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JAN ORIGINAL RESEARCH

Presence of patients’ families during cardiopulmonary resuscitation:


physicians’ and nurses’ opinions
Fatma Demir

Accepted for publication 14 April 2008

Correspondence to F. Demir: D E M I R F . ( 2 0 0 8 ) Presence of patients’ families during cardiopulmonary resusci-


e-mail: fatma.demir@ege.edu.tr or tation: physicians’ and nurses’ opinions. Journal of Advanced Nursing 63(4), 409–
fddemir@yahoo.com 416
doi: 10.1111/j.1365-2648.2008.04725.x
Fatma Demir PhD
Assistant Professor
School of Nursing, Ege University, Izmir, Abstract
Turkey Title. Presence of patients’ families during cardiopulmonary resuscitation: physi-
cians’ and nurses’ opinions.
Aim. This paper is a report of a study to determine the opinions of physicians and
nurses who work in a university hospital intensive care unit and emergency
department about the presence of patients’ families during cardiopulmonary
resuscitation in these units.
Background. Healthcare professionals have conflicting opinions about the presence
of patients’ families during cardiopulmonary resuscitation. Families who are al-
lowed to be present have less fear and worry, feel they have supported their family
member and are able to cope more easily.
Method. The data for this descriptive questionnaire study were collected between
November 2006 and January 2007. The respondents were 62 physicians and 82
nurses who worked in an emergency department or in cardiology or anaesthesia
intensive care units in Turkey. The data were collected using a questionnaire and the
responses summarized using frequencies and percentages. The chi-squared test was
performed to test for differences in the opinion by profession, educational level, or
number of years of working experience in the profession.
Findings. The response rate was 79%. Of the respondents, 82Æ6% did not think it
was appropriate for patients’ families to be present during cardiopulmonary
resuscitation. The most common concerns mentioned were that the family would
interfere with the team’s activities (56Æ3%) and that resuscitation is a very traumatic
procedure (43Æ6%).
Conclusion. Policies need to be developed regarding this topic because the absence
of policy can cause misunderstanding and differences in practice. Further research is
needed to determine what public education is needed to facilitate implementation of
such policies.

