Mixed Methods: Ideal for Research in the Emergency Department

Purpose:

The aim of this paper is to report the findings from a Mixed Methods PhD study which incorporated a two phase approach to investigating the implementation and practice of family presence during resuscitation (FPDR) in the emergency department.

The practice of allowing family to be present during resuscitation has been debated among clinicians working in emergency departments since the early 1980’s. There remains cause for further investigation with evidence that the practice and implementation of FPDR continues to remain inconsistent. FPDR in both adult and paediatric resuscitations was formally endorsed in the year 2000 by leading Emergency Associations and Resuscitation Councils¹ who were responsible for releasing practice guidelines. This study aimed to investigate the implementation and practice of FPDR with the objective of identifying the benefits, barriers and enablers², evaluating the role of the family support person, and assessing the level of education and training in rural and metropolitan emergency departments, in Victoria, Australia.

Methods: 

 A mixed methods sequential explanatory design was utilized to investigate the extent to which FPDR is implemented and practiced. Phase One disseminated a quantitative questionnaire to ascertain the extent to which emergency personnel endorsed and supported FPDR practice and to explore current training and education. The survey was divided into 5 key interest areas including: demographic data, qualifications, resuscitation team, family presence – personnel attitudes, and training and education. Phase Two incorporated a total of four weeks, in two Victorian, emergency departments, observing adult and paediatric resuscitations. Qualitative data collection tools included a combination of observation field notes, semi-structured audiotaped interviews and resuscitation template notes.   

Results:

 A total of 347 questionnaires were included in the final data set with a 27% response rate representing emergency personnel from rural and metropolitan emergency departments in Victoria, Australia. Descriptive and inferential statistics were used to describe the population followed by a factor analysis of the 26 statements on FPDR. A total of 65 doctors and 282 nurses completed the questionnaire, with a mean age of 37.2 years and a mean of 7.8 years working emergency care. The doctors (77%, n=50) and nurses (79%, n=222) believed that family had a right to be present during resuscitation events and that it helped with the grieving process (54% of doctors and 62% of nurses). The staff greatly agreed that a designated support person was essential when allowing family to be present (89% of doctors and 92% of nurses)³. Following a content analysis of the open ended responses the acronym ER-DRIP was developed which helped to define the essential information that family required during a resuscitation event⁴. The acronym stands for E-emergency personnel, R-reassurance, D-diagnosis, R-regular updates, P-prognosis. During the observations in Phase Two of the study a total of 29 interviews were conducted together with observation of six rural and 18 metropolitan resuscitations. The interviews were audiotaped and later transcribed for analysis. A content analysis was conducted and six major themes emerged including; the importance of the care coordinator, balance of power, delivering bad news, life experience generates confidence, allocating roles and family centre care in action.

Conclusion:

In order to investigate complex emergency issues such as FPDR a Mixed Methods approach was essential and yielded a rich data set that lead to the development of a number of future recommendations in training and education, practice and implementation of FPDR in both adult and paediatric resuscitations.