Exploring emergency nurses’ attitudes toward family presence during resuscitation: A cross-sectional study in Southwest China

Exploring emergency nurses’ attitudes toward family presence during resuscitation: A cross-sectional study in Southwest China | 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 Article Exploring emergency nurses’ attitudes toward family presence during resuscitation: A cross-sectional study in Southwest China Tao Lin, Yongli Gao, Yanzi Zhang, Xiaoqing Zhang, Xin Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8039224/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract Several medical institutions and associations in developed countries support family presence during resuscitation (FPDR); however, in China, FPDR has not been implemented, clear policies do not exist, and few studies have examined it. Therefore, this study investigates emergency nurses’ FPDR perceptions and their influencing factors. A total of 315 emergency nurses from Sichuan Province, China, completed a general questionnaire and the Chinese versions of the Family Presence Risk–Benefit and Family Presence Self-Confidence Scales. A t-test and chi-squared test were conducted for intergroup comparisons, and an analysis of variance assessed multiple classification data. Multiple linear regression analysis explored factors associated with the benefits and risks of FPDR. Of the 382 questionnaires distributed, 315 valid responses were collected (valid response rate = 82.46%). Years of working in emergency nursing, holding an emergency specialist nurse certificate, and the number of times family members were invited during resuscitation were associated with perceived benefits and risks of FPDR ( p < .05). Perceived benefits were negatively correlated with perceived risks and positively correlated with perceived resuscitation confidence (r = .51, p < .001). To promote the implementation of FPDR, nursing managers should develop implementation guidelines, reshape perceptions among medical staff, and respect family members’ needs. Health sciences/Diseases Health sciences/Health care Health sciences/Health occupations Health sciences/Medical research Health sciences/Risk factors cross-sectional study emergency nursing resuscitation family presence during resuscitation China Introduction Resuscitation is the recovery of a patient’s vital signs through mechanical, physiological, and pharmacological means during an emergency, such as cardiac or respiratory arrest [ 1 , 2 ]. During resuscitation, the patient’s family is typically not allowed in the clinical area; thus, the psychological effects of resuscitation on family members are often ignored [ 1 , 2 ]. Family presence during resuscitation (FPDR) implies that the medical team allows family members to be present, providing visual and physical support to patients during cardiopulmonary resuscitation (CPR) [ 3 , 4 ]. Since the 1980s, FPDR has been controversial internationally. Some believe that FPDR may lead to ethical and practical clinical dilemmas, such as (1) interfering with the resuscitation process and thus altering its effect; (2) increasing medical staff workload; (3) causing psychological trauma to family members; and (4) increasing doctor–patient conflicts and medical disputes [ 5 – 8 ]. However, no evidence indicates that FPDR increases negative emotions or medical disputes among medical staff [ 9 , 10 ]. By contrast, evidence has shown that FPDR positively affects patients, family members, and medical staff [ 9 ] by reducing anxiety, fear, and helplessness of family members, relieving their pain, enabling families to make medical decisions more quickly, promoting the acceptance of death, and improving family satisfaction [ 11 – 13 ]. Moreover, medical staff can quickly obtain information on the patient’s condition and make rapid clinical decisions, which can hasten the recovery process, promote the recognition of professionals by family members, and improve the professional identity and image of medical staff [ 14 , 15 ]. Professional guidelines suggest that medical staff should allow FPDR, as it is a fundamental right of patients and their family members [ 16 , 17 ]. Family members of emergency patients with acute, rapidly progressing diseases experience anxiety, tension, emotional instability, or overreaction, leading to significant physiological and psychological crises [ 18 , 19 ]. Currently, FPDR is supported by many medical institutions or associations in developed countries [ 20 , 21 ]. In 1993, the American Alliance for Emergency Care documented the legitimacy of resuscitation and developed guidelines [ 22 ]. Research emphasizes that FPDR should be encouraged in emergency care [ 23 ]. However, few studies have examined FPDR in China, where it has not been implemented, and no clear legal provisions, relevant policies, or regulations exist. Research predominantly conducted in Hong Kong, Taiwan, and other neighboring regions indicates that medical staff typically have low acceptance of FPDR [ 24 ], which is important for clinical practice research. Therefore, this study examined the attitudes of emergency nurses toward FPDR to provide a practical basis for the formulation and improvement of policies and regulations. Methods Design, Setting, and Sample This study employed a cross-sectional design. Stratified cluster sampling was used to select hospitals from the eastern, southern, western, and northern regions of Sichuan Province, China. Three secondary or lower hospitals and four tertiary hospitals were selected from each region, comprising 28 hospitals. A total of 382 emergency nurses worked in these hospitals at the time of this study. Convenience sampling was used to select participants from August to September 2024. The inclusion criterion was that the nurse had to be an active registered emergency nurse for at least one year; the exclusion criteria were being a rotation or student nurse and not being on duty during the study period. WeChat, a commonly used communication software in China, was employed to generate questionnaire links and QR codes. Members of the Emergency Professional Committee of the Sichuan Nursing Society were contacted through the society’s social media account. Subsequently, these members contacted the heads of the nursing departments in the regions where the selected hospitals were located to request their participation. After obtaining informed consent, an electronic link to the survey was sent to the hospitals. The head nurses of the hospitals’ emergency departments asked emergency nurses to complete the questionnaire. Uniform guidelines explained the purpose of the study. Questionnaires were completed and submitted only after obtaining informed consent from the nurses. This study was approved by the Ethics Review Committee of West China Hospital of Sichuan University (approval number: 2020 [833]) and all research were performed in accordance with relevant guidelines and regulations. To maintain survey integrity, only fully completed questionnaires could be submitted. Missing answers were flagged with relevant prompts when participants clicked the “Submit” button. Questionnaires could be completed using desktop computers, tablet computers, mobile phones, or other devices. Only one questionnaire could be completed per account and device to avoid duplication. The Chinese versions of the Family Presence Risk–Benefit Scale (FPR-BS) and Family Presence Self-Confidence Scale (FPS-CS) contain 22 and 17 items, respectively. As the sample size should be 10 times the number of items [ 25 ], and considering a 20% rate of invalid responses, a sample size of 275 participants was required. We distributed 382 questionnaires and collected 315 valid responses (valid response rate = 82.46%). The high response rate was likely influenced by Chinese cultural norms, encouraging participation in research [ 26 ]. The authority of nursing managers may also have affected the response rate. Research Tools General Information Questionnaire This questionnaire collected information on gender, age, education level, marital status, presence of children, job title, position, years of nursing work (including standardized training), years of working in emergency nursing, personal monthly income, holding an emergency specialist nurse certificate, whether the nurse had resuscitated patients, the number of CPRs performed, whether nurses’ family members had experienced CPR, and the number of times family members were invited during resuscitation. Chinese Version of the FPR-BS (Nurse Version) The FPR-BS was developed by Twibell et al. [ 27 ] to measure nurses’ perceptions of the benefits and risks of FPDR. The Chinese version contains 22 items assessing one dimension [ 2 , 12 ]. Responses are rated on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). Items 2, 3, and 11–14 were reverse-scored. Higher scores indicate greater perceived