Running head: INTEGRATIVE LITERATURE REVIEW 1

Integrative Literature Review

Kathleen E. Fleck

Bon Secours Memorial College of Nursing

Christine Turner, PhD

NUR 4122

November 12, 2017

“I Pledge”
INTEGRATIVE LITERATURE REVIEW 2

Abstract

The purpose of this integrative review is to examine literature related to the effects of family

presence during resuscitation on their perception of the experience. The recent shift from patient-

centered to family-centered delivery of healthcare has led to an increased interest in the potential

benefits associated with family witnessed resuscitation. Databases such as PubMed, OVID, and

EBSCO Medline Complete were utilized to find research articles. Research articles were selected

based on their satisfaction of the detailed research criteria designated for this specific topic. The

final selection resulted in five research articles, three quantitative, one qualitative, and one mixed

study. The results of these studies are synonymous and clearly identify the benefits of allowing

family members to witness resuscitation of their loved ones. Not only did family members

experience a decrease in psychological feelings of anxiety, depression, and stress, but they also

experienced a sense of relief. There are limitations to this review primarily stemming from the

lack of experience and authority of the writer. Providers of healthcare can use the results found

in this literature review as evidence to support the practice of giving family members the option

to witness resuscitation. Knowing that presence during resuscitation can ultimately benefit the

psychological state of family members in the future, resources should be available to

accommodate those needs. Improvement to future research can be executed by focusing on

long-term psychological effects on family members who witness resuscitation in addition to

initial outcomes.
INTEGRATIVE LITERATURE REVIEW 3

Integrative Literature Review

The purpose of this integrative review is to identify the positive and negative

psychological effects and experiences of witnessed resuscitation on family members who are

present during resuscitation. There has been a recent shift in the delivery of healthcare from

patient-centered to family-centered care resulting in the development of family presence studies

(O’Connell et al., 2017). Previous research around this topic has shown that family members

who are present during resuscitation are at risk of developing future emotional and physical

issues (Jabre et al., 2013). On the other hand, witnessing resuscitation has been shown to

potentially benefit family members by decreasing post-traumatic stress disorder (PTSD)

symptoms and showing them that life saving measures were exhausted (Jabre et al., 2013).

Overall, little background information exists in regards to the experiences of family

members who have witnessed resuscitation of a loved one (De Stefano et al., 2016). This

shortage of research has led to a lack of acceptance of the practice in many instances (O’Connell

et al., 2017). The aim of this literature review is to collect appropriate information regarding the

writer’s PICOT question, “In family members, what is the effect of witnessing resuscitation on

their perception of the experience compared with not witnessing resuscitation after the event?”

Design and Search Methods

The research design is an integrative review. The online databases utilized for the search

were PubMed, OVID, and EBSCO Medline Complete. Key terms that were used when

conducting the search were family presence, resuscitation, FPDR, and witnessing resuscitation.

The databases yielded approximately 450 articles. In order to uphold consistency, the search was

limited to peer-reviewed research studies, written in English, and published within the past 5

years. The range of publication dates began in 2013 and ended in 2017. Other filters were
INTEGRATIVE LITERATURE REVIEW 4

applied to narrow down the search even further and yielded only articles from academic journals

with full-text available.

The final criteria for inclusion was that the article pertain to the PICOT question, “In

family members, what is the effect of witnessing resuscitation on their perception of the

experience compared with not witnessing resuscitation after the event?” In order for the articles

to be included in the literature review, the writer ensured that the perspective of each article

focused on the family member and not the healthcare team members or patient. The final

selection resulted in five research articles, three quantitative (Jabre et al., 2013; Leske,

McAndrew, Brasel, & Feetham, 2017; Soleimanpour et al., 2017), one qualitative (De Stefano et

al., 2016), and one mixed (O’Connell et al., 2017) study.

