ARTICLE IN PRESS

International Journal of Nursing Studies 44 (2007) 8392

www.elsevier.com/locate/ijnurstu

Family presence during CPR: A study of the experiences and

opinions of Turkish critical care nurses
A. Badira,, D. Sepitb
a
Koc University School of Health Sciences, Guzelbahce Sok. No: 20, Nisantasi, Istanbul, Turkey
Semahat Arsel Nursing Education and Research Center, Koc University School of Health Sciences, Guzelbahce Sok. No: 20,
Nisantasi, Istanbul, Turkey

Received 30 March 2005; received in revised form 22 November 2005; accepted 22 November 2005

Abstract
Background: The concern over family witnessed cardiopulmonary resuscitation has been a frequent topic of debate in
many countries.
Objectives: The aim of this descriptive study is determine the experiences and opinions of Turkish critical care nurses
about family presence during cardiopulmonary resuscitation and to bring this topic into the critical care and the public
limelight in Turkey.
Methods: Study population consisted of critical care nursing staff at four hospitals afliated with the Ministry of
Health, three hospitals afliated with universities and three hospitals afliated with Social Security Agency Hospitals. A
total of 409 eligible critical care nurses were surveyed using a questionnaire which is consisted of 43 items under 3 areas
of inquiry.
Results: None of the hospitals that participated in this study had a protocol or policy regarding family witnessed
resuscitation. More than half of the sample population had no experience of family presence during cardiopulmonary
resuscitation and none of the respondents had ever invited family members to the resuscitation room. A majority of the
nurses did not agree that it was necessary for family members to be with their patient and did not want family members
in resuscitation room. In addition, most of the nurses were concerned about the violation of patient condentiality, had
concerns that untrained family members would not understand CPR treatments, would consider them offensive and
thereby argue with the resuscitation team. The nurses expressed their concern that witnessing resuscitation would cause
long lasting adverse emotional effects on the family members.
Conclusion: This study reveals that critical care nurses in Turkey are not familiar with the concept of family presence
during cardiopulmonary resuscitation. In view of the increasing evidence from international studies about the value of
family presence during cardiopulmonary resuscitation we recommend educational program about this issue and policy
changes are required within the hospitals to enhance critical care in Turkey.
r 2005 Elsevier Ltd. All rights reserved.
Keywords: Family witnessed resuscitation; Critical care unit; Critical care nurses; Experiences; Opinions; Family members

What is already known about the topic?

Corresponding author. Tel.: +90 212 311 26 09.

 Even

E-mail address: abadir@ku.edu.tr (A. Badir).

0020-7489/$ - see front matter r 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijnurstu.2005.11.023

though the option of family presence during

invasive procedures and resuscitation is permitted by

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A. Badir, D. Sepit / International Journal of Nursing Studies 44 (2007) 8392

84




health care professionals in some countries, family

members requests to witness resuscitation were
usually disapproved for various reasons.
Several studies report the advantages of family
member presence during resuscitation.
The concern over family witnessed CPR, which is a
frequent topic of debate in other countries, is yet to
be brought into the public limelight in Turkey.

What this paper adds

 This study reveals that critical care nurses in Turkey




are not familiar with the concept of family presence

during cardiopulmonary resuscitation.
Educational program about family presence during
CPR can be developed to inform culturally appropriate policy and practice changes within hospitals.
Turkish nurses need ongoing professional education
in relation to this topic in order to contribute to
policy and practice change that will enhance critical
care in Turkey.

1. Introduction
Family members play a signicant role in the health
and well being of the patient and their involvement is an
integral part of the patient recovery process. Cardiopulmonary resuscitation (CPR) is an emergency procedure that is often employed after cardiac or respiratory
arrest. Presence of family members during resuscitation
of a loved one still remains controversial, in spite of
studies reporting the experiences and opinions of health
care professionals, family members and patients regarding family witnessed CPR.
1.1. Background
In North America, the exclusion of family members
from resuscitation procedures has been brought to
attention in the 1980s and early 1990s. In Europe, the
issue was called into question in 1996 only after an
article (Adams et al., 1994) was published following a
series of equestrian related injuries in the United
Kingdom.
Several studies report the advantages of family
member presence during resuscitation. According to
these studies, family members reassure themselves that
everything possible was done for their loved one and feel
supportive to the patient and the staff. Advocates of
family witnessed CPR also state that families share
critical information with the staff regarding patient
status. In addition, family members anxiety and fear
may be lessened and their presence may assist their grief
process (Doyle et al., 1987; Robinson et al., 1998;

