A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the Degree of Master of Medicine in Anaesthesia Johannesburg, 2015 / The aim of this study was to describe the resuscitation skills profile and self-­‐perceived adequacy of resuscitation skills of registrars in four major disciplines in the Faculty of Health Sciences at Wits: anaesthesiology, general surgery, orthopaedic surgery and obstetrics and gynaecology. The study focused mainly on the popular BLS, ACLS and ATLS resuscitation courses. A prospective, contextual, descriptive study design was used. An anonymous questionnaire was distributed to registrars. Information collected included demographics, resuscitation course qualifications, self-­‐perceived adequacy of resuscitation skills, and any impediments to completing a resuscitation course. One hundred and ninety (n=190) participants were entered into the study. BLS, ACLS and ATLS courses were completed by 161, 133 and 106 participants respectively. There was a high inter-­‐disciplinary difference in completion rates. Of participants who had completed BLS, ACLS and ATLS courses, 25.55%, 34.59%, 68.88% were current in their certification respectively. Registrars cited a lack of time (59.47%), cost (36.32%) and inability to take leave (28.42%) as the main impediments to completion of a resuscitation course. The majority of participants (65,79%, n=125) felt that their resuscitation skills were adequate. Registrars were less confident in managing anaphylaxis and dysrhythmia than inserting a CVP, or managing shock or airway. Registrars who had previously completed either ACLS or ATLS were more confident inserting a CVP (p=0.0024), managing dysrhythmia (p=0.0008) and managing an airway (p=0.0166) than those who had not completed any courses at all. While a high level of completion of BLS, ACLS and ATLS courses was found in the surveyed registrars, the rate of current certification was low. There was a high overall reported level of confidence in resuscitation skill. A number of impediments exist for registrars to complete resuscitation courses. More certification and re-­‐certification in resuscitation courses is required.

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Thesis (M.S.)--University of Wyoming, 2007. / Title from PDF title page (viewed on Feb. 9, 2009). Includes bibliographical references (p. 41-45).

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MSc (Med), Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand / Resuscitation of patients, be it medical or surgical, occurs on a daily basis in the Emergency Department. The resuscitation is usually pressurised and frantic, as a result family members are escorted out of the resuscitation room to a waiting room where they are isolated from the resuscitation. Since the late 1980’s the practice of Family Witnessed Resuscitation (FWR) has been explored1. FWR means that family members are invited into the resuscitation area whilst the medical team is attempting to resuscitate the patient. This practice has often been suggested but the opinions of medical staff remain varied 2,3,4. Resuscitation as discussed in this report is the medical proceedings that occur at a time when a patient presents with a life threatening emergency, be it medical or surgical, to an emergency department and the medical staff are unsuccessful in re-establishing respiratory efforts and cardiac output to maintain life. A review of the literature indicates that FWR is a means of the family gaining closure when the resuscitation is unsuccessful by observing the process of resuscitation and having their family member’s last moments clearer and more defined in their memory. The decision of FWR is one that needs to be taken by the family after the invitation has been extended by the medical team leader. There needs to be nursing staff available to be in attendance with the family at all times to answer their questions and explain procedures. The views of practitioners surveyed on FWR tend to vary, but irrespective there is a recurrent theme regarding the concerns expressed by emergency room doctors towards FWR. These concerns include traumatisation of the family, increased stress being placed on the medical team to perform while being watched, possible family interference with the resuscitation and the possibility of medico-legal consequences. These concerns are not simply regional but seem to be universal. This study sampled two groups of doctors:  Doctors actively working in emergency departments in the Gauteng area in Medi-Clinic and Life Healthcare facilities. These are private healthcare facilities.  Doctor participants in the University of the Witwatersrand, Faculty of Health Sciences Master in Science in Emergency Medicine programme. These doctors work in emergency departments in both the private and provincial sectors. This study found that there is not complete acceptance of FWR; 48 out of the 101 doctors in the sample had never considered allowing family to witness resuscitation. Doctor’s opinions vary regarding which family members, if any, they would allow to witness resuscitation, at which point in the resuscitation process they would allow family into the resuscitation area and how many family members would be permitted into the resuscitation at any one time. The opinion in this study was that due to space constraints no more than two family members would be allowed in the resuscitation area at any one time. Training and continued professional development seem to impact positively on the practice of FWR. The attendance at American Heart Association (AHA) courses such as Paediatric Advance Life Support (PALS) and AHA Acute Cardiac Life Support (ACLS) positively influences the doctors’ acceptance of FWR. Should death occur due to the acute life threatening emergency and resuscitation attempts are unsuccessful then FWR assists family in coming to terms with the death of a relative and is seen by the public to make the resuscitation a more humane process. The literature review and findings of this study concur that FWR is a practice that should be occurring in emergency departments. Some nursing councils have drawn up guidelines and mission statements that will ensure FWR is common place in the Emergency Departments (Appendix 1). If FWR is to become common practice then emergency departments need to be encouraged to draw up protocols and have processes in place that ensure that this process is performed in a way that allows staff to operate efficiently and the family to gain the most they can from a grave situation. The emergency medicine doctor that is in charge of the patient needs to be aware of the protocols and procedures that are in place in order to be able to facilitate FWR. In studies from KwaZulu Natal5, Western Cape6 and this study from Gauteng show that no unit in South Africa has policies yet. This study found that although FWR is currently not common practice in emergency departments in the Gauteng area, it is a practice that emergency doctors are willing to encourage in the future. The doctor’s attitude toward FWR is influenced positively by attendance at AHA PALS and AHA ACLS courses and the experience of the doctor of working in the emergency department. Doctors do have some concerns about the practice including psychological traumatisation of family members, extended length of resuscitation and medico-legal complications. It was found that parents would be the family members that are most likely to be invited by the medical team to witness the resuscitation of a family member and that the doctor would restrict witnesses to two family members only. It would seem that FWR will start occurring in emergency departments.

