Presence Family During Acute Resuscitation
Question:
Discuss About The Presence Family During Acute Resuscitation.
Answer:
Introduction
The presence of family members during the acute resuscitation of one of their family members has been a major subject of contention in nursing and other related fields of medicine. Due to an increasing need for Evidence-based practice (EBP), many researchers have considered these subject and came up with various findings and recommendations (Boehm 2008). However, these researchers did their work in different places and came up with varying levels of evidence. This paper considers research papers of various levels of evidence conducted in the last 10 years in America. The main research articles that this paper considers are experimental, for example, randomized control trials and surveys. The paper also considers meta-analyses and systemic reviews provided such papers were authored in America and provide a review of experimental papers. The paper uses these papers to set an argument for and against family presence during resuscitation (FPDR).
PICO question:
Does the presence of family members during the acute resuscitation of patients in the emergency department enhance the outcomes of the resuscitation process both for the patient and their family?
P – Patients needing acute resuscitation in the acute department.
I – Presence of family members during acute resuscitation
C – None
O – Outcomes of the resuscitation process for both the patient and their family
Family Presence during Resuscitation
Research conducted by healthcare professionals suggest that FPDR and invasive procedures carried out in health care rooms help family members to understand the seriousness of the life threatening events, support grieving, give the family a chance to see the effort put by the care team, facilitates communication and help reduce litigation risk (Tinsley et al. 2008).
Many of the research papers show that even though many healthcare workers would frown at it, the presence of family members during acute resuscitation of one of them is not so bad and is something that policymakers should even encourage. First, many authors found that the presence of family members during the acute resuscitation helped them to accept the realities of death more easily (De Stefano et al. 2016). Further, by seeing the doctors try their best, it would be easier for them to accept the grief as they could see their family members die despite the extraordinary measures and efforts taken by the medical team.
Further, the presence of family members during the resuscitation process helped them to grieve in a better way. Grief is usually a difficult time. Many family members often become depressed or suffer from post-traumatic stress disorder (PTSD) after the death of a loved one, especially when the death occurred in extremely traumatizing circumstances (Tinsley et al. 2008). Research evidence suggests that the rates of depression and PTSD are much lower in family members who witnessed the resuscitation process than those who did not (Oczkowski et al. 2015). Therefore, for its benefits to the family members, it is worth to have family members witnessing the process of acute resuscitation.
Moreover, PFDR is advantageous to the clinician too. Most family members often file malpractice of negligence suits against physicians or nurses after the demise of their loved ones. However, having the family witness the process of resuscitation will help them to appreciate the efforts, professionalism, and sacrifice that the medical team have to put in to save their loved ones and hence limit the possibility of them filing suits against the medical team (Jabre et al. 2013). Further, FPDR does not interfere with medical activity (Jabre et al. 2013). Considering its advantage even to the medical team, it is worth to allow the family to witness resuscitation.
On the lower side, however, FPDR can be disastrous to the family, the patient, and the medical team. First, since the main focus of resuscitation is the patient, anything in the resuscitation room or any decisions that the healthcare team make should be beneficial to the patient. The decision to allow family members to witness acute resuscitation does not benefit the patient and should, thus, be prohibited (Brasel, Entwistle & Sade 2016).
Further, since the family members do not have medical training, they may lack the mental toughness to witness some of the largely traumatizing procedures that the healthcare team has to perform on the patient. Even though research may prove contrary, some of the procedures such as cardiopulmonary resuscitation and emergency thoracotomy are extremely traumatizing and can cause numerous long-term effects in witnesses who do not have the necessary mental toughness to witness them (McClement, Fallis & Pereira. 2009). The witnesses can also develop a negative attitude towards the procedure and end up signing legal documents like advanced directives, which decree that the individuals will not undergo extreme measures. Such can be dangerous in the long-term as such individuals will lose lives where resuscitation could have saved them.
