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Insight: Should Family Members be Allowed During a Patient’s Resuscitation?

Submitted by on August 3, 2014 – 11:02 PM

jp-CARDIAC-articleLargeA new controversial challenge that health care providers are facing is of allowing family members in room during resuscitation. Though this subject has brought a lot of discussion but I believe that family should not be permissible at the time of resuscitation since it’s a situation in which we try to save patient’s life through mechanical, pharmacological and physiological means (Leung & Chow, 2012). When I was working in a tertiary care hospital; there was a patient who ended up in cardiac arrest, during resuscitation the family came inside and started asking multiple questions from the staff, due to which time keeper was unable to concentrate and record accurate time of medication administration and it delayed the next dose, due to which the patient expired. Hence, in such critical condition where it is question of someone’s life and death, family should not be allowed because it delays the code of patient, increases the stress of paramedical staff and violates the right of patient’s confidentiality.

The most important reason for not allowing family members is that it delays code of a patient (Charron & Kautz, 2010). Resuscitation is a situation in which decisions should be made quickly so that patient’s life can be saved but family presence can interrupt staff which can impede necessary decisions. Additionally, patients are in critical situation of cardiopulmonary resuscitation, so this increases stress level of family members which ultimately makes environment tense for staff, hinders code of patient and can delay early defibrillation. Furthermore, because of family presence staff will not have enough zones to work effectively as we have limited space in ward setting and hence it will distract staff from their efforts.

However, presence of family is emotionally beneficial for patient and their families (Charron & Kautz, 2010). Resuscitation is a process in which patients are emotionally week and are afraid of what is happening so when patients have undergone invasive procedures, attendants’ presence makes them feel comfortable, stronger and helps them to regain their hopes. Family presence enhances family-centered care as family is involved in giving care and decisions are made around patient and family. Moreover, witnessing the process of resuscitation lowers the incidence of post-traumatic stress disorder symptoms among family members (Boehm, n.d.). It also helps in early recovery of family members from trauma and they are less frightened even after months.

 

Still, I would say that family members create distractions and disturbances during resuscitation which hinders the staff’s performance. Furthermore, many a times there is staff shortage so we can’t assign one specific staff member who can stand with the relatives to provide support and inform about what’s happening with the patient.

 

Secondly, it exaggerates the anxiety and stress in paramedical staff. As most of the families are not linked with medical fields so they are unaware of the medical terminologies, so if they witness an error or misunderstand any comment, they will lose their confidence and trust upon health care professionals and as a result staff will be more pressurized. Likewise, family presence creates stress among staff that their performance is being monitored. Staff will have continuous fear that relatives are watching them and it will further increase the chances of error. Another issue that can occur is the fear of unintentional mistakes by staff. They feel distressed by not maintaining professional distance and can commit unintentional mistakes which can lead to litigation.

 

My opponents would say that family’s presence creates strong relationship between staff and family members, efforts of resuscitation are enhanced and become more respectful in the presence of family, so it will help to generate healthy bond between them. Family presence provides hope and encouragement to staff providing resuscitation and they can confidently perform their efforts (Arce, 2013). Medical professionals feel inspired knowing the families believe that everything was done to save their loved one and family can accept the unavoidable death and seriousness of illness after observing the hard work of paramedical staff. But altogether, we should not forget that it is the primary responsibility of staff to save patient’s life rather than make strong bonds with their families. Sometimes family members are not able to face the resuscitation of their loved ones or they cannot tolerate this, lose their hopes, become aggressive and can show disruptive behaviors which can injure them and others.

 

The third reason of not allowing family members is that it disrupts the patient’s right of confidentiality. Sometimes, families are unaware of patient’s disease process and during code different teams come to save patient’s life so their history is discussed in detail in front of the family, which breaks patient’s confidentiality.  In addition, resuscitation is an emergent condition where we need to perform certain procedures for which we need a consent form. If family is unaware of patient’s diagnosis and if patient is unable to sign it because of his/her condition, so family members will sign it and ultimately it will impede patient’s confidentiality. Furthermore, during resuscitation we need to perform invasive procedures like central line insertion, defibrillation etc. for which we need to expose patient, so family presence will break patient’s right of privacy and dignity.

 

However, it is family’s right to stay with their loved one during resuscitation. Family will be satisfied when they see that intense efforts are being made by staff to save their loved one so they will carry this feeling with them that all was done. In a stressful situation, family supports patient physically, emotionally and spiritually (Leung & Chow, 2012). Presence of family enhances patient’s will to live and as this time is considered as the last phase of patient’s life, so many people believe that family should provide care to patient and fulfill their emotional needs. In addition, there are many events where patient’s detailed history is needed, so family members can answer questions about patient’s history during resuscitation so that early interventions can be made.

