Best Practices and Training Needs Related to Interactions With Family Members During Neonatal Resuscitation Procedures: A Scoping Review Protocol

Best Practices and Training Needs Related to Interactions With Family Members During Neonatal Resuscitation Procedures: A Scoping Review Protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Best Practices and Training Needs Related to Interactions With Family Members During Neonatal Resuscitation Procedures: A Scoping Review Protocol Coralie HERVIEUX, Ahmed MOUSSA, Nathalie LOYE, Claude Julie BOURQUE This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4858360/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Family presence during a resuscitation (FPDR) in neonatology is unevenly accepted by healthcare professionals (HCPs). To develop innovative educational materials for resuscitation teams in the neonatal intensive care units (NICUs), evidence-based information is needed on constructive interactions with family members during the procedures. This protocol is for a scoping review that aims to identify the best practices regarding support and interactions of HCPs with family members during neonatal resuscitation in the NICU and to propose recommendations for developing a targeted in-situ simulation training. The review willfocus on HCPs’ perception of FPDR in terms of interpersonal skills, reluctance and need for interactional training. Methods and analysis : In 2021, Dainty and collaborators published a systematic review on FPDR (pediatric and neonatal) that focused on the impact on the patients as well as family-centered and HCP centred outcomes. From their literature strategic search, we will extrapolate and narrow down the search to “neonatology” and add relevant recent studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) model will guide the literature search on four electronic databases (ScienceDirect, PubMed, MEDLINE Ovid and CINAHL) for studies published from January 2012 to December 2022. Data collection process will be documented through a PRISMA-P flowchart, including the application of inclusion/exclusion criteria. After data extraction, we will conduct a descriptive thematic analysis to synthesise content and identify emerging themes on family support and interactions, and on behaviors and actions recommended for HCP during neonatal resuscitation. Ethics and dissemination : Formal ethic approval is not required, as primary data will not be collected in this study. The findings of this study will be disseminated through scientific conferences, publications, and knowledge transfer activities in simulation training in neonatology. Medical Ethics Family presence Neonatology Resuscitation Non-technical skills In-situ simulation Figures Figure 1 BACKGROUND 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: What are the behaviors and actions recommended for HCPs toward family members during neonatal resuscitation in the NICU? What are the knowledge gaps regarding the support and interactions of HCPs with family members during neonatal resuscitation in the NICU? METHODS AND ANALYSIS After a first exploration of recent publications on the subject, we noticed that the literature was limited on our specific subject and included many qualitative and mixed method studies. This is why we opted for a scoping review, using the Joanna Briggs Institute (JBI) framework through its use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a reporting guide for the review (Peters et al., 2021 ; Tricco et al., 2018 ). Eligibility criteria The central concept of the review is FPDR in neonatology and the interactions of HCPs with family members during neonatal resuscitation. Eligibility criteria for this scoping review will be developed to ensure that publications include specific information related to the objectives of this scoping review. All relevant peer-reviewed journal studies were included (qualitative, quantitative, or mix-method studies). Since there are not many publications on our subject in the specific healthcare setting of the NICU (compared to pediatric care in general), we sourced studies from around the world to gather as much information as possible. Inclusion criteria Availability in full text Focus on neonatal resuscitation in the NICU Inclusion of data on family presence during resuscitation Date of publication between January 2012 and December 2022 (ten years scope) Exclusion criteria Not available in French or English Focus on pediatric resuscitation Focus on the technical and/or medical aspects of a resuscitation Search strategy and information sources PROSPERO was initially scanned to see if any review was done on the subject, and this is how the systematic literature review published by Dainty et al. in 2021 was found ( http://www.crd.york.ac.uk/PROSPERO/CRD42021140363 ). To ensure that a robust review search strategy is followed, the services of an experienced librarian will be used. First, we will focus our initial search from Dainty and al.’s search strategy and will