On the healthcare staff, having FPDR can be disadvantageous to them. First, the time of acute resuscitation is an emotional time for the family; considering the level of emotion, the family members might end up harming the members of the healthcare team mentally or even physically (McClement, Fallis & Pereira. 2009). Secondly, FPDR tends to limit the space of operation of the healthcare team and hence making their work more difficult (Köberich et al. 2010). This factor also affects negatively on the part of the patient as they may end up not getting the best service as the healthcare staff operates in a limited space. Furthermore, the presence of family puts the members of the healthcare team under undue pressure to perform better. Even worse, some of the family members maybe malicious enough to even record some of the acts that the healthcare team do aside from protocol and use these as evidence in legal suits against these healthcare workers in case of unfavorable outcomes. Although, family members are always eager to be invited and be present at the deathbed of their loved ones during resuscitation, little is known about the patients’ feelings and perception of the whole experience. Further research need to be carried out to unmask some of these doubts in order to help patients during the procedures done in their life-threatening events.
Conclusion
FPDR has its disadvantageous to the family and the healthcare team. Nevertheless, FPDR does not seem to benefit the patient in any way. There is, however, no research evidence to show that it is harmful to the patient. On the contrary, there is convincing research evidence showing that the presence of family during acute resuscitation has advantageous long-term psychological impacts on the family members. Considering the current evidence, it is better to have the family present during acute resuscitation.
Moderate evidence based research suggest that family presence during resuscitation have no serious effects on adult resuscitation outcomes and may have positive outcome on the psychological outcomes among the family members. On the other hand, low evidence based research suggest that family presence during resuscitation have no effect on pediatrics resuscitation results. The generalization surrounding these findings outside the emergency room and pre-hospital setting is limited due to lack of trial sample in other forms of health care setting.
References
Boehm, J., 2008. Family presence during resuscitation. Code Communications Newsletter.
Brasel, K.J., Entwistle, J.W. and Sade, R.M., 2016. Should Family Presence Be Allowed During Cardiopulmonary Resuscitation?. The Annals of thoracic surgery, 102(5), pp.1438-1443. doi: 10.1016/j.athoracsur.2016.02.011
De Stefano, C., Normand, D., Jabre, P., Azoulay, E., Kentish-Barnes, N., Lapostolle, F., Baubet, T., Reuter, P.G., Javaud, N., Borron, S.W. and Vicaut, E., 2016. Family presence during resuscitation: a qualitative analysis from a national multicenter randomized clinical trial. PloS one, 11(6), p.e0156100. doi: 10.1371/journal.pone.0156100
Jabre, P., Belpomme, V., Azoulay, E., Jacob, L., Bertrand, L., Lapostolle, F., Tazarourte, K., Bouilleau, G., Pinaud, V., Broche, C. and Normand, D., 2013. Family presence during cardiopulmonary resuscitation. New England Journal of Medicine, 368(11), pp.1008-1018. Doi: full/10.1056/NEJMoa1203366
Köberich, S., Kaltwasser, A., Rothaug, O. and Albarran, J., 2010. Family witnessed resuscitation–experience and attitudes of German intensive care nurses. Nursing in critical care, 15(5), pp.241-250. https://doi.org/10.1111/j.1478-5153.2010.00405.x
McClement, S.E., Fallis, W.M. and Pereira, A., 2009. Family presence during resuscitation: Canadian critical care nurses’ perspectives. Journal of Nursing Scholarship, 41(3), pp.233-240. https://doi.org/10.1111/j.1547-5069.2009.01288.x
Oczkowski, S.J., management, I., Cupido, C. and Fox-Robichaud, A.E., 2015. The offering of family presence during resuscitation: a systematic review and meta-analysis. Journal of intensive care, 3(1), p.41. https://doi.org/10.1186/s40560-015-0107-2
Tinsley, C., Hill, J.B., Shah, J., Zimmerman, G., Wilson, M., Freier, K. and Abd-Allah, S., 2008. Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics, 122(4), pp.e799-e804.
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