Keywords: cardiopulmonary resuscitation, emergency nursing, family presence,


family-centred care, intensive care unit nursing, nursing, opinion

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F. Demir

the choice of being present during resuscitation. The Euro-


Introduction
pean Resuscitation Council (Baskett et al. 2005) also recom-
Cardiopulmonary resuscitation (CPR) is a combination of mended in their resuscitation guidelines that families be given
rescue breathing and chest compressions delivered to victims the choice of being present during CPR; the American Heart
thought to be in cardiac arrest (American Heart Association Association and the American Association of Critical Care
2007). It is generally implemented after cardiac arrest for the Nurses (2004) issued their own guidelines (Spittler 2006). In
purpose of saving the patient’s life (American Heart Associ- 2005, the American Heart Association advocated that this
ation 2005, Weslien et al. 2005). practice needed to be addressed during advanced cardiac life
Having a family member or members present in visual or support and paediatric advanced cardiac life support courses,
physical contact with the patient during CPR is known as and the ENA included this in their recommended trauma
‘Patient’s Family Presence During CPR’ (Meyers et al. 2000, nursing core course (Spittler 2006).
Mason 2003, Meyers et al. 2004). There are advantages and disadvantages of having patients’
However, allowing the presence of family members during families present during CPR for the patient, the family and
CPR is an ethical issue. Resuscitation is a procedure that is the healthcare professionals (Boudreaux et al. 2002, Sanford
generally implemented suddenly and the survival rate after et al. 2002, MacLean et al. 2003, Meyers et al. 2004,
the procedure is low (American Heart Association 2000, Aldridge & Clark 2005, Dill & Gance-Cleveland 2005), and
2005, Baskett et al. 2005). Families who do not witness these are summarized in Table 1.
resuscitation attempts are left anxiously awaiting an outcome Family presence during CPR is not a requirement or right
in waiting rooms. If the patient does not survive, families are but a choice, and it may not be appropriate for every family
confronted with concerns that not enough was carried out to (Redley et al. 2004, Aldridge & Clark 2005). However, it is
save the patient, guilt that they were not with them and recommended that a policy be developed for this procedure. In
sadness that they did not have a chance to say goodbye. such a policy, it is necessary for one of the healthcare
However, studies have shown that families who are allowed professionals (usually a nurse or physician) to be given this
to stay with the patient during CPR have less fear and worry, duty to meet the family and determine whether or not the
feel they have supported their family member, are able to family will be able to tolerate the situation. When the CPR
cope more easily with their loss and feel like they have a right team deems appropriate, this individual meets with the
to be with their loved one at such a critical time (American patient’s family, explains the situation and gives them the
Heart Association 2000, Sanford et al. 2002, Tercier 2002, option of going to the patient’s side for 3–5 minutes. When
Meyers et al. 2004, Redley et al. 2004, Aldridge & Clark this choice is accepted, this individual then gives the family
2005, Baskett et al. 2005, Dill & Gance-Cleveland 2005). some information about the healthcare personnel, patient’s
Despite international research and guidelines offering the appearance, how the procedure is carried out and for what
option of family presence during CPR, this practice remains situations they will be taken out of the room, and then stays
highly controversial among healthcare providers and, as a with the family and answers their questions while they are in
consequence, is rarely adopted in practice (Halm 2005). the resuscitation area (Meyers et al. 2004, Baskett et al. 2005).
Concerns about possible disruption to the resuscitation team, Most research on this topic has been conducted to
the risk of litigation and lasting traumatic memories for determine the opinions of families and healthcare profession-
patients’ families are cited as factors that inhibit uptake of the als about having patients’ families present during CPR.
practice (Boudreaux et al. 2002, Sanford et al. 2002, Findings from these studies revealed that the healthcare
MacLean et al. 2003, Meyers et al. 2004, Aldridge & Clark providers have mixed opinions regarding this practice.
2005, Dill & Gance-Cleveland 2005, Halm 2005). Helmer et al. (2000) reported that 64% of emergency nurses
and 18% of surgeons found the practice beneficial. In the
study by MacLean et al. (2003), 75% of intensive care unit
Background
and emergency department nurses supported the presence of
The first reported practice of family-witnessed resuscitation families during CPR, and in the study by Meyers et al. (2004)
took place at the Foot Hospital in Michigan in the United 96% of emergency department nurses supported it. The
States of America in 1982. Doyle et al. (1987) published this Meyers et al. (2000) and McClenathan et al. (2002) studies
report, which was based on a study conducted with 70 family showed that nurses supported the practice more than did
members who were present during resuscitation. physicians.
The Emergency Nursing Association (ENA 2005) recom- Studies have also shown that families want to be able to
mended that clinical guidelines should offer family members stay with the patient during CPR. In a study by Doyle et al.

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JAN: ORIGINAL RESEARCH Presence of patients’ families during cardiopulmonary resuscitation

Table 1 The advantages and disadvantages of having patients’ families present during cardiopulmonary resuscitation (CPR)

Advantages Disadvantages

The presence of patients’ families during CPR gives families an CPR is a very traumatic event for patients’ families
opportunity to say goodbye
Families are aware of the effort given for their patients. They There is the possibility of repercussions (e.g. complaints, legal action)
are witnesses to everything necessary being carried out
Families feel like they supported the patient and did not leave Families may interfere with procedures
them alone
Fear and worry of families are lessened. It has a positive effect The team may be uncomfortable
on grieving and coping processes
With this practice the patient and family are considered as a It has a negative effect on patients’ privacy/confidentiality
whole, family-centred care is provided and professional
behaviours are displayed
There may not be enough room for the patients’ families in the
resuscitation room
It may have a negative effect on the technical performance of the
resuscitation team
If there are incorrect procedures litigation may occur
When CPR is unsuccessful there may be less confidence in the physician
It may increase the stress on the team
Families may not be able to endure this situation and may faint. Then the
team may have to care for the family member instead of taking care of
the patient, and their work would be hindered