benefits and lower perceived risks of FPDR. The scale’s Cronbach’s α coefficient, previously reported as .93 [ 2 ], was .94 in this study. Chinese Version of the FPS-CS (Nurse Version) The FPS-CS was developed by Twibell et al. [ 27 ] to measure nurses’ confidence in managing resuscitation while implementing FPDR. The Chinese version comprises 17 items that assess a single dimension [ 2 , 12 ]. Responses are rated on a five-point Likert scale (1 = not confident to 5 = very highly confident). Higher scores indicate higher confidence in managing resuscitation-related procedures. The Cronbach’s α coefficient, previously reported as .93 [ 2 ], was .94 in this study. Analysis SPSS 25.0 software was used for data analysis. Ordinal data are expressed as mean ± standard deviation (x ± s). The t-test was used for intergroup comparisons, while analysis of variance assessed multiple classification data. Count data are reported as frequencies and percentages (n, %), and a chi-squared test was used for intergroup comparisons. Multiple linear regression analysis was used to explore factors associated with the benefits and risks of FPDR, with p < .05 considered statistically significant. Results Factors Influencing FPDR Perception Among Emergency Nurses Three factors—years of working in emergency nursing, holding an emergency specialist nurse certificate, and the number of times family members were invited during resuscitation—had a statistically significant effect on emergency nurses’ perceived benefits and risks of FPDR ( p < .05; see Supplementary Material S1). FPDR Perception Among Emergency Nurses Scores on the Chinese version of the FPR-BS ranged from 22 to 110. The total score followed a normal distribution, with a mean of 2.65 ± 0.69 (see Supplementary Material S2). Scores on the Chinese version of the FPS-CS ranged from 17 to 85, following a normal distribution, with a mean of 2.41 ± 0.59 (see Supplementary Material S3). Correlation Between Perceived Benefits and Risks of FPDR and Perceived Confidence The FPR-BS and FPS-CS scores were normally distributed. Pearson’s correlation analysis found that the perceived benefits and risks of FPDR and perceived self-confidence of emergency nurses were positively correlated (r = .51, p < .001). Factors Influencing Perceived Benefits and Risks of FPDR Higher confidence in FPDR was associated with higher scores for perceived benefits and lower scores for perceived risks. The more frequently nurses invited family members during resuscitation, the more positively they evaluated FPDR. Nurses with emergency specialist nurse certificates exhibited a more positive attitude toward FPDR, and nurses with more years of emergency nursing experience scored higher on the benefits and risks of FPDR (see Tables 1 and 2 ). These nurses perceived more benefits than risks. Table 1 Variable assignment Independent variable Assignment specification Expected direction FPS-CS Original input + Years of working in emergency nursing ≤ 5 = 1 6–10 = 2 11–15 = 3 16–20 = 4 > 20 = 5 + Holding an emergency specialist nurse certificate No = 1, Yes = 2 + Number of times family members were invited during resuscitation Never = 1 1–4 times = 2 5–10 times = 3 > 10 times = 4 + Note: FPS-CS: Family Presence Self-Confidence Scale. Table 2 Multiple linear regression analysis of factors influencing the perceived benefits and risks of FPDR among emergency nurses (n = 315) Nonnormalized coefficient Standardization coefficient t p Collinearity diagnosis B Standard error Beta VIF tolerance Constant .60 .13 - 4.55 < .001*** - - FPS-CS .47 .05 .40 9.50 < .001*** 1.07 .92 Years of working in emergency nursing .10 .02 .21 4.35 < .001*** 1.46 .68 Holding an emergency specialist nurse certificate .32 .07 .22 4.35 < .001*** 1.61 .61 Number of times family members were invited during resuscitation .11 .03 .15 3.43 .001*** 1.19 .84 R 2 .47 Adjusted R 2 .46 F 70.05*** D-W value 1.84 * p < .1, ** p < .05, *** p < .01. Note: Dependent variable: FPDR benefits and risks. FPDR: family presence during resuscitation; VIF: variance inflation factor; FPS-CS: Family Presence Self-Confidence Scale. Discussion Participants had a lower perception of FPDR benefits and a higher perception of risks. These results were similar to those reported by Chinese researchers [ 2 ]; however, greater perceived benefits have been reported in the United States [ 27 ], the United Kingdom [ 28 ], and Australia [ 29 ]. Medical staff’s perceptions of FPDR benefits and risks are influenced by work field, work experience, and culture [ 2 ]. Developed regions demonstrate high acceptance of FPDR [ 2 ]. Due to differences in traditional culture and clinical environments in Eastern countries, medical staff show low overall willingness regarding FPDR [ 2 ]. In our study, the score for the question “family members should be given the option to be present when a loved one is being resuscitated” was lower than the values reported in studies conducted in developed regions [ 27 – 29 ]. Most nurses did not agree that family members should freely choose whether to be present; therefore, respondents’ openness to FPDR was limited. Scores for “family members will panic when witnessing resuscitation” (3.44 ± 1.12) and “family members will have difficulty adjusting to the long-term emotional impact of watching a resuscitation effort” (3.27 ± 1.15) were higher than those reported in developed regions [ 23 – 25 ]. Average scores for the impact of resuscitation on patients, family members, nurses, and physicians were approximately 2.0: FPDR is “beneficial to patients” (2.06 ± 0.97), “beneficial to families” (2.095 ± 0.976), “beneficial to nurses” (1.93 ± 1.14), and “beneficial to physicians” (1.93 ± 1.11). These values were lower than those reported in developed regions [ 27 – 29 ]. Emergency nurses were not optimistic about the value of FPDR, generally believing that FPDR does not assist the resuscitation procedure, particularly regarding operational efficiency and nursing team performance, and that the presence of family members increases procedural difficulty. The average score on the FPS-CS for emergency nurses was 2.41 ± 0.59. Emergency nurses’ confidence in FPDR was below the moderate level, indicating low confidence in managing resuscitation procedures in the presence of family members. This confidence was lower than reported in the United States [ 27 ], the United Kingdom [ 28 ], and Australia [ 29 ], but similar to that found in Chinese surveys of general nurses [ 2 ]. Emergency nurses’ confidence in performing resuscitation tasks in the presence of family members varied by task. Nurses expressed relatively high confidence in technical procedures, such as “administering drug therapies” (3.02 ± 0.97) and “performing chest compressions” (3.05 ± 0.98), indicating strong confidence in their professional skills. However, average scores were lower for “communicating with family members about the resuscitation efforts” (2.61 ± 1.00), “providing psychological support to family members” (2.54 ± 0.92), and “identifying the spiritual and emotional needs of family members” (2.56 ± 0.90), indicating a need for improvement. Nurses’ confidence was low for “enlisting support from attending physicians for family presence” (2.22 ± 0.96), indicating limited perceived support and insufficiently sound teamwork mechanisms. Emergency nurses expressed relatively neutral or slightly negative attitudes toward FPDR. Although confident in technical operations, they expressed concerns and uncertainties regarding communication with and support for family members. FPDR increases psychological pressure on medical staff, which can affect behavior during resuscitation procedures. To promote FPDR, nurses need additional training and support, particularly in psychological support, family communication, and teamwork, emphasizing the need for education and training. Greater experience in emergency nursing was significantly associated with higher perceived benefits, as indicated by the higher scores for FPDR benefits and risks ( p < .001). Nurses with more than 20 years of service had a mean FPDR score of 3.16 ± 0.69, whereas those with 5 years of service or less had the lowest mean score (2.31 ± 0.58). Experienced nurses were more likely to recognize potential benefits of FPDR due to their experience and confidence. Nurses with positive perceptions and higher self-confidence were more likely to offer FPDR as an option [ 30 ]. Senior emergency nurses were more likely to perform resuscitation and were better equipped to identify and manage critically ill patients under complex and variable conditions. They could confidently manage resuscitation procedures, provide better services for patients and families, and improve treatment outcomes and the overall quality of emergency care. Holding an emergency specialist nurse certificate was significantly associated with higher perceived benefits