The demographic characteristics of the participants are shown in Table 1. Among the sample of ED HPs, 54.1% were nurses and 45.9% were physicians, and approximately 44% of the sample were Bahraini. The mean age (SD) for the participants was 37.1 years old (±9.1) with an almost equal distribution of males and females (52.1% males and 47.9% females). In terms of ED physician’s level, about 42% were senior physicians (Consultants, Senior-Registrar, or Chief Resident). Greater than 77% had 6 years of experience or more (73.1% physician and 81% nurses) and 89.8% participated in 1 or more CPR sessions per month (92.5% physicians and 87.3% nurses).
Knowledge and Participation in FPDR
The concept of FPDR was known by 76% of the sample (82.1% physicians and 70.9% nurses) and about 64% (73.1% physicians and 55.7% nurses) had participated in CPR in the past in which a family member was present (see Table 2).
In general, items (5-22) receiving a higher score on the Likert scale represented a higher agreement to FPDR by the study participants (“Strongly Agree” = 5, “Agree” = 4, “Neutral” = 3, “Disagree” = 2, Strongly Disagree = 1). Items 9, 11, 12, 15, 17, 18, 19, 20 and 22 were reverse-coded, where selecting “Strongly Agree” represented a more negative perception of FPDR and as such, the typical Likert score of 5 was recoded to be a score of 1 (see Table 3).
Zero-order correlations were calculated for gender (male/female), nationality (Bahraini/non-Bahraini), and level of experience (years), individually against scores on items 5-22 to determine if there were any possible confounds, i.e., demographics that correlated with the survey items, making them possible “third variables” in those relationships. These correlations (see Table 4) showed nationality to covary with 8 survey items (5, 8, 10, 14-16, 19, and 21) and gender to covary with item 5. This illustrates that gender may impact healthcare providers’ responses to supporting implementing/producing policy allowing FPDR in their institution. It also showed that nationality may impact participant opinions on FDPR enhancing professional satisfaction and behaviour, the importance of a support person and saying goodbye, and several items in code 1 and 2 (see Table 5).
Principal components analysis revealed the presence of four components with eighteen values exceeding 1, explaining 25.6%, 17.4%, 6.4% and 6.0% of the total of 55.6% variance, respectively. The scree plot revealed a clear break after the fourth component. Hence, the four components were considered for further analysis. To aid in the interpretation of these four components, Oblimin rotation was performed. The four components were divided into four key codes by the researchers according to the statement themes: code 1- personal beliefs about FPDR, code 2- impact on professional practice and performance, code 3- enhances professional satisfaction and behaviour and code 4- the importance of a support person and saying goodbye. These codes were selected from Porter et al.’s study (2015), which was chosen due to its relevant ED setting, multi-centric approach to collecting data, and a similar cluster of questions centred around the same themes (18).
Code 1: Personal Beliefs about FPDR
For code 1 (see Table 5), a significance testing for the composite index was performed using non-parametric tests. Mann Whitney tests showed that there was a significant difference in personal beliefs about FPDR between doctors and nurses (p <0.001). Physicians (53.7% vs 21.6% nurses) were more likely to support implementing/producing a policy allowing FPDR in their institution, while 58.2% of nurses disagreed with this. More physicians (62.7%) supported that family members should have the option to attend CPR for paediatric patients, while the majority of nurses (65.8%) did not support this (p <0.001). This significant difference also existed when healthcare providers were asked if family members should have the option to attend CPR for adult patients (55.2% physicians in support vs. 58.2% nurses against this).
Code 2: Impact on Professional Practice and Performance
Regarding FPDR’s impact on professional practice and performance (see Table 5), significance testing for the composite index was performed using non-parametric tests. Mann Whitney test showed that there were no significant differences in this code among doctors and nurses (p-values range from 0.112 to 0.943). Mean scores reflected that healthcare providers view FPDR as not having a major negative impact on professional practice and performance. The majority disagreed that FPDR would: cause psychological stress for family members (85.6%), interfere with patient CPR (56.1%), cause family members to witness error or misinterpret some actions during resuscitation (72.6%), or breach patient confidentiality (63.7%).
The majority also disagreed that FPDR would impact members of the code team negatively, e.g., causing stress (84.9%), posing physical threat (77.4%), increasing fear of complaints/litigations against members of the code team (74,6%), or impede training of junior staff during CPR (61.7%). Only 1 of the 9 items in code 2 showed a significant difference between nurses and physicians: while the majority of physicians (91%) and nurses (76%) agreed that adequate space is not needed for FPDR (item 15), there was still a significance between the two groups (p = 0.048).
Code 3: Enhancing Professional Satisfaction and Behavior
Code 3 (see Table 5), which included item 10 and 21, demonstrated a statistically significant difference between physicians and nurses (p< 0.01). Physicians (59.7%) were more like to agree that FPDR decreases family anger towards members of the code team, whereas nurses were more likely to be neutral (25.3%) or disagree (24.3%) (p= 0.004). Additionally, 68.6% of physicians agreed that FPDR will motivate members of the code team to manage the patient in a more humane manner, whereas only 34.2% of nurses agreed (p< 0.001).
Code 4: Importance of a Support Person and Saying Goodbye
There was a statistically significant difference in how physicians and nurses responded to code 4 (see Table 5), which focused on the theme of “The importance of a support person and saying goodbye” (items 14 and 16). More physicians (71.6%) than nurses (48.1%) agreed that FPDR keeps family members updated about the progress of resuscitation (p= 0.013). However, the majority of physicians (89.5%) and nurses (73.4%) agreed that FPDR needs dedicated and trained personnel to accompany family members (p< 0.001).