Healthcare Provider Attitudes and Beliefs Toward Family-Witnessed Resuscitation in Saudi Arabia

Purpose: Healthcare provider attitudes and beliefs towards family witnessed resuscitation (FWR) have been studied extensively in Western cultures^1-6. However, the literature shows little evidence of similar studies being conducted in Middle Eastern cultures^7-8. The study was undertaken at a medium sized community hospital setting in Saudi Arabia. The authors hypothesize that overall attitudes and beliefs will not be in favor of family witnessed resuscitation as an option. However, there may be significant differences by nationality, unit, length of service, profession, age, gender, years qualified, and previous encounter with family witnessed resuscitation. The researchers sought to determine if healthcare providers in Saudi Arabia had similar attitudes and beliefs to those previously reported in the literature and to guide the healthcare system in developing an institutional FWR policy.

Methods: The research design is a quantitative cross sectional descriptive study using a survey method. A convenience sample of nurses, doctors, paramedics, and respiratory therapists working in emergency departments, intensive care units, operating rooms, day surgery areas, and general and pediatric wards were recruited. Recruitment was via blast e-mail with instructions on how to obtain a hard copy of the survey. Paper copies of the survey were provided in each clinical area. A reminder was sent via e-mail at week two. Extra hard copies of the survey were provided in each clinical area. Envelopes were left in pre-designated areas for collection and were collected periodically. Inclusion criteria included all doctors, nurses, paramedics and respiratory therapists working in general and pediatric wards, intensive care units, operating rooms, day surgery units, and emergency departments in all five facilities. Exclusion criteria included all allied healthcare personnel not employed in the aforementioned units.The Emergency Nurses Association’s (ENA) Health Care Provider Attitudes and Beliefs Toward Family Presence Assessment Survey⁹ was used to address the study aims. The latest version of SPSS (23) was utilized for data analysis. Variables included age, gender, nationality, unit, profession, length of qualification, and duration of employment within the hospital system. The survey tool was utilized with permission granted by the ENA. There were 19 questions on the survey. Questions (Q) 1-10 were scored on a 5 point Likert scale with “1 = strongly agree” to “5 = strongly disagree.” Q’s 8 and 9 were reverse coded such that “1 = strongly disagree” and “5 = strongly agree”. This was done to compensate for the somewhat negative terminology in the questions. Thus analysis and comparisons could be made with the other questions. Q’s 11-16 were yes/no answers and Q’s 13-19 had free text options although it was not analyzed for this paper. In addition to the ENA tool, seven demographic questions were included before the survey questions. The survey consisted of questions related to feelings and beliefs of healthcare providers in relation to FWR during invasive procedures and resuscitation. This study will focus on only those questions relating to resuscitation, therefore there was no analysis performed on questions relating to invasive procedures (Q3, 5, 12a, 14a and 15a). Four main themes were identified for analysis. Identified themes were feelings (Q1, 2, 4), beliefs (Q6-8), stress (Q9) and fear of litigation (Q10). Dependent variables analyzed were feelings, beliefs, stress, and fear of litigation. Independent variables analyzed were age, gender, nationality, profession, unit, and years qualified.

Results: Of the 799 surveys distributed, 393 were returned representing a response rate of 49%. The majority of respondents were female (70.9%), over 40 years of age (69.9%), of Middle Eastern descent (29.1%), and were from emergency rooms and intensive care units (53.2%). The profession which had the most respondents was nursing (82.1%). Most participants were qualified in their professions more than 6 years (87.7%) and had been working in the healthcare organization for 0-15 years (84%). Seventy-eight percent of respondents were in support of family having the option to be present if accompanied by a facilitator. The majority of respondents were Middle Eastern (29%) followed by European (19%), Filipino (15%), Indian (13%) and Sub-Saharan African (11%) with the remaining five nationalities making up slightly more than 12%. Gender was significant across all four themes (p<0.05). Results of the analysis indicated a statistically significant difference between unit worked on and nationality and beliefs (p<0.05) and stress (p<0.05). Profession had a significant association with feeling comfortable providing psycho-social-spiritual support during FWR (p<0.05). Years qualified and age had no significant association with beliefs, feelings, fear, or stress.

Conclusion: This study explored the views of nurses, doctors, paramedics, and respiratory therapists providing resuscitative care. Results of the study may be used to develop institutional policy regarding family witnessed resuscitation. Implementation of an FWR policy would enable staff to make informed decisions based on evidence-based practice. Additionally, policy implementation would prevent individual healthcare provider beliefs from impacting patient care decision-making. The organization in question does not currently have an FWR policy. One intention of this study was to provide evidence that a policy was required regardless of the outcome of the study. Policy development would also help reduce fears and tensions among healthcare providers during resuscitation. Implementing a structured policy would ensure healthcare providers were informed and aware of their role in assisting family members as well as the patient in order to improve outcomes.