Abstract
Parental presence during pediatric resuscitation presents a complex challenge, often provoking mixed reactions from healthcare providers and families. This qualitative study explored how decisions about parental presence emerge from the experiences and perceptions of resuscitation teams and parents. An exploratory descriptive design was used across three pediatric hospitals. Data collection involved semi-structured interviews with 33 resuscitation team members and 20 parents who witnessed their child’s resuscitation. Thematic analysis identified patterns for participant accounts. Participants shared their experiences and perceptions regarding decision-making about parental presence during pediatric resuscitation. Two main themes emerged: (1) Double-edged sword of parental presence (reluctance to allow parental presence; permission for parental presence) and (2) emotional weight of parents’ decision to be present (decision to be present; indecision regarding presence). Findings highlight that parental presence involves balancing team readiness, environmental factors, and parental emotional state. Institutional policies should support offering presence as an option, reinforced by staff training and structured pre-briefing and debriefing to promote shared decision-making and strengthen family-centered care.
Introduction
Pediatric in-hospital cardiac arrest is relatively rare, occurring at an annual rate of 28.3 to 54.6 per 100,000 hospitalizations, with survival rates ranging from 12.8% to 47%, depending on clinical setting (Shimoda-Sakano et al., 2020). For infants under 1 year, prehospital cardiac arrest incidence is significantly higher, ranging from 65.5 to 72 per 100,000 annually, with hospital discharge survival between 1.1% and 20%. These critical events challenge resuscitation teams and profoundly impact families (Stewart, 2019).
Family-centered care (FCC) is increasingly recognized as a core principle in pediatric hospitals since the creation of the International Pediatric and Family-Centered Care (IPFCC) in 1996. Since then, FCC frameworks have been adopted by children’s hospitals worldwide, emphasizing dignity, collaboration, information sharing, and family involvement in care decisions (https://www.ipfcc.org). This includes offering parents the option to be present during their child’s resuscitation, a practice supported by the American Heart Association, which recommends family presence when feasible (Topjian et al., 2020). Evidence indicates that maintaining involvement and connection supports parental psychological resilience (McCann, 2021). Parental presence can reduce anxiety, shorten grieving periods, support emotional adjustment, help families accept loss, and even decrease forensic complaints (De Stefano et al., 2016; Dwyer, 2015; Lang, 2015). These benefits align with broader principles of FCC, which emphasize the importance of maintaining parent–child relationships during hospitalization to promote both psychological and physiological well-being (Power et al., 2021). The benefits of parental presence may differ by outcome. For bereaved parents, presence can support grief processing and reduce regret. For parents of children who survive, presence may foster trust, shared decision-making, and family engagement in recovery (Parra et al., 2018; Stewart, 2019).
Despite these advantages, implementation remains inconsistent. A systematic review by Dainty et al. (2021) found that provider attitudes toward family presence during resuscitation were divided. Many nurses and physicians express concerns about emotional distress, procedural disruption, and legal liability, often discouraging parental presence (Dwyer, 2015; Giles et al., 2016). In acute pediatric settings, nurses report feeling torn between clinical duties and supporting distressed parents, a conflict that contributes to ambivalence about family inclusion during high-acuity events (Ridgway et al., 2021). Mark (2021) further identified a lack of multidisciplinary guidelines and institutional policies to support this practice.
In many settings, family presence during resuscitation is accepted as standard FCC practice (Dainty et al., 2021; O’Connell et al., 2017; Toomey et al., 2017). Despite growing support for family presence during pediatric resuscitation, there remains a limited understanding of how decisions about parental presence are made in practice, particularly across diverse stakeholder perspectives. Existing studies often focus on provider attitudes or parental preferences in isolation, with little attention to the dynamic interplay between team readiness, institutional context, and family experiences. This gap limits the development of effective policies and shared decision-making frameworks in real-world clinical settings.
Aim
The aim was to explore how decisions about parental presence during pediatric resuscitation are made, drawing on the lived experiences and perceptions of both parents and members of resuscitation teams.
Research questions
1. How do members of pediatric resuscitation teams make decisions about allowing parental presence during resuscitation? 2. How do parents experience and perceive their role in decision-making about being present during their child’s resuscitation?
