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. 2025 Jan 7;8(1):e70320. doi: 10.1002/hsr2.70320

The Impact of Being Present During Resuscitation on Family Members: A Scoping Review Protocol

Ira Rahmawati 1,, Tamara Page 1,2, Lisa Conlon 1, Frank Donnelly 1
PMCID: PMC11705454  PMID: 39777276

ABSTRACT

Background and Aims

Family members of patients who are undergoing resuscitation may experience complex psychological challenges, including anxiety, depression, or posttraumatic stress symptoms. Although several studies have identified positive experiences of family members who were given the option to be present during their loved one's resuscitation, the actual impact of family presence during resuscitation on family members remains elusive and needs to be explored comprehensively. This review aims to identify the impact of being present during the resuscitation event of adult patients in in‐hospital settings on family members.

Methods

The proposed review will utilize the JBI methodology for scoping reviews. This review will include literature from all study designs that are published in English with no date restrictions. The inclusion criteria include studies evaluating the impact on family members after witnessing the resuscitation of a loved one or being present at the hospital during the event. This review will include studies conducted in intrahospital settings, including emergency departments, critical care units, and in‐hospital wards. This study will also emphasize the influences of social, cultural, and spiritual factors on FPDR practices. A systematic search will be conducted across five databases and gray literature. These include PubMed, CINAHL (EBSCO), Embase, Emcare, and PsycINFO, ProQuest Database, Open Access Theses and Dissertations, and Google Scholar. Two independent reviewers will screen titles and abstracts and assess the full text of selected articles against inclusion criteria. Discussion with all reviewer team members will be held when disagreements arise between the reviewers at each review stage. Data will be analysed and presented according to The Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Review.

Scoping Review Registration

This scoping review protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/U6AW8).

Keywords: cardiopulmonary resuscitation, family, family presence, impact, outcomes, resuscitation

1. Introduction

Patient‐family‐centered care (PFCC) is an approach to healthcare delivery that facilitates patients and their families collaborating with healthcare providers in the planning, delivery, and evaluation of care [1]. PFCC improves health outcomes in patients and their families and increases staff members' satisfaction. [1, 2] Family presence during cardiopulmonary resuscitation is consistent with PFCC concepts emphasizing the importance of treating patients holistically and in the context of the family as a unit [3, 4]. Family presence during resuscitation (FPDR) is defined as giving the option for one or more family members to be present in the resuscitation room during the patient's resuscitation event, which facilitates the family to have physical or visual contact with the patient [5, 6]. Although some family members may not wish to witness the resuscitation event [7], a significant number of studies have reported that family members and patients support the implementation of FPDR [3, 8, 9]. However, offering family members to be present during a resuscitation attempt remains controversial among some staff [10]. The psychological outcomes of witnessing the resuscitation attempt on family members may also be varied and needs to be explored further [10].

International resuscitation guidelines recommend offering an option for the family to be present during the patient's resuscitation event [11, 12, 13]. Benefits of FPDR for family members have been discussed in the literature [14]. Significant benefits of FPDR include increased communication and information sharing between the family and healthcare team, improved family members' understanding about the patient's current condition which may increase the family's satisfaction with the medical care being provided [4, 6, 15]. In the event of an unsuccessful resuscitation, FPDR may assure the family that all possible life‐saving measures have been taken [16, 17]. Having family present may not influence the patient's resuscitation outcomes, but it may reduce stress and posttraumatic stress symptoms among family members and, therefore, can be regarded as an act of advocacy for patients and their family [18]. However, published studies evaluating the impact of witnessing a loved one's resuscitation on family members showed mixed results [19, 20, 21, 22], and, therefore, further studies need to be undertaken.