(1987), 94% of families who stayed with the patient stated emergency department about the practice of the presence of
that if the same situation occurred again they would choose patients’ families during CPR in these units.
to be with the patient again, and 76% stated that staying was
beneficial in helping them accept the death. In the 1998 study
Design
by Meyers et al. 80% of the families would want to stay, and
in the 2000 study 97Æ5% of the families stated that they A descriptive survey design was used.
would want to be with the patient during CPR, and 100%
stated that this would be beneficial for them.
Participants
In recent years, influenced by professional organizations,
the media and research conducted on this topic, there has The study was conducted with staff in the emergency
been a steady increase in the practice of allowing family department and the cardiology and anaesthesia intensive
members to be present during CPR (Boudreaux et al. 2002, care units of an 1811-bed, university-affiliated hospital in
McClenathan et al. 2002, MacLean et al. 2003, Meyers et al. western Turkey. There were 102 nurses and 79 physicians
2004, Redley et al. 2004, Dill & Gance-Cleveland 2005). In working in these departments at the time of the study, and 62
spite of these developments and research, healthcare profes- physicians and 82 nurses participated. Therefore the response
sionals continue to have conflicting opinions on the issue rate was 79%. Among the 144 participants, 25 worked in
(Mason 2003, Meyers et al. 2004, Redley et al. 2004, Dill & emergency department, 41 in cardiology and 78 in the
Gance-Cleveland 2005, Fulbrook et al. 2005). These con- anaesthesia intensive care unit.
flicting opinions are also reflected in practice areas, and
institutional and personal differences occur (MacLean et al.
Data collection
2003).
The data were collected between 1 November 2006 and 26
January 2007. The aim of the study was explained to the
The study
nurses and physicians at continuing education meetings in
their departments. The survey questionnaire developed by the
Aim
researcher based on the literature was given to those who
The aim of the study was to determine the opinions of agreed to participate in the study. There were four open-
physicians and nurses who work intensive care unit and in an ended and 17 multiple choices in the questionnaire. The

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F. Demir

open-ended questions concerned why was it necessary for Table 2 Respondent demographics
family members to be present or not to be present during Number (%)
CPR, who should make this decision, if the family was given
permission to be present during CPR what kind of reaction Department
Emergency department 25 (17Æ4)
they had, and whether or not the respondent had anything
Anaesthesia intensive care unit 78 (54Æ2)
they wanted to add. Cardiology intensive care unit 41 (28Æ4)
Age (years)
<30 96 (66Æ7)
Ethical considerations 30–39 40 (27Æ8)
40–49 5 (3Æ5)
The study was approved by a university ethics committee and
50–59 2 (1Æ4)
the medical directors of the hospital. Participant consent was ‡60 1 (0Æ7)
assumed by return of a completed questionnaire. Gender
Female 106 (73Æ6)
Male 38 (26Æ4)
Data analysis Profession
Physician 62 (43Æ1)
The data were evaluated using Statistical Package for Social
Nurse 82 (56Æ9)
Sciences. The responses were summarized using frequencies Education of physicians (n = 62)
and percentages. Responses to the open-ended questions were Medical degree 40 (64Æ5)
content analysed. The chi-square test was performed to test Specialization 22 (35Æ5)
for differences in opinion by profession, educational level and Education of nurses (n = 82)
Associate degree 9 (10Æ9)
number of years of working experience in the profession.
Baccalaureate degree 72 (87Æ9)
Master’s degree 1 (1Æ2)
Primary position of physician (n = 62)
Findings
Research assistant 40 (64Æ5)
The age range of the participating physicians and nurses’ was Specialist 15 (24Æ2)
22–62 years. The mean age was 29Æ18 ± 6Æ11, the median Associate professor 4 (6Æ5)
Professor 3 (4Æ8)
was 27Æ50 ± 6Æ11 and the interquartile range (Q3–Q1) was
Primary position of nurse (n = 82)
6Æ75 years. Participant demographics are given in Table 2. Manager/administrator nurse 9 (11Æ0)
Respondents who thought it appropriate for the families to Ward/intensive care unit nurse 73 (89Æ0)
be present during CPR (13/144) were asked why this was Number of years in profession
necessary. Of these, 76Æ9% (10/13) stated that families could <3 69 (47Æ9)
4–7 35 (24Æ3)
see how much effort was made, 69Æ2% (9/13) that they would
8–11 22 (15Æ3)
be able to accept the situation more easily, 46Æ1% (6/13) that 12–15 9 (6Æ3)
it is a family’s right, 15Æ3% (2/13) that it increases families’ 16–19 3 (2Æ1)
confidence in physicians and 7Æ6% (1/13) that it improves ‡20 6 (4Æ2)
professional behaviour. Total 144 (100Æ0)
The percentage of physicians and nurses who did not think
it appropriate for the patients’ families to be present during permission (3Æ3%, 4/119), it would lengthen the time of
CPR was 82Æ6% (119 of 144). The reasons given for this were resuscitation (2Æ5%, 3/119), there were no national guidelines
as follows: they would interfere with the team’s activities on this topic (1Æ6%, 2/119), there might be litigation against
(56Æ3%, 67 of 119), the procedure was extremely traumatic them (0Æ8%, 1/119) and there was not enough space for the
(43Æ6%, 52 of 119), the team would be under pressure and patient’s family in the work environment (0Æ8%, 1/119).
this would have a negative effect on their performance Respondents who stated that they had given permission for
(22Æ6%, 27 of 119), the family would incorrectly interpret the families to be present during CPR (8Æ3%) were asked how
CPR procedure (21Æ8%, 26/119), the practice is not appro- this affected the families. Of these 5Æ5%, stated that family
priate for the cultural background and educational level of members became ill and fainted, 2Æ7% that family members
the Turkish public (15Æ9%, 19/119), family members might experienced fear, worry and anxiety, 1Æ3% that family
become ill or might faint and force the team to have to leave members felt guilty because it was a traumatic event, but
the patient to deal with them (15Æ9%, 19/119), only family 91Æ6% of respondents had never given permission to family
members who are also healthcare personnel should be given members to observe CPR.

