköterskor uttryckte oro för att de närstående skulle hindra eller störa under HLR, att teamet skulle uttrycka sig olämpligt, eller att de närstående kunde lida psykologiskt sett. Bland de positiva aspekter som redovisades angavs att de närståendes förståelse för situationen ökade, det ansågs kunna hjälpa dem i sorgeprocessen. De närstående som hade närvarat var övervägande positiva, och några som inte närvarat hade ångrat det. De uttryckte att de var till fördel att de kunde se att allt gjordes, att de kunde ge patienten stöd, och att de inte ville att patienten skulle dö ensam. Slutsats: Flera organisationer har i riktlinjer tagit ställning till att närstående bör få närvara vid HLR. Sjuksköterskor förefaller inte enade i sin uppfattning om närståendes närvaro vid HLR, då ungefär hälften är för, och hälften mot närståendes närvaro vid HLR i de studier som granskats. De närstående förefaller vara mer enade i uppfattningen att de vill närvara vid HLR.

Introdução: Partindo-se do pressuposto que o Cuidado Centrado no Paciente e na Família é o modo mais humanizado de prestar cuidado em saúde, faz-se necessário refletir sobre a aplicabilidade dessa abordagem em unidades de emergência pediátrica. Uma possibilidade é o favorecimento da presença da família no atendimento de emergência. O uso de protocolo e o treinamento de profissionais de saúde são ferramentas que fortalecem a prática. Objetivos: elaborar e aplicar na prática clínica um protocolo brasileiro que inclui a família no atendimento de emergência pediátrica. Método: estudo piloto do tipo descritivo observacional, realizado em três etapas: 1) elaboração do protocolo; 2) treinamento de profissionais para a aplicação do protocolo. O treinamento foi realizado com 26 profissionais de enfermagem atuantes em uma unidade de emergência pediátrica de um hospital de ensino, localizado na cidade de São Paulo e 3) análise da aplicação do protocolo na prática assistencial. Para essa análise, foi investigada a dinâmica do atendimento de emergência focando os aspectos relacionados à presença da família; as perspectivas de profissionais de saúde em relação ao conteúdo do protocolo e as anotações de enfermagem no que tange a aplicação do protocolo. Resultados: Foram analisados 65 atendimentos de emergência com a aplicação do protocolo. Em 65,6% dos atendimentos, foi designado um profissional de suporte; 93,4% das famílias aceitaram o convite para presenciar o atendimento e não ocorreu interrupção do atendimento ao paciente em consequência da presença desta. Ao avaliar o protocolo, 85,7% dos profissionais referiram confiança em aplicá-lo em sua prática profissional. As principais dificuldades percebidas pelos profissionais para aplicar o protocolo incluíram a falta de recursos humanos, a falta de treinamento de todos os profissionais e a falta de estrutura física para o acolhimento familiar. Em relação às facilidades, foram elencadas equipe sensibilizada à prática, suporte familiar, o CCPF como alicerce teórico e membros na equipe experientes sobre o tema. Em relação ao conteúdo, os profissionais consideraram o protocolo fácil e rápido de ser aplicado. Apenas em 50% das anotações de enfermagem foi registrado que a família estava presente no atendimento. Conclusões: As ações promotoras para a adoção institucional do protocolo incluem a sensibilização dos profissionais para acolher as famílias no atendimento de emergência e treinamento para a aplicação do protocolo na prática assistencial. Além disso, as ações que facilitam a implantação do protocolo na prática assistencial incluem respaldo teórico na abordagem do CCPF, profissionais que atuem como referência sobre o tema para os demais membros da equipe e designação de um profissional de suporte. / Introduction: Based on the assumption that Patient and Family Centered Care (PFCC) is the most humanized way of providing health care, it is necessary to reflect on the applicability of this approach in pediatric emergency units. One possibility is to favor the presence of the family in emergency care. The use of protocol and the training of health professionals are tools that strengthen the practice. Objectives: To elaborate and apply in clinical practice a Brazilian protocol that includes the family in pediatric emergency care. Method: pilot study of descriptive observational type, carried out in three stages: 1) elaboration of the protocol; 2) professional training for the application of the protocol. The training was performed with 26 nursing professionals working in a pediatric emergency unit of a teaching hospital, located in the city of São Paulo; and 3) analysis of the application of the protocol in the practice of care. For this analysis, it was investigated the dynamics of emergency care focusing on the aspects related to family presence; the perspectives of health professionals regarding the content of the protocol and the nursing notes regarding the application of the protocol. Results: A total of 65 emergencies were analyzed using the protocol. In 65.6% of the attendances a support professional was assigned; 93.4% of the families accepted the invitation to attend the service and there was no interruption of the patient care due to the presence of the family. When evaluating the protocol, 85.7% of the professionals reported confidence in applying it to their professional practice. The main difficulties perceived by professionals to apply the protocol included lack of human resources, lack of training of all professionals and lack of physical structure for the family. Regarding the facilities, the team was sensitized to practice, family support, the PFCC as a theoretical foundation and have experienced team members on the topic. Regarding content, professionals considered the protocol easy and quick to apply. Only 50% of the nursing notes recorded that the family was present in the care. Conclusions: The actions promoting the institutional adoption of the protocol include raising the awareness of professionals to receive families in emergency care and training for the application of the protocol in the practice of care. In addition, actions that facilitate the implementation of the protocol in the practice of care include theoretical support in the approach of the PFCC, professionals who serve as reference on the theme for the other members of the team and appointment of a support professional.