Intensive & Critical Care Nursing 64 (2021) 103003

Contents lists available at ScienceDirect

Intensive & Critical Care Nursing

Review Article

Witnessed resuscitation: A concept analysis

a r t i c l e i n f o a b s t r a c t

Article history: Background: The advance in the practice of resuscitation is globally recognised and fully sanctioned in
Received 5 June 2020 scientific world. However, practicing family presence during resuscitation, also known as witnessed
Revised 18 November 2020 resuscitation, is yet to be endorsed by healthcare professionals. Many professional nursing and physician
Accepted 6 December 2020
organisations have endorsed the practice of witnessed resuscitation by issuing guidelines. These organ-
isations support family presence during resuscitation due to the research proving its benefit for patients
and families.
Keywords:
Purpose: The purpose of this paper is to analyse the concept of witnessed resuscitation.
Witnessed resuscitation
Cardiac arrest
Method: A concept analysis was undertaken using Rodger’s (2000) evolutionary method.
Family presence Findings: The concept analysis suggests that witnessed resuscitation refers to the presence of a family
Emergency member or relative during a resuscitation procedure, mostly in emergency and complex critical care
Critical care areas. The defining attributes are family centred care approach, exercising patients and family rights
Concept analysis and autonomy in end of life care decisions and involvement of family as active and passive observers dur-
ing a resuscitation event.
Conclusion: Clarity surrounding witnessed resuscitation will guide the development of a conceptual
framework, expand nursing knowledge and identify the research required to advance understanding of
witnessed resuscitation in practice.
Ó 2020 Elsevier Ltd. All rights reserved.

Implications for clinical practice

 The findings of the concept witnessed resuscitation are relevant to clinical practice that promotes a family centred care approach to
allow family presence during resuscitation in critical care settings.
 It will advance understanding and knowledge of healthcare professionals (physicians and nurses) and evidence based clinical prac-
tice of family presence during resuscitation.
 It will prepare and educate healthcare professionals to develop policy and guidance to implement family presence during resusci-
tation in clinical settings.
 It will help to eliminate the moral distress, anxiety and fear experienced by clinical nurses forced to make difficult decisions during
resuscitative events.

The term resuscitation means revival or restoration of life from the presence of family member or ‘‘witnessed resuscitation” is
potential or apparent death through artificial respiration and car- yet to be fully explored (Salmond et al., 2012; Walker, 2005). The
diac massage; ultimately maintaining patient’s physiologic and recent development in palliative care, the positive momentum in
cognitive functions (Lederman, 2019; Anderson et al., 2005). The the family centred care approach, high performance of bystander
advancement of resuscitative procedures from basic to advanced, cardiopulmonary resuscitation and other technological advance-
in science and practice has progressed significantly in the develop- ments have facilitated many complex procedures in critical or
ment of life saving procedures. However, resuscitative practice in emergency care services (Salmond et al., 2012). Also, the new para-
digm shift in medicine and nursing has occurred, moving from a
E-mail address: [email protected] paternalistic approach to team work and patient-family centred

https://doi.org/10.1016/j.iccn.2020.103003
0964-3397/Ó 2020 Elsevier Ltd. All rights reserved.
S. Meghani Intensive & Critical Care Nursing 64 (2021) 103003

