Family presence during resuscitation has been studied and discussed since the 1980s (Doyle et al., 1987). Overall, in the literature, parents and family members want to be offered the choice of whether or not to be present with their child during resuscitation or not (Jabre et al., 2014). On the other hand, it has remained a controversial issue amongst HCPs, the less experienced ones showing more discomfort and worries about impacts on their performance (Yoxall et al., 2015). In the NICU, little is known about the impact of family presence on teams’ performance during invasive procedures or life-threatening events such as tracheal intubations and cardiopulmonary resuscitation (CPR). A recent study in 13 NICUs indicated that family presence during neonatal resuscitation varies widely across hospitals, with an average presence of family members in less than 10% of all cases (Brei et al., 2021). According to this study, no significant association was observed with family presence and adverse intubation outcomes. On the other hand, other studies show contradictory results. According to some, family presence could result in a higher stress level for the team during neonatal resuscitation, the other primary associations with stress being oxygenation failure of the newborn, hemodynamic instability, and difficult intubation(Umoren et al., 2020). However, others argue that HCPs perceive a significant reduction of workload when at least one family member was present during resuscitation(Zehnder, Law, & Schmölzer, 2020). In the event of a resuscitation resulting in death, there is also little information on the behaviors to recommend to HCPs regarding their interactions with present parents (Lizotte et al., 2020). Recent studies suggest simple communication behaviors identified by parents and HCPs such as introducing oneself, using the child's first name, recognizing the parents’ presence, preparing the parents for what may occur including death, ending resuscitation without asking the parents, speaking clearly about the death, offering the possibility of close proximity between the parents and their child, sitting down to discuss, reducing feelings of guilt, accepting silences and knowing the procedures following death (Deacon, O’Neill, & Gilfoyle, 2020; Lizotte et al., 2020).
The American Heart Association (AHA) and the European Resuscitation Council (ERC) resuscitation guidelines have supported the presence of family member during CPR (Lederman, 2016). However, the quality of the evidence on which this is based on has not yet been evaluated in depth. In 2021, Dainty and collaborators conducted a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation (Dainty et al., 2021). They wanted to study the correlation between family presence during resuscitation compared to no family presence in improved patients, family-centered, and HCP-centered outcomes. Based on this systematic review, we cannot say that family presence is to be avoided, but we cannot say that everything is going well for the family and HCPs. Even in their extensive literature search, they found no comparative studies that directly measured the impact of family presence on patients, families, and healthcare professional as well as the impact on the performance on resuscitation in the NICU specifically. The only seven articles found related to the neonatal population were mainly qualitative studies with semi-structured interviews (Dainty et al., 2021). The conclusion drawn by the authors, was that there is no outcome-oriented evidence to inform recommendations for practice or policy either for or against families being present during neonatal resuscitation and the impacts on HCPs. Furthermore, no current or underway systematic reviews or scoping reviews on the HCPs’ perception of FPDR in terms of interpersonal skill, reluctance and need for training on how to interact with family members during neonatal resuscitation were identified. Yet, recent publication conclude that more studies are needed to understand best practices in interactions between HCPs and family members and optimal HCP behaviors to teach and encourage during resuscitation in the NICU (Dainty et al., 2021; Deacon, O’Neill, & Gilfoyle, 2020).
Rationale
In the context of continuing professional trainings and developing educational material on non-technical skills (NTS) performed by HCP during neonatal resuscitation in the NICU, we need to explore the literature carefully to understand the issues and to identify the best practices in evidence-based studies. NTS play an important role during neonatal resuscitation; these skills encompass situation awareness, decision-making, task management, leadership and teamwork (Yeung et al., 2014). NTS also include communication with family members present, but the quality of these interactions and their impact are less documented so far. For these reasons, a scoping review will be conducted to systematically map the research done in this area, as well as to identify any existing gaps in knowledge.
Objectives
The objective of this scoping review is to identify the knowledge base and NTS to be taught during training, and to create recommendations for developing targeted in situ simulation training incorporating family presence during neonatal resuscitation in the NICU. Based on the objectives of this scoping review, we will answer the following questions:
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What are the behaviors and actions recommended for HCPs toward family members during neonatal resuscitation in the NICU?
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What are the knowledge gaps regarding the support and interactions of HCPs with family members during neonatal resuscitation in the NICU?