Through The Eyes of Medical Professionals: Family Presence During Cardiopulmonary Resuscitation - Case Study Example

Through The Eyes of Medical Professionals: Family Presence During Cardiopulmonary Resuscitation Abstract In the implementation of a patient centered care, a number of healthcare institutions have allowed family members to witness cardiopulmonary resuscitation. Researchers have reported the benefits of this practice not only to patients, but their families, and care providers as well. Family members have also signified their desire to be with their family during this time, and consider their presence to be fundamental to the patient and to themselves. However, this practice has remained controversial. This paper reviewed research literatures that were done to assess majorly the healthcare professionals’ views on the topic. Overall, there seems to be an agreement as to the benefits of having patients’ families in the resuscitation process. But several limitations of designs emerged including small samples, low response rates, and the associated probable selection bias. Also a lack of consistency in the survey tools used makes evaluation of result between the researches complicated. Recommendations are also discussed regarding a more in depth and thorough research and lack of policy and implementing guidelines and an investigation of the effects of family presence during resuscitation not only on the patients and their families, but also its effects on the medical professionals. Introduction Emergence of technologies and the realization of new and better alternatives in medical care provide that health service providers adapt themselves to the changing times (Aldridge, 2005). Traditionally resuscitative efforts and invasive medical procedures have been restricted to patients and their health care providers. But in recent times, family members’ presence during resuscitation is now being acknowledged as important and practiced in some health care facilities (Duran, et al, 2007). It remains to be a widely debated ethical issue particularly to those medical professionals often involved in life-threatening situations (Nibert, 2005). A number of national organizations have propagated the implementation of this practice, including ENA, AAP, ACEP and a host of others. This report will focus mainly on resuscitation efforts, particularly in the critical care and emergency departments. This report aims to identify opposing arguments and their respective points and reach a conclusion as to why, despite studies that show their benefits, there is much resistance in the implementation of this practice and if implementation of guidelines and policies will help alleviate the reasons for such resistance. Review of Literature Using PUBMED, MEDSCAPE/MEDLINE databases, a literature review was conducted covering the years from 1998 to the present. Terminologies used for the research included CPR, family presence, family member presence, resuscitation, relatives inside resuscitation rooms. A number of studies regarding the topic was recovered and though most of these studies show positive outcomes, the notion of family members’ presence during resuscitation efforts remain to be a medical enigma. It is evident that further studies are required in order to fully assimilate the value of family presence and clear policies and guidelines are warranted if an effective provision for family members’ presence during resuscitation and invasive procedures are to be implemented. In order to identify critical care and emergency nurses’ inclination, and practices towards family presence during resuscitation and invasive procedures and any existing policies Maclean’s group in 2003 sent a 30-item survey by mail to 1500 random members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association, all Registered Nurses. Of the 3000 prospective respondents, only 984 responded, getting only a 33% response rate. 473 were critical care nurses, 456 emergency nurses and 55 nurses either practiced both or did not provide the information. All were registered nurses practicing in all 50 states and the District of Columbia. In the study nearly all the nurses worked in institutions where no written policy dealing with the option of family presence during CPR and invasive procedures were implemented. Almost half of the respondents accounted that even without written policy family members of patients were given the option to witness CPR or invasive procedures. It can be noted that majority of the respondents supported family presence. Moreover, a third of the respondents prefer written policies to allow family presence during said procedures, although another third prefer unwritten policies. The study shows almost 75% of respondents favor some kind of option allowing family members’ presence and almost all of the respondents took or would consider taking a patient’s family to witness CPR and/or invasive procedure. Findings also note that most of the supporters of policies that allow for families to be present had previous experiences with family members’ presence during such procedures. Another important finding in the study was that during invasive procedures family members frequently asked to be present although it is remarkably lower for CPR. It can be noted that only a third of the perceived respondents actually returned the survey, rendering the survey poorly generalized, add to that the fact that only members of the American Association of Critical-Care Nurses and ENA were part of the survey and their response may not account for the preferences of the entire critical care and emergency nurses. Also, the survey was conducted only to a part of the medical