Findings and Results

The results and findings of the five reviewed research studies clearly identify the benefits

of allowing family members to witness resuscitation (De Stefano et al., 2016; Jabre et al., 2013;

Leske et al., 2017; O’Connell et al., 2017; Soleimanpour et al., 2017). A summary of each

research article is located in Table 1: Qualitative and Quantitative Article Evaluation. The writer

structured the review based on the summaries of each individual research study.

In a qualitative study by De Stefano et al. (2016), researchers sought to understand, “how

families experience cardiopulmonary resuscitation of a relative, by detailing the emotional

meaning of the benefits and disadvantages of their presence” (p. 2) during the event. This study

was based in France used a sequential explanatory design. Researchers explored opinions related

to the experience of the family members regarding their decision to be present during

resuscitation or to not be present to further interpret the findings of a quantitative study. The

initial sample size consisted of 540 participants, however, “saturation was reached after the
INTEGRATIVE LITERATURE REVIEW 5

analysis of 30 interviews out of a randomly selected sample of 75 family members” (p. 1). Data

collection strategies consisted of a clinical psychologist led pre-drafted telephone interview that

covered three topics concerning the family member and their experience. Interview data was

analyzed using the “grounded theory and based on a technique of constant comparison” (p. 4).

Researchers used the NVivo software v. 10 to analyze data and uncovered four principle themes

and twelve sub-themes. Examples include, “choosing to be actively involved, communication

between family and medical team, perception of the reality of death, and experience and reaction

of the relative witnessing resuscitation” (p. 4-9). Findings reflected that being present during

resuscitation tended to positively affect the family member in their perception, cognition, and

emotional feelings around the event.

In a quantitative study by Jabre et al. (2013), researchers tried to determine if family

members given the option of witnessing resuscitation had a reduction in PTSD-related

symptoms. This was a prospective, cluster-randomized, controlled trial study conducted on 570

relatives of patients given resuscitation in a home setting in France. Data was collected 90 days

after the resuscitation event using a structured questionnaire conducted over the telephone by a

psychologist. The Impact of Event Scale (IES) and Hospital Anxiety and Depression Scale

(HADS) were also used to evaluate the presence of PTSD-related symptoms in participants. Data

was analyzed using Student’s t-test, Wilcoxon signed-rank test, chi-square test, and Fischer’s

exact test. Results from the study were conclusive that PTSD-related symptoms, such as anxiety

and depression, are higher in the family members who were not present during resuscitation of

their loved one. The results from the study showed that the presence of family members during

resuscitation does not affect the effectiveness of resuscitation, patient survival, or the level of

emotional stress on the healthcare team.

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Leske et al. (2017) conducted a quantitative study with the purpose of examining the

effects of family presence during resuscitation on family outcomes in patients who survived a

traumatic injury, in this case related to gunshot wounds (GSW) and motor vehicle crashes

(MVC). A conceptual model was used as the framework for the study and depicted the influence

of family strengths on family outcomes. The research design was a multivariate, prospective, and

comparative study with 140 family members of trauma patients in a Level 1 Trauma Center in

Wisconsin. Data collection was conducted 72 hours after resuscitation in a private waiting area.

The following instruments were used to evaluate participant outcomes: Family Crisis-Oriented

Personal Evaluation Scale (F-COPES), Family Problem-Solving Communication Index, State

Trait Anxiety Inventory (STAI), Acute Stress Disorder Scale (ASD), Family Member Well-

being Index (FMWBI), and Family Satisfaction in the Intensive Care Unit Scale. Data was

analyzed using SPSS for windows software v. 22 and analysis of covariance (ANCOVA).

Findings yielded by the study showed the initial effects of witnessed resuscitation on the family

member. These results indicated that family presence during resuscitation resulted in decreased

anxiety, stress, and improved the overall well-being of the family member.

