Thesis:

Factors Influencing Implementation of Family Witnessed Resuscitation Practice among Nurses Working In Medical-Surgical Units in Siaya County Referral Hospital, Kenya

The family witnessed resuscitation (FWR) is offering a family member an option to be present in the room while a loved one is being resuscitated to sustain life. Despite the recommendation by various professional bodies, FWR is not widely practiced among medical-surgical nurses and its implementation is inconsistent across healthcare settings. This study aimed to investigate nurse-related factors influencing implementation of FWR, identify nurses’ perceived benefits and establish their perceived risks of this practice among nurses in medical-surgical units in Siaya county referral hospital (SCRH). The study was cross-sectional analytical survey, quantitative and qualitative approaches of data collection were used. A total of 71 registered nurses participated in the study. A stratified random sampling design was used to obtain study participants from various units within the medical-surgical department of SCRH, Kenya. Quantitative data was collected using Family Presence during resuscitation benefit and risk assessment form and Family presence during resuscitation self-confidence scale designed by Twibel et al, approval to use the tool was granted by the original owner through written permission. Qualitative data was collected using Key Informant Interview. Quantitative data was analyzed using SPSS version 26 and NVIVO version 11 was applied for qualitative analysis. Categorical data were analyzed descriptively using graphs, frequency tables. Continuous variables were described using measures of central tendencies and dispersion. Chi-square and binary logistic regression were used to analyze the association between independent and dependent variables. Significance level of p-value ≤ 0.05 was set, confidence interval was 95%. Qualitative data were transcribed and generated themes were interpreted then triangulated to increase the credibility and validity of the findings. To enhance understanding, themes were validated by inclusion of supporting quotes. The study revealed a significant association between implementation of FWR practice and advanced specialized training (X2 =4.125, df =1, p =0.042), training on FWR (X2 =6.728, df =1, p =0.009) and nurse’s perceived self-confidence (X2 =8.060, df =2, p =0.010).The odds ratio value indicated that nurses who had advanced specialized training apart from basic nursing were 3.3 times more likely to implement the practice than those with no other training (OR=3.28, 95% CI 1.10-9.80). Nurses trained on FWR were 4.4 times more likely to implement the practice than those with no such training (OR=4.42, 95% CI 1.35-14.92). Nurses who perceived quite/very confident were 4.9 times more likely to implement FWR than those who were somewhat confident (OR=4.94, 95% CI 1.07-22.71). FWR practice was not significantly associated with years of nursing experience, affiliation to professional organizations, and the number of times one participated in resuscitation process. Regarding perceived benefits, 83.1% of the respondents affirmed that family would accept that everything possible was done to save life of their loved one. However, 38.0 % of the respondents thought that family would disrupt the resuscitation process. Ethical clearance to conduct this research was obtained from Mount Kenya University Institutional of Ethics and Review Committee. The authorizations were obtained from appropriate offices within Siaya County and participating hospitals. Participation was voluntary, and participants signed informed consent.