Attitudes, implementation and practice of family presence during resuscitation (FPDR): a quantitative literature review
- Authors: Porter, Joanne , Cooper, Simon J. , Sellick, Kenneth
- Date: 2013
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 21, no. 1 (2013), p. 26-34
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- Description: Aim To undertake a review of the quantitative research literature, to determine emergency staff and public attitudes, to support the implementation and practice of family presence during resuscitation in the emergency department. Background FPDR although endorsed by numerous resuscitation councils, cardiac, trauma and emergency associations, continues to be topical, the extent to which it is implemented and practiced remains unclear. Review methods A review of the quantitative studies published between 1992 and October 2011 was undertaken using the following databases: CINAHL, Ovid Medline, PSYCHINFO, Pro-Quest, Theses Database, Cochrane, and Google Scholar search engine. The primary search terms were ‘family presence’, and ‘resuscitation’. The final studies included in this paper were appraised using the Critical Appraisal Skills Programme criteria. Results Fourteen studies were included in this literature review. These included quantitative descriptive designs, pre and post-test designs and one randomized controlled trial (RCT). The studies were divided into three main research areas; investigation of emergency staff attitudes and opinions, family and general public attitudes, and four papers evaluating family presence programs in the emergency department. Studies published prior to 2000 were included in the background. Conclusion FPDR in the emergency department is well recognised and documented among policy makers, the extent in which it is implemented and practiced remains unclear. Further research is needed to assess how emergency staff are educated and trained in order to facilitate family presence during resuscitation attempts.
Family presence during resuscitation (FPDR): Preceived benefits, barriers and enablers to implementation and practice
- Authors: Porter, Joanne , Cooper, Simon J. , Selllick, Kenneth
- Date: 2014
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 22, no. 2 (2014), p. 69-74
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- Description: Introduction There are a number of perceived benefits and barriers to family presence during resuscitation (FPDR) in the emergency department, and debate continues among health professionals regarding the practice of family presence. Aim This review of the literature aims to develop an understanding of the perceived benefits, barriers and enablers to implementing and practicing FPDR in the emergency department. Results The perceived benefits include; helping with the grieving process; everything possible was done, facilitates closure and healing and provides guidance and family understanding and allows relatives to recognise efforts. The perceived barriers included; increased stress and anxiety, distracted by relatives, fear of litigation, traumatic experience and family interference. There were four sub themes that emerged from the literature around the enablers of FPDR, these included; the need for a designated support person, the importance of training and education for staff and the development of a formal policy within the emergency department to inform practice. Conclusion In order to ensure that practice of FPDR becomes consistent, emergency personnel need to understand the need for advanced FPDR training and education, the importance of a designated support person role and the evidence of FPDR policy as enablers to implementation.
Adult deterioration detection system (ADDS) : An evaluation of the impact on met and code blue activations in a regional healthcare service
- Authors: Missen, Karen , Porter, Joanne , Raymond, Anita , de Vent, Kerry , Larkins, Jo-Ann
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 2 (2018), p. 157-161
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- Description: Aims: To evaluate the impact of Acute Deterioration Detection System (ADDS) charts introduced to a regional healthcare service. Background: To assist health professionals in identifying essential elements for recognizing patient clinical deterioration, a national initiative introduced track and trigger observation charts, to hospitals in Australia. This study investigated whether the introduction of ADDS charts had an impact on the number of Medical Emergency Team (MET) and Code Blue activations at one regional healthcare service, according to their incident recording database. Method: A retrospective study of all Code Blue and MET activations was undertaken at a regional hospital, pre and post the introduction of ADDS charts in a two year period, June 2012 to June 2014. Results: There was a significant increase in MET activations from 5.91 to 11.27 per 1000 admissions (p < 0.01) after the implementation of ADDS charts. There was also an unexplained non-significant increase from 0.50 to 0.88 per 1000 admissions in the activations of Code Blue during this period (p = 0.05). It was also found that ADDS charts did not overly influence the activation criteria for calling a MET/Code Blue, except for an increase in reports of high heart rate and a decrease in the use of the criteria ‘worried’. Conclusion: The introduction of ADDS charts has provided health professionals with a clear track and trigger set of criteria, improving the detection of early signs of deterioration in patients. This study demonstrated an increase in activations as a result of the introduction of ADDS charts in one regional healthcare service.