412  2008 The Author. Journal compilation  2008 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH Presence of patients’ families during cardiopulmonary resuscitation

The decision about whether the family could be present level (v2 = 1Æ844, d.f. = 4, P = 0Æ764) or number of years of
during CPR should be a team decision, according to 47Æ2% of working experience in the profession (v2 = 9Æ977, d.f. = 10,
the participating physicians and nurses; however, others P = 0Æ443).
thought that the decision should be made by a physician and
nurse (26Æ4%), a physician (20Æ8%), the physician and family
Discussion
(2Æ8%), or the family members (2Æ7%).
In response to the question about whether or not they
Study limitations
would like to add anything, 84Æ1% of physicians and nurses
did not add anything, but 8Æ3% stated that the Turkish This study was conducted in a university hospital emergency
public’s cultural background and educational levels were not department, cardiology and anaesthesia intensive care units
appropriate for observing this procedure, 5Æ5% that it was with physicians and nurses who were willing to participate.
not necessary to traumatize the relatives and 2Æ1% that only There are some differences between the emergency depart-
family members who were also healthcare personnel should ment and intensive care unit in terms of the rate of CPR,
be given permission to observe CPR. patients’ conditions and the work environment. The fact that
Responses to the fixed-choice questionnaire items are participants worked in the different departments may be a
shown in Table 3. There were no statistically significant limitation of this study. In addition, the research would have
differences according to chi-square test for finding the been more comprehensive if patients’ family members had
families’ presence during CPR to be appropriate according been included. Finally, in Turkey, health services are
to profession (v2 = 5Æ660, d.f. = 2, P = 0Æ060), educational provided by the Ministry of Health and funded by the

Table 3 Responses to fixed-choice questionnaire items about family presence during cardiopulmonary resuscitation (CPR)

Number (%)

In your opinion should the patient’s family be present during CPR?


Yes 13 (9Æ0)
No 119 (82Æ6)
No idea 12 (8Æ4)
What are the practices related to family presence during CPR in the unit where you work?
We do not have any written policy that permits the presence of the patient’s family but we do 3 (2Æ1)
give permission
We do not have any written policy that permits the presence of the patient’s family and we do 135 (93Æ8)
not permit it
We do not have any written policy that permits the presence of the patient’s family but we do 2 (1Æ4)
give permission occasionally
We have a written policy that forbids the presence of patient’s families so we do not give permission 4 (2Æ8)
Have you received education about a family’s presence during CPR?
Yes, during my baccalaureate education 3 (2Æ1)
Yes, during my specialist training 1 (0Æ7)
Yes, in continuing education 2 (1Æ4)
Yes, at a conference, symposium 3 (2Æ1)
No, I have not 135 (93Æ8)
Have you read any articles/research about the families’ presence during CPR?
Yes 20 (13Æ9)
No 124 (86Æ1)
Did you know that international guidelines have recommendations on this subject?
Yes 3 (2Æ1)
No 141 (97Æ9)
Until now have you ever had a family member who wanted to be with the patient during CPR?
Rarely 51 (35Æ4)
Never 93 (64Æ6)
Until now have you ever given permission to a family member to observe CPR?
Rarely 12 (8Æ3)
Never 132 (91Æ7)
Total 144 (100Æ0)