Meyers et al., 2000; MacClean et al., 2003). Several

published articles investigated whether families would
elect to be with their loved one during resuscitation. In a
recent quantitative study by Wagner (2004), participating family members of patients who received CPR were
interviewed. The study revealed that most family
members struggle with the decision about whether they
should remain with their loved one during resuscitation.
Even though the option of family presence during
invasive procedures and resuscitation is permitted by
health care professionals in some countries, family
members requests to witness resuscitation were usually
disapproved for various reasons. Health care professionals have expressed concerns for the psychological
trauma to the witnessing family members and performance anxiety of the resuscitation team. They also
feared that family members may impede clinical care
and act inappropriately if they became too emotional. In
addition, there were concerns over crowded emergency
rooms, and shortage of nurses who would assist the
family members during the resuscitation procedures
(Redley and Hood, 1996; Eichhorn et al., 1996; Belanger
and Reed, 1997; Rosenczweig, 1998; Meyers et al., 2000;
Eichhorn et al., 2001; MacClean et al., 2003; McClenathan et al., 2002; McGahey, 2002; Fulbrook et al.,
2005). Families who witnessed invasive procedures or
CPR state they would choose to be present with their
loved one should the situation arise again (Belanger and
Reed, 1997; Hanson and Strawser, 1992; Meyers et al.,
2000). In addition, certain studies report that during
invasive procedures and CPR, families did not experience any adverse psychological effects nor did they lose
control and disrupt the performance of the critical care
providers (Doyle et al., 1987; Belanger and Reed, 1997;
Robinson et al., 1998; Boyd and White, 1998; Meyers
et al., 2000; Kidby, 2003).
Emergency Nurses Association (ENA) (2001) of the
United States adopted a resolution in 1993 to support
the option of family presence during CPR attempts.
ENA expressed the need for further research related to
the presence of family members during resuscitation and
supported the development and dissemination of educational resources for critical care personnel concerning
policies, practices and programs supporting the option
of family presence. Supported by new research in the
eld, ENA published their written policies in 1994
advocating the option of family member presence during
CPR and invasive procedures. In 2000, the American
Heart Association and the International Liaison Committee released their guidelines for CPR advocating
family witnessed resuscitation and recommending that
family member presence be allowed during CPR
attempts. Similarly, the issue of family member presence
during CPR is included in the basic life support manual
released by the European Resuscitation Council. Some
researchers have been tried to do some research enhance

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to staff response (Walker, 1999; Clark et al., 2001;

Adams et al., 2002) in CPR and discussed ethical issues
(Sanford et al., 2002; Nibert, 2005) related to family
witnessed resuscitation.
To the knowledge of the authors, within Turkey, there
is no report or published work regarding family member
presence during CPR in medical and nursing journals.
The concern over family witnessed CPR, which is a
frequent topic of debate in other countries, is yet to be
brought into the public limelight in Turkey.
Like most developing countries Turkey has embraced
the ideologies of globalization and is moving towards a
more Westernized approach to development as it
prepares to lay the basis for participation in the EU.
There has been a rapid expansion of the private sector in
the provision of health care which is expected to increase
further with government incentives and the changing
expectations of an expanding middle class with private
health insurance (Savas et al., 2002). Turkey also has a
very large tourist industry with many millions of Western
tourists visiting each year and a large expatriate community. Most Western countries also host large Turkish
migrant communities. While family presence during CPR
is not currently an issue for either nurses or families in
Turkey it can be expected to become an issue for the
above reasons and the general preference for private
health care even among the poor because of a lack of
condence in the public sector (Savas et al., 2002).
In view of the increasing evidence from international
studies about the value of family presence during CPR
and the rapid changes taking place in the Turkish health
care system due to globalization it is important to
examine the experiences and opinions of nurses to
determine what the current situation is. It is important
to determine whether Turkish nurses are aware of the
international trends and their preparedness for the
inevitable changes of globalization. A Turkish study
can inform the body of nursing knowledge in relation to
how nurses manage change in rapidly modernizing health
care systems as globalization penetrates many developing
countries. In order to enhance critical care in Turkey an
educational program about family presence during CPR
can be developed to inform culturally appropriate policy
and practice changes within hospitals.
2. Methods
The aim of this study is to investigate the opinions
and experiences of critical care nurses regarding family
member presence during resuscitation.
Study Questions:

 What

are the experiences of critical care nurses

regarding the presence of family members during
CPR?

