In 1982 Foote Hospital in Jackson, Michigan, experienced two events in which family members refused to leave the bedside during the resuscitation of their loved one. Foote Hospital, like most hospitals, had a policy of “no family presence” during resuscitation and took this opportunity to examine their practice. Findings revealed that 72% of families surveyed would prefer to be in the resuscitation room and 71% of staff supported the practice of family presence. In addition, the hospital’s Advanced Cardiac Life Support Committee found no difference in resuscitation events regardless of family presence. ^{11. and 18.} These findings launched a substantial base of research outlining the benefits of family presence during resuscitation.

Following Foote Hospital’s lead, other researchers conducted surveys to examine the attitudes of family members toward family presence during resuscitation. Meyers et al²⁷ conducted a retrospective study on the beliefs of family members (N = 25) who had experienced the death of a loved one in the emergency department. Although none of the families surveyed was present in the resuscitation room, 80% reported they would have chosen to be present and 96% stated families should have the choice. A year later Boie et al⁸ surveyed parents’ (N = 400) attitudes toward family presence during resuscitation and invasive procedures. Overall, 81% wanted to be present if the child was conscious. ⁸ The percentage dropped to 71% if the child was unconscious. If the child was likely to die, 83% of parents wished to be present.

The second phase of research reported the positive effects of family presence on family members. Overwhelmingly studies have proven that families want the option to be present and will choose to be so if family presence is facilitated. 3.^{6.11.24. and 25.} Foote Hospital surveyed family members who were offered the option of family presence during resuscitation. The majority of families, 94%, stated that after experiencing family presence, they would choose to be present again. ^{6. and 29.} In these studies, families stated that having knowledge of the care their loved one was receiving, as well as the ability to have the opportunity to provide comfort, assisted with attaining closure.

Multiple studies have demonstrated that family presence has been instrumental in meeting the emotional needs of families. ^∗ Engaging families in an active role, encouraging the family to touch, talk, support, and soothe the patient, allows the family members to become empowered in the care of their loved one. Studies including perspectives from both families and health care providers conclude that family presence is helpful to the patient, family, and staff. ^†

Post resuscitation evaluation of the effects of family presence has found no traumatic memories for family members. ^{10. and 28.} Holzhauser et al²⁰ did find a significant relationship between families who were present during resuscitation and the belief that their presence was beneficial to the surviving patient. In the same study 96% of family members present in the resuscitation room believed that their presence assisted in accepting the outcome of their loved one’s illness or injury. ²⁰

Despite the overwhelming evidence of the benefits of family presence for the patient and family, some health care providers express concern that the resuscitation is too traumatic for family members. ^{9.11.18.28. and 34.} Robinson et al³⁴ conducted a study to examine the psychological effect of witnessing the resuscitation of a loved one. Findings included no reported fear of the events in the resuscitation room. Families also stated contentment with the decision to remain present and that grief was eased by sharing the last moments of life with their loved one. Grief scores of the families remaining present were lower than the control group families who did not have the option of family presence. ³⁴

Studies have been conducted to evaluate the incidents in which family members have interrupted care, have been asked to leave the room, or felt faint/ill. O’Connell et al³¹ found that 4% (N = 197) of families were asked to leave the resuscitation room after they had chosen to be present. Reasons for leaving included enhanced provider comfort during intubation (1%), concern about possible child abuse (less than 1%), providing a brief break for emotionally overwhelmed family members or family members displaying inappropriate behavior (1%), and providing support to an inconsolable family member (1%). ³¹ Merlevede et al²⁶ reported that families who left the resuscitation room on their own indicated that they left because of fear of disturbing the treatment of the patient and indicated a sense of remorse.

The patient experience in family presence is limited due to the number of precipitous deaths that occur with cardiovascular resuscitation. Current data reveal a survival rate of less than 17% for in-hospital cardiac and/or pulmonary arrest patients. ³² This limitation elicited a hypothetical survey by Benjamin et al⁷ to discern if people wanted to have their loved ones present during resuscitation. This study found that 72% (N = 200) reported that having family present in the room was positive. Other random studies conducted to gather information on the needs of the patients found that over half of those surveyed preferred to have family members present ^{16. and 25.} and most individuals thought their preferences for family presence should be determined at admission. ¹⁶

Eichhorn et al¹² studied actual patient response to family presence 2 months after the resuscitation event. Findings provided overwhelming support for the benefits the patient felt in having family members present, which outweighed any risk for their family member. Myers et al²⁸ reported patient themes paralleled those of family members. Patients stated they received comfort in knowing the family member was present and could comfort them and be an advocate for their care. Patients stated they had a right to family presence, indicating that having a family member present assisted in making them a real person to the health care provider.

Numerous “what-if-we-tried-it” surveys of health care workers have been conducted. More than 4,000 nurses, physicians, residents, and other health care providers at medical meetings and professional organizations have been surveyed about hypothetical family presence events. The main themes that have emerged include the following: less than half of the providers favor family presence; nurses (greater than 90%) are more likely to support family presence during resuscitation than physicians (greater than 75%); providers are more likely to support family presence during simple procedures versus resuscitation; an increase in support of family presence exists if there is an identified support person; health care providers who have experienced family presence during resuscitation are more supportive of the practice (63% to 86%); and experienced physicians are more comfortable than those early in their practice. ^{24.28.30. and 39.}

Benefits to the health care provider have also been reported from actual family presence events. Providers have found that family presence during resuscitation provides the health care worker an opportunity to increase communication with the family, ³¹ thus enhancing education in real time as interventions unfold. Families are able to obtain a grasp of the situation as they watch the events in the room and the intensity and speed with which the health care providers deliver care, giving the family a sense that everything was done to save the life of their loved one. ^{11.24. and 28.} Despite the outcome of the resuscitation, health care providers find that families are able to make better decisions and have a better understanding of the care that was provided. Litigation against health care providers decreases. ³¹ There is also support in the literature that family involvement in the resuscitation room affirms the patient’s humanity. ^{28. and 34.} It allows a sense of closure for families of patients who do not survive, allowing them the opportunity to say good-bye.

A significant number of national organizations support family presence during resuscitation. In 1993 the Emergency Nurses Association (ENA) became the first major organization to endorse family presence during resuscitation. Since that time ENA¹⁴ has published interdisciplinary guidelines and educational resources for implementation of family presence during invasive procedures and resuscitation. Since 1993 there have been numerous published guidelines, recommendations, and endorsements of family presence for health care providers. In 2006, 18 national organizations convened to publish the Report of the National Consensus Conference on Family Presence.²⁰ Organizations represented can be found in Box 13-1.