Navigating family-witnessed resuscitation in hospitals: content analysis of free-text survey data

Abstract

Background: Although international guidelines advocate family-witnessed resuscitation, its implementation varies considerably across countries. Clinical practice is often shaped by healthcare professionals' personal beliefs and preferences, rather than standardised practice or evidence-based protocols. While patients and families generally support family presence for its reassurance and emotional closure, healthcare professionals express concerns about its potential to cause trauma. Previous researchers have primarily examined nurses' perspectives, with limited focus on physicians' experiences. Moreover, most studies have been conducted in emergency and intensive care settings, leaving a gap in understanding collaborative perspectives across diverse clinical settings.

Objective: To describe nurses' and physicians' attitudes and experiences regarding family-witnessed resuscitation during adult cardiac arrest across various hospital departments and levels of care and to suggest key areas for targeted improvements and practical clinical applications.

Design: A qualitative design was applied to analyse free-text responses from a questionnaire distributed to healthcare professionals participating in an educational intervention.

Setting: Conducted in six Swedish hospitals, we included healthcare professionals from emergency care, internal medicine, cardiology, infectious diseases, and orthopaedic, thoracic, and abdominal surgery departments.

Participants: A total of 96 nurses and 48 physicians, with a mean age of 42 years and 15 years of working experience, participated, of which 51 % had prior experience with family-witnessed resuscitation.

Methods: A summative content analysis was conducted. Texts were repeatedly reviewed, condensed into keywords, coded, and grouped into sub-categories and categories, which were compared for similarities and differences. Keyword frequencies were calculated to summarise attitudes and experiences within each sub-category.

Results: Three categories and seven sub-categories emerged. Taking a stand or being indecisive reflected the tension between balancing patient and family wishes and healthcare professionals' preferences, with indecisiveness more common in cases involving vulnerable family members. Working under pressure encompassed challenges related to operational constraints during family-witnessed resuscitation, such as limited room capacity, confidentiality risks, insufficient family support, and disruptive family behaviours that could impair focus. Helping or harming the family captured the dual perception that family presence could facilitate understanding of the resuscitation process and support grieving if the patient did not survive, while also posing a risk of trauma for family members.

Conclusions: Family-witnessed resuscitation presents significant ethical and practical challenges for healthcare professionals. Targeted training may be essential to prepare them for managing the cognitive, psychological, cultural, and familial complexities inherent in these situations. The development and implementation of clear, evidence-based local guidelines can support resuscitation teams in adopting a consistent, safe approach to family-witnessed resuscitation. Such initiatives can enhance healthcare practice by balancing patient and family needs with ethical and professional standards.

Study registration: Not registered.

Keywords: Attitudes; Barriers; Family-witnessed resuscitation; Free-text responses; Healthcare professionals; In-hospital cardiac arrest; Qualitative.

Fig. 1

Proportions (%) of nurses’ and physicians’ attitudes and experiences generating free-text, divided into each sub-category (N = 144).