care (Hassankhani et al., 2017). Patients and family members are resuscitation could be the root of resistance by healthcare profes-
now a part of the holistic view, in which they are a large and com- sionals in practice setting. This conceptual analysis would be a sig-
plex whole in the context of witnessed resuscitation. Moreover, the nificant step in discussing the role of family members in
incidence of post traumatic stress disorder is reported as low in resuscitative events and establishing philosophy of witnessed
those witnessing resuscitation. Family members now have expec- resuscitation regardless of where the concept is applied.
tations of health care providers to enable family witnessed resus- An earlier concept analysis on witnessed resuscitation was pub-
citation and seeking permission to be present during lished (Walker, 2005) more than a decade previously. However,
resuscitation (Hassankhani et al., 2017). All these notions and with continuous technological advancements and the dynamic
developments call for attention to the application and practice of nature of nursing practice, this concept is still evolving. This paper
witnessed resuscitation among healthcare providers in critical care will update attributes to include the family centred care approach,
settings. patient and family rights and autonomy and other areas not dis-
Numerous publications provide a common understanding of the cussed in the previousearlier study. The reasons for conducting a
term witnessed resuscitation and its application in practice. How- concept analysis of ‘‘witnessed resuscitation” are many. First, there
ever, witnessed resuscitation has remained a controversial phe- will be a focus on understanding the differences in the challenges
nomenon over more than three decades. Many professional of practicing family presence during resuscitation in variety of set-
organisations, such as the Resuscitation Council in the United King- tings such as acute care, emergency, critical care areas and outpa-
dom (UK), the Emergency Nurses Association (ENA), the American tient community setting, among both adult and pediatric
Association of Critical Care (AACN), the American Heart Association population. However, most literature around this topic has been
(AHA) and the Canadian Critical Care Society have endorsed this discussed mainly in emergency and critical care settings. Secondly,
practice by issuing various guidelines (Tennyson, 2019). There is there is a need to advance the concept to the next level of knowl-
growing evidence that most nurses favour witnessed resuscitation edge development in the nursing discipline. By clarifying this
regarding it as an issue of advocacy for patients and their families evolving concept of witnessed resuscitation, further research
in contrast to clinicians who often share concerns of its deleterious investigating lived experiences, barriers and facilitating factors in
effects and medico-legal impact (Tennyson, 2019; Vincent & its application and practice can be undertaken. This conceptual
Lederman, 2017). Literature widely supports witnessed resuscita- work will assist researchers and educators to reflect on the phe-
tion as an example of family centred care and practising principles nomenon in nursing, to address clinical issues and its application
of autonomy that have consequential benefits to both patient and in diverse contextual settings. In addition, it will set the platform
family in the healthcare setting (Lederman, 2019). These benefits to strive in achieving the United Nations Sustainable Development
include comforting presence, satisfaction with the resuscitative Goal (SDG) number ten in strengthening family centred care,
process, decision making, right to sustain or withdraw resuscita- equity and respecting human rights while reducing disparity in
tion and decreased stress and anxiety (McClement et al., 2009). healthcare (United Nations, 2020).
Evidence suggests that providing the option of witnessed resusci-
tation to family members along with liaison support may not have
any effect on the patient’s resuscitative outcome, however, it does Aim & Method
reduce stress and post traumatic symptoms in family members
(Al-Mutair et al., 2012; Meghani et al., 2019; Oczkowski et al., The aim of this paper is to perform a concept analysis of wit-
2015). Engaging family in end of life care and resuscitation enable nessed resuscitation using Rodger’s (2000) evolutionary method.
the closure to begin grieving process, promote satisfaction and This method provides the basis for analysis of the concepts that
enhance therapeutic relationships between staff, patients and fam- are evolving and influenced by the context in which they are used
ily members Hassankhani et al., 2017). (Tofthagen & Fagerstrøm, 2010). This model involves an eight-
Witnessed resuscitation is an abstract and a debatable concept. stage process: (1) Identify the concept of interest (2) Identify sur-
Emergency and critical care settings are the most complex areas rogate terms and relevant uses of the concept (3) Identify and
where the frequency of resuscitation attempts is common. Family select appropriate realm for data collection (4) Identify the attri-
presence during resuscitation (FPDR) or family witnessed resusci- butes of the concept (5) Analyze data regarding the above charac-
tation (FWR) or witnessed resuscitation (WR) is often considered teristics of the concept (6) Identify references, antecedents and
as challenging practice as shared by healthcare professionals. The consequences of the concept (7) Identify a model case of the con-
common challenges reported in the literature are lack of healthcare cep; and (8) Identify implications for further development of the
professionals’ knowledge regarding FPDR, lack of acceptance to concept. The paper will add to the new knowledge that will guide
perform FPDR among nurses and physicians, lack of policy regard- future research and practice. The paper describes the phenomenon
ing FPDR and lack of managerial support for FPDR (De Robertis historically and contextually using seminal and recent work fol-
et al., 2017). Nevertheless, such a practice is evolving and repre- lowed by relevant uses of the concept in acute care, emergency,
sents a significant paradigm shift. Despite this controversial prac- and critical care settings. Conceptual clarity is further enhanced
tice concern, based on research evidence, experts’ opinions, through antecedents, identification of attributes, consequences,
family members opinion polls and many international organisa- and a model case. An operational definition and implications for
tions, have endorsed the practice of witnessed resuscitation practice and research are also included.
(McClement et al., 2009). It is important to understand that the
family is a central social unit that shares a close relationship and
involvement in patient care. This involvement is not mutually Literature search strategy
exclusive, rather shares the involvement along with the continuum
from passive to active involvement in care. Dreyer & Nortvedt Several databases MEDLINE, PUBMED, CINHAL, Ovid, and Goo-
(2008) described that family involvement in care begins from gle Scholar were used to obtain material on the concept of interest.
admittance to discharge. The family involvement components are Search terms included resuscitation, cardiac arrest, witnessed
involvement as presence, involvement as care giver and receivers resuscitation, family presence, emergency care, critical care and
and involvement as decision makers. Therefore, lack of under- concept analysis. The search was not restricted to any culture or
standing about the role of family member during care and resusci- context and only articles using the English language were used.
tative events and lack of definition about the concept of witnessed The literature was drawn from a broad time frame (2000–2019)
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S. Meghani Intensive & Critical Care Nursing 64 (2021) 103003