85

 What

are the opinions of critical care nurses

regarding the presence of family members during
CPR?

2.1. Study population and sample selection

The survey universe comprised critical care nursing
staff at the research and teaching hospitals afliated
with universities and SSK (Social Security Agency) in
Istanbul, Turkey. Data for this study was collected
during 1 May 200430 July 2004.
Two hospitals refused to participate and were not
included in the study. The study population consisted of
critical care nursing staff at four hospitals afliated
with the Ministry of Health, three hospitals afliated
with universities and three hospitals afliated
with SSK (Social Security Agency). A total of 409
eligible critical care nurses were surveyed. Forty nine
refused to participate, 55 were on leave, 27 failed to
complete the questionnaires correctly. Overall, the
response rate of the study is 68% of the targeted sample
n 278.
2.2. Study design and data collection
Data were gathered using a survey questionnaire
which was developed by Fulbrook et al and the
questionnaire is consisted of 43 items under 3 areas of
inquiry. Areas of inquiry included in this survey were:
personal information of the nurses (1), their experiences
in regard to family witnessed CPR (2) and their opinions
on family witnessed CPR (3). The questionnaire was
developed following a comprehensive review of the
available and related literature. The cover page of the
survey stated the rationale and objectives of the
survey and introduced the key terms used frequently
throughout the survey. Section one consisted of
items assessing socio-demographic characteristics such
as: age, sex, experience in intensive care unit (ICU) and
nursing, specialty and main practice. Section two
consisted of six items with dichotomous response
alternatives (yes/no), and section three consisted of
Likert-type items (Agree/Do Not Know/Disagree).
Section three was subdivided intro three parts surveying
the inuence of family member presence during
CPR on decision making, health care professionals
and patient members, and possible CPR outcomes. Data
were collected after obtaining oral and written consent
from the concerned authorities of the hospitals. Permission was sought from the hospitals that participated to
the study and every attempt was made to conform to
international research ethics guidelines. The nurses who
gave oral and written consent to take part in the study
were informed the answers would be anonymous,
condential, and that the study data would be used
only for scientic purposes. The survey questionnaire

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A. Badir, D. Sepit / International Journal of Nursing Studies 44 (2007) 8392

was pilot tested on 30 nurse subjects in the same setting.

The questionnaire was determined to be appropriate,
feasible and understandable, and thereby granted no
further alterations.

2.3. Data analysis

Data were analyzed using the Statistical Package for
Social Scientists (SPSS 12.0 for windows). Descriptive
statistics were used for analyzing the data.

Table 1
Demographic data of the characteristics of the critical care
nurses n 278
Characteristics

Gender
Female
Male

268
10

96.4
3.6

Experience in ICU
p10 years
X11 years

237
36

85.1
13

Experience in nursing
p10 years
X11 years

209
58

76.5
21.2

6
94
51
20
82
13
12

2.2
33.8
18.3
7.2
29.5
4.7
4.3

248
26
4

89.2
9.4
1.4

Specialty
General Surgical Intensive Care Unit
Coronary Intensive Care Unit
Cardiovascular Intensive Care Unit
Neurosurgery Intensive Care Unit
Reanimation
Medical Intensive Care Unit
Emergency Surgical Intensive Care
Main practice
Practice
Management
Education

3. Results
3.1. Biographical data
Majority of the sample population (96.4%, n 268)
ranged in age from 1950 years with a mean age of
27.5575.279. In terms of experience, 76.5% n 209 of
the critical care nurses had less than 10 years of
experience in nursing and 85.1% n 237 had less
than 10 years of experience in ICU. Of the respondents,
33.8% n 94 worked in the coronary intensive care
unit, 29.5% n 82 worked in the reanimation unit and
89.2% n 248 were involved in general practice
(Table 1).
3.2. Nurses experiences of family witnessed resuscitation
Slightly more than half (63.7%, n 177) of the
sample population were inexperienced with family
presence during CPR. None of the respondents invited
family members to the resuscitation room, a majority
did not have a positive experience of family member
presence during CPR (88.8%, n 247) and some
specically had a negative experience (33.5%, n 93).
An interesting survey result was that none of the
hospitals had a protocol or policy regarding the
option of family member presence during resuscitation
(Table 2).
3.3. Nurse opinions regarding presence of family
members during CPR
3.3.1. Decision making regarding presence of family
members during CPR
When asked about their opinions on family member
presence during CPR, a majority of the nurses (83.1%,
n 231) did not feel it was necessary to invite family
members to be with the patient during CPR, 69.1% n
192 did not want relative members present, 78.8% n
219 indicated the reluctance of physicians to have
family members present during resuscitation. When

