Healthcare in the US in a Family-Oriented Manner - Research Paper Example

Family Presence during Cardiopulmonary Resuscitation Blue) and Invasive Procedures Abstract The paper investigates relative positions of healthcare professionals, family members and the general populace to find how family witnessing of cardiopulmonary resuscitation under life threatening (code blue) circumstances and invasive procedures configur4e in their opinions. It finds that, presently, without going back in time, all opinions are ripe for allowance of such witnessing under formal conditions. The paper also finds that salient organizations like the 'American Heart Association', the 'Emergency Nurses Asoociation' and others have already recommended such witnessing and have even recommended that hospitals in the US set standards for such. Yet it also finds that few hospitals to date have any such written policies and standards. The paper thus recommends that a more inclusive information system be instilled in the healthcare system such that family members of such threatened patients be presented with the option to witness these procedures. It also recommends that healthcare providers of such procedures, if they feel constrained in any manner by such witnessing, may be assisted to change their viewpoints or overcome their constraints in such a manner that their comfort at work is not compromised by such witnessing. Introduction This paper contrives to seek out, from the nursing point of view, whether family presence during cardiopulmonary resuscitation and invasive procedures is really necessary and helpful without being an impedance to the relevant nursing staff. In a life-threatening situation (meriting Code Blue status) where patient breathing stops under unnatural or suspicious circumstances cardiopulmonary resuscitation is applied by the present nursing staff with immediate notification to a physician and the nursing supervisor. The same applies for invasive procedures to a large extent. In the nursing profession cardiopulmonary resuscitation (CPR) (extremely invasive procedure) as well as invasive procedures are usually the concern of critical care staff and emergency nurses. Such nurses often find themselves in the midst of an ethical dilemma where, on the one side, there are the family members of patient liable to CPR or invasive procedure and, on the other, those physicians and healthcare professionals applying the resuscitation measures (Nibert, 2005) or invasive procedure measures. There are reports of nurses subjected to such dilemmas conceding that they have received no instructional advice in their training programs to allow them to resolve and mitigate such ethical problems (Nibert, 2005). Thus, this paper's intention to investigate various positions on this issue is deemed important and crucial to dispensation of care to critically-ill patients. Background As early as 1987, Doyle et al, in a pioneering study, decided to allow family presence during CPR at their institution (McClenathan et al, 2002). Since then more studies have proceeded and the research findings, instead of conclusively providing evidence to one side, have added to the present state of controversy where there is no general consensus on whether such family presence during this crucial life-supporting and invasive procedure is either beneficial or essential. In the August 22, 2000, issue of 'Circulation' the American Heart Association published its guidelines for family-witnessed resuscitation procedures (McClenathan et al, 2002). It is also noted that the 'Emergency Nurses Association' has since endorsed family-witnessed CPR and recommend that hospitals develop concomitant policies accordingly (Critchell and Marik, 2007). Other healthcare professional bodies similar to these have followed suit but, to date, there are very few hospitals that have actually and actively exerted themselves in this direction and set up formal policies to govern CPR under family surveillance (Critchell and Marik, 2007). There is very good reason for this lack of enthusiasm. Family-witnessed CPR and invasive procedures continues to be a controversial issue to date and there are two distinct conflicting sides that continue debating on whether the presence of family members is essential and beneficial to such sensitive life-support procedures. Professional Positions In the present context of family-centered care in the healthcare system in the US today, it is found that a special support system for family and friends of patients with informal and comprehensive information dissemination has been emphatically recommended for the US healthcare system. This support system, aside from provision for integrated approach to information dispensation, also provides for such as relaxed visiting hours, informal 'rooming in' hospital accommodation and friendly and relatively informal obstetrics delivery (Kuzin et al, 2007), aside from other family-centered facilities. General opinion, both professional and otherwise, in this direction has thus proceeded to the point where it has encroached upon interventions in the intensive care unit (ICU) such as CPR and invasive procedures. Advocates of this relatively benign policy postulate that the presence of family members helps preserve family values and instills a sense of family-centered service in the healthcare system where ethics not only revolves around the patient's total welfare but also that of family members whose well-being may well be inextricably integrated with that of the patient (Kuzin et al, 2007). On the other side, there are those in the healthcare system who feel that, intrinsically, staff in the process of providing such resuscitation or conducting such invasive procedures may feel distracted or inhibited in some manner by the presence of non-medical persons in the form of family members (Kuzin et al, 2007). Both positions hold true for adult and pediatric patients. Now that both sides of the debate has been formally introduced in succinct form the paper shall proceed to more thoroughly investigate research done on this to enable it to reach a decision on its own position. Perceptions In the Kuzin et al, 2007 study, the researchers observed that the respondents, mostly the nonphysicians, believed that family presence during invasive and extremely invasive (CPR) procedures in the ICU cannot be hampering. The nonphysicians were not personally involved in such procedures as they were not family members of any such patients. In this context it is noted that a greater percentage of the physicians among the respondents believed that such presence during these procedures may be distracting to the providers (Kuzin et al, 2007). In this study also, the paper finds that, interestingly, all