as this served the purpose of evolutionary concept analysis of wit- where most resuscitation events occur. Various international criti-
nessed resuscitation along with its historical development. cal care professionals in studies have reported that witnessed
resuscitation is not new for them. They have experienced it many
times during active resuscitation. Physicians and nurses with rising
Conduct of the concept analysis
seniority in emergency and critical care settings have expressed
increased comfort in giving options to witness and dealing with
According to Merriam Webster Online Dictionary (2016), the
family members during resuscitation (Feagan & Fisher, 2011;
word ‘‘resuscitate” is a verb and the Latin word resuscito, means
Holzhauser & Finucane, 2008; Walker, 2008). The practice of allow-
‘‘to revive”. ‘‘Resuscitation” is a noun, defined as ‘‘the act of reviv-
ing families to witness resuscitation is of global interest and has
ing someone from apparent death or from unconsciousness”. The
more positive attitudes towards it (McClement et al., 2009). Even
procedure of resuscitation in the literature is defined by medical,
though procedures that require more complex, fast and efficient
nursing, and allied health disciplines, however, its historical signif-
treatment for severely injured or surgical patients also verified
icance is from biblical times where it is described as ‘‘mouth to
the practice of witnessed resuscitation (Helmer et al., 2000). Evi-
mouth” and ‘‘breathing into”. Later, in the 20th century, in modern
dence suggests that an emergent and intense critical environment
procedure, the resuscitation came to include effective means of
in an acute care setting can invite the practice of witnessed resus-
chest compression, ventilation, cardiac massage, and use of a defib-
citation considering proposed guidelines by professional bodies.
rillator (Ekmektzoglou et al., 2012). According to Mosby’s Medical,
There is a strong support to parents’ involvement during paediatric
The Nursing and Allied Health dictionary (2005), resuscitation is
resuscitation and to exercise their choice. However, when it comes
defined as ‘the restoration and revival of life from potential or
to the notion of FPDR in adult population, the concept becomes
apparent death’. The common observation and understanding of
controversial. Intense disagreement is observed by the emergency
the term resuscitation are found in various dictionaries regardless
and critical care areas’ healthcare professional who choose to deny
of the context it is used.
family presence during resuscitation attempts.
The term ‘‘witness” is the prefix used with resuscitation. Litera-
Family Centred Care. In complex care settings, the witnessed
ture defines witnessed resuscitation as ‘the presence of family
resuscitation concept is now tied to the paradigm of Family Cen-
members or relatives during resuscitation’ (Boyd, 2000). ‘Family
tered Care approach. This approach encourages and recommends
presence during resuscitation’ or ‘witnessed resuscitation’, are
the participation of family members in patients’ holistic care, end
terms often used interchangeably in the literature. The term ‘wit-
of life decisions, presence of family members during rounds, inva-
ness’ has been used differently in inpatient and outpatient settings.
sive procedures and resuscitation (Curtis & Vincent, 2010). The
In inpatient settings, authors use the term ‘witness’ as next of kin,
outlook on the patient and family centred care provides a frame-
loved ones, family members or relatives (Lederman, 2019). Family
work for offering the option of witnessed resuscitation (ENA,
could be anyone who shares an intimate relationship with a
2007). Powers and Candela (2016) report that it is a traditional
patient or is someone who is very close to a patient (Lederman,
practice shift from separating families during a resuscitation event,
2019). In outpatient settings, the term ‘witness’ refers to any by-
