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.

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.

Det råder delade meningar angående närståendes närvaro under hjärt-lungräddning på sjukhus. Trots internationella riktlinjer från Emergency Nursing Association som säger att närstående bör erbjudas möjlighet att närvara under hjärt- lungräddning så följs ej dessa generellt på sjukhusen. Syftet: Var att beskriva närståendes upplevelser att närvara under hjärt-lungräddning på sjukhus. Metod: En litteraturstudie har gjorts där 13 vetenskapliga artiklar har granskats. Resultat: Närstående ville ha en valmöjlighet om de skulle närvara eller ej. De flesta närstående var nöjda med sitt beslut att närvara och skulle göra det igen trots att situationen upplevdes som svår. Närstående kände samhörighet med patienten och upplevde att de hanterade situationen bättre om de fick kontinuerlig information om händelseförloppet samt hade en stödperson vid sin sida. Sorgen underlättades då de delat den sista stunden med sin närstående. Slutsats: Närståendes närvaro under hjärt-lungräddning är fortfarande ett relativt outforskat område. Valmöjligheten att närvara är viktig, likaså kontinuerlig information och att ha en stödperson hos sig under hjärt-lungräddningen anses väsentligt. Närstående som varit närvarande under hjärt- lungräddning uppvisar lägre tendens till negativa psykologiska effekter och upplever även att sorgeprocessen underlättas. / A difference of opinion exists regarding the issue of relatives being present during cardiopulmonary resuscitation in hospital. Despite international guidelines from the Emergency Nursing Association stating that relatives should be offered the opportunity to be present during cardiopulmonary resuscitation, this is generally not the case. The aim: of this study was to describe relatives' experiences of being present during cardiopulmonary resuscitation in hospital. Method: A literature review in which 13 scientific papers have been reviewed. Results: Relatives preferred to be given the option to attend the cardiopulmonary resuscitation or not. Most relatives were satisfied with their decision to attend and would do it again even though the situation was perceived as difficult. Relatives experienced an emotional connection with the patient and felt that they handled the situation better if they were given continuous information on the events and had a support person at their side. Relatives also felt it easier to cope with the grieving process when they had shared their loved ones last moment. Conclusion: The attendance of relatives during cardiopulmonary resuscitation is still a relatively unexplored area. To be given the option to attend or not is important, as is continuous information during the resuscitation as well as a support person throughout the process. Relatives who were present during resuscitation showed lower tendency to experience negative psychological effects, and that the grieving process felt easier to go through.

Bakgrund: Omkring 10.000 människor drabbas årligen av hjärtstopp i samhället. För den bästa chansen till överlevnad krävs snabb behandling med HLR och defibrillering. Att medverka som närstående vid en återupplivning beskrivs som den mest traumatiska händelsen en människa kan bevittna, samtidigt ökas förståelsen av situationen och ger ett avslut. Sjuksköterskan har ett stort ansvar över patientens omvårdnad och relaterat till behovet av resurser och otillräckliga riktlinjer så kan sjuksköterskan hamna i en utsatt position. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskors erfarenheter av närståendes närvaro vid återupplivning med HLR efter hjärtstopp. Metod: En beskrivande litteraturstudie innehållande 12 vetenskapliga artiklar med kvalitativ, kvantitativ och mixad ansats. Artiklarna söktes fram genom den vetenskapliga databasen Medline via PubMed. Huvudresultat: Resultatet visade ingen konsensus i sjuksköterskornas erfarenheter. De ville inte ha närstående närvarande på grund av negativ effekt på utförandet. Känslor av otrygghet hos sjuksköterskorna skapades av närstående. Sjuksköterskorna ansåg att närstående blev traumatiserade av händelsen. Resursbehovet blev tydligt då sjuksköterskorna upplevde bemanningen för låg för att avsätta personal till närstående. Sjuksköterskornas professionalism ökade med närvaron och närståendes sorgeprocess främjades. Det var viktigt att beakta patientens egen önskning inom ämnet. Slutsats: Trots positiva effekter ansåg sjuksköterskorna att de negativa aspekterna dominerade. Det är en komplicerad fråga med olika åsikter. Informationen som framkommit ger insikter i hur närståendes närvaro upplevs. Detta behövs för att chefer och HLR-utbildade ska ta ställning, öka kunskapen och starta en diskussion om fenomenet. / Background: Approximately 10.000 people experience cardiac arrest every year. The best opportunity for survival is effective treatment with CPR and defibrillation. To participate as a relative during a resuscitation is described as traumatic, but it increases the understanding and gives a closure. Nurses have a responsibility for the patient’s care and due to resources and vague guidelines, nurses can be in an exposed position. Aim: The purpose of this study was to describe nurses’ experiences of relatives’ presence during resuscitation with CPR after cardiac arrest. Method: A descriptive literature review containing 12 scientific articles with qualitative, quantitative and mixed methods. The articles were identified in the database Medline via PubMed. Result: There was no consensus in the nurses’ experiences. They did not want relatives present due to negative impact on their work. Feelings regarding insecurity arose with relatives’ presence. According to the nurses, relatives became traumatized by the event. The staff level was too low to assign personnel to relatives due to the lack of resources. However, nurses also reported increased professionalism and that the relatives’ grieving process benefited. It was important to consider the patient's wishes on the subject. Conclusion: Despite positive effects, the nurses felt that the negative aspects dominated. It is a complicated question with multiple views. The results provide knowledge on how the presence of relatives is experienced. This is needed for personnel to take a stand, be educated and start to discuss the phenomenon.