Clinical attitudes, beliefs and perceptions of current practices of family presence during management of acute deterioration in the Emergency Department.

Abstract

Introduction: The epidemiology of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration, most probably due to the introduction of rapid response teams in most acute care hospitals. Further, through publication of the National Safety and Quality Health Service Standards there has been national recognition of the importance of family involvement throughout the entire patient journey, including during episodes of patient deterioration. Despite this epidemiological change and national push for family involvement during deterioration, research related to family presence during episodes of care continues to focus on care during resuscitation rather than care during acute deterioration.

Aim: To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients.

Methods: Clinicians (n=156) from a single study site in Melbourne, Australia completed a 17-item survey. The 17-item survey is a validated, reliable and previously published survey tool specific to clinician attitudes towards family presence during acute deterioration.

Results: Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Participants disagreed that the patient would experience increased levels of anxiety (62.9%) and stress (66.7%) by having family present during their deterioration episode. Participants agreed that witnessing a relative’s deterioration would be emotionally traumatic (82.1%) and stressful (89.1%). Few participants stated that they would feel an increased level of anxiety (37.1%) or stress (44.9%) by having family present during management of the deteriorating patient. Most (77.6%) participants stated that they included family during episodes of patient deterioration in their day-to-day practice. Further, 80.2% of participants felt comfortable providing psycho-social-spiritual support to family members during a patient’s episode of deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other countries of birth. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude toward including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience.

Conclusion: Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during a patient’s episode of acute deterioration.