to now including them as a way to promote family centred care
stander or rescuer who could be a stranger and not a close family
where families are considered as integral part in care and decision
member (Norris, 1998). In addition, a witness could be a parent
making. Literature identifies that family members or relatives who
during resuscitation of an infant or a child (Vincent & Lederman,
are given the option of witnessed resuscitation expressed satisfac-
2017). Thus, witnessed resuscitation is defined as ‘the involvement
tion, reduced anxiety, increased knowledge of the persons condi-
of a family member or relative, whether active or passive, in resus-
tion and facilitated grieving process (Al-Mutair et al., 2012).
citative efforts of their patient’. The family member may be present
Other views and opinions are found that suggest allowing the
at a distance or in proximity where one may talk and touch the
option of witnessed resuscitation to family members and providing
loved one (Lederman, 2019).
a facilitator to accompany them, supported families in decision
Historically, the main idea of witnessed resuscitation was orig-
making. Moreover, respecting patient’s and family’s autonomy
inated from the Foot Hospital Michigan in the United States of
which best fits in the framework of family centred care
America in 1983 (Al Mutair, 2017). This was the first time that fam-
(Lederman, 2019). Such an approach to care also promotes the
ily members had been encouraged to attend resuscitation attempts
relationships among patients, families and healthcare providers
and introduced the concept of facilitated participation. The inten-
(Institute for Patient- and Family-Centered Care (IPFCC), 2010).
sion of the participation is to involve healthcare professionals to
The core concept of family centered care involves families through-
support family members who wish to witness resuscitative event
out the life continuum, therefore, be it a birth or death or anywhere
of their loved ones (Meghani et al., 2019). The practice guidelines
in between, witnessed resuscitation should be allowed (Tomlinson
of witnessed resuscitation were first initiated and developed in
et al., 2010).
1995 by the United States by Emergency Nurses Association
Right and Autonomy. The concept witnessed resuscitation, is also
(ENA) and then endorsed by the Resuscitation Council (UK) for
used in the context of patients’ and families’ autonomy, their rights
its implementation in 1996 by healthcare professionals in the prac-
and the principles of social justice. Healthcare professionals often
tice settings (Boyd, 2000). Later, with the evolution of the practice,
do not allow family members to witness resuscitation and use a
many other international health organizations in different other
paternalistic approach either towards patients or families, where
countries endorsed the practice and offered a common under-
a family’s autonomy and wishes to participate in this important
standing of the concept in different contexts (Toronto & LaRocco,
event are ignored and not valued (Colbert & Adler, 2013;
2019).
Lederman, 2019). It is noteworthy that the guidelines of witnessed
resuscitation do not recommend that family members must be
Findings exposed to witnessed resuscitation or patients must allow family
members to experience this event. However, the idea is to give
Use of the concept patient and family members an option to decide whether they
wish to attend (Lederman, 2019). During end of life care, patients
The concept witnessed resuscitation is used in a variety of demonstrate special needs and often struggle making decisions
healthcare settings among diverse patient populations and is, for themselves and require continuous support, assistance and
specifically evident in emergency care and in critical care areas guidance. A family’s active involvement in end of life care and
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S. Meghani Intensive & Critical Care Nursing 64 (2021) 103003