Methods
This study is grounded in constructivist methodology, which recognizes that meaning is co-constructed through interaction between researcher and participant. We used an exploratory descriptive design to capture lived experiences and decision-making processes, aligning with the need for practical insights in clinical settings (Sandelowski, 2010).
Study design
This qualitative study used an exploratory descriptive design to examine decision-making processes regarding parental presence during pediatric resuscitation. Data were collected through semi-structured interviews with parents and healthcare providers. The research followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to ensure transparent, rigorous reporting (Buus and Perron, 2020) (see Supplemental File 1).
Study setting and population
Data were collected across three pediatric hospitals representing diverse clinical environments. Hospitals varied in size, with bed capacities ranging from 164 to 700. One hospital was located in an urban center and served a socioeconomically diverse population, including many families with public or no insurance. Another was a regional referral center for critically ill children, while the third specialized in pediatric oncology, caring for children with cancer and their families over extended treatment periods.
Resuscitation typically occurred in individual rooms within the emergency department (ED), while shared spaces with curtains were used in the intensive care unit (ICU) or general wards. No formal institutional policies governed parental presence during resuscitation in these settings. In most cases, the resuscitation team leader (usually a physician or experienced nurse) first determined whether parental presence was feasible based on situational factors. When permitted, parents then decided for themselves whether to enter, stay, or step away during the event.
The study population included two groups: members of resuscitation teams (only physicians and nurses were actively involved in resuscitation in this setting; therefore, they were the only healthcare providers included as members of the resuscitation team) and parents who presented in the hospital during their child’s resuscitation and were involved in the decision to enter the room, whether invited, excluded, or declining. This ensured direct experience of the decision-making process, capturing diverse perspectives on access, communication, and emotional factors, rather than only those physically present.
Inclusion criteria
Inclusion criteria for parents were having experienced at least one resuscitation event involving their child, being able to provide informed consent, and expressing willingness to participate in an interview. Parents were excluded if they exhibited severe psychological distress that could be exacerbated by participation. Healthcare providers were eligible for inclusion if they had an active role in resuscitation procedures in the emergency department or intensive care unit, possessed at least 2 years of clinical experience in acute pediatric care, and were willing to participate and provide informed consent.
Potential participants were identified through purposive sampling in collaboration with hospital coordinators. For healthcare providers, clinical supervisors or department heads provided a list of eligible staff based on role and experience. The first author then contacted eligible providers via email or in person during non-clinical hours, providing an information sheet and inviting them to participate. Participation was voluntary, and no professional consequences were associated with refusal.
For parents, the treating team (with participant consent) informed the research coordinator when parents had experienced their child’s resuscitation. With the family’s preliminary verbal agreement, the coordinator reviewed medical records to confirm eligibility and, if appropriate, shared contact details with the first author. Parents were then contacted by phone or message (SMS), using a dedicated research mobile number. An information sheet was sent in person, and verbal and written consent was obtained prior to the interview. To minimize distress, parents could choose the location, timing, and presence of a support person during the interview. A clinical psychologist was available to support families during any stage of the process if emotional distress arose.
All participants provided written informed consent prior to their interview. They were informed of their right to withdraw from the study at any time, without any impact on their clinical care or professional standing. This information was included in the participant information sheet and verbally reiterated before each interview.
Data collection
Semi-structured, face-to-face interviews were conducted individually by the first author. Before each interview, participants received information about the study’s purpose and provided written consent for audio recording. Healthcare professional interviews were conducted on-site at hospitals; parent interviews took place at locations of their choice, often at home or in quiet public spaces, to ensure comfort and confidentiality. The time of the interview was more than 3 months after the resuscitation crisis to allow for parents’ psychological symptoms to lessen (Curtis et al., 2016). To support emotional well-being, a psychologist attended interviews when requested by parents. A family member or friend could also accompany them if desired.
The interview guide was developed using a five-step framework by Kallio et al. (2016), including identifying initial questions; reviewing existing literature; drafting a preliminary guide; pilot testing after early interviews; and refining the final version. The complete interview guide, including distinct but thematically aligned questions for parents and healthcare providers, is available in Supplemental File 2.