refine it in collaboration with AP to match our studied subject (neonatology centered). Second, we will complete the search on MEDLINE Ovid from June 2020 to September 2022 to see if any new studies were published since this systematic literature review. Moreover, to identify potentially other relevant documents, the following bibliographic databases will also be searched from January 2012 to December 2022: ScienceDirect, PubMed, and CINAHL to cover a 10-year period. The search strategies will be adapted for each database, using comprehensive MESH and keywords for the concept of resuscitation, family presence, parental presence, neonatology, neonatal, and interactions. The final search strategy for each database and search engines can be found in Appendix 1 . The reference lists from Dainty and al. and the other selected articles will also be scanned for other publications of interest. All documents that will be retrieved from our searches will be exported into EndNote 20 to identify and remove duplicate records. Screening process and data extraction Data collection for the review will be documented through a PRISMA-P flowchart, including the application of inclusion/exclusion criteria as in Fig. 1 (Haowen et al., 2021 ). A three steps review will be performed by CH and discussed with CJB: 1) initial screening of each study by reviewing the title only, 2) reviewing the abstract and 3) reviewing the full text. Validation and/or uncertainty of criteria during screening process will be discussed between authors. The data from each study will be collected in a data extraction sheet (Microsoft Excel) that will be jointly developed by CH and CJB to determine which variables to extract (e.g. year of publication, country of origin, authors, main method, study design, field of study, information about interactions between HCPs and families during resuscitation, etc.). After extracting the data, a synthesis of the evidence base will be created in a table with a narrative review of the findings. The synthesis will also identify knowledge gaps on family support and interactions during neonatal resuscitation. Declarations Acknowledgements We wish to thank the librarian Alix Pincivy for her help on the search strategy. Contributors CH drafted the scoping review protocol with feedback from CJB and AM. All authors contributed to subsequent revisions and approved the protocol prior to its submission. Funding This study was funded by Program Audace, Fonds de recherche du Québec. The following author received payment from this funding source as a scholarship for her Masters in “Sciences Biomédicales (Option Éthique Clinique)”: Coralie Hervieux. Ethics approval and consent to participate Not applicable Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Author details 1 Faculté de Médecine, Université de Montréal, Montréal, Canada. 2 Centre de pédagogie appliquée aux sciences de la santé, Faculté de Médecine, Université de Montréal, Canada. 3 Département de pédiatrie, Université de Montréal, Canada. 4 Service de néonatalogie, CHU Sainte-Justine, Montréal, Canada. 5 Faculté d’éducation, Université de Montréal, Canada 6 Département de médecine de famille et de médecine d’urgence, Université de Montréal, Canada. References Brei BK, Sawyer T, Umoren R, Gray MM, Krick J, Foglia EE, Ades A, Glass K, Kim JH, Singh N, Jung P, Johnston L, Moussa A, Napolitano N, Barry J, Zenge J, Quek B, DeMeo SD, Shults J, Nishisaki A (2021) Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS. Archives Disease Child - Fetal Neonatal Ed 106(4):392–397. https://doi.org/10.1136/archdischild-2020-319709 Dainty KN, Atkins DL, Breckwoldt J, Maconochie I, Schexnayder SM, Skrifvars MB, Tijssen J, Wyllie J, Furuta M, Aickin R, Acworth J, Atkins D, Couto TB, Guerguerian A-M, Kleinman M, Kloeck D, Nadkarni V, Ng K-C, Nuthall G, Yeung J (2021) Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation 162:20–34. https://doi.org/10.1016/j.resuscitation.2021.01.017 Deacon A, O’Neill TA, Gilfoyle E (2020) A scoping review of the impact of family presence on pediatric resuscitation tem members. Pediatr Crit Care Med 21(12):e1140–e1147. https://doi.org/10.1097/PCC.0000000000002471 Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ (1987) Family participation during resuscitation: An option. Ann Emerg Med 16(6):673–675. https://doi.org/10.1016/S0196-0644(87)80069-0 Haowen J, Vimalesvaran S, Myint Kyaw B, Tudor Car L (2021) Virtual reality in medical students’ education: A scoping review protocol. BMJ Open 11(5):e046986. https://doi.org/10.1136/bmjopen-2020-046986 Jabre P, Tazarourte K, Azoulay E, Borron SW, Belpomme V, Jacob L, Bertrand L, Lapostolle F, Combes X, Galinski M, Pinaud V, Destefano C, Normand D, Beltramini A, Assez N, Vivien B, Vicaut E, Adnet F (2014) Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment. Intensive Care Med 40(7):981–987. https://doi.org/10.1007/s00134-014-3337-1 Lederman Z (2016) Family presence during cardiopulmonary resuscitation: Evidence-based guidelines? Resuscitation , 105 . e5–e6. https://doi.org/10.1016/j.resuscitation.2016.04.026 Lizotte M-H, Barrington KJ, Sultan S, Pennaforte T, Moussa A, Lachance C, Sureau M, Zao Y, Janvier A (2020) Techniques to communicate better with parents during end-of-life scenarios in neonatology. Pediatrics 145(2):e20191925. https://doi.org/10.1542/peds.2019-1925 Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H (2021) Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement 19(1):3–10. https://doi.org/10.1097/XEB.0000000000000277 Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Straus SE (2018) PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med 169(7):467–473. https://doi.org/10.7326/M18-0850 Umoren RA, Sawyer TL, Ades A, DeMeo S, Foglia EE, Glass K, Gray MM, Barry J, Johnston L, Jung P, Kim JH, Krick J, Moussa A, Mulvey C, Nadkarni V, Napolitano N, Quek BH, Singh N, Zenge JP (2020). . for the National Emergency Airway Registry for Neonates, I. Team stress and adverse events during neonatal tracheal intubations: A report from NEAR4NEOS. American Journal of Perinatology , 37 (14), 1417–1424. https://doi.org/10.1055/s-0039-1693698 Yeung J, Perkins G, Davies R, Bullock I, Lockey A, Gwinnutt C, Lott C, Hampshire S (2014) Introducing non-technical skills teaching to the Resuscitation Council (UK) Advanced Life Support Course. Resuscitation 85:S71. https://doi.org/10.1016/j.resuscitation.2014.03.178 Yoxall CW, Ayers S, Sawyer A, Bertullies S, Thomas M, Weeks D, A., Duley L (2015) Providing immediate neonatal care and resuscitation at birth beside the mother: Clinicians’ views, a qualitative study. BMJ Open 5(9):e008494. https://doi.org/10.1136/bmjopen-2015-008494 Zehnder E, Law BHY, Schmölzer GM (2020) Does parental presence affect workload during neonatal resuscitation? Archives Disease Child - Fetal Neonatal Ed 105(5):559–561. https://doi.org/10.1136/archdischild-2020-318840 Additional Declarations The authors declare no competing interests. Supplementary Files APPENDIX1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4858360","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Method Article","associatedPublications":[],"authors":[{"id":335846010,"identity":"475fde9d-3ad6-45be-80cf-ce537fe4de4a","order_by":0,"name":"Coralie HERVIEUX","email":"","orcid":"","institution":"Université de Montréal","correspondingAuthor":false,"prefix":"","firstName":"Coralie","middleName":"","lastName":"HERVIEUX","suffix":""},{"id":335846110,"identity":"f88f5fc7-b90c-4684-a4d5-381df6e04430","order_by":1,"name":"Ahmed MOUSSA","email":"","orcid":"","institution":"CHU Sainte-Justine","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"MOUSSA","suffix":""},{"id":335846111,"identity":"05f07193-66ec-4232-bcaf-27e9177f6e90","order_by":2,"name":"Nathalie LOYE","email":"","orcid":"","institution":"Université de Montréal","correspondingAuthor":false,"prefix":"","firstName":"Nathalie","middleName":"","lastName":"LOYE","suffix":""},{"id":335846112,"identity":"dad2dd6c-836b-404f-b4a1-b35043a1cf60","order_by":3,"name":"Claude Julie BOURQUE","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-9407-0872","institution":"Université de Montréal","correspondingAuthor":true,"prefix":"","firstName":"Claude","middleName":"Julie","lastName":"BOURQUE","suffix":""}],"badges":[],"createdAt":"2024-08-04 22:41:16","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4858360/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4858360/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62065208,"identity":"12a63ba7-6084-4574-a315-eb67a3eef8a1","added_by":"auto","created_at":"2024-08-09 00:40:37","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":82330,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of study selection process, as depicted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4858360/v1/c03b9c10a3c6b651c3e56450.jpeg"},{"id":62065212,"identity":"64727382-11aa-43f6-86b8-185d9b2214e8","added_by":"auto","created_at":"2024-08-09 00:40:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":399203,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4858360/v1/edb0e6d8-c24c-4547-883c-df0d70451c79.pdf"},{"id":62065210,"identity":"2a4fcc67-dfb5-4f21-96b1-63be6a1d72cf","added_by":"auto","created_at":"2024-08-09 00:40:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18596,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIX1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4858360/v1/f1d87608b3a9e11c3b737728.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eBest Practices and Training Needs Related to Interactions With Family Members During Neonatal Resuscitation Procedures: A Scoping Review Protocol\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eFamily presence during resuscitation has been studied and discussed since the 1980s (Doyle et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1987\u003c/span\u003e). 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., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). 