team. Doctors, patients, and patient families were not involved in the survey, monopolizing the survey to nurses. In March 2006, Holzhauser and company published the results of their research project conducted over a three year period undertaken to examine 3 major points in dealing with family presence during resuscitation: Examination of medical practitioner’s attitude to family presence after implementation; Medical practitioner’s attitudes to family members immediately after resuscitation; And family members’ attitudes towards being present during resuscitation efforts. Present report deals with the last 3rd installment of the research family members’ attitudes towards their presence at resuscitation. The establishment of a starting point for a body of scientific evidence in relation to family presence during resuscitation and invasive procedure was the primary intent of the research. The research took a randomized controlled trial using the survey method, where relatives of resuscitated patients were randomized on arrival at the ED, and one month post resuscitation, an over the phone survey/interview was conducted. Potential respondents were 18 years old and over, immediate family or significant other, whose family is a patient in Triage Category 1 or 2, can have an altered level of consciousness, Glasgow Coma Scale should be 13 or less, hypotensive, in respiratory distress or in need of cardiopulmonary resuscitation. Cases involving trauma were excluded in order to provide continuity between the control and experimental groups. A total of 58 respondents were placed in the experimental group while 30 respondents were placed in the control group. A number of them also worked in health care and some even experienced resuscitation prior to the event. Majority of the respondents were spouses or significant others. Among the respondents in the experimental group 43% preferred to be present while among the control group 67% preferred to be present and all of the respondents who were present during resuscitation were glad that they were present. Relatives felt reassured and cared for. Respondents whose relatives were revived during resuscitation felt that their presence was a factor in reviving their family member. It can also be noted that some of the respondent also expressed some hesitation, not necessarily because of the healthcare providers but of their own thoughts of getting in the way and being overly emotional. While Madden and Condon aimed to examine emergency nurses' current practices and understanding of family presence during CPR in the emergency department on October 2007. A quantitative descriptive design was used in the study. An ENA developed feedback form was given to emergency nurses working in a level I trauma emergency department at Cork University Hospital. Respondents were emergency nurses who had at least 6 months experience in emergency nursing. These nurses often took families to their patients during resuscitation (58.9%) and would do so again if opportunity arises (17.8%). Respondents also prefer a written policy that allows for such practices (74.4%). It is noted that conflicts within the emergency team is the most significant barrier to family members’ presence during resuscitation. And the most significant proponent will be a better understanding of the benefits involved in family presence during resuscitation. MacClenathan and Torrington surveyed healthcare professionals present at the International Meeting of the American College of Chest Physicians in San Francisco, CA, from October 23 to 26, 2000, in order to assess these healthcare professionals own views on the guidelines that recommended family members’ presence during resuscitation attempts. Five hundred ninety-two professionals were surveyed. Only 20% of the physicians and 39% of nurses and allied healthcare workers combined would permit family member presence during adult CPR. 14% of physicians and 17% of nurses would permit family presence during pediatric CPR. There was a significant difference among the opinions of US professionals, based on regional location. Healthcare professionals who disapprove of family presence during CPR did so because they fear psychological trauma to family members especially if their loved one did not survive. They also mentioned fearing that the family members will prove to be a distraction to the resuscitation team and there also seems to be fear in the medicolegal aspects. The result seems to support that majority of critical care professionals do not support the current recommendations regarding family presence during CPR. The participants of the survey were critical care professionals often dealing with end-of-life issues, are often faced with medical ethics and their negative attitude towards family witnessed resuscitation should not be easily dismissed as uniformed. It is crucial that rigorous scientific study of family witnessed resuscitation before its actual implementation From these literatures it can be derived that varying opinions are formed regarding the issue of family presence during resuscitation. It can be noted that even without a written policy majority of nurses have allowed and will allow family members to witness resuscitation and majority of them would prefer written policies. A majority of family members would also prefer to be present during these circumstances. Fear of criticism, litigation and family members’ intervention during treatment remains to be a cause for concern, especially for physicians. Without a clear guideline or policy regarding the issue, it is evident that mistakes will be made regarding practices pertaining to family witnessed resuscitation, whether or not families are