Data analysis
Thematic analysis was conducted using the method described by Thomas and Harden (2008), involving line-by-line coding of transcripts; development of descriptive themes; and generation of analytical themes. To preserve the distinct experiential perspectives of parents and resuscitation team members, transcripts were first analyzed separately by participant group. Subsequently, the research team integrated the two datasets during the analytical phase.
All interviews were audio-recorded and transcribed verbatim by the first author through repeated listening. Transcription included non-verbal cues such as pauses, laughter, and emotional expressions to preserve the richness of participants’ accounts. Two authors independently read each transcript multiple times and coded lines according to meaning and content. Codes were grouped into a hierarchical structure based on similarities and differences. New parent codes were created to capture broader meanings of initial codes, forming descriptive themes. Through collaborative discussion, higher-level analytical themes emerged that synthesized and interpreted the descriptive themes.
Coding was conducted iteratively: after every five interviews, the research team met to review emerging codes, resolve discrepancies, and refine the codebook. This process ensured consistency and transparency in theme development. Analysis was supported by MAXQDA 24 (VERBI Software GmbH, Berlin, Germany), which was used to organize codes, retrieve text segments, and visualize relationships within the hierarchical coding structure.
Illustrative participant quotes were included to enrich thematic descriptions. To protect participant confidentiality, all identifying information was removed from transcripts. Culturally appropriate pseudonyms (e.g., “Zahra,” “Ali,” “Leila,” and “Reza”) were assigned to participants based on common names in the local context. Each pseudonym is paired with a role descriptor (e.g., “Nurse” and “Mother”) and presented after the relevant verbatim quote in the Results section (see Supplemental File 3 for a detailed description of the analysis process).
Trustworthiness and rigor
Credibility was supported by dual coding, consensus meetings, and an audit trail (coding notes, meeting minutes, codebooks). To enhance the clinical relevance of the findings, we conducted an external expert review with four healthcare professionals, three nurses, and one physician, who were not participants in the study and had no prior involvement in data collection or analysis. They reviewed a summary of the findings and thematic interpretations to assess whether the results resonated with their clinical experience and provided feedback on clarity, plausibility, and relevance. However, it was not conducted with parents due to ethical concerns about re-traumatization; their voices were preserved through verbatim quotes and thick description.
Dependability was ensured via Thomas and Harden (2008) framework, iterative analysis, peer debriefing, and MAXQDA 24 for traceable coding. Reflexivity was maintained through researcher journals.
Demographic characteristics of resuscitation teams (N= 33).
Demographic characteristics of parents (N= 20).
Demographic characteristics of resuscitated children (N= 16).
Findings
Participant characteristics
Data collection spanned approximately 8 months, with individual interviews lasting 40–90 min. Theoretical saturation (Saunders et al., 2018) was achieved when no new themes emerged during analysis, confirmed through iterative coding and team discussion. This point coincided with the final four provider interviews and last three parent interviews. No new thematic insights were identified. A total of 53 interviews were conducted with 33 resuscitation team members and 20 parents (including four couples), after which recruitment ceased.
Resuscitation team members included nurses and physicians from emergency departments and intensive care units across three pediatric hospitals. All had participated in at least 10 pediatric resuscitations and had clinical experience ranging from 2 to 24 years (Table 1).
Of 178 eligible parents contacted via phone or secure messaging (SMS), 20 agreed to participate (response rate: 11.2%). Reasons for non-participation included emotional distress and time constraints. Parent participants were primarily mothers (n = 11), with nine fathers also taking part. Parent ages ranged from 17 to 48 years, and all had experienced their child’s resuscitation (Table 2). Resuscitated children were aged 1 month to 16 years, with conditions spanning acute emergencies, chronic illnesses, and congenital disorders (Table 3).
Findings of thematic analysis
There were two central themes shaping decision-making about parental presence during pediatric resuscitation: (1) Double-edged sword of parental presence (reluctance to allow parental presence; permission for parental presence) and (2) emotional weight of parents’ decision to be present (decision to be present; indecision regarding presence) (Figure 1). Quotes from participants were mentioned to enrich the understanding of themes and subthemes. Main themes and subthemes.