and risks of FPDR ( p < .001). Nurses who held this certificate scored significantly higher than those who had not (3.09 ± 0.57 vs. 2.36 ± 0.62), consistent with the findings of Chapman et al. [ 29 ]. Nurses with emergency specialist certificates had more positive attitudes toward FPDR because specialists are more professional and confident in responding to complex emergency situations, making them more likely to recognize FPDR benefits. A significant positive correlation was observed between the number of times family members were invited during resuscitation and nurses’ perceived benefits and risks of FPDR ( p < .001). The more frequently family members were invited, the higher nurses’ scores on FPDR benefits and risks. Nurses who had invited family members more than 10 times scored the highest (3.21 ± 0.49), whereas those who had never invited family members scored the lowest (2.43 ± 0.68). Through practical experience and interactions with family members, nurses gradually understood FPDR benefits, indicating the influence of FPDR proficiency on nurses’ attitudes. With the transformation of the medical model into a biopsychosocial approach and the promotion of holistic and family-centered nursing, care should address both patients and their family members. A positive correlation existed between nurses’ perceived FPDR benefits and their perceived self-confidence. However, a negative correlation was observed between perceived risks and self-confidence, and between perceived benefits and risks. This is consistent with domestic and international findings [ 2 , 27 – 29 ]. Most hospitals require families to wait outside the rescue room during CPR [ 18 ]. FPDR education for medical staff improves knowledge, attitudes, and practical abilities while reducing stress and anxiety. Most medical workers reported not receiving educational courses on resuscitation accompaniment, and no such courses exist in China. A systematic FPDR policy that provides support and guidance can improve medical staff confidence. However, most countries lack written FPDR policies [ 30 ]. Numerous studies have urged organizations and hospitals to develop FPDR policies to guide resuscitation teams [ 30 ]. Allowing family members to participate in FPDR enhances satisfaction with emergency care, alleviates anxiety and fear, reduces helplessness, relieves pain, and facilitates acceptance of the patient’s death. FPDR also improves patient care, and implementing FPDR in emergency nursing would change current clinical care standards. Emergency nurses primarily care for critically ill patients, are often involved in resuscitation, and can confidently manage procedures, providing quality care for patients and families. The results suggest that FPDR education would improve nurses’ knowledge, attitudes, and practical abilities and reduce stress and anxiety during FPDR. Emergency nurses perceived relatively low FPDR benefits and reported low self-confidence in implementing it. Greater perceived benefits were associated with lower perceived risks and higher confidence levels. Factors such as years of emergency nursing experience, the number of times family members were invited during resuscitation, holding an emergency specialist nurse certificate, and perceived confidence in FPDR influenced nurses’ perception of FPDR benefits and risks. This study has several limitations. First, convenience sampling may have created potential selection bias, allowing inclusion of nurses with strong positive or negative views. Second, the data were obtained from one province in China, and the sample size was limited. Multicenter, large-sample studies could explore differences among regions and hospitals. Third, this was a quantitative study; qualitative research would provide a deeper understanding of the topic. Qualitative interviews with medical staff, patients, and family members should be considered to explore attitudes toward FPDR among different groups. Declarations Competing interests The authors declare no competing interests. Ethics approval This study was approved by the Ethics Review Committee of West China Hospital of Sichuan University (approval number: 2020 [833]). The principles of voluntary participation, confidentiality, and non-maleficence were followed. Electronic informed consent was obtained from all participants. Funding This study was supported by the National Research Foundation of Nature Sciences (grant number: 82002009). Author Contribution All authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by Tao Lin and Yanzi Zhang. The first draft of the manuscript was written by Tao Lin. All authors commented on previous versions of the manuscript. All authors read and approved the final version. Acknowledgments The authors would like to thank all emergency nurses for their participation in and contribution to this study. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Albarran, J., Moule, P., Benger, J., McMahon-Parkes, K. & Lockyer, L. Family witnessed resuscitation: the views and preferences of recently resuscitated hospital inpatients, compared to matched controls without the experience of resuscitation survival. Resuscitation 80 , 1070–1073 (2009). Segond, N., Wittig, J., Kern, W. J. & Orlob, S. Towards a common terminology of ventilation during cardiopulmonary resuscitation. Resuscitation 207 , 110511 (2025). Meghani, S. Witnessed resuscitation: a concept analysis. Intensive Crit. Care Nurs. 64 , 103003 (2021). Walker, W. & Gavin, C. Family presence during resuscitation: a narrative review of the practices and views of critical care nurses. Intensive Crit. Care Nurs. 53 , 15–22 (2019). Fernández, E. M., Martín, G. M. & Herrera, M. J. Family witnessed resuscitation and invasive procedures: patient and family opinions. Nurs. Ethics . 28 , 645–655 (2021). Fulbrook, P., Latour, J. M. & Albarran, J. W. Paediatric critical care nurses’ attitudes and experiences of parental presence during cardiopulmonary resuscitation: a European survey. Int. J. Nurs. Stud. 44 , 1238–1249 (2007). Hassankhani, H., Zamanzadeh, V., Rahmani, A., Haririan, H. & Porter, J. E. Family presence during resuscitation: a double-edged sword. J. Nurs. Scholarsh. 49 , 127–134 (2017). Öztürk, E. A. & Koç, Z. Turkish validation of the family presence during resuscitation risk-benefit scale. Nurs. Crit. Care . 27 , 440–449 (2022). Twibell, R., Siela, D., Riwitis, C. & Neal, A. Waters, N. A qualitative study of factors in nurses’ and physicians’ decision-making related to family presence during resuscitation. J. Clin. Nurs. 27 , e320–e334 (2018). Willmes, M. et al. Impact of family presence during cardiopulmonary resuscitation on team performance and perceived task load: a prospective randomised simulator-based trial. BMJ Open. 12 , e056798 (2022). Fulbrook, P., Albarran, J. W. & Latour, J. M. A European survey of critical care nurses’ attitudes and experiences of having family members present during cardiopulmonary resuscitation. Int. J. Nurs. Stud. 42 , 557–568 (2005). Guo, L. et al. Translation and validation of the Chinese version of Perceptions of the Self-Confidence Scale and the Benefits and Risks of Family Presence during Resuscitation. Chin. Nurs. Res. 21 , 3826–3831 (2023). McAlvin, S. S. & Carew-Lyons, A. Family presence during resuscitation and invasive procedures in pediatric critical care: a systematic review. Am. J. Crit. Care . 23 , 477–484 (2014). Leung, N. Y. & Chow, S. K. Attitudes of healthcare staff and patients’ family members towards family presence during resuscitation in adult critical care units. J. Clin. Nurs. 21 , 2083–2093 (2012). Oczkowski, S. J., Mazzetti, I., Cupido, C. & Fox-Robichud, A. E. The offering of family presence during resuscitation: a systematic review and meta-analysis. J. Intensive Care . 3 , 41 (2015). Davidson, J. E. et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit. Care Med. 45 , 103–128 (2017). Lederman, Z. Family presence during cardiopulmonary resuscitation. J. Clin. Ethics . 30 , 347–355 (2019). Li, R. & Xi, S. Overview of the development stage of emergency nurse training in Shanghai. Chin. J. Nurs. Educ. 16 , 668–671 (2019). Yuan, X. & Fan, Y. Emergency nurses’ attitudes towards family presence during cardiopulmonary resuscitation. PLA Nurs. J. 31 , 1–4 (2014). Giles, T., de Lacey, S. & Muir-Cochrane, E. How do clinicians practice the principles of beneficence when deciding to allow or deny family presence during resuscitation? J. Clin. Nurs. 27 , e1214–e1224 (2018). McMahon-Parkes, K., Moule, P., Benger, J. & Albarran, J. W. The views and preferences of resuscitated and non-resuscitated patients towards family witnessed resuscitation: a qualitative study. Int. J. Nurs. Stud. 46 , 12–21 (2009). Moreland, P. Family presence during invasive procedures and resuscitation in the emergency department: a review of the literature. J. Emerg. Nurs. 31 , 58–72 (2005). Toronto, C. E. & LaRocco, S. A. Family perception of and experience with family presence during cardiopulmonary resuscitation: an integrative review. J. Clin. Nurs. 28 , 32–46 (2019). Lai, M. K., Aritejo, B. A., Tang, J. S., Chen, C. L. & Chuang, C. C. Predicting medical professionals’ intention to allow family presence during resuscitation: a cross-sectional survey. Int. J. Nurs. Stud. 70 , 11–16 (2017). Memon, M. A. Sample size for survey research: review and recommendations. J. Appl. Struct. Equat Model. 