preparation for bereavement often result in a smooth grieving pro- threatening situation emerges. These situations are dealt with by
cess, facilitates advanced care planning, withhold or withdraw life a certified basic and advanced level life support team commonly
saving treatments, achieve sense of accomplishment, facilitate known as code team or rapid response team. These events most
relationships, promote satisfaction and quality of life (Melhado, & often occur in tertiary care settings but may happen in primary
Byers, 2011; Waldrop, & Meeker, 2012). or secondary care services, in hospital wards or clinics or outside
In the ethical discourse, it is common to acknowledge that com- hospital settings. To experience and practice witnessed resuscita-
petent patients and families have a right to make decisions, a right tion, a resuscitation event needs to take place in the presence of
to refuse treatment, a right to be involved in care and even a right qualified staff and family. Witnessed resuscitation may be exer-
to die. Similarly, the notion of autonomy applies to giving options cises when family members are given the option to be present,
to family members for witnessed resuscitation if patients wish for or if a person expresses his/her wish to allow family member in
their loved ones to be present. resuscitative event, thus allowing shared partnership and decision
Simultaneously, exercising the right of family members to see making in care.
their loved ones in the moments before death (Oczkowski et al.,
2015). In some studies, it remained a concern that even keeping Consequences
with the principle of autonomy and allowing family members to
be present during resuscitation, may have a negative influence The consequences of witnessed resuscitation are well identified
on patient’s outcome (Mian et al., 2007). in the literature. Both positive and negative experiences have been
Most empirical evidence supports that witnessed resuscitation shared by healthcare professionals. Witnessed resuscitation may
has no negative influence on patient outcomes and rather has bring satisfaction, reduced anxiety, facilitated grieving, and pro-
shown improvement in psychological outcomes of both patient vide understanding about all possible measures are performed,
and family members (Tennyson, 2019). Ninety-six percent of allow last minute presence with loved ones and so forth. On the
patients’ families perceived witnessed resuscitation as their right other hand, witnessed resuscitation may cause interruption of
and as a positive experience (Meyers et al., 2000). family members during resuscitation, psychological trauma, staff
Active and Passive Observer. In several studies, the witness role is being watched, emotional distress and trauma for family members.
viewed as both an active and passive observer of a resuscitative Instead, the idea of allowing family members during resuscitation
event. De Stefano et al. (2016) have reported families’ experiences is well supported by patients and family members (Tudor et al.,
of being active in the resuscitation procedure. Some participants 2014). In addition, medico legal implications are also addressed
were interviewed and expressed that since they had begun cardiac relating to this concept in which no concern of litigation is present
massage of their loved ones before arriving at the emergency in the empirical evidence (Al Mutair, 2017; Mian et al., 2007).
department, they felt themselves part of the resuscitative process Policies and position statements regarding witnessed resuscita-
from the onset. They wanted to be present throughout the resusci- tion are already endorsed by many international organisations.
tative process in emergency room. Moreover, they could also make
end of life care decisions for their patients in collaboration with
healthcare providers. Additional literature supports the practice Attributes
of witnessed resuscitation attempts as helpful in the grieving pro-
cess as shared by nurses in a qualitative study. Nurses in the study Witnessed resuscitation is an evolving concept supported by
believed that witnessed resuscitation gives an opportunity to fam- international health organizations in practice settings. Following
ily members to be physically present, touch, speak to, and provide attributes widely define the concept of witnessed resuscitation:
emotional support to their patients (McClement et al., 2009). On Witnessed resuscitation can occur in emergency and critical care
the contrary, opposite opinions are shared that realistic view of areas. Those who witness resuscitation, are family members, or rel-
resuscitation of loved ones and prolong grieving process is trau- atives or next of kins. The witness in resuscitative process could be
matic and non-therapeutic for family members. Surveys of health- an active or passive observer. Witness or family members are part-
care professionals also reveal that family members often get fearful ners in end of life care and decision making that are included in the
and aggressive while observing resuscitative efforts (De Robertis framework of family centered care approach. Witness or family
et al., 2017). Such controversies direct this notion to refer to the member share rights and autonomy in making a choice to be pre-
guidelines and statements endorsed by international professional sent during resuscitation.
organisations.
The guidelines indicate that family members should be Model case
screened first for their emotional status. Families should be given
an option to be present while accompanied by a facilitator The model case reflects the identified attributes of witnessed
throughout the process to encourage constant communication resuscitation mentioned above. A person had a cardiac arrest and
and support during this difficult time (ENA, 2007; Oczkowski presented at an emergency department, accompanied by her
et al., 2015). It is evident that emergency rooms are usually stress- daughter who initiated cardiopulmonary resuscitation on the
ful and crowded with rapid changes in clinical condition of way to the hospital. She stayed at the bedside in the resuscitation
patients. During that situation it is extremely complex to identify room. She was asked by a nurse whether she would like to be with
family and take end of life decisions with them. her mother during the resuscitative process. She affirmed her will-
Under such pressures and possible liability, it is likely that ingness to be present and to observe resuscitative interventions
healthcare professionals would focus more on outcomes rather performed on her mother by the resuscitation team, though, it
giving priority to end of life care decisions (De Robertis et al., was quite a painful and emotional situation for her. A medical offi-
2017). cer leading the code team was in continuous communication with
her while asking her about her mother’s previous history and pre-
arrest event/situation. At the same time, the medical officer also
Referents and Antecedents explained the life sustaining measures that were being taken.
The daughter looked satisfied and noted that the whole code team
In an emergency care setting or in critical care areas, resuscita- performed their job efficiently and all possible interventions were
tion begins when cardiac emergency, respiratory arrest, or life- done by the team in her presence to save her mother’s life. After
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S. Meghani Intensive & Critical Care Nursing 64 (2021) 103003