Table 2
Nurses experiences of family witnessed resuscitation
Experiences

Have you experienced a situation in which family members were present during CPR?
Has a family member ever asked you if they could present during CPR?
Have you ever invited a family member to be present during CPR?
Does your unit/ward have a protocol or policy document on family presence during CPR?
Have you had one or more positive experiences of family members being present during CPR?
Have you had one or more negative experiences of family members being present during CPR?

Yes

No

101
57

30
93

36.3
20.5

10.8
33.5

177
218
278
278
247
183

63.7
78.4
100
100
88.8
65.8

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A. Badir, D. Sepit / International Journal of Nursing Studies 44 (2007) 8392

asked about their opinions on who was responsible for

extending family members the opportunity to be present
during CPR, 56.9% n 158 did not think nurses were
responsible, 55% reported that it was the physicians
responsibility and 77.7% n 216 reported that a joint
responsibility of all members of the resuscitation team
was necessary. Of the respondents, 88.1% n 245
were concerned about the violation of patient condentiality, 88.5% n 246 had concerns that untrained
family members would not understand CPR treatments
and consider them offensive thereby argue with the
resuscitation team and 75.9% believed family members
should not be involved in decisions regarding the
patient. It is also interesting to note that when asked if
present during CPR, whether families would be more
likely to accept decisions to stop resuscitation efforts,
43.2% n 120 of the nurses did not express an
opinion and 36.7% n 102 were in agreement
(Table 3).
3.3.2. Effect of family member presence on health care
providers and patient family members
Of the respondents, 87.8% n 244 reported that
resuscitation was very stressful for families, 74.1% n
206 believed that certain decisions made during
resuscitation might upset family members and 78.8%
n 219 indicated that it was not benecial for
patients.
Majority of the respondents (84.2%, n 234) believed that presence of family members would cause
undue stress on the staff, 64.7% n 180 indicated that
family members might be inclined to interfere with the
resuscitation team, 71.5%n 199 mentioned that
there was not enough personnel to assist the family
members during resuscitation, 70.9% n 197 expressed concern regarding the limited space, 83.1% n
231 reported that family witnessed CPR was not a
common practice for family members to witness
resuscitation and 62.2% n 173 were concerned that
if family members were present during resuscitation, one
of the members of the resuscitation team would have to
be present with the family at all times (Table 4).
3.3.3. Influence of family member presence on CPR
outcome
Majority of the respondents (88.5%, n 246) expressed concern that witnessing resuscitation would
cause long lasting adverse emotional effects on the
family members, 55.4% n 154 did not agree that
families would consider the resuscitation process as cruel
or abusive and 75.2% n 209 disagreed that family
member presence can potentially result in a lawsuit.
When asked whether family member presence would
lead the family to believe that everything possible was
done for their loved one, 43.5% n 121 of the

87

respondents did not agree and 28.1% n 78 were

uncertain.
Of the respondents, 54.7% n 152 believed that the
resuscitation team would be more likely to prolong the
resuscitation attempt if a family member was present,
68% n 189 thought that family member presence
during CPR would not strengthen the bond between the
nurses and the family and 73.4% n 204 disagreed
that presence of family members beneted the patient.
Almost half of the respondents (57.2%, n 159)
disagreed that the presence of family members would
assist the familys grief process by being with their loved
one during the nal moments and 53.2% n 148
believed presence would actually prolong the emotional
readjustment at the loss of a loved one.
When asked whether the respondents agreed presence
is crucial for family members to share the nal moments
with their loved one upon unsuccessful CPR, 46.6%
n 99 did not agree, 23.7% were undecided and
29.2% agreed with the statement (Table 5).