Although this review will not focus on pediatric resuscitations, it is important to note that currently, family presence during pediatric resuscitation is more common and accepted by the HCPs compared to the presence of family during adult resuscitation [23]. Most studies that explored nurses' attitudes toward FPDR in pediatric units revealed that nurses were supportive of the practice [24]. Studies have reported that being present at pediatric resuscitation was a positive experience for parents, and, that no parent, who was surveyed 3 months after being present at their child's resuscitation, reported traumatic memories [24, 25]. The literature surrounding the impact on and experiences of family members when present during adult resuscitations is contradictory, less comprehensive, and needs to be further explored. Practices, outcomes, and HCPs support for FPDR vary by geographic area and culture [26]. Therefore, cultural, social and religious factors that may impact the family preferences, experiences and outcomes related to FPDR should also be addressed.

A preliminary search was conducted in April 2024 on PubMed, the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, Open Science Framework registry, and PROSPERO. The search found no systematic reviews or scoping reviews focusing on the impact of being present during the patient's resuscitation on family members currently being undertaken. A previous systematic review, conducted in 2023, evaluated the effects of giving relatives an option to be present during a family member's resuscitation on the occurrence of Posttraumatic stress disorder (PTSD) and related psychological symptoms. This systematic review included only three randomized control trials (RCTs), and concluded that there was inadequate evidence to draw any conclusions on the effects of FPDR on family members' psychological consequences [27]. Witnessing the resuscitation event of a family member may have a significant impact on the family, which might not be limited to adverse psychological outcomes such as; PTSD, anxiety, or depression; but may also assist individuals to have a greater appreciation of life and their future [28]. These outcomes can potentially be explored by study designs other than RCTs. In addition, Professional organizations recommend FPDR should be given as option [14, 29], without promoting or discouraging either decision. The optional aspect is vital because FPDR may not be desirable for all family members [30]. Also, considering the potential traumatizing effect and the ethics of studies around the resuscitation of a loved one, RCTs on FPDR are less likely to be conducted.

Another systematic review conducted in 2022 evaluated the effects of FDPR on HCPs, patients and family members [10]. However, this review focused only cardiopulmonary resuscitation (CPR) in all settings including in and out of hospital settings [10]. In‐hospital cardiac arrest (ICHA) is a different clinical condition from out‐hospital cardiac arrest (OHCA), with distinct patient populations and underlying causes of arrest [31]. Moreover, in IHCAs, interventions provided in the resuscitation event may be more complex, with the staff involved in the event usually having more control of the situation and more staff in attendance as compared with OHCA. Therefore, the family's experiences and interpretation of the event might be different and should be evaluated separately. Furthermore, the review by Considine et al. [10] also excluded studies from gray literature, unpublished studies and theses, which may have potentially valuable insights. FPDR and related practices are influenced by sociocultural contexts [26]. Therefore, a scoping review is required to explore this topic further and potentially reveal new evidence from diverse geographical and socio‐cultural areas.

This scoping review, therefore, aims to identify the impact of being present during the patient's resuscitation attempt on adult family members. Exploring evidence related to FPDR is relevant due to the increase implementation of PFCC in a wide range of health care settings and the importance of treating people holistically even in emergency and critical situations. This scoping review also aims to identify gaps in the literature and guide future research.

2. Review Question

What is the impact on family members who are present during the resuscitation of a loved one?

2.1. Inclusion Criteria

2.1.1. Participants

This review will consider studies that explore both family presence and non‐presence during adult patients' resuscitation. Family members will include individuals who are over 18 years of age and who are considered family members. The definition of family adopted for this review includes individuals bounded by biological, legal, social, spiritual, or emotional relationships and support the patient's health and well‐being [32, 33]. Therefore, studies that considered as ‘significant others’ of the patient, such as the primary caregiver as a family member will be included in this review. Studies examining the impact of resuscitation on children will be excluded.

2.1.2. Concepts

There are three concepts that are required for study inclusion: family presence, resuscitation, and impact.

Family presence is the presence of one or more family member in the resuscitation room during the patient's resuscitation event [34], enabling visual and/or physical contact with the patient.