seeing her mother with the resuscitation team for 20 minutes, the Conclusion
daughter asked them if her heartbeat had resumed.
Unfortunately, despite intense resuscitative measures, the team This concept analysis of witness resuscitation led to new mean-
were unable to gain return of spontaneous circulation. By being ings and unique dimensions of the phenomena. New findings were
part of this painful situation, the daughter decided to withdraw reported in the paper which were not presented in a previous con-
cardiopulmonary resuscitation. Later, she was asked if she wants cept analysis found in the literature. This conceptual work provides
to spend sometime alone with her deceased mother with addi- a rich contextual understanding of the concept and identified attri-
tional support from nurses along with a grief counsellor. butes, antecedents, and consequences of witnessed resuscitation.
The use of concept entails family centred care approach, respects
family’s rights, and autonomy in accordance with the sustainable
developmental goals given by United Nations. The concept analysis
Discussion
will guide nurse researchers, educators, clinicians, and policy mak-
ers with increased awareness, understanding and wider applica-
Family presence during resuscitation (FPDR) has remained a
tion of the concept in practice settings.
controversial topic for three decade and its implementation is yet
to be fully realized in critical care. Nurses have more positive atti-
tudes towards witnessed resuscitation compared to physicians Ethical statement
(Meghani et al., 2019) and family members desire to be present
and choose to participate in resuscitative event (Meghani et al., The manuscript does not have any ethical concerns and does
2019). Witnessed resuscitation is a complex concept, an advanced not involve human subjects as this is a concept analysis paper.
clinical practice that needs critical understanding, knowledge and Therefore, ethical approval was not required.
careful application in practice settings. A lack of understanding
surrounding this concept could result in limitations at the level Declaration of Competing Interest
of healthcare providers to fully practice this approach in practice
settings especially in critical and emergency areas in the hospital. This is to certify that the author has no conflict of interest and
It is evident that providers, recipients and the context of care can has no affiliations with or involvement in any organization or entity
influence the understanding of the concept in emergency situa- with any financial interest or non-financial interest in the subject
tions, in acute care and in critical care settings. The steps presented matter or materials discussed in this manuscript.
in this paper utilising Rodger’s method further promotes a shared
understanding of the concept and encourages a family centred care
References
approach among healthcare providers in hospital settings.
The concept also recognises family member’s needs, wishes and Al Mutair, A., 2017. Should Family be Allowed During Resuscitation. Resuscitation
preferences and empowers them to make appropriate treatment Aspects, 43.
decisions and healthcare choices in terms of patient care. Al- Mutair, A. S., Plummer, V., & Copnell, B., 2012. Family presence during
resuscitation: A descriptive study of nurses’ attitudes from two Saudi
The approach allows shared partnership among patients, fami- hospitals. Nursing in Critical care 17(2), 90-98.
lies, and healthcare professionals to promote wellbeing and quality Anderson, D. M, Keith, J., Novak, P. D, & Elliot, M. A., 2005. Mosby’s medical, nursing,
of life. Additionally, the concept advocates for the sustainable & allied health dictionary. (6th ed.). St. Louis, Mosby.
Boyd, Russell, 2000. witnessed resuscitation by relatives. Resuscitation 43 (3), 171–
development goal of provision of patient/family rights, respecting 176.
values and beliefs and maintaining equity and equality towards Colbert, J.A., Adler, J.N., 2013. Family presence during cardiopulmonary
