title: Health care professionals' concerns regarding in-hospital family-witnessed cardiopulmonary resuscitation implementation into clinical practice.
abstract: In-hospital, family-witnessed cardiopulmonary resuscitation of adults has been found to help patients' family members deal with the short- and long-term emotional consequences of resuscitation. Because of its benefits, many national and international nursing and medical organizations officially recommend this practice. Research, however, shows that family-witnessed resuscitation is not widely implemented in clinical practice, and health care professionals generally do not favour this recommendation.
  
  
  
  To describe and provide an initial basis for understanding health care professionals' views and perspectives regarding the implementation of an in-hospital, family-witnessed adult resuscitation practice in two European countries.
  
  
  
  An inductive qualitative approach was used in this study.
  
  
  
  Finnish (n = 93) and Polish (n = 75) emergency and intensive care nurses and physicians provided written responses to queries regarding their personal observations, concerns and comments about in-hospital, family-witnessed resuscitation of an adult. Data were analysed using inductive thematic analysis.
  
  
  
  The study analysis yielded five themes characterizing health care professionals' main concerns regarding family-witnessed resuscitation: (1) family's horror, (2) disturbed workflow (3) no support for the family, (4) staff preparation and (5) situation-based decision.
  
  
  
  Despite existing evidence revealing the positive influence of family-witnessed resuscitation on patients, relatives and cardiopulmonary resuscitation process, Finnish and Polish health care providers cited a number of personal and organizational barriers against this practice. The results of this study begin to examine reasons why family-witnessed resuscitation has not been widely implemented in practice. In order to successfully apply current evidence-based resuscitation guidelines, provider concerns need to be addressed through educational and organizational changes.
  
  
  
  This study identified important implementation barriers for allowing families in critical care settings to be present during resuscitation efforts. These results can be further used in developing and adjusting clinical practice policies, protocols and guidelines related to family-witnessed resuscitation.
authors.affiliation: Early Stage Researcher, University of Eastern Finland, Faculty of Health Sciences, Department of Nursing Science, Kuopio, Finland.
authors.forename: Natalia
authors.initials: N
authors.lastname: Sak-Dankosky
authors.affiliation: The Medical University of Warsaw, 2nd Department of Anaesthesiology and Intensive Therapy, Public Central Teaching HospitalWarsaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Andruszkiewicz
authors.affiliation: Vice Chair for Research, University of Pittsburgh, School of Nursing, Department of Acute & Tertiary Care, Pittsburgh, PA, USA.
authors.forename: Paula R
authors.initials: PR
authors.lastname: Sherwood
authors.affiliation: University Researcher, University of Eastern Finland, Faculty of Health Sciences, Department of Nursing Science, Kuopio, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Kvist
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000523:psychology*; D003657:Decision Making; D005060:Europe; D005190:Family / Q000523:psychology*; D005387:Finland; D017408:Guidelines as Topic; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D009936:Organizational Innovation; D036301:Qualitative Research
keywords: attitude of health personnel; ethical issues; family; family-witnessed resuscitation; in-hospital cardiac arrest