Double-edged sword of parental presence
Healthcare providers described parental presence as a deeply ambivalent experience, potentially beneficial for FCC but fraught with clinical and emotional risks. This duality emerged across interviews, framing presence not as a simple policy choice but as a tension-laden decision shaped by team dynamics, personal experience, and situational context.
Reluctance to allow parental presence
Many resuscitation team members expressed strong reservations about allowing parents into the resuscitation space, particularly those with limited clinical experience. Their concerns centered on performance pressure, procedural disruption, and fear of misinterpretation.
Providers repeatedly highlighted how the watchful eyes of parents amplified their stress levels and, in some cases, impaired their technical performance. As one nurse recounted, parental presence could escalate anxiety to the point of physical symptoms: “Parents or family members often hinder us during resuscitation and significantly increase our stress. There have been times when I performed procedures perfectly when no parents were around, but as soon as I felt their eyes on me, my hands started shaking, and I had to ask a more experienced colleague to take over” (Sadeghi, nurse).
This sense of vulnerability was not limited to inexperienced staff. Even seasoned clinicians supported exclusion in certain contexts, noting that structural constraints, such as insufficient staffing or malfunctioning equipment, could magnify the risks of misinterpretation. A physician emphasized how technical issues could be misunderstood as incompetence: “There are situations where equipment malfunctions — for instance, during intubation, the laryngoscope light wouldn't turn on. These kinds of incidents can easily lead to complaints from parents” (Karimi, doctor).
Beyond technical challenges, staffing shortages were also perceived as barriers to safely accommodating parents. As one nurse explained: “We don’t have enough experienced staff across all shifts to safely accommodate parents during resuscitation” (Neshat, nurse).
In addition to systemic concerns, participants described moments when parents actively interfered with resuscitation efforts. Such disruptions, whether through shouting, questioning, or physically intervening, were perceived as potentially compromising patient safety. For example, one nurse recalled: “We’ve had cases where parents interfered directly with resuscitation efforts. They would shout things like, ‘What are you doing? I don’t want you to do this to my child!’ Such interruptions cost us valuable time during critical moments” (Ramezani, nurse).
A doctor echoed this sentiment, describing how heightened parental emotions could derail the focus of the team: “Parents often cry loudly, become aggressive, or say things that create tension and prevent the team from focusing on their tasks” (Darabi, doctor).
Finally, participants expressed concerns about the psychological toll on parents themselves. Witnessing invasive procedures without adequate medical knowledge was feared to leave long-lasting emotional scars. As one physician noted: “Resuscitation is inherently invasive, and witnessing it can leave a permanent emotional impact on parents” (Nakhaii, doctor).
Another provider described how routine interventions, such as chest compressions, were sometimes misinterpreted as harmful: “We were compressing her chest, but they couldn’t grasp the rationale behind it. They thought we were hurting their child” (Bakhshi, doctor).
Together, these narratives underscore a prevailing hesitation among providers, who viewed parental presence as a source of professional strain, operational disruption, and emotional risk.
Permission for parental presence
Despite these widespread reservations, parental presence was not categorically rejected. Providers described instances where they made case-by-case decisions, shaped by parental understanding, emotional composure, and ethical considerations.
In situations where parents demonstrated prior familiarity with their child’s condition, providers felt more confident permitting their presence. For example, a nurse reflected on a long-term patient’s parents, whose ongoing involvement appeared to emotionally prepare them for the resuscitation event: “There was a child who had been hospitalized for a long time. His parents had witnessed his condition throughout the course of treatment. I think this helped prepare them emotionally for being present during the resuscitation” (Kiani, nurse).
Similarly, parents’ emotional stability was a decisive factor. A nurse described how a calm and insistent mother was eventually allowed to remain nearby: “When the child’s condition worsened, I initially asked the mother to stay outside, but she remained calm and insisted on staying nearby. Eventually, I allowed her to stand quietly in the corner, her patience and self-control made it easier for me to agree” (Mosavi, nurse).
To balance transparency with safety, some providers employed modified strategies, such as allowing parents to observe from a distance. One nurse explained: “We try to let parents observe the resuscitation from a distance so they can see what we are doing, without being directly involved” (Moradi, nurse).
