Active Resuscitation

In the traditional hospital setting, most family members were always excluded from a resuscitation room, especially when life-saving measures are being initiated. The nurses would occasionally break away from the room to update the family members on the status and progress of their loved ones (Abre, et al, 2013). In this ancient era, the contribution of family members in the process of resuscitation was not appreciated; instead they were seen as a source of constant interruptions during that critical time. However, research shows that the system is changing, and families nowadays more often than not are able to exercise their right of being present in the resuscitation room beside their loved ones (Marco, 2011). In the United Sates, allowing these family members to be present especially during cardiopulmonary resuscitation (CPR) has yielded a bone of contention across the medical field, giving rise to heated debates (Hung & Pang, 2011). In the past two decades, however, the inclusion of family members in the process of resuscitation has gained wide success, steadily evolving and allowing family presence (FP) as it is widely known, a social right.

Family presence (FP) is simply defined as the inclusion of family members, especially the adults in the patient care area during the process of resuscitation, in a posture that allows for physical or visual contact (Doolin, Quinn, Bryant, Lyons & Kleinpell, 2011). Dating back to 1982, family presence during resuscitation can be traced back to Foote Hospital in Jackson, where two distinct family members had demanded to be included in the resuscitation room with their loved ones. In one case, a family member, after an emotional ride with her loved one in an ambulance, refused to leave his side, even during the critical moment of administering treatment (Mahabir & Sammy, 2012). On yet another occasion, a woman whose husband had been shot in the line of duty, begged to stay by his side during the whole procedure. In both cases, a chaplain was assigned to stay with them, and later an evaluation was done, which revealed positive results from the families and the staff members as well (Mahabir & Sammy, 2012). In the same hospital, a need to conduct a survey on those whose patients had died arose, and out of the 18 participants involved, 13 of them responded in the affirmative, translating to 72% of the total number (Hung & Pang, 2011). From this evidence, it was concluded that family presence during resuscitation is an important aspect of health care, and should be embraced under controlled conditions.

Over the years, research has widely been done on the psychological impact of family presence during resuscitation. In 1994, the Emergency Nurses Association took a bold move to adopt a resolution that supported FPDR (family presence during resuscitation), and this has been in place for as long as could be possible (Doolin, Quinn, Bryant, Lyons & Kleinpell, 2011). Public opinion polls conducted also indicate similar results: massive support for family presence. NBC conducted a public survey in 1999 and 2000, and a massive majority of 70% of the respondents would rather go for family presence, than exclusion. Other researches targeting families, for instance, Meyers survey of 1998 at the Parkland Hospital situated in Dallas, bolstered this move by revealing a massive support of 80% family members opting for FPDR option.

One would want to ask the perceived benefits of the presence of family during the process of resuscitation. Well, experts as well as family members themselves have cited various reasons. For instance, this arrangement helps the family to realize how serious the condition of their patient is. This prepares them psychologically for any unspoken outcome, and helps them be in spiritual assistance to the patient (Leung & Chow, 2012). Moreover, it fosters the appreciation for tireless efforts of the medical team, and convinces the family members that even if the resuscitation process did not turn out well, every possible option was exploited (Porter, Cooper & Sellick, 2013). This is important in bringing peace and satisfaction as well as acceptance of fate by the family members. In addition, it also dispels the dread and wonders of the unknown, especially if the no family member were not around to witness the foregoing. In FPDR, the value and importance of the patient to the family is also stressed to the medical staff, so that maximum attention is given to the patient (Walker, 2008). It provides comfort to the patient, knowing that the family members are close by, gives one the strength and motivation to fight the disease (Itzhaki, Bar-Tal & Barnoy, 2012). After all, even the medical practitioners point out that healing occurs by faith. In addition, full information about a patient’s history of illness and other pertinent details are provided to the medical team to ensure an effective and overarching process implementation (Hauda, 2011).

Health care providers agree with the FPDR program, though this varies from one profession to another, and according to the level of experience and specialty. In numerous surveys conducted regarding this matter, about 86% to 96% of the total number of nurses surveyed endorsed this initiative, though physicians have been portrayed to exhibit less enthusiasm on this matter (Doolin, Quinn, Bryant, Lyons & Kleinpell, 2011). Physicians generally do not support the constant interruptions and hysteresis from family members, though Meyers points out that the response of medical practitioners is likely to improve with time as they witness more of this process. Though some health care providers have fears ranging from distractions to service provision, emotional outbursts, stubbornness of distraught family members, anxiety, lack of space, fear for lack of confidentiality, to the concern that errors can be witnessed by family members; most of them are still in support of the idea of FPDR (Leske, McAndrew, Evans, Garcia & Brasel, 2012).

From the perspective of health care providers, FPDR serves to remind all the staff members that the patient is a family man/woman, and needs to be given equal care as any other patient (Al-Mutair, Plummer & Copnell, 2012). Additionally, the arrangement provides the medical staff with more holistic care during the critical moment of resuscitation to the patient, and encourages more cordial and professional conduct of the staff. It also reaffirms and reminds the health care provider of his position as an advocate for the resuscitating patient; and makes him shift more focus to the dignity and privacy of the patient (Itzhaki, Bar-Tal & Barnoy, 2012). Moreover, this arrangement offers the all-important opportunity for the medical staff to furnish the family members with technical information on the status of the patient, which is crucial for easing anxiety that most certainly builds up within them (Leske, McAndrew, Evans, Garcia & Brasel, 2012).

