Compared with the study by Twibell et al. (2008) and in reference to the validity of the indices, a more dispersed distribution has been obtained, with higher indices of asymmetry and kurtosis, to the point that the self-confidence index does not comply with the principle of normality. In both questionnaires, the Cronbach’s α is very similar, with our FPRB being α = 0.95 in RB and α = 0.96 that of Twibell et al. (2008) and FPSC obtaining an α = 0,94 while Twibell et al. (2008) obtained α = 0.95, so we can affirm that we were able to replicate the reliability of both indices. For the correlation between the two scales (FPRB-FPSC), it is significant and with a moderate intensity of the relationship (r = 0.65 and α < 0.001), with the one by Twibell et al (2008), an r = 0.56 and an α < 0.001, slightly below the obtained in this study
In the factor analysis, six variables have been identified that do not completely work in the risk and benefit index, with three of them excluded from both studies and the remaining variables either excluded or have obtained low factorial loads in one or another study. (Table 2, at the end of the article)
The fundamental difference from Twibell et al. (2008) is that in our study, there are additional variables that have generated different correlations in certain factors. Thus, it is worth asking what underlying dimensions they wanted to measure, risks, benefits or self-confidence, since different meanings of these concepts emerge from the results, either due to polysemy or because they are items that do not define these dimensions well. For example, polysemy was found in the index of self-confidence, since the health professionals’ self-confidence behaves differently if spoken from the social perspective (treatment of families, communication), in which those who agree in the FP have more confidence and those who do not agree have less confidence, or if there is talk of technical procedures that are assumed to be conducted, they agree or disagree with the FP.
The perceptions of the effect of FP on satisfaction surveys measure a risk or a benefit, since in all combinations of factor analyses, these are variables that do not correlate with the rest of the index items.
It does not seem that transcultural translation has produced any disturbance, but rather that the health personnel in this study have different opinions from health professionals in the United States sample.
For the comparison of the sample, the inclusion of medical personnel in the study has made it possible to increase the presence of men and older professionals with more extensive experience, although the differences between medical personnel and nurses have not been significant in most of the variables. The sample in this study, although smaller (n = 237), is more representative in terms of hospital units. (Table 3).
RESULTS TWIBELL et al (2008) | % | | RESULTS CSG HEALTH PERSONNEL. | % |
GENDER | Woman | 95.7 | | GENDER | Woman | 69.2 |
| Man | 2.1 | | | Man | 31.8 |
AGE (years) | Less than 24 years | 4.5 | | AGE (years) | From 20 to 35 | 35.0 |
| From 25 to 39 | 38.1 | | | From 36 to 55 | 47.7 |
| From 40 to 55 | 46.1 | | | More than 55 | 17.3 |
| More than 55 | 8.5 | | Years of experience | Less than 1 | 5.5 |
Years | Less than 1 | 3.7 | | | From 1 to 5 | 18.1 |
of | From 1 to 5 | 18.4 | | | From 6 to 10 | 14.3 |
experience | From 6 to 10 | 21.9 | | | From 11 to 20 | 27.8 |
| From 11 to 20 | 30.7 | | | More than 20 years | 34.2 |
| More than 20 years | 23.5 | | Highest level of education completed | Graduated | 48.1 |
Highest level of education completed | Graduated | 78 | | Bachellor |
Bachellor | | Army professional/Diploma |
Army professional/Diploma | | | Master/Doctorate | 51.9 |
| Master/Doctorate | 3.7 | | | | |
| Assistant nurse | | | Table 3. Comparative sociodemographic data. |
We observed that compared to the sample by Twibell et al. (2008), in this study, a much lower presence of professionals who have occasionally invited a relative to a resuscitation was obtained, which prevents evaluating this item, since there was only a total of 20 cases.
A lower predisposition to FPDR is observed due to a greater perception of risks and lower self-confidence than in Twibell et al. (2008), and this is the main result obtained in this study. This can be explained by taking into account the different characteristics of the sample, especially by the presence of medical personnel, who is the one who values FP the worst, but we believe that the key lies in cultural differences, as in this study, there are many fewer professionals who have ever invited relatives to attend a resuscitation process, and this constitutes a pattern that can condition everything else. A difference was identified between emergency assessments that would be very interesting to investigate.
We have obtained a correlation of indices very similar to Twibell et al. (2008): the medical and nursing staff who perceive the most benefits are those who are more confident on being able to manage the presence of families.
Another key difference has been that in this study, a single explanatory factor of the perception of inviting relatives or not to resuscitation has not been obtained, and qualitative questions have confirmed that the main barriers to inviting family members coincide with the theoretical framework presented by Twibell et al. (2008): avoid causing an unpleasant impact on families, fear of a disruptive reaction from families and fear that the resuscitation team will not work comfortably. However, the main reasons for inviting relatives present in their study by Twibell et al. (2008) are not the most mentioned by the participants of our study. The fact that families understand that everything was done for their loved one is one of the reasons mentioned by one in every 5 participants; positive management of grief is mentioned by one in ten, not highlighting the understanding of the severity of the patient .
In general, the assessment of the FPDR is more positive than negative. In relative terms to the averages of the indices, we have 48% of "detractors", but truly in absolute terms, only 12% of the participants are pure critics, because of the scores of both indices being below 2.5.
Physicians are more resistant to FPDR than nurses, especially in the emergency department, and professionals with specialty, but this variable is highly influenced by the profession, since it is the physicians who thus have a specialty. and the majority of nurses do not have it, in part due to the recent incorporation of specialties in the Spanish State. It is interesting to note that it is the area of emergency care where there is most reluctance to FPDR, since it is the area where there is greater contact with this procedure and also that it is in the social health field, in which these procedures are barely carried out, where there is more self-confidence, a result that could open doors to future research.
When asking who should make the decision, those who choose to give more responsibility to medical staff are those who see more risk in FP and who have less self-confidence (especially doctors with more experience and age). In contrast, those who see greater benefits and have more self-confidence (nurses and young professionals with less than five years of experience) choose to give decision-making responsibility to the patient.
It is observed that behind attitudes, there is a background of generational change that advances to allow FP. In this sense, the same trend is observed when we ask whether FP should be part of the patient's anticipated wills.
Limitations
While in Twibell et al. (2008), the original study obtained data that did not include a "do not know/do not answer" option in each question, this study had data that did take into account this response option. It is a decision that has its advantages, since it allows not forcing the professional to adopt a response to doubts, but on the other hand, it can sometimes function as an evasive category before having to make a decision in a given situation.
Medical staff and nurses, who at some point have witnessed CPR of a loved one, are mostly male, and there may be a gender bias in the FPDR.
We must take into account the difference of 12 years between one study and another, since the opinion of society and the training of health care professionals change, taking into account the principles of bioethics, especially autonomy, which gives more empowerment to the patient and the family, leaving behind clinical decisions of medical paternalism.