Finally, in cases where survival was unlikely, parental presence was often framed as ethically necessary. Several providers described inviting parents into the room so they could witness the team’s full efforts and find closure. As one physician shared: “When I sense that the child is not going to respond to resuscitation, I believe it is better for the parents to be present. This way, they can see with their own eyes that we are doing everything possible to save their child’s life” (Ghafari, doctor).
These accounts illustrate that while reluctance dominated providers’ perspectives, parental presence was not wholly dismissed. Instead, it was permitted under specific, carefully managed conditions, highlighting the nuanced and context-dependent nature of these decisions.
Emotional weight of parents’ decision to be present
While most parents expressed a strong desire to be present, their narratives revealed that the decision carried profound emotional weight. It was rarely simple or straightforward. Instead, it was shaped by protective instincts, fear, love, guilt, and enduring reflection. Parents did not speak with detachment; rather, they vividly recalled the intensity of these moments, sometimes with gratitude for having been present and other times with regret or psychological burden. Their stories demonstrate that the decision to be present, or not, remained an enduring part of how they made sense of their child’s resuscitation.
Decision to be present
For many parents, presence was seen as inseparable from their role as protectors and caregivers. Being in the room allowed them to witness what was happening, ensure that everything possible was being done, and provide comfort to their child. By contrast, exclusion was experienced as helplessness, suspicion, or abandonment.
One couple expressed that being kept outside created mistrust and a sense of neglect: “We wanted to be with our child, or at least see what was happening. We felt like they weren’t doing anything for him. It didn’t seem to matter to them whether he lived or died” (Ali, father; Zahra, mother).
Others described presence as a moral duty, a way of affirming their responsibility as parents: “It is my duty to be with my child. I needed to see for myself that they did everything they could, even if it didn’t work” (Leila, mother).
Parents also shared how exclusion heightened their anxiety, leading them to find ways to glimpse inside, desperate for information: “We needed to know what was happening with our child. Sometimes we would look through the door and see many doctors and nurses around the bed. Not being allowed in made us extremely anxious” (Reza, father).
For some, presence carried the deep comfort of knowing their child was not alone. Holding a hand or simply being present was seen as an act of love and reassurance: “His hand was in mine, he wasn’t afraid, and he seemed able to endure what was happening” (Elham, mother).
In other cases, presence was framed as a final opportunity to say goodbye, a memory that parents held onto with gratitude despite the pain of loss: “I realized he was slipping away, and I’m grateful I was there, so I could say goodbye to my child in that last moment” (Mohammad, father). “I’m glad I was with her in those final moments” (Bahar, mother).
These accounts highlight that for many parents, presence was not just a choice but a deeply meaningful act of protection, love, and closure.
Indecision regarding presence
Although most parents strongly desired to be present, some parents described ongoing struggles with their decision. For a few, the burden of witnessing resuscitation left them with painful, intrusive memories. Others who chose not to be present later questioned whether they had missed an important moment. These reflections reveal not indifference but the enduring psychological costs of both presence and absence.
For those who stayed, the memory of resuscitation could become a source of distress long after the event. One mother explained how the scene haunted her repeatedly: “The image of my child being resuscitated constantly replays in my mind, like a painful recording. I can’t get rid of this disturbing scene. I often find myself wishing I had never seen it” (Fahimeh, mother).
Others who chose not to be present later questioned their decision, torn between self-protection and parental responsibility. One mother described this inner conflict: “At the time, I chose not to be there because watching such a scene would have been too painful for me. But now, I’m not sure if I made the right choice… Maybe it’s better if they are not present during their child’s resuscitation” (Fatemeh, mother).
These reflections highlight that the decision, whether to stay or step away, was never neutral. It carried lasting emotional consequences, shaping parents’ memories and sense-making long after the resuscitation ended, and underscoring the need for individualized, informed decision-making.
Discussion
This study was to explore how decisions about parental presence during pediatric resuscitation are made, based on the experiences and perceptions of both parents and resuscitation team members. The findings reveal a complex interplay of emotional, clinical, and contextual factors that shape these decisions, directly addressing the study aim. Two overarching themes emerged: Double-edged sword of parental presence and emotional weight of parents’ decision to be present. These findings reveal a significant divergence between healthcare providers’ concerns and parents’ desires for involvement, reflecting broader challenges in implementing FCC within high-stress clinical environments.