the goal of health for all. resuscitation — polling results. N. Engl. J. Med. 368 (26), e38.
Curtis, J.R., Vincent, J.L., 2010. Ethics and end-of-life care for adults in the intensive
Witnessed resuscitation has implications for research settings. care unit. Lancet 376 (9749), 1347–1353.
There is huge diversity and pluralistic views around the concept De Robertis, E., Romano, G.M., Hinkelbein, J., Piazza, O., Sorriento, G., 2017. Family
of witnessed resuscitation in healthcare. It is fundamental for presence during resuscitation: a concise narrative review. Trends Anaesthesia
Crit. Care 15, 12–16.
nurse practitioners and researchers to critically understand, inter-
De Stefano, C., Normand, D., Jabre, P., Azoulay, E., Kentish-Barnes, N., Lapostolle, F., &
nalise and signify the increased awareness and application of the Vicaut, E., 2016. Family presence during resuscitation: A qualitative analysis
evolving concept of witnessed resuscitation. Research will provide from a national multicenter randomized clinical trial. PLoS One, 11(6), 1-8.
Dreyer, A., Nortvedt, P., 2008. Sedation of ventilated patients in intensive care units:
new knowledge and new directions for research and practice areas
relatives’ experiences. J. Adv. Nurs. 61 (5), 549–556.
in the area of witnessed resuscitation that include, encouraging Ekmektzoglou, K.A., Johnson, E.O., Syros, P., Chalkias, A., Kalambalikis, L., Xanthos, T.,
family centered approach, and overall enhancement of wellbeing 2012. Cardiopulmonary resuscitation: a historical perspective leading up to the
of persons and their families. Moreover, the conceptual and opera- end of the 19th century. Acta Medico-historica Adriatica 10 (1), 83–100.
Emergency Nurses Association, 2007. Presenting the option for family presence sss.
tional understanding of the concept. Des Plaines, IL. Retrieved from http://www.ena.org.
Feagan, L.M., Fisher, N.J., 2011. The impact of education on provider attitudes
toward family-witnessed resuscitation. J. Emergency Nursing 37 (3), 231–239.
Hassankhani, H., Zamanzadeh, V., Rahmani, A., Haririan, H., Porter, J.E., 2017. Family
Limitations presence during resuscitation: a double-edged sword: family presence during
resuscitation. J. Nursing Scholarship 49 (2), 127–134.
Helmer, S.D., Smith, R.S., Dort, J.M., Shapiro, W.M., Katan, B.S., 2000. Family presence
The evolutionary nature of the concept witnessed resuscitation during trauma resuscitation: a survey of AAST and ENA members. J. Trauma:
has focused on adults who are accompanied by their family mem- Injury, Infection, Crit. Care 48 (6), 1015–1024.
Holzhauser, K., Finucane, J., 2008. Part B: a survey of staff attitudes immediately
bers in critical care and emergency care settings. In such complex post-resuscitation to Family Presence during resuscitation. Austr. Emergency
care areas, the frequency of resuscitation events is more and Nurs. J. 11 (3), 114–122.
requires multidisciplinary and patient family centered care Institute for Patient- and Family-Centered Care (IPFCC), 2010. Frequently asked
questions. Retrieved from http://www.ipfcc.org/faq.html.
approach. The further exploration of the concept could be deter-
Lederman, Z., 2019. Family for life and death: family presence during resuscitation.
mined in out of hospital or in-hospital and its variation in other IJFAB: Int. J. Feminist Approaches Bioethics 12 (2), 149–164.
care settings such as ward or clinic settings. Moreover, the way McClement, S. E., Fallis, W. M., & Pereira, A., 2009. Family presence during
in which the concept of witnessed resuscitation is identified as resuscitation: Canadian critical care nurses’ perspectives. Journal of Nursing
Scholarship, 41(3), 233-240.
active and passive witness may appear different in diverse context Meghani, S., Karmaliani, R., Ajani, K., Shehzad Bhamani, S., Khan, N.U., Lalani, N.,
of care. 2019. Knowledge, attitude, and practice of healthcare professionals regarding