4. Discussion
To the knowledge of authors, this is the rst and only
study conducted in Turkey to investigate the experiences
and opinions of critical care nurses on presence of family
members during resuscitation of their loved one.
Experiences and opinions of the critical care nurses are
discussed separately in two sections.
4.1. Nurses experiences of family witnessed resuscitation
Of the respondents, 63.7% n 177 reported they
did not experience a situation in which family members
were present during CPR. This ratio is higher than the
ndings of previous studies by McClenathan et al.
(2002) (59%, n 343) and Fulbrook et al. (2005)
(47.8%). In addition, none of the respondents in our
study offered the family members the opportunity to be
with their loved one during resuscitation and 78.4%
n 218 reported that family members did not request
to be present during resuscitation. In a study by Redley
and Hood (1996), comprising nurse respondents, only
14% believed families should always be invited to be
present during resuscitation, 11% thought they should
never be invited and 70% received a request from the
family members to be present during resuscitation. In a
study by Fulbrook et al. (2005), 45.5% of the nurses
were opposed to the presence of family members during
resuscitation and 28.2% received requests from the
family members to be present during resuscitation. This
ratio was found to be 31% in the MacClean et al. (2003)
study. In our study, the lack of requests from family
members to be present with their loved one during

83.1

78.8
23.0
32.4

55.0

17.2

9.0

9.0

75.9

20.1

231

219
64
90

153

48

25

25

211

56

120

30

14

44

27

18

37

13

43.2

10.8

2.5

2.9

5.0

15.8

9.7

6.5

13.3

4.7

21

32

102

36

246

245

216

81

158

192

Agree

36.7

13.0

88.5

88.1

77.7

29.2

56.9

69.1

7.5

11.5

88

Family members should always be

offered the opportunity to be with
the patient during CPR
Doctors want relatives to be present
during CPR
Nurses do not want relatives to be
present during CPR
Nurses should have the
responsibility for deciding if family
members are allowed to be present
during CPR
Doctors are responsible for
deciding if family members are
allowed to be present during CPR
It should be the joint responsibility
of all members of the resuscitation
team to decide whether (or not)
family members are allowed to be
present during CPR
There may be a problem of
condentiality in discussing details
about the patient if family members
are present during CPR
Because family members do not
understand the need for specic
intervention they are more likely to
argue with the resuscitation team
Family members should be present
during CPR so that they can be
involved in decisions
If present during CPR, family
members are more likely to accept
decisions to withdraw treatment

Do not know

Disagree

Table 3
Decision making regarding presence of family members during CPR n 278

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43
18
35
203
42
199
36
22
79
219

154
14
24
121
76
189
34
159
66
129

55.4
5.0
8.7
43.5
27.4
68.0
12.2
57.2
23.8
46.4

69
18
45
78
50
52
37
75
64
66

24.8
6.5
16.2
28.1
18.0
18.7
13.3
27.0
23.0
23.7

n
%

19.8
5.8
3.2
13.3
9.7
9.0
14.4
9.0
8.6
15.1

Do not know

55
16
9
37
27
25
40
25
24
42

Disagree

15.4
6.5
12.6
73.0
15.1
71.5
12.9
7.9
28.4
78.8

n
%

Do not know

Disagree

Family presence during CPR prevents family members developing distorted images or wrong ideas of resuscitation process
Family members will suffer negative long-term emotional effects if they are present during CPR
Rates of legal action against staff will increase because, when present, family members may misunderstand the actions of resuscitation team
Family presence during CPR helps family members to know that everything is being done for patient
The resuscitation teams are more likely to prolong the resuscitation attempt if a family member is present
Family presence during CPR creates a stronger bond between family and nursing team
Family presence during CPR is not benecial to the patient
Family presence during CPR helps the family member with the grieving process, if the patient does not survive
Family presence during CPR prolongs emotional readjustment at the loss of family member
Family presence during unsuccessful CPR is important because it enables family members to share the last moments with the patient

Table 5
Inuence of family member presence on CPR outcome

Family members are very likely to interfere with the resuscitation process
Family members should not be present during CPR because it is too distressing for them
Nursing and medical staff nd it difcult to concentrate when relatives are watching
The performance of the team will be positively affected due to the presence of family members
During CPR the resuscitation team may say things that are upsetting to family members
There are enough nursing staff to provide emotional support and remain with the family member during resuscitation
Most bed areas are too small to have a family member present during resuscitation
It is not a normal practice for family members to witness the resuscitation of a family member
If family members are present during CPR, there should be a member of the resuscitation team whose only role is to look after family
Family presence during CPR is benecial to the patient

Table 4
Effect of family member presence on health care providers and patient FMs