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F. Demir

Ministry of Finance. Therefore, it is not possible to make emotional effect on the family. In the study by Meyers et al.
direct comparisons with reports in the literature which relate (2004), 57% of healthcare professionals were concerned that
to countries where health care is funded through insurance or the family would incorrectly interpret CPR and later demand
other systems. However, it is suggested that the findings in a legal investigation, while 26% of nurses said this in the
this study are useful at a national and an international level study by Fulbrook et al. (2005). In the current study,
by reflecting cultural differences in the opinions of healthcare however, 21Æ8% of respondents thought that the family
professionals. would incorrectly interpret the CPR procedure, and 0Æ8%
that they might open a court case. This result may have
occurred because of the low numbers of court cases opened
Discussion of findings
against healthcare personnel in Turkey. In contrast to all
Very few respondents (9%, 13 of 144) found it appropriate these concerns, no reports were found in the literature of
for patients’ families to be present during CPR. This result is problems with having the patients’ families present during
very low in comparison with other research conducted in CPR, that families interfered with the procedure or that being
recent years (MacLean et al. 2003, Meyers et al. 2004, Halm present had a negative effect on the family (MacLean et al.
2005). In the study by MacLean et al. (2003) 75% of 2003, Redley et al. 2004, Aldridge & Clark 2005, Dill &
intensive care unit and emergency department nurses and in Gance-Cleveland 2005). During CPR when the family is
the study by Meyers et al. (2004) 96% of emergency given the choice with the appropriate conditions mentioned
department nurses supported the presence of families during above, the concerns of healthcare professionals on this
CPR. This difference in acceptance level may arise from subject may be alleviated.
cultural differences There has been no research in Turkey on In the present study, a very small percentage (2Æ5%, three of
how physicians’ or nurses’ assumptions about patients’ 119) of respondents thought that the duration of the resusci-
cultural and educational backgrounds affect their decisions tation procedure would be extended in the presence of the
for their patients. Although this issue needs further investi- family. In the study by Fulbrook et al. (2005) 38Æ7% of the
gation, it is common for older and uneducated Turkish nurses thought that this would be the case, but in the study by
women, in particular, but also for Turkish men, to express Meyers et al. (2004) 85% of healthcare professionals stated
their grief physically with loud wailing, beating their chests that they could comfortably work in the presence of the family
and fainting. Patients’ family members have even assaulted during CPR and 84% that, even if the family was present, their
emergency department physicians and nurses in Turkey when performance and the patient outcomes would not change.
a patient has died. There is also the unfounded assumption by Nearly all (93Æ8%, 135 of 144) of the respondents in the
nurses and physicians that people who are more culturally present study stated that there was no written policy on this
‘refined’ and have a higher educational level will be more topic in the unit where they worked, and the that family
likely to go to a private hospital and that the majority of their members were not permitted to be present during CPR. In the
patients at a university hospital are culturally ‘ignorant and study by MacLean et al. (2003) with intensive care unit and
backward’. Although these attitudes are difficult to quantify, emergency department nurses, the presence of a policy giving
they may have bearing on physicians and nurses’ attitudes the family the permission to be present during CPR was 5%
towards their patients, being judgmental, belittling or, in this and the presence of a policy forbidding their presence was
instance, not being willing to take the time to explain CPR to 1%. Our findings are therefore consistent with the literature.
family members. Four of the physicians and nurses included in our research
In this study, the percentage of physicians and nurses who stated that there was a written policy forbidding the presence
did not think it was appropriate for the patients’ families to of the patients’ families during CPR. However, this is not
be present during CPR was very high (82Æ6%, 119 of 144) consistent with responses from other individuals working on
(Table 3). The reasons given for this were that the family the same units. The managers of the three units where this
would interfere with the team (56Æ3%, 67 of 119), that the research was conducted were asked about this situation and
procedure was extremely traumatic (43Æ6%, 52 of 144), and they responded that there was no written policy. In conclu-
that the team would be under pressure (22Æ6%, 27 of 119) sion, none of the units where this research was conducted had
and it would have a negative effect on their performance. In a a policy (giving permission or forbidding it) about the
study by Meyers et al. (2004), 38% of the healthcare presence of families during CPR. Not having a formal policy
professionals thought that the family would interfere with may have led to misunderstanding and different practices.
CPR, while Fulbrook et al. (2005) reported that 20Æ2% of the Previous research has shown that the overwhelming
nurses studied were concerned that it would have a negative majority of families want to be with the patient during