5
S. Meghani Intensive & Critical Care Nursing 64 (2021) 103003

family presence during resuscitation: an interventional study in a tertiary care Tennyson, C.D., 2019. Family presence during resuscitation: updated review and
setting, Karachi, Pakistan. Connect: World Crit. Care Nursing 13 (1), 46–55. clinical pearls. Geriatric Nursing 40 (6), 645–647.
Melhado, L.W., Byers, J.F., 2011. Patients’ and surrogates’ decision-making Tofthagen, R., & Fagerstrøm, L. M., 2010. Rodgers’ evolutionary concept analysis–a
characteristics: withdrawing, withholding, and continuing life-sustaining valid method for developing knowledge in nursing science. Scandinavian
treatments. J. Hospice Palliative Nursing 13 (1), 16–28. https://doi.org/ Journal of Caring Sciences, 24, 21-31.
10.1056/NEJMsa0907901. Tomlinson, K.R., Golden, I.J., Mallory, J.L., Comer, L., 2010. Family presence during
Meyers, T.A., Eichhorn, D.J., Guzzetta, C.E., Clark, A.P., Klein, J.D., Taliaferro, E., Calvin, A., adult resuscitation: a survey of emergency department registered nurses and
2000. Family presence during invasive procedures and resuscitation: the experience staff attitudes. Adv. Emergency Nursing J. 32 (1), 46–58. https://doi.org/
of family members, nurses, and physicians. Am. J. Nursing 100 (2), 32–43. 10.1097/TME.0b013e3181cbe902.
Mian, P., Warchal, S., Whitney, S., Fitzmaurice, J., & Tancredi, D., 2007. Impact of a Toronto, C.E., LaRocco, S.A., 2019. Family perception of and experience with family
multifaceted intervention on nurses’ and physicians’ attitudes and behaviors presence during cardiopulmonary resuscitation: an integrative review. J. Clin.
toward family presence during resuscitation. Critical Care Nurse, 27(1), 52-61. Nurs. 28 (1-2), 32–46.
Norris, R.M., 1998. Fatality outside hospital from acute coronary events in three Tudor, K., Berger, J., Polivka, B.J., Chlebowy, R., Thomas, B., 2014. Nurses’ perceptions
British health districts, 1994–5. British Med. J. 316 (7137), 1065–1070. of family presence during resuscitation. Am. J. Crit. Care 23 (6), E88–E96.
Oczkowski, S.JW., Mazzetti, I., Cupido, C., Fox-Robichaud, A.E., 2015. Family https://doi.org/10.4037/ajcc2014484.
presence during resuscitation: a Canadian critical care society position paper. United Nations, 2020. Sustainable development goal. Retrieved from https://www.
Canadian Respiratory J. 22 (4), 201–205. un.org/sustainabledevelopment/sustainable-development-goals/.
Powers, K. A., & Candela, L., 2016. Family presence during resuscitation: Impact of Vincent, C., Lederman, Z., 2017. Family presence during resuscitation:
online learning on nurses’ perception and self-confidence. American Journal of extending ethical norms from paediatrics to adults. J. Med. Ethics 43
Critical Care, 25(4), 302-309. (10), 676–678.
Rodgers, B. L., 2000. Concept analysis: An evolutionary view. in: Rodgers, B., Knalf Waldrop, D.P., Meeker, M.A., 2012. Communication and advanced care planning in
sss, K., Concept Development in Nursing: Foundations, Techniques, and palliative and end-of-life care. Nurs. Outlook 60 (6), 365–369. https://doi.org/
Applications (pp. 77-101). Philadelphia: W.B. Saunders. 10.1016/j.outlook.2012.08.012.
Salmond, S. W., Paplanus, L. M., Jadotte, Y. T., & Viera, D. L., 2012. A systematic Walker, W.M., 2005. Witnessed resuscitation: a concept analysis. Int. J. Nurs. Stud.
review of family witnessed resuscitation and family witnessed invasive 43, 377–387. https://doi.org/10.1016/j.ijnurstu.2005.05.006.
procedures in adults in hospital settings internationally-part I: perspectives of Walker, W., 2008. Accident and emergency staff opinion on the effects of family
patients and families. International Journal of Evidence-Based Healthcare, 10 presence during adult resuscitation: Critical literature review. Journal of
(3), 288. Advanced Nursing, 61(4), 348-362.