Resuscitation in this review includes the action of reviving patients from unconsciousness or seeming death with a variety of potential interventions [31]. Studies examining the impact of having family members present during invasive procedures, as part of resuscitation attempts and trauma resuscitations, will also be included in this review.

Impact of being present during the resuscitation on family members include all outcomes and which were assessed in the studies. These may include physiologic, psychological, spiritual, and social outcomes, experiences of the event, as well as impact on daily activities and the quality of life of family members.

2.1.3. Context

This review will include studies conducted at in‐hospital settings, including the Emergency Department (ED), Intensive Care Unit (ICU), and hospital wards. Studies that include both adult and pediatric resuscitation will be included if the adult population is identified and separated from presented the children's population within the data. Studies that were conducted solely in the pediatric, neonatal, maternal, and prehospital settings will be excluded.

2.1.4. Types of Sources

This scoping review will consider all studies that measured family members' outcomes after witnessing the resuscitation of their loved ones or being present at the hospital during the event. The study designs may include quasi‐experimental designs, randomized and non‐randomized controlled trials, and before and after studies. Observational studies, prospective and retrospective cohort studies, case series, individual case reports, and descriptive cross‐sectional studies will also be included. All forms of qualitative studies will be included in this review. Gray literature will be considered when it relates explicitly to the participants, concepts, and context of this review. This review will exclude review articles, systematic evidence synthesis texts, and opinion papers.

3. Methods

This proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews [35] and will be reported according to the Preferred Reporting Items for Systematic Review and Meta‐Analysis Extension for Scoping Review (PRISMA ScR) [36].

3.1. Search Strategy

The search strategy will aim to locate both published and unpublished studies. A preliminary search of PubMed and CINAHL (EBSCO) was carried out to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for PubMed (see Appendix A1). The search strategy, including all identified keywords and index terms, will be adapted for each included database and/or information source. The reference list of all included sources of evidence will be screened for additional studies. The reference list of systematic reviews on similar topics will also be screened for additional articles.

The process of developing a search strategy was assisted by a university liaison librarian. The review team will continue to collaborate with the university librarian to develop the complete search strategy for all databases. The databases to be searched include PubMed, CINAHL (EBSCO), Embase, Emcare, and PsycINFO. Sources of gray literature to be searched include ProQuest Database, Open Access Theses and Dissertations, and the first 20 pages of hits for a Google Scholar Search. There will be no date restriction for the search. However, non‐English publications will be excluded due to financial and time limitations for translations.

3.2. Study Selection

Following the search, all identified citations will be collated and uploaded into EndNote version 20 (Clarivate Analytics, Pennsylvania, USA) with duplicates removed. The yielded records will be imported to the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) (JBI, Adelaide, Australia) [37]. The titles and abstracts will be initially screened by two independent reviewers for assessment against the inclusion criteria for the review. The full text and the citation details of potentially relevant sources will be imported into JBI SUMARI. The full text of selected sources will be assessed in detail against the inclusion criteria by two independent reviewers. The reason for exclusion of the sources at full text that do not meet the eligibility will be recorded and reported in the scoping review. Any disagreements that arise between reviewers at each stage of the selection process, will be resolved through discussion with the review team. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a PRISMA flow diagram [35].

3.3. Data Extraction

The data extracted will include specific details about the participants, concept, context, study methods, and key findings relevant to the review question. A draft of the data extraction tool, developed by the reviewer team, is available in Appendix A2. The reviewers will pilot test the tool utilizing four included studies, and the tool will be modified as necessary to improve its accuracy and efficiency. All changes will be reported in the full review report.

Two independent reviewers will extract data from the included studies, undertaking data extraction for 10% of sources included in the full‐text studies. The extracted data will then be cross checked to ensure data accuracy. Any discrepancies will be resolved with a discussion with the full review team [35]. One reviewer will then finalize the remaining 90% of data extraction from sources included in the full‐text studies. The complete data extraction results will be consulted and discussed within the review team.