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., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In the NICU, little is known about the impact of family presence on teams\u0026rsquo; 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., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, others argue that HCPs perceive a significant reduction of workload when at least one family member was present during resuscitation(Zehnder, Law, \u0026amp; Schm\u0026ouml;lzer, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). 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., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Recent studies suggest simple communication behaviors identified by parents and HCPs such as introducing oneself, using the child's first name, recognizing the parents\u0026rsquo; 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\u0026rsquo;Neill, \u0026amp; Gilfoyle, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lizotte et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe American Heart Association (AHA) and the European Resuscitation Council (ERC) resuscitation guidelines have supported the presence of family member during CPR (Lederman, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). 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., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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\u0026rsquo; 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., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Deacon, O\u0026rsquo;Neill, \u0026amp; Gilfoyle, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eRationale\u003c/h2\u003e \u003cp\u003eIn 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., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe 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:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWhat are the behaviors and actions recommended for HCPs toward family members during neonatal resuscitation in the NICU?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat are the knowledge gaps regarding the support and interactions of HCPs with family members during neonatal resuscitation in the NICU?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"METHODS AND ANALYSIS","content":"\u003cp\u003eAfter a first exploration of recent publications on the subject, we noticed that the literature was limited on our specific subject and included many qualitative and mixed method studies. This is why we opted for a scoping review, using the Joanna Briggs Institute (JBI) framework through its use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a reporting guide for the review (Peters et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tricco et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria\u003c/h2\u003e \u003cp\u003eThe central concept of the review is FPDR in neonatology and the interactions of HCPs with family members during neonatal resuscitation. Eligibility criteria for this scoping review will be developed to ensure that publications include specific information related to the objectives of this scoping review. All relevant peer-reviewed journal studies were included (qualitative, quantitative, or mix-method studies). Since there are not many publications on our subject in the specific healthcare setting of the NICU (compared to pediatric care in general), we sourced studies from around the world to gather as much information as possible.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAvailability in full text\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFocus on neonatal resuscitation in the NICU\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eInclusion of data on family presence during resuscitation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDate of publication between January 2012 and December 2022 (ten years scope)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eNot available in French or English\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFocus on pediatric resuscitation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFocus on the technical and/or medical aspects of a resuscitation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy and information sources\u003c/h2\u003e \u003cp\u003ePROSPERO was initially scanned to see if any review was done on the subject, and this is how the systematic literature review published by Dainty et al. in 2021 was found (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.crd.york.ac.uk/PROSPERO/CRD42021140363\u003c/span\u003e\u003cspan address=\"http://www.crd.york.ac.uk/PROSPERO/CRD42021140363\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). To ensure that a robust review search strategy is followed, the services of an experienced librarian will be used. First, we will focus our initial search from Dainty and al.