The theme “Double-edged sword of parental presence” resonates with global findings on provider ambivalence toward family presence during resuscitation (Dainty et al., 2021; Mark, 2021). Most healthcare professionals expressed reluctance toward allowing parental presence, citing procedural disruption, emotional distress, and potential legal implications, particularly among less experienced staff. However, our study extends this understanding by revealing how this duality is not merely a personal hesitation but is deeply shaped by structural factors, such as staffing levels and physical space, which constrain even supportive providers from allowing presence. These barriers align with global evidence highlighting provider anxiety, lack of institutional policies, and insufficient training as key obstacles to implementation (Mark, 2021; Slater, 2019). Our findings are also consistent with Ridgway et al. (2021), who identified FCC as both a value and a stressor for nurses. They suggest that without institutional support, individual willingness is insufficient, and highlight the need for system-level change over attitude-focused interventions.
A frequently cited reason for excluding parents was increased stress and performance pressure under observation. Less experienced team members described feeling self-conscious or hesitant, sometimes deferring actions to senior colleagues. More experienced providers emphasized structural limitations, including lack of trained personnel and inadequate space, as primary barriers to safely accommodating families. These findings suggest that while individual attitudes matter, organizational readiness plays an equally critical role. As Cho et al. (2025) noted, reducing job stress, enhancing coping abilities, and strengthening psychological resources for pediatric nurses can foster more effective, compassionate collaboration with parents during critical events. Our results also align with studies identifying team experience as a prerequisite for parental presence (Slater, 2019; Yoxall et al., 2015) and support Lindsay et al.’s (2024) recommendation for formal education and simulation training on family presence.
Concerns about parental interference were evident. Some participants described emotionally overwhelmed parents shouting or attempting to interrupt procedures, resulting in care delays. These observations echo Mark’s (2021) findings and reinforce calls for structured family support during resuscitation, including assigning a dedicated support person (Dainty et al., 2021). Thus, decisions about parental presence must consider team readiness, environmental suitability, and parental emotional state. Establishing human and structural support systems can significantly facilitate shared decision-making and improve experiences for all involved.
Parents’ emotional burden aligns with research on decision-making under extreme stress, where protective instincts conflict with fear of psychological harm (Palamarchuk and Vaillancourt, 2021). Our findings challenge the notion of uniformly positive outcomes, showing that valued presence can later evoke regret or trauma. This aligns with Mark’s (2021) argument that offering presence as an option must be accompanied by pre-briefing and emotional preparation.
Most parents, conversely, expressed a strong desire to be present during their child’s resuscitation, aligning with prior studies (Dainty et al., 2021; Tíscar-González et al., 2021). Presence was viewed as fulfilling a protective role, ensuring care transparency, and offering emotional support, values echoed across Western and non-Western contexts (Ghavi et al., 2022; O’Connell et al., 2017). Most parents valued being present, reporting that it helped them cope emotionally and ensured they witnessed every effort to save their child. Some described physical contact as comforting during trauma, a finding supported by evidence linking parental presence to reduced post-event guilt and greater acceptance of outcomes (De Stefano et al., 2016; Lang, 2015). Parents’ view of presence as “being there until the end” aligns with research on resilience in chronic illness (McCann, 2021). Active participation, even in unsuccessful resuscitations, may serve as a protective factor, supporting emotional adjustment and reducing regret.
While American Heart Association guidelines increasingly support family presence during resuscitation (Brumberg et al., 2024; Topjian et al., 2020), our findings highlight significant gaps in implementation, particularly in settings lacking formal policies, a challenge also documented in other low- and middle-income countries (Vardanjani et al., 2021). Our findings indicate that cultural norms and institutional practices shape guideline implementation. Without formal policies, decisions rely on individual discretion, risking inconsistency and inequity. Global recommendations must be locally adapted, considering resources, team readiness, and cultural views of family roles.