 

Apart from this, we should not forget that health care workers have taken the oath to maintain patient’s secrecy, so family’s presence will hinder the fulfilling of that oath (Kosowan, 2011). Moreover, if we know that nothing can be done further to save patient’s life, so in such situation staff has fear of giving up efforts in front of family because they think that family will create issues if efforts are called off.

In conclusion, family should not be permitted to stay in room during resuscitation as it creates disruption in code, increases tension in staff and breach patient’s confidentiality. Although family members are an important part of patient’s life but sometimes their presence can disrupt the important decisions. Although it is a matter of breaking trusting relationship among family and staff, but respecting patient’s right to live should be at priority which will be successful only when staff will be able to perform their efforts with concentration. So, to prevent such issues and improve chances of patient’s survival, strict policies and educational programs should be arranged and implemented and effective counseling of families should be done so that better understanding can be made possible regarding the effects of their presence in code.

References
Arce, J. (2013). Family presence during CPR. Journal of Advance Health Care Network for Nurses. Retrieved from http://nursing.advanceweb.com/Features/Articles/Family Presence-During-CPR.aspx

Mutair, A. S., Plummer, V.,  & Copnell, B. (2012). Family presence during resuscitation: A descriptive study of nurses’ attitudes from two Saudi hospitals. British Association of Critical Care Nurses, Nurses In Critical Care, 17(2), 90-98. doi: 10.1111/j.1478-5153.2011.00479.x

Boehm, J. (n.d). Family presence during resuscitation. Retrieved from http://www.zoll.com/CodeCommunicationsNewsletter/CCNL05_08/CodeCommunications05_08.pdf

Charron, L. B., & Kautz, D. D. (2010). Should family members have the option to be present during resuscitation efforts? Academy of Medical-Surgical Nursing, 9(3), 4-6. Retrieved from https://vpn.aku.edu/ehost/pdfviewer/,DanaInfo=web.a.ebscohost.com+pdfviewer?sid=fb3e91fe-95ea-4b6f-bbae-62b41df80f95%40sessionmgr4005&vid=1&hid=4101

Critchell, C. D., & Marik, P.E. (2007). Should family members be present during cardiopulmonary resuscitation? A review of the literature. American Journal of Hospice and Palliative Medicine, 24(4), 311-317. doi: 10.1177/1049909107304554

Doolin, C. T., Quinn, L. D., Bryant, L. G., Lyons, A. A., & Kleinpell, R. M. (2011). Family presence during cardiopulmonary resuscitation: Using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines. American Academy of Nurse Practitioners, 23, 8-14. doi: 10.1111/j.1745-7599.2010.00569.x

Hung, M. S. Y., & Pang, S. M. C. (2011). Family presence preference when patients are receiving resuscitation in an accident and emergency department. Journal of Advanced Nursing, 67(1), 56–67. doi: 10.1111/j.1365-2648.2010.05441.x

Itzhaki, M., Bar-Tal, Y., & Barnoy, S. (2012). Reactions of staff members and lay people to family presence during resuscitation: The effect of visible bleeding, resuscitation outcome and gender. Journal of Advanced Nursing, 68(9), 1967–1977. doi: 10.1111/j.1365-2648.2011.05883.x

Kosowan, S., & Jensen, L. (2011). Family presence during cardiopulmonary resuscitation: Cardiac health care professional’s perspective. Canadian journal of Cardiovascular Nursing, 21(3), 23-29. Retrieved from https://vpn.aku.edu/ehost/,DanaInfo=web.a.ebscohost.com+detail?sid=5b58ac17-d8b9-47e1-837ea1ac020c1478%40sessionmgr4002&vid=1&hid=4101&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=ccm&AN=2011299577

Leung, N. Y., & Chow, S. K.Y. (2012). Attitudes of healthcare staff and patients’ family members towards family presence during resuscitation in adult critical care units. Journal of Clinical Nursing, 21, 2083–2093. doi: 10.1111/j.1365-2702.2011.04013.x 2083

Miller, J. H., & Stiles, A. (2009). Family presence during resuscitation and invasive procedures: The nurse experience. Qualitative Health Research, 19(10), 1431–1442. doi: 10.1177/1049732309348365

 

 

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