\u0026rsquo;s search strategy and will refine it in collaboration with AP to match our studied subject (neonatology centered). Second, we will complete the search on MEDLINE Ovid from June 2020 to September 2022 to see if any new studies were published since this systematic literature review. Moreover, to identify potentially other relevant documents, the following bibliographic databases will also be searched from January 2012 to December 2022: ScienceDirect, PubMed, and CINAHL to cover a 10-year period.\u003c/p\u003e \u003cp\u003eThe search strategies will be adapted for each database, using comprehensive MESH and keywords for the concept of resuscitation, family presence, parental presence, neonatology, neonatal, and interactions. The final search strategy for each database and search engines can be found in \u003cspan refid=\"Sec10\" class=\"InternalRef\"\u003eAppendix 1\u003c/span\u003e. The reference lists from Dainty and al. and the other selected articles will also be scanned for other publications of interest. All documents that will be retrieved from our searches will be exported into EndNote 20 to identify and remove duplicate records.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eScreening process and data extraction\u003c/h2\u003e \u003cp\u003eData collection for the review will be documented through a PRISMA-P flowchart, including the application of inclusion/exclusion criteria as in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e(Haowen et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A three steps review will be performed by CH and discussed with CJB: 1) initial screening of each study by reviewing the title only, 2) reviewing the abstract and 3) reviewing the full text. Validation and/or uncertainty of criteria during screening process will be discussed between authors. The data from each study will be collected in a data extraction sheet (Microsoft Excel) that will be jointly developed by CH and CJB to determine which variables to extract (e.g. year of publication, country of origin, authors, main method, study design, field of study, information about interactions between HCPs and families during resuscitation, etc.). After extracting the data, a synthesis of the evidence base will be created in a table with a narrative review of the findings. The synthesis will also identify knowledge gaps on family support and interactions during neonatal resuscitation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to thank the librarian Alix Pincivy for her help on the search strategy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCH drafted the scoping review protocol with feedback from CJB and AM. All authors contributed to subsequent revisions and approved the protocol prior to its submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Program Audace, Fonds de recherche du Qu\u0026eacute;bec. The following author received payment from this funding source as a scholarship for her Masters in \u0026ldquo;Sciences Biom\u0026eacute;dicales (Option \u0026Eacute;thique Clinique)\u0026rdquo;: Coralie Hervieux.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Facult\u0026eacute; de M\u0026eacute;decine, Universit\u0026eacute; de Montr\u0026eacute;al, Montr\u0026eacute;al, Canada.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2 \u0026nbsp;\u0026nbsp;\u003c/sup\u003eCentre de p\u0026eacute;dagogie appliqu\u0026eacute;e aux sciences de la sant\u0026eacute;, Facult\u0026eacute; de M\u0026eacute;decine, Universit\u0026eacute; de Montr\u0026eacute;al, Canada.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e D\u0026eacute;partement de p\u0026eacute;diatrie, Universit\u0026eacute; de Montr\u0026eacute;al, Canada.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e Service de n\u0026eacute;onatalogie, CHU Sainte-Justine, Montr\u0026eacute;al, Canada.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u0026nbsp;\u003c/sup\u003eFacult\u0026eacute; d\u0026rsquo;\u0026eacute;ducation, Universit\u0026eacute; de Montr\u0026eacute;al, Canada\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e6\u0026nbsp;\u003c/sup\u003eD\u0026eacute;partement de m\u0026eacute;decine de famille et de m\u0026eacute;decine d\u0026rsquo;urgence, Universit\u0026eacute; de Montr\u0026eacute;al, Canada.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrei BK, Sawyer T, Umoren R, Gray MM, Krick J, Foglia EE, Ades A, Glass K, Kim JH, Singh N, Jung P, Johnston L, Moussa A, Napolitano N, Barry J, Zenge J, Quek B, DeMeo SD, Shults J, Nishisaki A (2021) Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS. 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Pediatrics 145(2):e20191925. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2019-1925\u003c/span\u003e\u003cspan address=\"10.1542/peds.2019-1925\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H (2021) Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement 19(1):3\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/XEB.0000000000000277\u003c/span\u003e\u003cspan address=\"10.1097/XEB.0000000000000277\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Straus SE (2018) PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. 