respondents, physicians and nonphysicians, who contacted family members of patients subjected to such procedures found that most of such members did not wish to be present during such procedures. From this singular study the paper can thus conclude, as far as it can be done on the basis of one study, that the general opinion, nonphysician or of persons not directly related to the healthcare system, is that it is beneficial to have family members witness invasive and CPR procedures while, when confronted with the actual situation, it seems that family members so not seem too enthusiastic to be present. It may also be, though, that such family members are not well informed enough to judge, even if superficially, whether their presence at the ICU can benefit either themselves or the patient. This point may be noted for later dealings. Nevertheless, the study finds that most respondents, both physician and nonphysician, believe that family member presence during such interventions do not involve medicolegal complications (Kuzin et al, 2007). This is an ethical viewpoint and it also may be noted for later dealings. In another study, MacLean et al, 2003, the researchers made a 30-item survey of 1500 members of the 'American Association of Critical-Care Nurses' and another 1500 members of the 'Emergency Nurses Association'. They found that, of the 984 successful respondents, only 5% worked at units where written policies were required for family presence during invasive and CPR procedures while 48% (mean value) worked at units where no such written policy were required. 36% (mean value) believed that written policy was required for such presence while 40% (mean value) believed that no such written policy was essential (MacLean et al, 2003). The survey also found that 40% (mean value) had already allowed family members to be present during invasive and CPR procedures while 195% (mean value) were willing to do so in the future. Interestingly also, the respondents reported that 31% of family members requested to be present during CPR while the figure for invasive procedures was considerably higher at 61% (MacLean et al, 2003). This last may be so because of the more daunting nature of CPR compared to invasive procedures. Attitudes There are two attitudinal bases to be investigated in this context - that of the family members or significant others and that of the healthcare workers involved in the intervention procedures. It is noted here that traditional approaches to this from the healthcare professional point of view is rather paternalistic and parochial in the sense that family presence is regarded as unnecessarily intrusive and distractive (Thornton, Undated). This can be borne out by the fact that only 5% of surveyed institutions actually had a written policy endorsing family presence during such procedures (MacLean et al, 2003). Nevertheless, this same study also notes that only about 1% of such institutions actively discouraged such presence with written statements. Thus, it is concluded in this regard that while the majority of such institutions do not actively discourage family presence they do not actively promote it either. On the other side, earlier studies have found that an overwhelming number of members of affected families want at least the option of presence during such procedures presented to them. It may be that they do not opt to be present every time there is necessity for such procedures (Thornton, Undated). This last is borne out by the fact that a large number of members of affected families did not care to attend such procedures when surveyed (Kuzin et al, 2007). Here again, in this context, the paper concludes that there may be essence for more comprehensive information on what these procedures may entail both to the patient and his/her concerned near and dear ones so that these latter can decide on whether they really should be present at such procedures or not. Also, it is noted in a more immediate context that family members in significant numbers - 31% for CPR and 61% for invasive procedures - did attend these (MacLean et al, 2003) demonstrating that they were not unmindful of their need to be present at a time when their near and dear one was being rescued to life. Also, in the context of changing attitudes among healthcare professionals today it is noted that a large percentage of these, especially critical care and emergency nurses, did care to invite family presence at these procedures, whether under written policy directions or not (MacLean et al, 2003). Conclusion In conclusion the paper finds that it may be necessary to provide family members with more detailed information on what cardiopulmonary resuscitation and invasive procedures may imply for the patient and themselves. It has also been found that most of such family members do opt to be presented with formal rules and regulations that allow them the option to be present during such procedures (Thornton, Undated). Since it is found that such formal written standards are currently unavailable at most US hospitals though such are recommended by many leading healthcare professional associations (Critchell and Marik, 2007) some proceedings should be initiated to ensure that they are in place as soon as soon as is possible. This is to ensure that the present stance at providing healthcare in the US in a family-oriented manner is preserved. The paper also observes that healthcare professionals mostly have no major personal inhibition towards such family presence and any that do have such may be assisted to change their viewpoints or overcome their constraints without compromising their comforts at work. Reference Nibert, Ainslie T., Teaching Clinical Ethics Using a Case Study: Family Presence During Cardiopulmonary Resuscitation, Crit Care Nurse 2005 Feb; 25(1); 38-44. McClenathan, Bruce M., et al, Family Member Presence During Cardiopulmonary Resuscitation: A Survey of US and International Critical Care Professionals, Chest, 2002; 122; 2204-2211. Kuzin, Julie K., et al, Family-Member Presence During Interventions in the Intensive Care Unit: Perceptions of Pediatric Cardiac Care Providers, pediatrics, Vol. 120, No 4; October 2007, pp. e895-e901. MacLean, Susan L., et al, Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses, American Journal of Critical Care, 2003; 12; 246-257. Thornton, Jason M., Family Member Presence During Resuscitation and Invasive Procedures, Undated, Duke University School of Nursing. Extracted 3rd November, 2007, from: Critchell, C. Dana, and Marik, Paul E., Should Family Members be Present During Cardiopulmonary Resuscitation: A Review of the Literature, American Journal of Hospice and Palliative Medicine, Vol. 24, No. 4, 311-317; 2007. Read More