4 , i–xx (2020). Lin, T., Gao, Y. & Feng, X. Relationship between information literacy and innovative behavior of emergency specialist nurses: a cross-sectional study in southwest China. Int. Emerg. Nurs. 71 , 101356 (2023). Twibell, R. S. et al. Nurses’ perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. Am. J. Crit. Care . 17 , 101–111 (2008). Bray, I., Kenny, G., Pontin, D., Williams, R. & Albarran, J. Family presence during resuscitation: validation of the risk–benefit and self-confidence scales for student nurses. J. Res. Nurs. 21 , 306–322 (2016). Chapman, R., Watkins, R., Bushby, A. & Combs, S. Assessing health professionals’ perceptions of family presence during resuscitation: a replication study. Int. Emerg. Nurs. 21 , 17–25 (2013). Powers, K. & Reeve, C. L. Factors associated with nurses’ perceptions, self-confidence, and invitations of family presence during resuscitation in the intensive care unit: a cross-sectional survey. Int. J. Nurs. Stud. 87 , 103–112 (2018). Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials.docx Cite Share Download PDF Status: Published Journal Publication published 17 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 26 Mar, 2026 Reviews received at journal 25 Mar, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers agreed at journal 28 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 07 Feb, 2026 Reviewers invited by journal 28 Jan, 2026 Editor assigned by journal 28 Jan, 2026 Editor invited by journal 20 Nov, 2025 Submission checks completed at journal 15 Nov, 2025 First submitted to journal 15 Nov, 2025 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. 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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-8039224","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":581819500,"identity":"f3d0c127-0b2d-42d4-88bd-58d497922912","order_by":0,"name":"Tao Lin","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Lin","suffix":""},{"id":581819501,"identity":"3ee94ea1-1b12-456a-bfa4-1b38bcad2a96","order_by":1,"name":"Yongli Gao","email":"","orcid":"","institution":"Sichuan University, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yongli","middleName":"","lastName":"Gao","suffix":""},{"id":581819502,"identity":"66fa9242-b0eb-4bab-9f61-4bfb81a90a58","order_by":2,"name":"Yanzi Zhang","email":"","orcid":"","institution":"West China Hospital, Sichuan University Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Yanzi","middleName":"","lastName":"Zhang","suffix":""},{"id":581819503,"identity":"89ec4349-0f82-484d-8f04-10a8513c98f2","order_by":3,"name":"Xiaoqing Zhang","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqing","middleName":"","lastName":"Zhang","suffix":""},{"id":581819504,"identity":"48979167-0cc7-4eda-b7ed-7797303dbdd6","order_by":4,"name":"Xin Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYFAC/ocPPlRAmBJEauFhNpxxhkQtbNK8baRokZ+Re0Cad16dvMEB5oO3eRjs8ghqYew5l2A4d9thww0H2JKteRiSiwlqYWZvMEh4u+1AgsEBHjNpHoYDiQ2EtLAxMxgc4J1TB9TC/404LTzsPYaNvA3MIFvYiNMiwXMsmXHGscOGMw+zGVvOMUgmrEV+RvLxHx9q6uT5jjc/vPGmwo6wFgRgBhEGxKsfBaNgFIyCUYAHAAD+Pjfiq2fsXAAAAABJRU5ErkJggg==","orcid":"","institution":"Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-11-05 14:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8039224/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8039224/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-48992-4","type":"published","date":"2026-04-17T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":107350853,"identity":"3dfa6fb4-d36a-4dbc-b5ea-a53015d2408e","added_by":"auto","created_at":"2026-04-20 16:05:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":326027,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8039224/v1/aea5c5d2-9a4e-4f17-adf7-09c3f1ecb856.pdf"},{"id":101490564,"identity":"e21e8cd3-650b-4271-a260-7b497b338670","added_by":"auto","created_at":"2026-01-30 09:58:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":34218,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-8039224/v1/b03d07e614d4b09698fedbd8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring emergency nurses’ attitudes toward family presence during resuscitation: A cross-sectional study in Southwest China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eResuscitation is the recovery of a patient\u0026rsquo;s vital signs through mechanical, physiological, and pharmacological means during an emergency, such as cardiac or respiratory arrest [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. During resuscitation, the patient\u0026rsquo;s family is typically not allowed in the clinical area; thus, the psychological effects of resuscitation on family members are often ignored [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Family presence during resuscitation (FPDR) implies that the medical team allows family members to be present, providing visual and physical support to patients during cardiopulmonary resuscitation (CPR) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince the 1980s, FPDR has been controversial internationally. Some believe that FPDR may lead to ethical and practical clinical dilemmas, such as (1) interfering with the resuscitation process and thus altering its effect; (2) increasing medical staff workload; (3) causing psychological trauma to family members; and (4) increasing doctor\u0026ndash;patient conflicts and medical disputes [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, no evidence indicates that FPDR increases negative emotions or medical disputes among medical staff [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. By contrast, evidence has shown that FPDR positively affects patients, family members, and medical staff [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] by reducing anxiety, fear, and helplessness of family members, relieving their pain, enabling families to make medical decisions more quickly, promoting the acceptance of death, and improving family satisfaction [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, medical staff can quickly obtain information on the patient\u0026rsquo;s condition and make rapid clinical decisions, which can hasten the recovery process, promote the recognition of professionals by family members, and improve the professional identity and image of medical staff [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Professional guidelines suggest that medical staff should allow FPDR, as it is a fundamental right of patients and their family members [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFamily members of emergency patients with acute, rapidly progressing diseases experience anxiety, tension, emotional instability, or overreaction, leading to significant physiological and psychological crises [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Currently, FPDR is supported by many medical institutions or associations in developed countries [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In 1993, the American Alliance for Emergency Care documented the legitimacy of resuscitation and developed guidelines [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Research emphasizes that FPDR should be encouraged in emergency care [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, few studies have examined FPDR in China, where it has not been implemented, and no clear legal provisions, relevant policies, or regulations exist. Research predominantly conducted in Hong Kong, Taiwan, and other neighboring regions indicates that medical staff typically have low acceptance of FPDR [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], which is important for clinical practice research. Therefore, this study examined the attitudes of emergency nurses toward FPDR to provide a practical basis for the formulation and improvement of policies and regulations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign, Setting, and Sample\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional design. Stratified cluster sampling was used to select hospitals from the eastern, southern, western, and northern regions of Sichuan Province, China. Three secondary or lower hospitals and four tertiary hospitals were selected from each region, comprising 28 hospitals. A total of 382 emergency nurses worked in these hospitals at the time of this study. Convenience sampling was used to select participants from August to September 2024. The inclusion criterion was that the nurse had to be an active registered emergency nurse for at least one year; the exclusion criteria were being a rotation or student nurse and not being on duty during the study period.