Researches that focus on the perspective of the patient regarding family presence during resuscitation have not been adequately conducted, but dismal data available shows that about 72% of the patients would want their family members’ presence (Hapman, Watkins, Bushby & Combs, 2013). In a study carried at Parkland Hospital, it emerged that most patients feel comforted, supported and loved by this arrangement; they feel that they have the family members, besides the medical staff, as their advocates, and that the caregivers are reminded of their personhood by their family members’ presence; and that it enhanced the bond between the patient and family and alters the health care environment (Itzhaki, Bar-Tal & Barnoy, 2012). In one large study conducted by Benjamin where about 200 patients were interviewed, over 73% of them wanted their families to be present, citing that they did not consider this as a breach into their privacy and confidentiality (Al-Mutair, Plummer & Copnell, 2012). Most people lodge this argument that why should a person be excluded from another at the end of life, while they have spent time together throughout their life?

Several other researches have been conducted to determine whether there is support for FPDR. Barrrat and Willis conducted a survey on bereaved relatives, seeking their opinions concerning the need to be present during resuscitation. Phone interview was used in this research, after they had visited the emergency department at their respective hospitals, and a higher percentage confirmed that they would like the opportunity to be present beside their loved ones in the resuscitation rooms (Fell, 2009). Robinson et al also used a randomized, regulated method of trial to carry out an evaluation on whether relatives would prefer FPDR, and whether witnessing the resuscitation process had any psychological impact on them and their patients. Low levels of disparities from existing literature were found (Ganz & Yoffe, 2012). Moreover, Weslein carried out a semi-structured interview involving 17 participants, which was aimed at exploring varied experiences of family members during resuscitation process. Though the sample size was small, this study provides insight into the issue, as 12 participants expressed positivity in their desire to be present (Hapman, Watkins, Bushby & Combs, 2013). In another study carried out in France involving a fairly large sample size of 57o participants (relatives of patients experience problem of cardiac arrest), 79% of the total number opted to stay and with their patients. This study focused on another different but important aspect: post-traumatic stress disorder (PTSD). A control group which was not exposed to the resuscitation process was used and comparative data filed about the two groups. It was found PTSD was higher in the control group than among the relatives who had witnessed the process of resuscitation. These were due to high levels of depression and anxiety reported among those who did not witness the process, because of fear of unknown.

Out of all the systematic reviews presented in this paper, it suffices to conclude that members of a family should be allowed to witness the resuscitation efforts of the patients. Since more benefits are set to be gained than damages caused, there has been much lobby for this initiative by both medical and human rights organizations. It is a time to bury the old style and embrace new developments, as people become more enlightened on their unspoken rights as human beings.

References

Abre, P., et al (2013). Family presence during cardiopulmonary resuscitation. The New England Journal Of Medicine, 368(11), 1008-1018.

Al-Mutair, A., Plummer, V., & Copnell, B. (2012). Family presence during resuscitation: a descriptive study of nurses’ attitudes from two Saudi hospitals. Nursing In Critical Care, 17(2), 90-98.

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. Journal Of The American Academy Of Nurse Practitioners, 23(1), 8-14.

Fell, O. (2009). Family Presence During Resuscitation Efforts. Nursing Forum, 44(2), 144-150.

Ganz, F., & Yoffe, F. (2012). Intensive care nurses’ perspectives of family-centered care and their attitudes toward family presence during resuscitation. The Journal Of Cardiovascular Nursing, 27(3), 220-227.

Hapman, R., Watkins, R., Bushby, A., & Combs, S. (2013). Assessing health professionals’ perceptions of family presence during resuscitation: a replication study. International Emergency Nursing, 21(1), 17-25.

Hauda, I. (2011). Family Presence during Resuscitation Efforts. New York: McGraw-Hill; 2011.

Hung, M. Y., & Pang, S. C. (2011). Family presence preference when patients are receiving resuscitation in an accident and emergency department. Journal Of Advanced Nursing, 67(1), 56-67.

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.

Leske, J., McAndrew, N., Evans, C., Garcia, A., & Brasel, K. (2012). Challenges in conducting research after family presence during resuscitation. Journal Of Trauma Nursing: The Official Journal Of The Society Of Trauma Nurses, 19(3), 190-194.

Leung, N., & Chow, S. (2012). Attitudes of healthcare staff and patients’ family members towards family presence during resuscitation in adult critical care units. Journal Of Clinical Nursing, 21(13-14).

Mahabir, D., & Sammy, I. (2012). Attitudes of ED staff to the presence of family during cardiopulmonary resuscitation: a Trinidad and Tobago perspective. Emergency Medicine Journal: EMJ, 29(10), 817-820.

Marco, C. (2011). Family Presence during Resuscitation. New York: McGraw-Hill.

Porter, J., Cooper, S., & Sellick, K. (2013). Attitudes, implementation and practice of family presence during resuscitation (FPDR): a quantitative literature review. International Emergency Nursing, 21(1), 26-34.

Walker, W. (2008). Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature review. Journal of Advanced Nursing, 61, 348-362.