O’Connell et al. (2017) used a mixed methods study to address the attitudes, behaviors,

and experiences of family members witnessing the resuscitation of a pediatric patient. A sample

of 126 family members were observed in three Level 1 Pediatric Trauma Centers located in

Texas, Pennsylvania, and Washington, DC. Data was collected three to six months after the

event via structured telephone interviews and focus groups. The Parental Family Present Attitude

Scale-FM (PFPAS-FM) and Parental Family Not Present Attitude Scale-FM (PFNPAS-FM)

were used to evaluate the experiences of the study participants. The data was analyzed using

SAS version 9.2, chi-square, Fisher exact test, 2-sample t tests, analysis of variance, Wilcoxon
INTEGRATIVE LITERATURE REVIEW 7

rank-sum tests, and Kruskal-Wallis tests. The results of the study depicted a strong correlation

between family members who were present during resuscitation and reports of a positive

experience of the event. The themes identified by the authors illustrate that family member

presence reduces anxiety, allows family members to witness that all options were exhausted, and

ultimately facilitates the grieving process.

Soleimanpour et al. (2017) developed a quantitative study to increase evidence on the

effect of family presence during resuscitation and the future development of psychological

disorders. Using an interventional, quasi-experimental design, 133 family members were

observed in this study based in Iran . Participants were put into two variable groups: the

intervention group, made up of relatives who were present during resuscitation, and the control

group, made up of relatives who were not present to witness resuscitation. Data was collected 90

days after the resuscitation event through telephone interviews. The HADS and IES

questionnaires were used to evaluate participant outcomes. The data was analyzed using SPSS

version 16, chi-square, t test, and Mann-Whitney U-test. Results were compiled into three

categories, “being present, satisfaction, and coping with presence consequences” (p. 115). In

general the findings reflected a decrease in anxiety, depression, and stress and an increase in

coping ability in those family members who were present during resuscitation.

Discussion and Implications

The results of the research articles reviewed illustrate a noticeable positive correlation

between family members’ presence during resuscitation and their overall psychological

perception of the experience. The PICOT question set by the writer of this integrative review is

supported by the research included in this review, as evidenced by the similar results of the

studies. Although there has been speculation around family presence during resuscitation and the
INTEGRATIVE LITERATURE REVIEW 8

increased risk of future psychological issues, the results of this integrative review implicate that

the practice of allowing family to witness resuscitation is actually beneficial to those individuals

(De Stefano et al., 2016; Jabre et al., 2013; Leske et al., 2017; O’Connell et al., 2017;

Soleimanpour et al., 2017). One aspect of this integrative review that exhibits importance is the

inclusion of various global healthcare settings. For example, settings ranged from Level 1

Trauma Centers to home resuscitation efforts by trained medical professionals.

Due to the limited availability of evidence-based research regarding family witnessed

resuscitation, the practice of family presence during resuscitation is not a widely utilized concept

in many healthcare systems (De Stefano et al., 2016; Leske et al., 2017; O’Connell et al., 2017).

The results found during this literature review can be used by healthcare providers to support the

practice of giving family members the option to witness resuscitation. Knowing that presence

during resuscitation can ultimately benefit the psychological state of family members, resources

should be available to accommodate those needs. Improvements should be made in future

research to further support the current research results. Future research on this topic should

include examining long-term psychological effects on family members, rather than focusing on

initial results less than six months from the event.

Limitations

There was an abundance of limitations that should be mentioned regarding this

integrative review. The most impactful limitation is the lack of experience and authority of the

writer of this review, which leads to the decreased credibility of the literature review as a whole.

Another limitation is the lack of research regarding the topic as it directly pertains to the

perceptions of the family members witnessing the resuscitation, versus perceptions of the
INTEGRATIVE LITERATURE REVIEW 9

healthcare team or patient. All articles were published within the past five years, therefore, the

literature review is not exhaustive.

Each article presented with study-specific limitations including, inadequate sample size

and insufficient study design due to ethical limitations (O’Connell et al., 2017; Soleimanpour et

al., 2017). It should also be mentioned that not all of the studies pertained to patients who died

during resuscitation efforts; this infers that the results could have been significantly different had

the subjects all been exposed to the same situational outcome. A final limitation is the risk of

bias ensuing from the fact that this literature review is a class assignment.