permitted to see their family members during resuscitation. Patient care and family support system will continue to grapple in the dark, groping for answers for patient and their families concerning this issue. Recommendations After reviewing the literature published regarding this issue, it is evident that resistance in allowing family presence during resuscitation is largely based on the fear of litigation for health care professional, physicians in particular, the thought of family members interfering and causing a distraction with the treatment, and the notion of psychological trauma/impact (Mason, 2003). It is not evident in the studies if implementation of policies and guidelines will alleviate resistance to its implementation. It can also be discerned that health professionals’ attitudes is a major obstacle in the implementation (Tsai, 2002). It can also be noted that despite lack in written policies, many healthcare professionals, mostly nurses, bring family members to their patient’s bedside and many will chose to do so again. Varying results show that there is a need for a more in depth and thorough research. These studies show a monopolized area of research, meaning it was confined to a limited number of respondents and therefore cannot accurately predict the real viewpoints of the mainstream of healthcare professionals. A need to form a centralized policy and implementing guidelines in the practice letting the families witness resuscitation. It is also recommended that aside from written policies, an educational program for the implementation and practice of Family Witnessed Resuscitation be developed in order for training and further understanding of the process be assimilated into the existing patient care practices. Also information dissemination for family members should be implemented, letting them know that they have a choice. Moreover, it is also recommended that formation of a support system for families who will witness resuscitation that will serve as an anchor when and if the times comes that resuscitation will be needed. Conclusion In writing this paper, words were sometimes hard to come by in order to fully contextualize the thoughts that formed in the mind. Conflicting emotions and the need to input personal ideas and attitudes, especially in the review of literature was hard to control. Finding studies regarding the issue were not hard, there were a wealth of literature to found about the topic, what was hard was in choosing what literature to include in the paper that would accurately deliver set goals in the writers mind. Goals that aim to deliver a well written paper that is unbiased and impartial. But writing this paper proves that everyone, including this writer has formed an opinion regarding the matter and it may have a significance in the course of writing this paper. Family presence during resuscitation is not an easy topic to deal with. Dealing with human emotions on all sides of the fence is an obstacle that has to be addressed. Everyone has a reason for their opinion but in the end, this writer believes that it should be a choice, an option for the family, to be present during resuscitation, but there should be a guideline and a policy to follow if continuity in treatment and smooth transitions is to be achieved and ultimately it should be the patient’s well being that is the primary concern. Overall writing this paper wasn’t an easy task, going through the research materials causes strain to the eyes, but important lessons were learned. The first is that one shouldn’t have preconceived notions concerning topics to be research, it clouds the judgment and accurate interpretation of facts and issues may be compromised. Another lesson learned is that if a research is to be accurate and complete, it takes a great deal of time and it helps if one can follow a time table and an outline. Lastly, doing this paper has taught this writer that for a better and a more patient centered care system in the healthcare profession, adaptation of research-based practice is an important facilitator in reaching this goal. References Aldridge, M., Clark, A. (2005) Making the Right Choice: Family Presence and the CNS. Clinical Nursing Specialist 19(3), 113-116 Duran, C., Oman, K., Abel, J., Koziel V., Szymanski, D. (2007) Attitudes Toward and Beliefs About Family Presence: A Survey of Healthcare Providers, Patients‘ Families, and Patients. American Journal of Critical Care 16 (3), 270-279 Holzhauser, K., Finucane, J., De Vries, S., (2006) Family Presence During Resuscitation: A Randomized Controlled Trial of the Impact of Family Presence. Australasian Emergency Nursing Journal 8 (4), 139-147 MacLean, S., Guzzetta, C., White, C., Fontaine, D., Eichhorn, D., Meyers, T., Desy, P. (2003) Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses. American Journal of Critical Care 12(3), 246-257 Madden, E., Condon, C., (2007) Emergency Nurses’ Current Practices and Understanding of Family Presence During CPR. Journal of Emergency Nursing 33(5), 443-440 Mason, D. (2003) Family Presence: Evidence vs Tradition. American Journal of Critical Care. 12(3), 190-192 McClenathan, B., Torrington, K., Uyehara, C. (2002) Family Member Presence During Cardiopulmonary Resuscitation: A Survey of US and International Critical Care Professionals. CHEST The Official Publication of the American College of Chest Physicians 122;2204-2211 Nibert, A. (2005) Teaching Clinical Ethics Using A Case Study Family Presence During Cardiopulmonary Resuscitation. Critical Care Nurse 25(1), 38-44 Tsai, E. (2002) Should Family Members Be Present During Cardiopulmonary Resuscitation? Sounding Board, The New England Journal of Medicine 346(13), 1019-1021 Read More