The concept of family witnessed resuscitation in South African critical care areas is one that is rarely practiced. In the majority of cases family members are ushered away from the resuscitation area, and this task is usually one that is performed by the critical care nurse. Consequently, the critical care nurse in the South African public health sector is relatively inexperienced in family witnessed resuscitation. In addition to this, few institutions have written policies with regards to family presence. Hence, the importance of uncovering critical care nurses opinions and perceptions of family presence during resuscitation. Therefore, the aim of this study was to explore and describe a select group of critical care nurses perceptions and opinions regarding family presence during resuscitation. A qualitative study was undertaken in which one-on-one semi structured interviews were conducted as a means of data collection. The following question was asked of the participants, ‘As a critical care nurse, if your patient was been resuscitated, and the family members requested to be present, how would you feel?’. In addition to this the following question was asked of the participants with regards to written policy within the institution used in this study, ‘Is there a policy in place in this institution regarding family presence?’. A total of 11 interviews were conducted including participants of various cultures and previous experiences of family witnessed resuscitation. The data collection and analysis processes were integrated as each interview was directly transcribed following the interview. The data analysis process was guided by Tesch’s method for qualitative data analysis. Four nurses interviewed in this study felt that family witnessed resuscitation is unacceptable, and two were unsure. However, these nurses did waver with regards to this. Nine participants expressed reservations regarding family witnessed resuscitation including the potential traumatic effects that it could have on the family. In addition to this, four participants had concerns that family members might interfere with resuscitation efforts came to light. Six participants also feared that their own shortcomings might be exposed to family members should they observe resuscitation attempts. Three nurses in this study believe that family members may misinterpret issues pertaining to resuscitative efforts, and that the physical space at the bedside would be inadequate. Six participants pointed out that it is norm to ask family members to leave the resuscitation area, in part due to habit, and thus could be preventing family members being invited to the bedside. In addition to this, lack of policy guidelines may be acting as a barrier to allowing and facilitating nurses to invite family members to witness resuscitation. In contrast, five nurses in this study had accepting views on family witnessed resuscitation. This, despite the lack of previous experience these nurses had with regards to family witnessed resuscitation. And as mentioned, nurses did waver with regards to this. Psychological pre-preparation of the family emerged as a concern for three participants. Three of the eleven nurses interviewed would extend an offer to family members to be at the bedside during resuscitation. Four participants felt that a benefit to family witnessed resuscitation is the opportunity it may offer for closure for the family should the resuscitation attempt be unsuccessful. In concluding, the participants in this study are inexperienced in the field of family witnessed resuscitation, and most participants wavered with regards to their perceptions with regards to family witnessed resuscitation.

Diss. Univ. Zürich, 2009. / Sonderdruck aus: Schweizer Monatsschrift für Zahnmedizin. Bd. 117, Nr. 8, 2007.

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