Conclusion

Findings discussed in this integrative review support the PICOT question highlighting the

influence of family presence during resuscitation on the positive perceptions of the family

members’ experience. Common themes that emerged from family members witnessing

resuscitation efforts are a decreased incidence of anxiety, depression, and stress, as well as,

feelings of relief regarding the patient’s distress and the fact that all resuscitative actions were

exhausted (De Stefano et al., 2016; Jabre et al., 2013; Leske et al., 2017; O’Connell et al., 2017;

Soleimanpour et al., 2017). Providing family members with the option to witness resuscitation of

a loved one should be considered in healthcare settings as appropriate. Education pertaining to

the benefits of allowing family presence during resuscitation should be shared with all healthcare

team members so they understand the impact that this option can have on the future

psychological health of those family members.

INTEGRATIVE LITERATURE REVIEW 10

References

De Stefano, C., Normand, D., Jabre, P., Azoulay, E., Kentish-Barnes, N., Lapostolle, F., . . .

Adnet, F. (2016). Family presence during resuscitation: A qualitative analysis from a

national multicenter randomized clinical trial. Public Library of Science One, 11(6): 1-12.

doi:10.1371/journal.pone.0156100

Jabre, P., Belpomme, V., Azoulay, E., Jacob, L., Bertrand, L., Lapostolle, F., . . . Adnet, F.

(2013). Family presence during cardiopulmonary resuscitation. The New England

Journal of Medicine, 368(11): 1008-1018. doi:10.1056/NEJMoa1203366

Leske, J. S., McAndrew, N. S., Brasel, K. J., & Feetham, S. (2017). Family presence during

resuscitation after trauma. Journal of Trauma Nursing, 24(2): 85-96.

doi:10.1097/JTN.0000000000000271

O’Connell, K., Fritzeen, J., Guzzetta, C. E., Clark, A. P., Lloyd, C., Scott, S. H., . . . Kreling, B.

(2017). Family presence during trauma resuscitation: Family members’ attitudes,

behaviors, and experiences. American Journal of Critical Care, 26(3): 229-239.

doi:10.4037/ajcc2017503

Soleimanpour, H., Tabrizi, J. S., Rouhi, A. J., Golzari, S. E., Mahmoodpoor, A., Esfanjani, R.

M., & Soleimanpour, M. (2017). Psychological effects on patient’s relatives regarding

their presence during resuscitation. Journal of Cardiovascular and Thoracic Research,