Emergency resuscitation team roles: What constitutes a team and who's looking after the family
- Authors: Porter, Joanne , Cooper, Simon J. , Taylor, Beverley
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Nursing Education and Practice Vol. 4, no. 3 (2014), p. 124
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- Description: Aim of study: This study aimed to investigate the attitudes of personnel working in emergency departments on the constitution of a resuscitation team in particular the perceptions of the family liaison role. Methods: A paper base survey on family presence during resuscitation was distributed to emergency personnel working in 18 public departments in the state of Victoria, Australia. Results: A combination of nurses (n = 282) and doctors (n = 65) working in rural and metropolitan emergency departments, identified seven unique resuscitation team roles. Resuscitation teams were identified as comprising of three doctors, three nurses and one other which could be either. Respondents identified seven unique roles as consisting of a team leader, airway doctor, airway nurse, procedure doctor and procedure nurse, drugs nurse and a scribe. The respondents identified the following components as key to discussions with family members; emergency personnel, reassurance, diagnosis, regular updates, intervention, and prognosis (ER-DRIP). Conclusion: The acronym ER-DRIP can be used as a reminder to emergency staff when speaking with family members during resuscitation events ensuring they receive all the necessary information and support.
Rating teams’ non-technical skills in the emergency department : A qualitative study of nurses’ experience
- Authors: Porter, Joanne , Cant, Robyn , Cooper, Simon J.
- Date: 2018
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 38, no. (2018), p. 15-20
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- Description: Introduction: Non-technical skills (NTS) teamwork training can enhance clinicians’ understanding of roles and improve communication. We evaluated a quality improvement project rating teams’ NTS performance to determine the value of formal rating and debriefing processes. Methods: In two Australian emergency departments the NTS of resuscitation teams were rated by senior nurses and medical staff. Key measures were leadership, teamwork, and task management using a valid instrument: Team Emergency Assessment Measure (TEAM™). Emergency nurses were asked to attend a focus group from which key themes around the quality improvement process were identified. Results: Main themes were: ‘Team composition’ (allocation of resuscitation team roles), ‘Resuscitation leadership’ (including both nursing and medical leadership roles) and ‘TEAM™ ratings promote reflective practice’ (providing staff a platform to discuss team effectiveness). Objective ratings were seen as enabling staff to provide feedback to other team members. Reflection on practice and debriefing were thought to improve communication, help define roles and responsibilities, and clarify leadership roles. Conclusion: Use of a non-technical skills rating scheme such as TEAM™ after team-based clinical resuscitation events was seen by emergency department nurses as feasible and a useful process for examining and improving multi-disciplinary practice, while improving team performance. © 2018 Elsevier Ltd
Family Presence During Resuscitation (FPDR) : Observational case studies of emergency personnel in Victoria, Australia
- Authors: Porter, Joanne , Miller, Nareeda , Giannis, Anita , Coombs, Nicole
- Date: 2017
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 33, no. (2017), p. 37-42
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- Description: Introduction Family Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR. Methods One rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study. Results Seventeen adult presentations (Metro n = 9, Rural n = 8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication. Conclusion During 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education. © 2016 Elsevier Ltd
Family presence during resuscitation (FPDR) : A survey of emergency personnel in Victoria, Australia
- Authors: Porter, Joanne , Cooper, Simon J. , Taylor, Beverley
- Date: 2015
- Type: Text , Journal article
- Relation: Australasian Emergency Nursing Journal Vol. 18, no. 2 (2015), p. 98-105
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- Description: Background: Family presence during resuscitation (FPDR) has been endorsed internationally by resuscitation councils since the year 2000; however, the extent to which FPDR is practiced in emergency settings requires further investigation. Methods: Emergency personnel ( n= 347) from 18 participating emergency departments across the state of Victoria, Australia completed a 10-page questionnaire, which was designed to develop an understanding of the current practice and implementation of FPDR and to ascertain the differences in practice between adult and paediatric resuscitations. Results: Emergency personnel update their adult and paediatric advanced life support qualifications annually with 87% of nurses and 65% of doctors completing adult life support and 72% of nurses and 49% of doctors completing paediatric advanced life support training. The majority of nursing staff reported support for FPDR (83%) with over 70% indicating that it is apart of their current practice. There was strong agreement from both nurses (79%) and doctors (77%) that the family have the right to be present. A family support person was deemed as essential by nurses (92%) and doctors (89%) when allowing family to be present. A factor analysis was conducted on participant statements, revealing four codes; impact on professional practice and performance, personnel beliefs about FPDR, professional satisfaction and the importance of a support person and saying goodbye. Conclusion: A family support person was highlighted as essential to the successful implementation of FPDR, together with the development of a comprehensive training the education program for emergency personnel. FPDR continues to be a significant issue and further investigation into FPDR practice and implementation in the ED is warranted. © 2014 College of Emergency Nursing Australasia Ltd.
Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM)
- Authors: Cooper, Simon J. , Cant, Robyn , Sellick, Kenneth , Porter, Joanne , Somers, George , Kinsman, Leigh , Nestel, Debra
- Date: 2010
- Type: Text , Journal article
- Relation: Resuscitation Vol. 81, no. 4 (2010), p. 446-452
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- Description: Aim To develop a valid, reliable and feasible teamwork assessment measure for emergency resuscitation team performance. Background Generic and profession specific team performance assessment measures are available (e.g. anaesthetics) but there are no specific measures for the assessment of emergency resuscitation team performance. Methods (1) An extensive review of the literature for teamwork instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of seven independent experts for face and content validity. (4) Instrument testing on 56 video-recorded hospital and simulated resuscitation events for construct, consistency, concurrent validity and reliability and (5) a final set of ratings for feasibility on fifteen simulated ‘real time’ events. Results Following expert review, selected items were found to have a high total content validity index of 0.96. A single ‘teamwork’ construct was identified with an internal consistency of 0.89. Correlation between the total item score and global rating (rho 0.95; p < 0.01) indicated concurrent validity. Inter-rater (k 0.55) and retest reliability (k 0.53) were ‘fair’, with positive feasibility ratings following ‘real time’ testing. The final 12 item (11 specific and 1 global rating) are rated using a five-point scale and cover three categories leadership, teamwork and task management. Conclusion In this primary study TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians’ tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties.
A review of code blue activations in a single regional Australian healthcare service : a retrospective descriptive study of RISKMAN data
- Authors: Porter, Joanne , Peck, Blake , McNabb, Tiffinee , Missen, Karen
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 29, no. 1-2 (2020), p. 221-227
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- Description: Background: In the case of life-threatening conditions such as respiratory or cardiac arrest, or the clinical deterioration of the patient, a Code Blue activation may be instigated. A Code Blue activation involves a team of advanced trained clinicians attending the emergency needs of the patient. Aims and objectives: The aim of the study was to explore the number of cases of Code Blue activations, looking at the timing, clinical ward, diagnosis and activation criteria while noting cases where escalation from a Medical Emergency Team (MET) call occurs in one Regional Healthcare Service in Victoria, Australia, over a six-year period. Methods: A quantitative retrospective descriptive study of Code Blue emergencies over a six-year period from June 2010 to June 2016 was conducted. Data collected from the RISKMAN program operating at a single site was imported into SPSS (V 22) for descriptive statistical analysis. A STROBE EQUATOR checklist was used for this study (see File S1). Findings: The majority of Code Blue activations were male (59%, n = 127) and aged between 70 and 89 years of age (43%, n = 93). A Code Blue activation was more likely to occur at 08:00 hr, 14:00 hr or 22:00 hr, corresponding to the nurses’ change in shift, with the majority of Code Blues (27.8%, n = 60) occurring in the emergency department. Cardiac arrest was the main activation criterion with 54.6% (n = 118) cases followed by respiratory arrest (14%, n = 32). Interestingly, 20% (n = 45) of the Code Blue activations were upgraded from a Medical Emergency Team (MET) call. Conclusion: This project has produced several interesting findings surrounding Code Blue activations at one regional healthcare service which are not present in existing literature and is worthwhile for further investigation. Relevance to clinical practice: Understanding Code Blue activation criteria, common timings (month, time of day) and patient demographics ensures clinicians can remain vigilant in watching for the signs of patient deterioration and improve staff preparedness Code Blue events. © 2019 John Wiley & Sons Ltd