Attitudes of Community Hospital Critical Care Nurses Toward Family-Witnessed Resuscitation

Brandon D. Gomes, BSN, RN; Ouida P. Dowd, MSN, RN, ACNS-BC, CCRN; Kristen A. Sethares, PhD, RN, CNE


Am J Crit Care. 2019;28(2):142-148. 

In This Article

Abstract and Introduction


Background: Family-witnessed resuscitation is not consistently practiced in critical care despite the fact that it is recommended and research shows that it supports the emotional needs of families and patients and improves decision-making, care, and communication. Nurses support the idea of family-witnessed resuscitation but may not believe it should be standard practice.

Objectives: To examine the attitudes of American community hospital critical care nurses about family-witnessed resuscitation and to identify differences in attitudes between nurses who have and have not experienced it.

Methods: This cross-sectional, descriptive study of 40 critical care nurses was conducted at 2 community hospitals. Demographic data were collected and a previously developed questionnaire was used to survey participants on their attitudes about family-witnessed resuscitation factors including decision-making, process, and outcomes.

Results: Most participants (92%) had experienced family-witnessed resuscitation and most had positive attitudes about the benefits and outcomes of family-witnessed resuscitation. Participants did not believe that family presence is too distressing for families or that resuscitation team performance would be negatively affected. Participants indicated that fear of litigation, family disruption of resuscitation, and family misinterpretation of procedures would not increase with family presence.

Conclusions: Findings show that community hospital critical care nurses support family-witnessed resuscitation. Prior experiences and cultural beliefs should be considered when developing family-witnessed resuscitation policies. Further research is needed on the influence of these factors on nurses' attitudes toward family presence to inform practice.


Family-witnessed resuscitation (FWR) has been a subject of debate for many years. Also known as family presence during resuscitation or witnessed resuscitation, FWR is the opportunity for family members to be present (in visual and/or physical contact) with a patient during cardiopulmonary resuscitation (CPR).[1,2] As a result of increasing requests from families who want to be with their relatives during resuscitation activities, FWR has been gradually accepted.[3] Research shows that FWR meets emotional needs of both the family and the patient,[4] and national health care organizations including the National Academy of Medicine and the American Association of Critical-Care Nurses support the practice of FWR and advocate that family members of all patients undergoing resuscitation be given the option to be present.[5]

Despite a wealth of publications on the benefits of FWR, it is not universally practiced.[6–11] Only one-third of American nurses have implemented FWR.[8] Studies show that nurses may support the idea of FWR but may not support it being offered to all families as a standard practice.[3,4,12] More research on nurses' attitudes about FWR is needed.[8,11,13,14]

The authors reviewed 174 studies on FWR and family presence during resuscitation. Most research on nurses' perceptions of FWR has been conducted at regional medical centers or large teaching hospitals in metropolitan areas of Australia, Canada, Europe, and the United States. Health care professionals in rural areas may have different attitudes about FWR than those in urban areas.[15,16] In addition, the FWR attitudes of critical care nurses at nonteaching community hospitals have not been fully explored.[15–17] The nonteaching community hospital setting may influence nurses' FWR experiences and attitudes because less-severe cases are treated there and because fewer educational opportunities are available.[17] Prior experiences may also influence nurses' attitudes about FWR. Further research will improve our understanding of the factors that influence the adoption and routine practice of FWR. The purpose of this study was to examine the attitudes about FWR of critical care nurses in American community hospitals and to identify differences in attitudes between nurses who have and have not experienced FWR. This study adds to the knowledge of the attitudes and experiences influencing nurses' decisions to invite families to be present while a loved one undergoes resuscitation.