64.7
87.8
84.2
13.6
74.1
18.7
70.9
83.1
62.2
5.7

52
246
209
77
152
36
204
43
148
81

18.7
88.5
75.2
27.7
54.7
13.0
73.4
15.5
53.2
29.2

Agree

180
244
234
38
206
52
197
231
173
16

Agree

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A. Badir, D. Sepit / International Journal of Nursing Studies 44 (2007) 8392

resuscitation can be rationalized by unawareness of such

an option.
All participants in our study reported that there was
no written policy regarding family member presence
during CPR in their institution. The absence of hospital
policy regarding family presence during resuscitation
was found to be 5% in North America (MacClean et al.,
2003) and 5.6% in Europe (Fulbrook et al., 2005).
Of the nurses in our study, 36.3% n 101 experienced a situation in which family members were present
during CPR. Among the experienced group of nurses,
10.8% n 30 had a positive experience of family
member presence during resuscitation. Similar results
were reported by MacClean et al. (2003) and Fulbrook
et al. (2005).
Majority of nurses in our study did not experience a
situation in which family members were present during
resuscitation. None of the nurses offered the family
members the opportunity to be present during resuscitation and most did not receive any request from the
family members to be present during CPR members. In
addition, family witnessed CPR has yet to become a
public issue in Turkey. These ndings can be partially
explained by the unfamiliarity of both the nursing staff
and the family members with the option of being present
during CPR.
4.2. Nurse opinions regarding presence of family
members during CPR
4.2.1. Decision making regarding presence of family
members during CPR
Majority of the respondents (83.1%, n 231) agreed
that family members should not always be offered the
opportunity to be with the patient during CPR, 69.1%
n 192 were opposed to the presence of family member
presence and 78.8% n 219 mentioned the reluctance of
physicians. In a UK study (Mitchel and Lynch, 1997)
comprising physicians and emergency and trauma services
nursing staff, 37% of the participants supported the option
for family member presence during resuscitation. In their
study, nurses were more open to the option of family
member presence during CPR when compared to physicians. Of the participants in Fulbrook et al. (2005) study,
47% supported family presence during CPR. In the same
study, 33.3% of the nurses thought family presence should
not be allowed during resuscitation and 78.2% mentioned
that physicians did not allow family members during CPR.
In a separate study by Meyers et al. (2000), 96% of
registered nurses, 79% of physician residents and 19%
attending physicians supported family member presence
during CPR with a considerable difference between nurse
and physician replies.
In our study, 56.9% n 158 of the nurses believed
they should have responsibility in deciding whether
families should be present during resuscitation, 55%

indicated that it was the physicians responsibility and

77.7% n 216 agreed on a joint responsibility of all
members of the resuscitation team. Of the respondents,
75.9% did not support the idea that family members
should be present during CPR so they can be involved in
the decision process regarding the patient. This particular issue was also investigated by Fulbrook et al.
(2005). Of their participants, 63% believed nurses
should not be responsible for the decision for deciding
whether family member should be allowed during CPR,
29% believed it was the responsibility of the physician
and 75.6% agreed on a joint decision. Only 23.4%
thought that family members should be involved in the
decision making.
A majority of our participants (88.1%, n 245) were
concerned that presence of family members during CPR
would violate patient condentiality as opposed to
62.9% in Fulbrook et al. (2005) study. The concern
with the issue of patient condentiality can be explained
by the sudden decisions taken loudly by the resuscitation
team. However, this explanation was shown to be
unrealistic by Boyd and White (1998) and Boyd
(2000)) and Mason (2003). Majority of the nurses in
our study (88.5%, n 246) agreed that resuscitation
efforts might be considered offensive by the family
members, possibly causing tension between the members
of the family and the resuscitation team. When asked
whether family members might decide to stop resuscitation efforts, about half of the sample population (43.2%,
n 120) were uncertain and 36.7% n 102 were in
agreement. Of the nurses in our study, 63.7% did not
have an experience regarding family member presence
during CPR; therefore the lack of experience might
partially explain the survey results. Of the respondents
in Fulbrook et al. (2005) study, 30.6% expressed
concerns that untrained family members might be
offended by the CPR efforts and argue with the
resuscitation team and 52.8% believed that family
members can decide to end resuscitation.
4.2.2. Effect of family member presence on health
care providers and patient family members
Of the respondents in our study, 83.1% indicated that
family member presence during CPR was not a common
practice, 78.8% n 219 did not nd family presence
benecial for the patient, 74.1% n 206 were concerned that decisions taken by the resuscitation team
might upset the members of the family, and 84.2% n
234 indicated that family member presence might
hinder the performance of the resuscitation team. Our
ndings show similarities with Fulbrook et al. (2005)
study. Disapproval among the nurses in our study
regarding the presence of family members during CPR
can be linked to the lack of awareness on family
witnessed CPR and restricted visitor policy in Turkey. A
majority of the nurses (87.8%, n 244) were concerned