3.4. Data Analysis and Presentation

The Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Review (PRISMA‐ScR) will be followed for data analysis and presentation [36]. This review will consider both quantitative and qualitive studies. Therefore, data analysis of this review will be conducted, where possible, using a descriptive numerical summary for the quantitative studies and a thematic analysis for qualitative studies. The results will be presented in tabular and diagrammatic form, with this followed by a narrative summary. The review will highlight how the results relate to the review question. Cultural, social, and religious factors contributing to FPDR practice will be explored and presented. The gaps in the literature related to the impacts of FPDR on family members will also be highlighted. This will then guide future research on this topic.

Author Contributions

Ira Rahmawati: conceptualization, writing–original draft, methodology, project administration, formal analysis, data curation, investigation. Tamara Page: investigation, writing–review and editing, methodology, formal analysis, supervision, data curation. Lisa Conlon: writing–review and editing, visualization, supervision, validation. Frank Donnelly: supervision, conceptualization, writing–review and editing, validation, methodology, resources.

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgments

The authors would like to thank Vikki Langton, a University Librarian at the University of Adelaide for the assistance with the search strategy. This study receives no specific grant from any funding agency. The research associated with this protocol is part of a student PhD project and is supported by The Indonesia Endowment Fund for Education (LPDP) and Adelaide Nursing School Supplementary Scholarship ‐ The University of Adelaide. Open access publishing facilitated by The University of Adelaide, as part of the Wiley ‐ The University of Adelaide agreement via the Council of Australian University Librarians.

Appendix 1.

Search strategy PubMed

Table A1.

Preliminary search produced 1526 results. Data searched: 18 April 2024.

Search Query Records retrieved
#1 “Resuscitation”[mh] OR Resuscitat*[tiab] OR Cardiopulmonary Resuscitation*[tiab] OR CPR [tiab] OR heart massage[tiab] OR cardiac life support[tiab] 158,200
#2 “family”[mh] OR Family[tiab] OR families[tiab] OR familial[tiab] OR Relative*[tiab] OR next of kin*[tiab] OR Significant other*[tiab] OR parent*[tiab] OR father*[tiab] OR mother*[tiab] OR sibling*[tiab] OR spouse*[tiab] OR grandparent*[tiab] OR grandfather*[tiab] OR grandmother*[tiab] OR sister*[tiab] OR brother*[tiab] OR child*[tiab] OR “Caregivers”[mh] OR caregiver*[tiab] 4,925,233
#3 “Stress, Psychological”[mh] OR “Resilience, Psychological”[mh] OR “Adaptation, Psychological”[mh] OR Resilien*[tiab] OR psychological Adaptation*[tiab] OR psychological Stress*[tiab] OR stressful*[tiab] OR caregiver burden*[tiab] OR emotional exhaust*[tiab] OR coping[tiab] OR emotional adjustment*[tiab] OR “Stress Disorders, Posttraumatic”[mh] OR Posttraumatic Stress Disorder*[tiab] OR “Depression”[mh] OR depression* [tiab] OR “Anxiety”[mh] OR anxiety*[tiab] OR “Quality of Life”[mh] OR quality of life [tiab] OR “Psychological Well‐Being”[mh] OR well‐being[tiab] 1,458,474
#4 #1 AND #2 AND #3 1675
Limited to English language 1526

Appendix 2.

Table A2.

Data extraction instrument.

Reviewer Date Record number
Author Year of publication
Study Title
Country of origin
Study Objective/Phenomenon of interest
Study methods
Study settings
Population/participants
Sample size
Inclusion and exclusion criteria
Interventions (if applicable)
Variables (if applicable)
Data analysis
Outcomes
Author's conclusion

Data Availability Statement

The authors have nothing to report.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The authors have nothing to report.


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