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JAN: ORIGINAL RESEARCH Presence of patients’ families during cardiopulmonary resuscitation

differences in responses to illness and death. In this study,


What is already known about this topic 15Æ9% of respondents who stated that it was not appropriate
• Healthcare professionals have conflicting opinions for the family to be present during CPR gave the reason as the
about the presence of patients’ families during car- public was not having appropriate cultural backgrounds and
diopulmonary resuscitation (CPR). educational levels. This differs from reports in the literature.
• Studies and guidelines offer the option of the presence In addition, in this study, the high percentage (91Æ7%) of
of patients’ families during CPR. the physicians and nurses who have not given permission to
the patients’ families to be present during CPR may be
interpreted as their traditional practices and their lack of
What this paper adds knowledge on this current topic continues. An indicator of
• The majority of physicians and nurses did not think it this assumption is the finding that nearly all of the partici-
appropriate for patients’ families to be present during pants (93Æ8%) stated that they had not received education on
CPR. this topic, did not know that professional organizations had
• The concerns of participants were consistent with made recommendations about it (97Æ9%) and had not read an
those reported in the literature except, that they article or research about it (86Æ1%) (Table 3). It is suggested
thought that the cultural background and educational that it would be beneficial to deal with the conflicting
level of the public were not appropriate for their information that healthcare professionals have about this
attendance during resuscitation attempts. topic in continuing education programmes, and by develop-
• Policies need to be developed regarding this topic be- ing written policies, starting national guideline development
cause the absence of policy can cause misunderstand- projects, and following international publications and guide-
ing and differences in practice. lines.
• Further research is needed to determine what public According to reports in the literature, nurses support the
education is needed to facilitate implementation of presence of families during CPR more than do the physicians
such policies. (Helmer et al. 2000, Meyers et al. 2000, 2004, Boudreaux
et al. 2002, McClenathan et al. 2002, MacLean et al. 2003,
Mason 2003, Redley et al. 2004, Fulbrook et al. 2005). As
educational level and years of experience in the profession
CPR (Doyle et al. 1987, Meyers et al. 1998, Eichhorn et al. increase, the percentage of those supporting family presence
2001, Redley et al. 2004, Baskett et al. 2005). However, in during CPR also increases (Helmer et al. 2000, Meyers et al.
the present study only one-third (35Æ4%) of the participating 2000, Redley et al. 2004). In contrast, in this study, no
physicians and nurses stated that families had asked to be statistically significant differences were found in relation to
with the patient during CPR (Table 3). This percentage is finding the family’s presence during CPR to be appropriate
similar to that in the study by MacLean et al. (2003) but according to profession, educational level or number of years
lower than in the Helmer et al. (2000) study. of working experience in the profession. This may be a result
Respondents who stated that they had given permission to of an inadequate number of personnel available to support
families to be present during CPR (8Æ3%) were asked how the family during CPR.
this affected the family, and they reported that all have had
negative experiences. This finding is different from that
Conclusion
reported in the literature, where the majority of healthcare
professionals describe positive experiences (Doyle et al. 1987, Nearly all of the physicians and the nurses who participated
Meyers et al. 2000, MacLean et al. 2003). In addition, it is in this research did not think that it was appropriate for
known that the presence of the families during CPR is patients’ families to be present during CPR. The opinions and
beneficial to the patient, the family and the healthcare experiences of families need to be investigated to evaluate the
professionals (MacLean et al. 2003). In the study by effects of cultural background and educational level on the
MacLean et al. (2003), 44% of nurses stated that it was topic. However, the absence of a permitting or forbidding
very beneficial for the patient and the family to be present policy can cause misunderstanding and differences in
during CPR. In the current study, the reactions reported to practice. It would be possible to eliminate the differences
have been shown by family members present during CPR and unnecessary concerns about this practice by developing a
may have been a result of lack of preparation, lack of formal policy for the units where this research was con-
attention from healthcare personnel during CPR, or cultural ducted.

 2008 The Author. Journal compilation  2008 Blackwell Publishing Ltd 415
F. Demir

Author contributions members present during cardiopulmonary resuscitation. Interna-


tional Journal of Nursing Studies 42, 557–568.
FD performed study design, data collection, data analysis and Halm M.A. (2005) Family presence during resuscitation: a critical
drafting of the manuscript. review of the literature. American Journal of Critical Care 14, 494–
511.
Helmer S.D., Smith R.S., Dort J.M., Shapiro W.M. & Katan B.S.
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