\u003c/p\u003e \u003cp\u003eWeChat, a commonly used communication software in China, was employed to generate questionnaire links and QR codes. Members of the Emergency Professional Committee of the Sichuan Nursing Society were contacted through the society\u0026rsquo;s social media account. Subsequently, these members contacted the heads of the nursing departments in the regions where the selected hospitals were located to request their participation. After obtaining informed consent, an electronic link to the survey was sent to the hospitals. The head nurses of the hospitals\u0026rsquo; emergency departments asked emergency nurses to complete the questionnaire. Uniform guidelines explained the purpose of the study. Questionnaires were completed and submitted only after obtaining informed consent from the nurses. This study was approved by the Ethics Review Committee of West China Hospital of Sichuan University (approval number: 2020 [833]) and all research were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003cp\u003eTo maintain survey integrity, only fully completed questionnaires could be submitted. Missing answers were flagged with relevant prompts when participants clicked the \u0026ldquo;Submit\u0026rdquo; button. Questionnaires could be completed using desktop computers, tablet computers, mobile phones, or other devices. Only one questionnaire could be completed per account and device to avoid duplication.\u003c/p\u003e \u003cp\u003eThe Chinese versions of the Family Presence Risk\u0026ndash;Benefit Scale (FPR-BS) and Family Presence Self-Confidence Scale (FPS-CS) contain 22 and 17 items, respectively. As the sample size should be 10 times the number of items [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and considering a 20% rate of invalid responses, a sample size of 275 participants was required. We distributed 382 questionnaires and collected 315 valid responses (valid response rate\u0026thinsp;=\u0026thinsp;82.46%). The high response rate was likely influenced by Chinese cultural norms, encouraging participation in research [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The authority of nursing managers may also have affected the response rate.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch Tools\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information Questionnaire\u003c/h2\u003e \u003cp\u003eThis questionnaire collected information on gender, age, education level, marital status, presence of children, job title, position, years of nursing work (including standardized training), years of working in emergency nursing, personal monthly income, holding an emergency specialist nurse certificate, whether the nurse had resuscitated patients, the number of CPRs performed, whether nurses\u0026rsquo; family members had experienced CPR, and the number of times family members were invited during resuscitation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eChinese Version of the FPR-BS (Nurse Version)\u003c/h3\u003e\n\u003cp\u003eThe FPR-BS was developed by Twibell et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] to measure nurses\u0026rsquo; perceptions of the benefits and risks of FPDR. The Chinese version contains 22 items assessing one dimension [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Responses are rated on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree). Items 2, 3, and 11\u0026ndash;14 were reverse-scored. Higher scores indicate greater perceived benefits and lower perceived risks of FPDR. The scale\u0026rsquo;s Cronbach\u0026rsquo;s α coefficient, previously reported as .93 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], was .94 in this study.\u003c/p\u003e\n\u003ch3\u003eChinese Version of the FPS-CS (Nurse Version)\u003c/h3\u003e\n\u003cp\u003eThe FPS-CS was developed by Twibell et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] to measure nurses\u0026rsquo; confidence in managing resuscitation while implementing FPDR. The Chinese version comprises 17 items that assess a single dimension [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Responses are rated on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;not confident to 5\u0026thinsp;=\u0026thinsp;very highly confident). Higher scores indicate higher confidence in managing resuscitation-related procedures. The Cronbach\u0026rsquo;s α coefficient, previously reported as .93 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], was .94 in this study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eSPSS 25.0 software was used for data analysis. Ordinal data are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s). The t-test was used for intergroup comparisons, while analysis of variance assessed multiple classification data. Count data are reported as frequencies and percentages (n, %), and a chi-squared test was used for intergroup comparisons. Multiple linear regression analysis was used to explore factors associated with the benefits and risks of FPDR, with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05 considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing FPDR Perception Among Emergency Nurses\u003c/h2\u003e \u003cp\u003eThree factors\u0026mdash;years of working in emergency nursing, holding an emergency specialist nurse certificate, and the number of times family members were invited during resuscitation\u0026mdash;had a statistically significant effect on emergency nurses\u0026rsquo; perceived benefits and risks of FPDR (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; see Supplementary Material S1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFPDR Perception Among Emergency Nurses\u003c/h2\u003e \u003cp\u003eScores on the Chinese version of the FPR-BS ranged from 22 to 110. The total score followed a normal distribution, with a mean of 2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69 (see Supplementary Material S2). Scores on the Chinese version of the FPS-CS ranged from 17 to 85, following a normal distribution, with a mean of 2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59 (see Supplementary Material S3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation Between Perceived Benefits and Risks of FPDR and Perceived Confidence\u003c/h2\u003e \u003cp\u003eThe FPR-BS and FPS-CS scores were normally distributed. Pearson\u0026rsquo;s correlation analysis found that the perceived benefits and risks of FPDR and perceived self-confidence of emergency nurses were positively correlated (r\u0026thinsp;=\u0026thinsp;.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing Perceived Benefits and Risks of FPDR\u003c/h2\u003e \u003cp\u003eHigher confidence in FPDR was associated with higher scores for perceived benefits and lower scores for perceived risks. The more frequently nurses invited family members during resuscitation, the more positively they evaluated FPDR. Nurses with emergency specialist nurse certificates exhibited a more positive attitude toward FPDR, and nurses with more years of emergency nursing experience scored higher on the benefits and risks of FPDR (see Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These nurses perceived more benefits than risks.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariable assignment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssignment specification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExpected direction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPS-CS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginal input\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of working in emergency nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003e6\u0026ndash;10\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003e11\u0026ndash;15\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003e16\u0026ndash;20\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHolding an emergency specialist nurse certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u0026thinsp;=\u0026thinsp;1, Yes\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of times family members were invited during resuscitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003e1\u0026ndash;4 times\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003e5\u0026ndash;10 times\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 times\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e+\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote: FPS-CS: Family Presence Self-Confidence Scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis of factors influencing the perceived benefits and risks of FPDR among emergency nurses (n\u0026thinsp;=\u0026thinsp;315)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNonnormalized coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardization coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eCollinearity diagnosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eBeta\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVIF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003etolerance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPS-CS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of working in emergency nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHolding an emergency specialist nurse certificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of times family members were invited during resuscitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAdjusted R\u003c/em\u003e\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e70.05***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-W value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e* \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.1, ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\u003cp\u003eNote: Dependent variable: FPDR benefits and risks.