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that resuscitation was too stressful for the family and

64.7% n 180 indicated that family members might
be inclined to interfere with the resuscitation team.
These particular concerns were listed as the most
common reasons for disapproving family member
presence during resuscitation (Mitchel and Lynch,
1997; Fulbrook et al., 2005). However, certain studies
indicate that the concerns of health care professionals
were unfounded. Results of these particular studies
suggest that family members did not experience any
adverse emotional effects after witnessing resuscitation
and acted appropriately without disrupting the performance of the resuscitation team (Doyle et al., 1987;
Belanger and Reed, 1997; Robinson et al., 1998; Boyd
and White, 1998; Meyers et al., 2000).
Of the respondents in our study, 62.2% n 173
were concerned that one of the crucial members of the
resuscitation team would have to assist the family
members during resuscitation, 71.5% n 199 did not
think there was enough personnel to assist the family
members and 70.9% n 197 were concerned about the
limited space. Our ndings are similar to those of
previous studies on family witnessed CPR (Redley and
Hood, 1996; Eichhorn et al., 1996; Belanger and Reed,
1997; Rosenczweig, 1998; Meyers et al., 2000; Eichhorn
et al., 2001; MacClean et al., 2003; McClenathan et al.,
2002; Fulbrook et al., 2005).
4.2.3. Influence of family member presence on CPR
outcome
Of the participant nurses in our study, 73.4% n 204
thought that presence of family members during CPR was
not benecial for the patient, 88.5% n 246 were
concerned about the traumatic effects of CPR procedures
on family members and 68% n 189 did not believe
presence of family members would strengthen ties between
nurses and family members. Upon unsuccessful CPR,
57.2% n 159 of the nurses believed being present
during CPR would not assist the family members grief
process and 53.2% n 148 were concerned that their
readjustment would be prolonged. Our ndings contradict
previous studies, which reported the benets of family
member presence during CPR (Robinson et al., 1998;
Eichhorn et al., 2001). Fulbrook et al. (2005) also reported
similar ndings supporting the advantages of family
presence during CPR.
One of the interesting results of our study is that
75.2% n 209 of the nurses disagreed that family
members doubts on certain resuscitation procedures
would prompt a lawsuit.

5. Limitations of the study

The population of this study was limited to critical
care nurses at research and teaching hospitals in

91

Istanbul. Due to the lack of published work on the

family member presence during CPR in Turkey, results
of our study were compared to outside studies.
Furthermore, participant responses were assumed to
be valid and reliable.

6. Conclusion
According to our results none of the hospitals had a
protocol or policy regarding the option of family member
presence during resuscitation. Thus, Turkish critical care
nurses are not familiar with the presence of family member
during CPR. A majority of the nurses did not agree it was
necessary to invite family members to be with the patient,
did not want relatives in resuscitation room, and also did
not want to be responsible for decisions regarding family
witnessed resuscitation. Most of the nurses were concerned
about the violation of patient condentiality, had concerns
that untrained family members would not understand CPR
treatments, would consider them offensive and thereby
argue with the resuscitation team. Others expressed
concern that witnessing resuscitation would cause long
lasting adverse emotional effects on the family members.
This study revealed that critical care nurses in Turkey
are not informed by the international literature on the
concept of family witnessed resuscitation and need
further education to inform them of the issues. In view
of the increasing evidence from international studies
about the value of family presence during CPR and the
rapid changes taking place in the Turkish health care
system due to globalization, this study reveals that
Turkish nurses need ongoing professional education in
relation to this topic in order to contribute to policy and
practice change that will enhance critical care in Turkey.
This will enable Turkish nurses to collaborate with other
members of the healthcare team to develop written
guidelines that support the needs of patients family
members and health professionals in this critical time.
This may produce a more unied and consistent
approach to this sensitive aspect of clinical practice.
Future research efforts should focuses on the views of
other members of the health care team, and the
collection data related to the impact of cultural factors
on family members of patients who undergo CPR.

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Further Reading
Family presence during CPR and invasive procedures, 2004.
AACN News (21:11), 45.