In the present study, 94% of the participants had FPDR experience. In this regard, a study, which was conducted in Portugal, reported that 100% of prehospital emergency personnel had FPDR experience in EMS [33]. This statistic was 87% in France [9] and 95.3% in the United States of America [10]. These results show that the presence of family members during the patients’ prehospital resuscitation is very common and the personnel members have considerable experience of resuscitation in the presence of the patients’ family members [9–11]. Therefore, these experiences can be used to develop training guidelines for the personnel in order to support the patients’ family members during their resuscitation in prehospital emergency.
The results showed that the score of the personnel members’ attitudes towards FPDR was lower than the mean value. These results are in line with the results of the studies which were conducted in Turkey [11] and Portugal [33] which they reported that the majority of prehospital emergency personnel members disagreed with the family presence during resuscitation. Furthermore, the results of other studies have indicated that most of the EMS team members do not prefer to provide resuscitation in the presence of the patents’ family members and a large number of them feel uncomfortable about resuscitating the patients in the presence of their family members [9, 10]. This attitude can affect the personnel’ physical and mental health and performance along with the quality of cardiopulmonary resuscitation outcomes [9–11]. Therefore, it is necessary to include the necessary training for performing a resuscitation in the presence of the patients’ family members, management of the resuscitation scenes, and provision of information about the patients’ conditions in the national standard curriculum for the prehospital emergency personnel.
In this study, the most important factor which prompted the participants to adopt negative attitudes towards FPDR was the stressfulness of the resuscitation process for the patients’ family. The other relevant factors included the family members’ interference in the process of resuscitation, the prolongation of the resuscitation process, the difficulty in making decisions to terminate the resuscitation process, and the increase in the personnel members’ emotional stress. These results support the results of the studies conducted by Amaral et al. [33] and Belpomme et al. [9]. Likewise, some other studies have reported that the personnel’ feeling of being under surveillance [11, 34], the family members’ interference in the personnel members’ operation [10, 33] and the family members’ stress [33] constitute the factors which prompt the personnel to adopt negative attitudes towards FPDR. In order to deal with these issues, it is possible to take certain measures. These measures include providing the patients’ family members with information about the resuscitation conditions using the media, using cubicle curtains, and getting help from the experienced health care providers at the scene. These measures can reduce the family members’ stress level, improve the situation, and prompt the personnel members to adopt more positive attitudes towards FPDR.
In this study, the family members’ reassurance and increased understanding of the efforts of the resuscitation team and the facilitation of their grief process were reported as important advantages of FPDR. These results are in line with the results of a study carried out by Amaral et al. [33]. In this regard, a study by Compton et al. indicated that 37% of the personnel members believed that FPDR prepared the family members to accept the patients’ death [10]. Nonetheless, based on our results 63.3% of the personnel members believed that FPDR facilitated the family members’ grief process. This difference between the results of the above-mentioned study and the present study may contribute to the cultural and social differences of the contexts of each study. In this regard, the personnel’ advice and support and the presence of support teams such as social workers at the resuscitation scenes can facilitate the management of the resuscitation.
This study was the first study that investigated the prehospital emergency personnel members’ self-confidence in their ability to perform resuscitation in the presence of the patients’ family members. The results of the study showed that the personnel’ self-confidence was higher than the mean value (65.94 ± 15.89). Moreover, it was higher than the obtained values in the results of the studies which have been conducted in hospital departments. In this regard, the self-confidence score was 61.2 ± 1.19 in a study on nurses in the inpatient wards of the state of Kentucky [30]. Moreover, the above-mentioned score was 53.86 ± 11.7 [28] and 52.91 ± 12.69 [27] in the studies on nurses in the special care units in Qazvin (Iran) and the nurses of teaching hospitals in Tabriz (Iran), respectively. These results are in line with the results of the present study.
In the present study, the personnel members’ highest self-confidence score was related to their ability to perform cardiac massage and to give electric shocks to the patients. This result shows that the personnel implemented the AHA recommendations [35]. Furthermore, the personnel had a low level of self-confidence in their ability to communicate with the patients’ family members and to meet their spiritual and emotional needs. Most of the prehospital scenes are managed by only two personnel members [15, 36]. Furthermore, the personnel members concentrate all their efforts on the patients’ resuscitation and do not pay attention to their family members [37]. Therefore, it is recommended that the personal members receive training in communication skills.
The results showed that there was a significant correlation between the personnel’ attitude towards FPDR and their self-confidence in their ability to perform resuscitation in the presence of the patients’ family members. The higher score of the personnel members’ self-confidence was associated with their more positive attitudes towards FPDR. These results support the results of a study conducted by Twibell et al. They showed that nurses with higher levels of self-confidence had more positive attitudes towards FPDR [29]. Likewise, the results of a studies conducted in Australia [38], the United States of America [30], Jordan [39], Iran [27, 28] showed that there was a relationship between the hospital nurses’ attitudes towards FPDR and their self-confidence in their ability to perform resuscitation in the presence of the patients’ family members.
The results of the present study indicated that the personnel members who had received advanced cardiopulmonary resuscitation training had higher levels of self-confidence and more positive attitudes towards FPDR. In this regard, the results of the previous studies have shown that the personnel members’ training results in an increase in their self-confidence to perform resuscitation and improves their attitudes towards FPDR [30, 40, 41]. In addition, based on the results, the personnel with considerable experience had higher levels of self-confidence. This result supports the results of the previous studies [40, 42, 43].
In the present study, the personnel members who had a degree in emergency medical had higher levels of self-confidence in comparison with the personnel members who had a degree in the other disciplines. In this regard, another study in Iran showed that the prehospital emergency personnel who had a degree in emergency medical were more comfortable with their job conditions compared to the nurses [44]. In addition, the smaller numbers of the family member’s presence during resuscitation were associated with the personnel members’ more positive attitudes towards FPDR and their higher levels of self-confidence. It seems that there is a need to take a number of measures to perform the patients’ resuscitation far from the crowded places. These measure may include informing the people about the resuscitation process to prevent them from gathering at the resuscitation scenes, transferring the patients to the ambulance, using cubicle curtains, getting help from experienced individuals, and asking the patients’ other family members to leave the resuscitation scenes.
Limitations
This study had some limitations. First, it was conducted in one province in the northwest of Iran. This issue may affect the generalizability of the results of the study. Therefore, the findings of this study should be interpreted with caution since they may not be generalizable to all of the prehospital personnel members in Iran. Finally, the results may not be generalized to the countries in which the EMTs constitute the prehospital care providers.