\u003c/p\u003e\n\u003cp\u003eFPDR: family presence during resuscitation; VIF: variance inflation factor; FPS-CS: Family Presence Self-Confidence Scale.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eParticipants had a lower perception of FPDR benefits and a higher perception of risks. These results were similar to those reported by Chinese researchers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]; however, greater perceived benefits have been reported in the United States [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], the United Kingdom [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and Australia [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Medical staff\u0026rsquo;s perceptions of FPDR benefits and risks are influenced by work field, work experience, and culture [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Developed regions demonstrate high acceptance of FPDR [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to differences in traditional culture and clinical environments in Eastern countries, medical staff show low overall willingness regarding FPDR [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, the score for the question \u0026ldquo;family members should be given the option to be present when a loved one is being resuscitated\u0026rdquo; was lower than the values reported in studies conducted in developed regions [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Most nurses did not agree that family members should freely choose whether to be present; therefore, respondents\u0026rsquo; openness to FPDR was limited. Scores for \u0026ldquo;family members will panic when witnessing resuscitation\u0026rdquo; (3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12) and \u0026ldquo;family members will have difficulty adjusting to the long-term emotional impact of watching a resuscitation effort\u0026rdquo; (3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15) were higher than those reported in developed regions [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Average scores for the impact of resuscitation on patients, family members, nurses, and physicians were approximately 2.0: FPDR is \u0026ldquo;beneficial to patients\u0026rdquo; (2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97), \u0026ldquo;beneficial to families\u0026rdquo; (2.095\u0026thinsp;\u0026plusmn;\u0026thinsp;0.976), \u0026ldquo;beneficial to nurses\u0026rdquo; (1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14), and \u0026ldquo;beneficial to physicians\u0026rdquo; (1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11). These values were lower than those reported in developed regions [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Emergency nurses were not optimistic about the value of FPDR, generally believing that FPDR does not assist the resuscitation procedure, particularly regarding operational efficiency and nursing team performance, and that the presence of family members increases procedural difficulty.\u003c/p\u003e \u003cp\u003eThe average score on the FPS-CS for emergency nurses was 2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59. Emergency nurses\u0026rsquo; confidence in FPDR was below the moderate level, indicating low confidence in managing resuscitation procedures in the presence of family members. This confidence was lower than reported in the United States [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], the United Kingdom [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and Australia [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], but similar to that found in Chinese surveys of general nurses [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEmergency nurses\u0026rsquo; confidence in performing resuscitation tasks in the presence of family members varied by task. Nurses expressed relatively high confidence in technical procedures, such as \u0026ldquo;administering drug therapies\u0026rdquo; (3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97) and \u0026ldquo;performing chest compressions\u0026rdquo; (3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98), indicating strong confidence in their professional skills. However, average scores were lower for \u0026ldquo;communicating with family members about the resuscitation efforts\u0026rdquo; (2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00), \u0026ldquo;providing psychological support to family members\u0026rdquo; (2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92), and \u0026ldquo;identifying the spiritual and emotional needs of family members\u0026rdquo; (2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90), indicating a need for improvement. Nurses\u0026rsquo; confidence was low for \u0026ldquo;enlisting support from attending physicians for family presence\u0026rdquo; (2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96), indicating limited perceived support and insufficiently sound teamwork mechanisms.\u003c/p\u003e \u003cp\u003eEmergency nurses expressed relatively neutral or slightly negative attitudes toward FPDR. Although confident in technical operations, they expressed concerns and uncertainties regarding communication with and support for family members. FPDR increases psychological pressure on medical staff, which can affect behavior during resuscitation procedures. To promote FPDR, nurses need additional training and support, particularly in psychological support, family communication, and teamwork, emphasizing the need for education and training.\u003c/p\u003e \u003cp\u003eGreater experience in emergency nursing was significantly associated with higher perceived benefits, as indicated by the higher scores for FPDR benefits and risks (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Nurses with more than 20 years of service had a mean FPDR score of 3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69, whereas those with 5 years of service or less had the lowest mean score (2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58). Experienced nurses were more likely to recognize potential benefits of FPDR due to their experience and confidence. Nurses with positive perceptions and higher self-confidence were more likely to offer FPDR as an option [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSenior emergency nurses were more likely to perform resuscitation and were better equipped to identify and manage critically ill patients under complex and variable conditions. They could confidently manage resuscitation procedures, provide better services for patients and families, and improve treatment outcomes and the overall quality of emergency care.\u003c/p\u003e \u003cp\u003eHolding an emergency specialist nurse certificate was significantly associated with higher perceived benefits and risks of FPDR (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Nurses who held this certificate scored significantly higher than those who had not (3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57 vs. 2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62), consistent with the findings of Chapman et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Nurses with emergency specialist certificates had more positive attitudes toward FPDR because specialists are more professional and confident in responding to complex emergency situations, making them more likely to recognize FPDR benefits.