9(2): 113-117. doi:10.15171/jcvtr.2017.19

INTEGRATIVE LITERATURE REVIEW 11

Table 1: Qualitative and Quantitative Article Evaluation

First Author De Stefano (2016) – Master of Science; Ph.D Candidate, AP-HP Emergency Medicine
(Year)/Qualifications (France); AP-HP, Department of Child and Adolescent Psychiatry and General Psychiatry;
Paris 13 Sorbonne University
Background/Problem  Little background information exists in regards to the qualitative experiences of family members
Statement who have witnessed resuscitation of a loved one.
 The purpose of this study is to understand how families experience CPR of a relative, by detailing
the emotional meaning of the benefits and disadvantages of their presence during resuscitation
Conceptual/theoretical  No theoretical framework is adequately identified in this study, as a result of the absence of not
Framework defining themes characterizing the experiences of family members.
 Researchers wanted to see if witnessing resuscitation had an effect on family member’s
perceptions of the experience.
Design/  Qualitative analysis w/ a sequential explanatory design
Method/Philosophical  Qualitative component of French randomized multicenter trial
Underpinnings  Researchers used opinions (or subjective data) related to the experience of the family members
regarding their decision to be present during resuscitation or to not be present to further interpret
the findings of a quantitative study
Sample/ Setting/Ethical  Initial sample size included 540 participants
Considerations  Setting: in the homes of person needing CPR
 Saturation was reached after analysis of 30 interviews out of randomly selected sample of 75
family members
 Ethical considerations- informed written consent received from participants & approval from
Patient Protection Committee of Aulnay-sous-Bois. Patient privacy maintained by restricting the
use of the full data set and by requiring anonymity in regards to interviews used in publications
Major Variables Studied (and  Intervention group- family members asked if they wanted to be present during CPR
their definition), if  Control group- family members not offered to witness CPR
appropriate
Measurement Tool/Data  Data collection strategies- clinical psychologist led pre-drafted telephone interview that covered
Collection Method 3 topics concerning the family member and their experience
 Data collected by means of recorder which was later copied to print
Data Analysis  Interview data analyzed using grounded theory and based on a technique of constant comparison
 3 phases of: open coding, axial coding, selective coding
 Analysis performed individually by 3 researchers who met regularly for comparison &
INTEGRATIVE LITERATURE REVIEW
Findings/Discussion
Appraisal/Worth to practice
First Author
(Year)/Qualifications
Background/Problem
Statement
12
discussion
 NVivo software v. 10 used to characterize info into themes
 Researchers found four principle themes and 12 sub-themes:
o Theme 1:Choosing to be actively involved in resuscitation
 To be actively involved in the resuscitation process, to feel emotionally able
to be present, to support the patient during CPR, to see the efforts of the
resuscitation team, wish to protect oneself
o Theme 2: Communication between the family members and the emergency team
 Medical information for the relative, satisfaction (or dissatisfaction) with the
medical team’s intervention
o Theme 3: Perception of the reality of death
 Awareness of death at the arrival of the emergency team, watching CPR and
the conduct of the participants
o Theme 4: Experience and reaction of the relative witnessing (or not) the resuscitation
 Presence: feeling of relief in relation to the patient’s distress, presence:
experience of excessively heroic treatment and intrusion of shocking images,
absence: experience of violence, brutality, and dehumanization
 Being present tended to positively affect family in the following ways:
o Perception – understanding of reality of death
o Cognition – thoughts related to support & communication w/ healthcare team
o Emotions – experience of shock and relief
 This study shows the benefit of family feeling like an active participant, being able to choose to
be present, and being able to show self-efficacy can decrease and protect against traumatic
grieving
 Sense of agency- concept where person can master and control their own environment
 Offering family members choice to witness resuscitation can emotionally protect them down the
road
Jabre (2013) – Medical Doctor, Doctor of Philosophy, Department of Health Sciences
Research
 Family members present during CPR are at risk of developing future emotional and physical
issues
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 Witnessing CPR could also benefit family members by showing them that life saving measures
were exhausted & provide opportunity for a last goodbye
 Purpose – determine if family members given the option of witnessing resuscitation had a
reduction in PTSD-related symptoms
Conceptual/theoretical  Not discussed
Framework