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Team stress and adverse events during neonatal tracheal intubations: A report from NEAR4NEOS. \u003cem\u003eAmerican Journal of Perinatology\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(14), 1417\u0026ndash;1424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1055/s-0039-1693698\u003c/span\u003e\u003cspan address=\"10.1055/s-0039-1693698\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeung J, Perkins G, Davies R, Bullock I, Lockey A, Gwinnutt C, Lott C, Hampshire S (2014) Introducing non-technical skills teaching to the Resuscitation Council (UK) Advanced Life Support Course. Resuscitation 85:S71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.resuscitation.2014.03.178\u003c/span\u003e\u003cspan address=\"10.1016/j.resuscitation.2014.03.178\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoxall CW, Ayers S, Sawyer A, Bertullies S, Thomas M, Weeks D, A., Duley L (2015) Providing immediate neonatal care and resuscitation at birth beside the mother: Clinicians\u0026rsquo; views, a qualitative study. BMJ Open 5(9):e008494. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmjopen-2015-008494\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2015-008494\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZehnder E, Law BHY, Schm\u0026ouml;lzer GM (2020) Does parental presence affect workload during neonatal resuscitation? Archives Disease Child - Fetal Neonatal Ed 105(5):559\u0026ndash;561. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/archdischild-2020-318840\u003c/span\u003e\u003cspan address=\"10.1136/archdischild-2020-318840\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"1b92435f-1172-4ef2-856b-46999caad6fe","identifier":"10.13039/100008240","name":"Fonds de Recherche du Québec-Société et Culture","awardNumber":"2021- AUDC-287803","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Montreal","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Family presence, Neonatology, Resuscitation, Non-technical skills, In-situ simulation","lastPublishedDoi":"10.21203/rs.3.rs-4858360/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4858360/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Family presence during a resuscitation (FPDR) in neonatology is unevenly accepted by healthcare professionals (HCPs). To develop innovative educational materials for resuscitation teams in the neonatal intensive care units (NICUs), evidence-based information is needed on constructive interactions with family members during the procedures. This protocol is for a scoping review that aims to identify the best practices regarding support and interactions of HCPs with family members during neonatal resuscitation in the NICU and to propose recommendations for developing a targeted in-situ simulation training. The review willfocus on HCPs’ perception of FPDR in terms of interpersonal skills, reluctance and need for interactional training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and analysis\u003c/strong\u003e: In 2021, Dainty and collaborators published a systematic review on FPDR (pediatric and neonatal) that focused on the impact on the patients as well as family-centered and HCP centred outcomes. From their literature strategic search, we will extrapolate and narrow down the search to “neonatology” and add relevant recent studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) model will guide the literature search on four electronic databases (ScienceDirect, PubMed, MEDLINE Ovid and CINAHL) for studies published from January 2012 to December 2022. Data collection process will be documented through a PRISMA-P flowchart, including the application of inclusion/exclusion criteria. After data extraction, we will conduct a descriptive thematic analysis to synthesise content and identify emerging themes on family support and interactions, and on behaviors and actions recommended for HCP during neonatal resuscitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics and dissemination\u003c/strong\u003e: Formal ethic approval is not required, as primary data will not be collected in this study. The findings of this study will be disseminated through scientific conferences, publications, and knowledge transfer activities in simulation training in neonatology.\u003c/p\u003e","manuscriptTitle":"Best Practices and Training Needs Related to Interactions With Family Members During Neonatal Resuscitation Procedures: A Scoping Review Protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 00:40:33","doi":"10.21203/rs.3.rs-4858360/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83de999a-1a5a-4fb5-bd8c-88ac38fa8436","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35723357,"name":"Medical Ethics"}],"tags":[],"updatedAt":"2024-08-09T00:40:33+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-09 00:40:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4858360","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4858360","identity":"rs-4858360","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}