\u003c/p\u003e \u003cp\u003eA significant positive correlation was observed between the number of times family members were invited during resuscitation and nurses\u0026rsquo; perceived benefits and risks of FPDR (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). The more frequently family members were invited, the higher nurses\u0026rsquo; scores on FPDR benefits and risks. Nurses who had invited family members more than 10 times scored the highest (3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49), whereas those who had never invited family members scored the lowest (2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68). Through practical experience and interactions with family members, nurses gradually understood FPDR benefits, indicating the influence of FPDR proficiency on nurses\u0026rsquo; attitudes.\u003c/p\u003e \u003cp\u003eWith the transformation of the medical model into a biopsychosocial approach and the promotion of holistic and family-centered nursing, care should address both patients and their family members.\u003c/p\u003e \u003cp\u003eA positive correlation existed between nurses\u0026rsquo; perceived FPDR benefits and their perceived self-confidence. However, a negative correlation was observed between perceived risks and self-confidence, and between perceived benefits and risks. This is consistent with domestic and international findings [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost hospitals require families to wait outside the rescue room during CPR [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. FPDR education for medical staff improves knowledge, attitudes, and practical abilities while reducing stress and anxiety. Most medical workers reported not receiving educational courses on resuscitation accompaniment, and no such courses exist in China. A systematic FPDR policy that provides support and guidance can improve medical staff confidence. However, most countries lack written FPDR policies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Numerous studies have urged organizations and hospitals to develop FPDR policies to guide resuscitation teams [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAllowing family members to participate in FPDR enhances satisfaction with emergency care, alleviates anxiety and fear, reduces helplessness, relieves pain, and facilitates acceptance of the patient\u0026rsquo;s death. FPDR also improves patient care, and implementing FPDR in emergency nursing would change current clinical care standards. Emergency nurses primarily care for critically ill patients, are often involved in resuscitation, and can confidently manage procedures, providing quality care for patients and families. The results suggest that FPDR education would improve nurses\u0026rsquo; knowledge, attitudes, and practical abilities and reduce stress and anxiety during FPDR.\u003c/p\u003e \u003cp\u003eEmergency nurses perceived relatively low FPDR benefits and reported low self-confidence in implementing it. Greater perceived benefits were associated with lower perceived risks and higher confidence levels. Factors such as years of emergency nursing experience, the number of times family members were invited during resuscitation, holding an emergency specialist nurse certificate, and perceived confidence in FPDR influenced nurses\u0026rsquo; perception of FPDR benefits and risks.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, convenience sampling may have created potential selection bias, allowing inclusion of nurses with strong positive or negative views. Second, the data were obtained from one province in China, and the sample size was limited. Multicenter, large-sample studies could explore differences among regions and hospitals. Third, this was a quantitative study; qualitative research would provide a deeper understanding of the topic. Qualitative interviews with medical staff, patients, and family members should be considered to explore attitudes toward FPDR among different groups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eEthics approval\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Ethics Review Committee of West China Hospital of Sichuan University (approval number: 2020 [833]). The principles of voluntary participation, confidentiality, and non-maleficence were followed. Electronic informed consent was obtained from all participants.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was supported by the National Research Foundation of Nature Sciences (grant number: 82002009).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by Tao Lin and Yanzi Zhang. The first draft of the manuscript was written by Tao Lin. All authors commented on previous versions of the manuscript. All authors read and approved the final version.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank all emergency nurses for their participation in and contribution to this study.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlbarran, J., Moule, P., Benger, J., McMahon-Parkes, K. \u0026amp; Lockyer, L. Family witnessed resuscitation: the views and preferences of recently resuscitated hospital inpatients, compared to matched controls without the experience of resuscitation survival. \u003cem\u003eResuscitation\u003c/em\u003e \u003cb\u003e80\u003c/b\u003e, 1070\u0026ndash;1073 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSegond, N., Wittig, J., Kern, W. J. \u0026amp; Orlob, S. Towards a common terminology of ventilation during cardiopulmonary resuscitation. \u003cem\u003eResuscitation\u003c/em\u003e \u003cb\u003e207\u003c/b\u003e, 110511 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeghani, S. Witnessed resuscitation: a concept analysis. \u003cem\u003eIntensive Crit. Care Nurs.\u003c/em\u003e \u003cb\u003e64\u003c/b\u003e, 103003 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker, W. \u0026amp; Gavin, C. Family presence during resuscitation: a narrative review of the practices and views of critical care nurses. \u003cem\u003eIntensive Crit. Care Nurs.\u003c/em\u003e \u003cb\u003e53\u003c/b\u003e, 15\u0026ndash;22 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez, E. M., Mart\u0026iacute;n, G. M. \u0026amp; Herrera, M. J. Family witnessed resuscitation and invasive procedures: patient and family opinions. \u003cem\u003eNurs. Ethics\u003c/em\u003e. \u003cb\u003e28\u003c/b\u003e, 645\u0026ndash;655 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFulbrook, P., Latour, J. M. \u0026amp; Albarran, J. W. Paediatric critical care nurses\u0026rsquo; attitudes and experiences of parental presence during cardiopulmonary resuscitation: a European survey. \u003cem\u003eInt. J. Nurs. Stud.\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e, 1238\u0026ndash;1249 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHassankhani, H., Zamanzadeh, V., Rahmani, A., Haririan, H. \u0026amp; Porter, J. E. Family presence during resuscitation: a double-edged sword. \u003cem\u003eJ. Nurs. Scholarsh.\u003c/em\u003e \u003cb\u003e49\u003c/b\u003e, 127\u0026ndash;134 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;zt\u0026uuml;rk, E. A. \u0026amp; Ko\u0026ccedil;, Z. Turkish validation of the family presence during resuscitation risk-benefit scale. \u003cem\u003eNurs. Crit. Care\u003c/em\u003e. \u003cb\u003e27\u003c/b\u003e, 440\u0026ndash;449 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTwibell, R., Siela, D., Riwitis, C. \u0026amp; Neal, A. Waters, N. A qualitative study of factors in nurses\u0026rsquo; and physicians\u0026rsquo; decision-making related to family presence during resuscitation. \u003cem\u003eJ. Clin. Nurs.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e, e320\u0026ndash;e334 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWillmes, M. et al. Impact of family presence during cardiopulmonary resuscitation on team performance and perceived task load: a prospective randomised simulator-based trial. \u003cem\u003eBMJ Open.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e, e056798 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFulbrook, P., Albarran, J. W. \u0026amp; Latour, J. M. A European survey of critical care nurses\u0026rsquo; attitudes and experiences of having family members present during cardiopulmonary resuscitation. \u003cem\u003eInt. J. Nurs. Stud.\u003c/em\u003e \u003cb\u003e42\u003c/b\u003e, 557\u0026ndash;568 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo, L. et al. Translation and validation of the Chinese version of Perceptions of the Self-Confidence Scale and the Benefits and Risks of Family Presence during Resuscitation. \u003cem\u003eChin. Nurs. Res.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 3826\u0026ndash;3831 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcAlvin, S. S. \u0026amp; Carew-Lyons, A. Family presence during resuscitation and invasive procedures in pediatric critical care: a systematic review. \u003cem\u003eAm. J. Crit. Care\u003c/em\u003e. \u003cb\u003e23\u003c/b\u003e, 477\u0026ndash;484 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeung, N. Y. \u0026amp; Chow, S. K. Attitudes of healthcare staff and patients\u0026rsquo; family members towards family presence during resuscitation in adult critical care units. \u003cem\u003eJ. Clin. Nurs.