Design/  Quantitative study

Method/Philosophical  Prospective, cluster-randomized, controlled trial
Underpinnings
Sample/ Setting/Ethical  570 relatives of patients given CPR by 15 prehospital emergency medical units in France
Considerations participated
 Resuscitation conducted at home
 Approved by IRB- French law allowed patient consent to be waived due to emergency nature of
research, deferred consent was required from family member participants
Major Variables Studied (and  Intervention group- family members asked if wanted to be present during resuscitation,
their definition), if communication guide used to introduce scene & help w/ announcement of death
appropriate  Control group- family members not given option to be present during resuscitation, physician &
healthcare team interacted with these individuals in standard manner
Measurement Tool/Data  Structured questionnaire conducted over the telephone by psychologist (90 days after CPR)
Collection Method  Used Impact of Event Scale (IES) & Hospital Anxiety and Depression Scale (HADS)
 Secondary analyses- demographic & clinical data of patients recorded using Utstein style
 Data was analyzed using Student’s t-test, Wilcoxon signed-rank test, chi-square test, and
Fischer’s exact test.
Data Analysis  Data reported as means or medians and interquartile ranges for continuous variables & as
percentages for categorical variables
 Student’s t-test or the Wilcoxon signed-rank test used to evaluate continuous data
 Chi-square test or Fisher’s exact test used to evaluate categorical data
 Statistical tests performed with the use of SAS software, version 9.2
Findings/Discussion  PTSD-related symptoms higher in control group than in intervention group
 Symptoms of anxiety were higher in control group, family members suffering from depression
did not differ between control and intervention groups but was lower in family members present
during resuscitation
INTEGRATIVE LITERATURE REVIEW
Appraisal/Worth to practice
First Author
(Year)/Qualifications
Background/Problem
Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and
their definition), if
appropriate
Measurement Tool/Data
Collection Method
14
 Study found that effectiveness of CPR, patient survival, and level of emotional stress (healthcare
team) not effected by presence of family member
 Family member presence during CPR contributes to positive results on psychological
evaluations
Leske (2017) – Doctor of Philosophy, Registered Nurse, Fellows American Academy or
Nursing, Adult Health Clinical Nurse Specialist, College of Nursing- University of Wisconsin-
Milwaukee, Froedtert and the Medical College of Wisconsin-Froedtert Hospital
 Family witnessed resuscitation intended to support family-centered care but effects of family
presence during resuscitation on families have not been well studied
 Benefits for family members include knowing everything was done for patient, supportive &
helpful feelings, communication between family & healthcare provider, fostering grieving
 Purpose- examine effects of family presence during resuscitation in patients who survived
gunshot wounds & motor vehicle crashes
 Conceptual model of family adaptation in response to stress event used to guide variable
selection and measures
 Model looked at influence of family strengths on family outcomes
o Family strengths: coping, resources, communication
o Family outcomes: anxiety, stress, well-being, satisfaction
 Quantitative study
 Multivariate, prospective, comparative study
 Sample size- family members of 140 trauma patients
 Southeastern Wisconsin’s adult Level 1 trauma center
 Study approved by hospital and medical school’s IRB & written informed consent obtained
from all participants
 Intervention group- family member present during resuscitation
 Control group- family member not present during resuscitation
 Data collected in private waiting room or conference room 72 hours after resuscitation
 Self-report instruments used:
o Family Inventory of Resources for Management (FIRM)
INTEGRATIVE LITERATURE REVIEW
Data Analysis
Findings/Discussion
Appraisal/Worth to practice
First Author
(Year)/Qualifications
Background/Problem
Statement
Conceptual/theoretical
Framework
Design/
Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
15
o Family Crisis-Oriented Personal Evaluation Scale (F-COPES)
o Family Problem-Solving Communication Index
o State Trait Anxiety Inventory (STAI)
o Acute Stress Disorder (ASD)
o Family Member Well-Being Index (FWBI)
o Family Satisfaction in the Intensive Care Unit Scale
 Data analyzed with SPSS for windows software
 Analysis of convariance (ANCOVA) used to measure family strengths
 Propensity score created to account for any differences between study groups
 Findings showed that family presence during resuscitation resulted in decreased anxiety, stress,
and improved well-being for those family members
 These findings showed the initial effects of witnessed resuscitation on the family member
 Participating in family presence during resuscitation may assist family in being better prepared
to help the patient during initial critical care timeframe
 Healthcare teams should continue to offer family presence during resuscitation
 It can facilitate positive family outcomes but ultimately long-term effects of family members
after witnessing resuscitation remain TBD
O’Connell (2017) – Medical Doctor, Master of Education, American Board of
Pediatrics/Emergency Medicine, Emergency Medical Specialist, Associate Professor of
Pediatrics and Emergency Medicine at the George Washington University School of Medicine
and Health Sciences and Children’s National Health System
 Moving from patient-centered care to family-centered care however, lack of acceptance of
family presence during resuscitation because of lack of research backing benefits
 Purpose- measure attitudes, behaviors, experiences of family members who witnessed
resuscitation of a pediatric patient
 Not identified
 Mixed methods- Quantitative & Qualitative
 Observational
 Sample size- 126 family members
INTEGRATIVE LITERATURE REVIEW
Considerations
Major Variables Studied (and
their definition), if
appropriate
Measurement Tool/Data
Collection Method
Data Analysis
Findings/Discussion
Appraisal/Worth to practice
16
o 99 present; 27 not present
 3 regional American College of Surgeons- Level 1 pediatric trauma centers
 Family members present during resuscitation
 Family members not present during resuscitation
 Structured telephone interviews & focus group meetings- 3 to 6 months after event
 Telephone interviews & focus groups audio recorded and transcribed to print
 Focus group used standardized scripted guide as discussion prompt
 Parental Family Present Attitude Scale- FM (PFPAS-FM)
 Parental Family Not Present Attitude Scalse- FM (PFNPAS-FM)
 Means, medians, & ranges used to evaluate continuous variables
 Chi-square or Fisher exact tests for categorical data
 2-sample t tests, analysis of variance, Wilcoxon rank-sum tests, or Kruskal-Wallis tests used for
continuous variables
 Constant comparative technique used to analyze telephone interview & focus group info
 Themes discovered using a thematic analysis technique
 Family member present:
o Positive attitude about being with child during resuscitation
o Felt it was important for them to be with child during resuscitation
o Helped them to understand condition of child & decreased child’s anxiety & their
anxiety
o Believed they had a right to be present, did not make a difference in medical care child
received, and would do it again
 Family member not present:
o Wanted to be present with child during resuscitation & thought it would decrease anxiety
 8 shared themes
 Both family members present and not agreed that they had right to be present, allowed for them
to better advocate for patient, better ability for information sharing/communication
 Themes identified illustrated congruency across data types
o Presence reduces parent and child anxiety, allows family member to witness everything
possible was done, facilitates grieving process, no interference in care
 Family benefits from presence during resuscitation resulted from this study
 Organizes responses of family members who witnessed resuscitation to serve as evidence for
INTEGRATIVE LITERATURE REVIEW 17