Strengths and limitations
This study’s strength lies in its inclusion of both parental and resuscitation team perspectives, providing a comprehensive understanding of decision-making dynamics. The qualitative approach enabled deep exploration of lived experiences, yielding valuable insights into the emotional and contextual factors shaping parental presence during pediatric resuscitation.
Several limitations should be acknowledged. All qualitative research findings are context-specific and might not be generalized broadly. Selection bias may be present, as individuals with strong views could have been more likely to participate. Parents who were not present during resuscitation were excluded due to distance, late arrival, or other barriers; their experiences of exclusion or regret may differ. The study did not assess post-resuscitation debriefing or psychosocial support, as these were not systematically provided, highlighting a gap for future research. Additionally, cultural and institutional variations may limit transferability across settings. Finally, no parents with lived experience of pediatric resuscitation were involved in the study’s design, and future work should prioritize meaningful family partnership from the earliest stages of research conception.
Implications for practice and policy
These findings reinforce core FCC principles (dignity, partnership, and emotional support) and highlight the need to operationalize them during high-stress events like resuscitation. To bridge evidence and practice, institutions should establish clear policies on parental presence. Staff education and simulation training can reduce anxiety and build confidence. Assigning a dedicated support person, offering pre-resuscitation counseling, and providing post-event emotional support improve family and team outcomes. Future research should develop culturally adapted tools, such as briefing templates and debriefing protocols, to support shared decision-making and meaningful implementation of guidelines in diverse clinical settings.
Conclusion
This study highlights the complex and often conflicting dynamics that shape decisions about parental presence during pediatric resuscitation. Parents overwhelmingly see presence as a moral imperative to protect, witness, and say goodbye, while many healthcare providers view it as a source of stress or risk. These perspectives stem not from personal bias but from structural constraints, emotional burdens, and the lack of supportive policies.
Offering presence is not a binary choice but a nuanced practice requiring preparation, support, and shared understanding. Aligning with FCC principles, institutions must replace ad hoc decisions with systematic approaches that respect both parental rights and team readiness, through culturally appropriate frameworks that enable shared decision-making.
Bridging the evidence–practice gap demands more than guidelines: it requires cultural change, targeted training, and human-centered systems that support compassionate, collaborative care in critical moments. By integrating family and provider experiences, this study advances a more balanced, ethical model of pediatric resuscitation.
Supplemental material
Supplemental Material - Decision-making for parental presence in pediatric resuscitation: A qualitative study of parents’ and resuscitation team members’ experiences and perceptions
Supplemental Material for Decision-making for parental presence in pediatric resuscitation: A qualitative study of parents’ and resuscitation team members’ experiences and perceptions by Arezoo Ghavi, Hadi Hassankhani, and Fenella J Gill in Journal of Child Health Care.
Supplemental material
Supplemental Material - Decision-making for parental presence in pediatric resuscitation: A qualitative study of parents’ and resuscitation team members’ experiences and perceptions
Supplemental Material for Decision-making for parental presence in pediatric resuscitation: A qualitative study of parents’ and resuscitation team members’ experiences and perceptions by Arezoo Ghavi, Hadi Hassankhani, and Fenella J Gill in Journal of Child Health Care.
Supplemental material
Supplemental Material - Decision-making for parental presence in pediatric resuscitation: A qualitative study of parents’ and resuscitation team members’ experiences and perceptions
Supplemental Material for Decision-making for parental presence in pediatric resuscitation: A qualitative study of parents’ and resuscitation team members’ experiences and perceptions by Arezoo Ghavi, Hadi Hassankhani, and Fenella J Gill in Journal of Child Health Care.
Footnotes
Acknowledgments
The authors would like to appreciate the resuscitation teams who worked in the pediatric hospitals and volunteered their time to participate in the study. We would also like to thank the parents who had experience with their child’s resuscitation and shared their perceptions and experiences by participating in the study.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical considerations
The study received ethical approval from the Institutional Review Board of Islamic Azad University under reference number IR.AZMED.REC.1402.1081.
Consent to participate
All participants were fully informed about the study’s purpose, and written consent was obtained before interviews began. Personal identifiers were removed from all data to ensure anonymity and confidentiality.
Data Availability Statement
Data will be made available upon request.
Supplemental material
Supplemental material for this article is available online.
References
Supplementary Material
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