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 2083\u0026ndash;2093 (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOczkowski, S. J., Mazzetti, I., Cupido, C. \u0026amp; Fox-Robichud, A. E. The offering of family presence during resuscitation: a systematic review and meta-analysis. \u003cem\u003eJ. Intensive Care\u003c/em\u003e. \u003cb\u003e3\u003c/b\u003e, 41 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavidson, J. E. et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. \u003cem\u003eCrit. Care Med.\u003c/em\u003e \u003cb\u003e45\u003c/b\u003e, 103\u0026ndash;128 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLederman, Z. Family presence during cardiopulmonary resuscitation. \u003cem\u003eJ. Clin. Ethics\u003c/em\u003e. \u003cb\u003e30\u003c/b\u003e, 347\u0026ndash;355 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi, R. \u0026amp; Xi, S. Overview of the development stage of emergency nurse training in Shanghai. \u003cem\u003eChin. J. Nurs. Educ.\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e, 668\u0026ndash;671 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan, X. \u0026amp; Fan, Y. Emergency nurses\u0026rsquo; attitudes towards family presence during cardiopulmonary resuscitation. \u003cem\u003ePLA Nurs. J.\u003c/em\u003e \u003cb\u003e31\u003c/b\u003e, 1\u0026ndash;4 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiles, T., de Lacey, S. \u0026amp; Muir-Cochrane, E. How do clinicians practice the principles of beneficence when deciding to allow or deny family presence during resuscitation? \u003cem\u003eJ. Clin. Nurs.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e, e1214\u0026ndash;e1224 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcMahon-Parkes, K., Moule, P., Benger, J. \u0026amp; Albarran, J. W. The views and preferences of resuscitated and non-resuscitated patients towards family witnessed resuscitation: a qualitative study. \u003cem\u003eInt. J. Nurs. Stud.\u003c/em\u003e \u003cb\u003e46\u003c/b\u003e, 12\u0026ndash;21 (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoreland, P. Family presence during invasive procedures and resuscitation in the emergency department: a review of the literature. \u003cem\u003eJ. Emerg. Nurs.\u003c/em\u003e \u003cb\u003e31\u003c/b\u003e, 58\u0026ndash;72 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToronto, C. E. \u0026amp; LaRocco, S. A. Family perception of and experience with family presence during cardiopulmonary resuscitation: an integrative review. \u003cem\u003eJ. Clin. Nurs.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e, 32\u0026ndash;46 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai, M. K., Aritejo, B. A., Tang, J. S., Chen, C. L. \u0026amp; Chuang, C. C. Predicting medical professionals\u0026rsquo; intention to allow family presence during resuscitation: a cross-sectional survey. \u003cem\u003eInt. J. Nurs. Stud.\u003c/em\u003e \u003cb\u003e70\u003c/b\u003e, 11\u0026ndash;16 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMemon, M. A. Sample size for survey research: review and recommendations. \u003cem\u003eJ. Appl. Struct. Equat Model.\u003c/em\u003e \u003cb\u003e4\u003c/b\u003e, i\u0026ndash;xx (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin, T., Gao, Y. \u0026amp; Feng, X. Relationship between information literacy and innovative behavior of emergency specialist nurses: a cross-sectional study in southwest China. \u003cem\u003eInt. Emerg. Nurs.\u003c/em\u003e \u003cb\u003e71\u003c/b\u003e, 101356 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTwibell, R. S. et al. Nurses\u0026rsquo; perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. \u003cem\u003eAm. J. Crit. Care\u003c/em\u003e. \u003cb\u003e17\u003c/b\u003e, 101\u0026ndash;111 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBray, I., Kenny, G., Pontin, D., Williams, R. \u0026amp; Albarran, J. Family presence during resuscitation: validation of the risk\u0026ndash;benefit and self-confidence scales for student nurses. \u003cem\u003eJ. Res. Nurs.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 306\u0026ndash;322 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChapman, R., Watkins, R., Bushby, A. \u0026amp; Combs, S. Assessing health professionals\u0026rsquo; perceptions of family presence during resuscitation: a replication study. \u003cem\u003eInt. Emerg. Nurs.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 17\u0026ndash;25 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowers, K. \u0026amp; Reeve, C. L. Factors associated with nurses\u0026rsquo; perceptions, self-confidence, and invitations of family presence during resuscitation in the intensive care unit: a cross-sectional survey. \u003cem\u003eInt. J. Nurs. Stud.\u003c/em\u003e \u003cb\u003e87\u003c/b\u003e, 103\u0026ndash;112 (2018).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cross-sectional study, emergency nursing, resuscitation, family presence during resuscitation, China","lastPublishedDoi":"10.21203/rs.3.rs-8039224/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8039224/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSeveral medical institutions and associations in developed countries support family presence during resuscitation (FPDR); however, in China, FPDR has not been implemented, clear policies do not exist, and few studies have examined it. Therefore, this study investigates emergency nurses\u0026rsquo; FPDR perceptions and their influencing factors. A total of 315 emergency nurses from Sichuan Province, China, completed a general questionnaire and the Chinese versions of the Family Presence Risk\u0026ndash;Benefit and Family Presence Self-Confidence Scales. A t-test and chi-squared test were conducted for intergroup comparisons, and an analysis of variance assessed multiple classification data. Multiple linear regression analysis explored factors associated with the benefits and risks of FPDR. Of the 382 questionnaires distributed, 315 valid responses were collected (valid response rate\u0026thinsp;=\u0026thinsp;82.46%). Years of working in emergency nursing, holding an emergency specialist nurse certificate, and the number of times family members were invited during resuscitation were associated with perceived benefits and risks of FPDR (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). Perceived benefits were negatively correlated with perceived risks and positively correlated with perceived resuscitation confidence (r\u0026thinsp;=\u0026thinsp;.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). To promote the implementation of FPDR, nursing managers should develop implementation guidelines, reshape perceptions among medical staff, and respect family members\u0026rsquo; needs.\u003c/p\u003e","manuscriptTitle":"Exploring emergency nurses’ attitudes toward family presence during resuscitation: A cross-sectional study in Southwest China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 09:57:35","doi":"10.21203/rs.3.rs-8039224/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-26T04:52:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-25T16:14:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197236902302063228637516465340936186800","date":"2026-03-25T06:07:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270010461151613109156449004716036061458","date":"2026-02-28T07:02:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T00:31:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35648903152054601239377529699518200406","date":"2026-02-10T00:03:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136468978711901577936362545531403080459","date":"2026-02-07T20:11:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T12:16:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-28T12:15:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-20T10:25:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-16T04:15:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-11-16T04:12:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb6ba63c-3af0-4d46-8823-a89b26a523e5","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":61900023,"name":"Health sciences/Diseases"},{"id":61900024,"name":"Health sciences/Health care"},{"id":61900025,"name":"Health sciences/Health occupations"},{"id":61900026,"name":"Health sciences/Medical research"},{"id":61900027,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-04-20T16:03:20+00:00","versionOfRecord":{"articleIdentity":"rs-8039224","link":"https://doi.org/10.1038/s41598-026-48992-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-04-17 15:57:11","publishedOnDateReadable":"April 17th, 2026"},"versionCreatedAt":"2026-01-30 09:57:35","video":"","vorDoi":"10.1038/s41598-026-48992-4","vorDoiUrl":"https://doi.org/10.1038/s41598-026-48992-4","workflowStages":[]},"version":"v1","identity":"rs-8039224","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8039224","identity":"rs-8039224","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}