Family presence during resuscitation: a constructivist grounded theory.

Author: Tracey Michelle Giles

Giles, Tracey Michelle, 2015 Family presence during resuscitation: a constructivist grounded theory., Flinders University, School of Nursing & Midwifery

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Each year, thousands of people suffer cardiac arrest in hospitals around the world. Despite ongoing advances in resuscitation technology, around 90% of these people die – often surrounded by clinical experts, but separated from their loved ones. Family presence during resuscitation was introduced in the early 1980s so that family could be with their loved ones during life-threatening events. Since that time, this phenomenon has been discussed extensively in the international literature and there is growing support from health professionals and the public. The current body of evidence supports important benefits for family members, including helping with closure and grieving, and reducing incidences of post-traumatic stress. Yet, despite this evidence and endorsement from professional groups in Australia and overseas, family presence during resuscitation is not practiced widely or consistently in Australia and rationales for poor uptake are unclear.

Existing Australian research into the phenomenon is limited and significantly skewed toward quantitative aims. A constructivist grounded theory approach was therefore used to examine factors and perceptions impacting family presence during resuscitation practices in Australian hospitals. In-depth interviews were conducted with registered nurses, doctors, paramedics, family members and a resuscitation patient to interpret and explain their meanings and subsequent actions when deciding whether to practice or participate in family presence during resuscitation. The systematic application of core grounded theory methods facilitated the generation and integration of a conceptual theory that explains the phenomenon from the perspective and in the context of the people who experienced it.

The substantive grounded theory developed during this study was the social construction of conditional permission. This theory comprised a series of value-laden judgements as part of the decision-making process to practice or participate in family presence during resuscitation. The substantive theory offers an explanation for the wide variations and inconsistencies that are evident in current practice. In the absence of any formal policies, decision-making around family presence during resuscitation was influenced primarily by people’s values, preferences, and pre-existing expectations around societal roles and status. As a result, current practices were highly subjective and variable.

Although some findings in this study were shown to link to existing constructs, this theory is unique in how it has used a new approach to interpret and explain rather than merely describe attitudes and practices around family presence during resuscitation. This theory contributes to an enhanced understanding of related practices in Australian hospitals and has important implications for future practice, education, research and policy around. The introduction of clinical protocols and associated education is recommended as an important starting point to ensure future practice is guided by evidence and standards for health consumer safety and welfare, rather than by the personal values and preferences of the individuals ‘in charge’ of permissions.

Keywords: cardiopulmonary resuscitation, family presence, grounded theory, decision-making, professional-family relations, ethics

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2015
School: School of Nursing & Midwifery
Supervisor: Professor Eimear Muir-Cochrane