Family in the Resuscitation Room: Polish and Finnish Nurses' Experience and Attitudes towards Family-Witnessed Cardiopulmonary Resuscitation in a Hospital Setting

Monday, 9 November 2015: 2:05 PM

Natalia Sak-Dankosky, MSN, BSN, RN1
Pawel Andruszkiewicz, PhD, MD2
Paula R. Sherwood, PhD, MSN, BSN, RN, CNRN, FAAN3
Tarja Kvist, PhD, MSN, RN1
(1)Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
(2)2nd Department of Anesthesiology and Intensive Therapy, The Medical University of Warsaw, Warsaw, Poland
(3)University of Pittsburgh, Pittsburgh, PA, USA

Background: Family-witnessed resuscitation offers an option for patients’ families to be present during in-hospital cardiopulmonary resuscitation (CPR). It represents principles of the Family-Centered Care Theory which recognizes needs of family members and emphasizes their important role in patients’ health and sickness. Due to the research suggesting possible benefits of family-witnessed resuscitation (Clark et al. 2013), many nursing and medical organizations, such as Emergency Nurses Association, European Resuscitation Council and  American Heart Association, have officially recommended this practice. There is evidence that while in some countries family-witnessed resuscitation is accepted and implemented, there are many places in which it is not respected and still remains highly controversial (Sak-Dankosky et al. 2014).

Purpose: The purpose of this study is to describe Finnish and Polish emergency (ER) and intensive care (ICU) nurses' experience in family-witnessed resuscitation, and to determine whether there are a differences between their experiences and attitudes towards this practice.

Methods: A total of 270 ICU and ER registered nurses from three university hospitals in Poland and three in Finland took part in the study. A structured questionnaire, developed by Fulbrook P., Albarran J. W. and Latour J. M., was used to collect data. For the purpose of the study the questionnaire was translated into Polish and Finnish, using standard forward-back translation method, and then pilot-tested in order to check the accuracy of the translation. Questionnaire was divided into three parts: first asked about socio-demographic characteristics of the participants, second asked six questions with dichotomous answer alternatives about nurses’ experience on family-witnessed resuscitation, and third consisted of thirty 5-point Likert scale questions about nurses’ attitudes towards this phenomenon. Attitude questions were divided into three areas of inquiry: (1) decision-making, (2) process, and (3) outcomes. Data, collected between July and December 2013, were analyzed using SPSS 19.0 for Windows. Descriptive statistics such as frequencies, percentage distributions, means and standard deviations were used to characterize the sample. Chi-square test was used to analyze whether there are country differences in previous family-witnessed resuscitation experience. Mann-Whitney U-test was used to order to determine differences in attitudes between countries. The study is a part of a larger project exploring experiences and attitudes of Finnish and Polish health care professionals and family members towards family-witnessed resuscitation, and was approved by University Committee on Research Ethics.

Results: Most respondents were women (83%). Finland was represented by 153 (57%) registered nurses and Poland by 117 (43%). Mean age was 40 (±SD 10.01) and was approximately the same in both countries. Out of 265 nurses who reported their specialty area, 85 (32%) worked in emergency departments and 180 (68%) in intensive care units. Average working experience was 15 years (±SD 9.88), and was higher in Poland (18 years), than in Finland (13 years). Twelve percent of participants reported obtaining Master's degree in Nursing. The greater number of nurses worked as clinical practitioners (94%). Only 6% worked as educators, managers and researchers. The majority of nurses (72%) have never experienced family-witnessed resuscitation, however among those who have, Polish nurses had significantly more experience than Finnish nurses (p=0.003). A total of 76.2% nurses disagreed that family-witnessed resuscitation should be a normal practice. Only 14.5% claimed that it would be a good idea, while 9.3% were not sure. There was no significant difference between Polish and Finnish nurses regarding this statement (p=0.375). There was, however, a significant difference between the way Finnish and Polish nurses view the process of family-witnessed resuscitation (p=0.031). Polish respondents represented slightly more agreement with the negative process-related consequences of this practice than those from Finland. Level of agreement on aspects regarding attitudes towards decision-making process (p=0.133), and the outcomes of family-witnessed resuscitation (p=0.111) were not found to be significantly different between these two countries.

Conclusions: Exploring experiences and attitudes towards family-witnessed resuscitation is important in determining why, even though this option is widely recommended, in some countries it is not implemented into practice. Inviting family to be present at the bedside during CPR performed in a hospital setting, is not common in Poland and Finland. It might be explained by rather negative attitude towards this practice in both countries. Despite agreement on the aspects related to decision-making process and outcomes of family-witnessed resuscitation, there are differences regarding process-related attitudes towards this practice. This might be explained by the differences in health care systems and work organization in Poland and Finland. Negative attitudes towards family-witnessed resuscitation have been previously linked to the lack of experience and education regarding this problem (Edwards et al. 2013). It would be beneficial to develop training plans which would improve nurses’ understanding of the benefits of family-centered care. Results of this study can help to create a global picture of the extent of the phenomenon and guide further decision-making process. Better understanding of health care professionals’ experiences and attitudes will help develop proper strategies, policies and guidelines regarding family-witnessed resuscitation practice, and thus improve the quality of nursing care.


  1. Clark, A., P., Guzzetta, C., E., & O'Connell, K., J. (2013). Family presence during resuscitation attempts is associated with positive psychological effects for the observers. Evidence Based Mental Health, 16(3), 78-78. doi: 10.1136/eb-2013-101354
  2. Sak-Dankosky, N., Andruszkiewicz, P., Sherwood, P., R., & Kvist, T. (2014). Integrative review: nurses' and physicians' experiences and attitudes towards inpatient-witnessed resuscitation of an adult patient. Journal of Advanced Nursing, 70(5), 957-974. doi: 10.1111/jan.12276
  3. Edwards, E.E., Despotopulos, L.D., & Carroll, D.L. (2013). Changes in provider perceptions of family presence during resuscitation. Clinical Nurse Specialist, 27(5), 239-244. doi: 10.1097/NUR.0b013e3182a0ba13