healthcare providers to use to better prepare families for participation in resuscitation efforts in
the future

First Author Soleimanpour (2017) – Tabriz Health Services Management Research Center; Professor of
(Year)/Qualifications Anesthesiology and Critical Care and also Deputy Dean of Research and Technology of the
Medical Faculty Tabriz University of Medical Sciences, Tabriz Iran; ATLS Instructor of
American College of Surgeons
Background/Problem  Purpose- study the effect of family presence during resuscitation on the effect of developing
Statement psychological disorders
 Also looked at the effect of the presence of a trained support person for those who wished to
witness resuscitation on family member psychological state
Conceptual/theoretical  Not identified
Framework
Design/  Interventional, quasi-experimental study
Method/Philosophical  Quantitative
Underpinnings
Sample/ Setting/Ethical  Sample size – 133 relatives
Considerations o Control- 59; intervention- 74
 Emergency ward of Imam Reza hospital, Tabriz University of Medical Sciences
 Approved by committee of ethics of TUOMS & written informed consent received from all
participants
Major Variables Studied (and  Intervention group- relative wanted to be present during resuscitation, informed by healthcare
their definition), if professional of CPR process
appropriate  Control group- relatives not asked to be present during resuscitation, if decided to witness CPR
were not given a healthcare support member
Measurement Tool/Data  Telephone interviews and questionnaires
Collection Method  Impact of Event Scale (IES)
 Hospital Anxiety and Depression Scale (HADS)
Data Analysis  Data analyzed using SPSS version 16
 Chi-square test used to compare qualitative variables
 T-test and Mann-Whitney U-test used to compare quantitative variables
Findings/Discussion  Results compiled into 3 categories:
INTEGRATIVE LITERATURE REVIEW
Appraisal/Worth to practice
18
o Being present
o Satisfaction
o Coping with presence consequences
 PTSD and anxiety are lower in the resuscitation witnessed group than in the non-witnessed
group
 Being present during resuscitation and having a support person helps family members to cope
and decreases stress, anxiety, and PTSD after witnessed resuscitation
 Providing family members who wish to witness resuscitation with a support person helps to
reduce anxiety, stress, and other psychological disorders
 Emotional and psychological support and interventions are effective and help prevent
development of psychological disorders