Factors influencing decision-making around family presence during resuscitation: a grounded theory study.
OBJECTIVE
The aim of this study was to examine factors impacting family presence during resuscitation practices in the acute care setting.


BACKGROUND
Family presence during resuscitation was introduced in the 1980s, so family members/significant others could be with their loved ones during life-threatening events. Evidence demonstrates important benefits; yet despite growing support from the public and endorsement from professional groups, family presence is practiced inconsistently and rationales for poor uptake are unclear.


METHODS
Constructivist grounded theory design.


METHODS
Twenty-five health professionals, family members and patients informed the study. In-depth interviews were undertaken between October 2013-November 2014 to interpret and explain their meanings and actions when deciding whether to practice or participate in FPDR.


RESULTS
The Social Construction of Conditional Permission explains the social processes at work when deciding to adopt or reject family presence during resuscitation. These processes included claiming ownership, prioritizing preferences and rights, assessing suitability, setting boundaries and protecting others/self. In the absence of formal policies, decision-making was influenced primarily by peoples' values, preferences and pre-existing expectations around societal roles and associated status between health professionals and consumers. As a result, practices were sporadic, inconsistent and often paternalistic rather than collaborative.


CONCLUSIONS
An increased awareness of the important benefits of family presence and the implementation of clinical protocols are recommended as an important starting point to address current variations and inconsistencies in practice. These measures would ensure future practice is guided by evidence and standards for health consumer safety and welfare rather than personal values and preferences of the individuals 'in charge' of permissions.
Flinders University School of Nursing and Midwifery, Adelaide, South Australia, Australia. tracey.giles@flinders.edu.au.
Tracey
T
Giles
Flinders University School of Nursing and Midwifery, Adelaide, South Australia, Australia.
Sheryl
S
de Lacey
Flinders University School of Nursing and Midwifery, Adelaide, South Australia, Australia.
Eimear
http://orcid.org/0000-0002-5036-4908
E
Muir-Cochrane
D003422:Critical Care; D003657:Decision Making; D005190:Family; D066296:Grounded Theory; D006801:Humans; D012151:Resuscitation
acute care; cardiopulmonary resuscitation; decision-making; family presence; grounded theory; nursing; qualitative research