Emergency nursing Essay Example
Title:Witnessing and Participating in Cardiopulmonary Resuscitation as a Healthcare
Professional by relatives
The presence of patient’s family members during resuscitation has emerged as a significant practice issue, igniting considerable controversy globally. Stewart and Bowker (1997) point out that customarily, family members of the patient undergoing cardiopulmonary resuscitation or invasive procedures are not permitted to be present because of concerns that clinical actions are likely to be compromised and that witnessing the incident might be too traumatic for the family members. Mangurten (2005) also alleged that the potential hazard of liability can easily be increased. Early advocates of permitting family members of the patient to be present during resuscitation faced increased resistance than the current advocates since the former had little or no scientific study to support their ideas. Historically, numerous practitioners thought that presence of family members during resuscitation was unsuitable and injurious to families. It was rarely practiced, and solely on Ad hoc basis. However, several institutions have recently developed formal protocol and policies to support the practice and family presence during resuscitation has been subject of immense research (Bassler, 1999).
Presence of family members during resuscitation
According to Schilling (1994), family presence during resuscitation, abbreviated as FDR is the presence of family members in the patient care region, in a location that affords physical or visual contact with the patient during resuscitation procedures. FDR entails the monitored, selective admission of at least two family members into the emergency care area where there loved one is being resuscitated. Trained facilitators screen family members before they enter into the care region, offer constant supervision and emotional support for the relatives whilst observing resuscitation, and also arrange sorrow counseling and spiritual support after resuscitation has been concluded. Family presence during resuscitation might take place in the trauma resuscitation room or emergency room, intensive care units, inpatient units and pre and post procedure recovery areas (Bradley, 2010).
Family presence during cardiopulmonary r5esusctitation is a traumatic and abrupt clinical incident that regularly leads to death of the patient or permanent change of his health condition. Rattrie (2000) points out that Relatives may not only be called upon see a family member during resuscitation, but family members are also at times called upon to give end of life or other vital decisions during this greatly emotional event. Permitting family presence during resuscitation has been suggested as a means to better support emotional needs of the family members and enhance improved decision making (Bradley, 2010).
Whether from the patient and the family, or from medical professional point of view, the presence of relatives whilst loved one is undergoing invasive procedures or resuscitation procedures seem unimaginable and hard. Based upon this reasoning and on the anecdotal opinions that resuscitation attempt would be very traumatic for family members to see and that attendance of relatives would interrupt staff performance, relatives of critically injured or ill patients have normally been kept out from the treatment or resuscitation area (Walsh, 2004). Nevertheless, a growing body of research reveals that there are numerous benefits to relatives being present during these efforts to the patients, family members and medical professionals involved in the care of the patient. For numerous medical professionals, presence of family members is a standard procedure while others feel that it is an emerging process that needs understanding and training to assist advocate for and execute within their health care setting (Walsh, 2004).
Perspectives of healthcare providers on family presence during resuscitation
According to Tucker, (2002), holistic healthcare providers care for patients, as well as patient’s family members. They feel that incorporating family presence during resuscitation supports patients together with their families. Unfortunately, numerous healthcare providers still do not support presence of family members. Researchers have studied of healthcare providers’ attitudes towards and beliefs on family members’ presence. In the survey of emergency department nurses and physicians Meyers (2000) established that healthcare professionals had numerous concerns about patients’ family members being present during the resuscitation process.
The study reveled that healthcare providers are concerned that the resuscitation procedures would upset family members that the staff would experience increased emotional stress that family members would be interruptive, that presence of family members would meddle with treatment and that members of the family wouldn’t be prepared to tackle a resuscitation situation. Through using the family presence protocol created by the emergency nurses association, a study carried by Meyers (2000) revealed that healthcare providers feel that witnessed resuscitation is beneficial because it helps to meet the spiritual and emotional needs of the patients’ family empowers family members, assists the family to get an understanding of the condition of the patient.
Additionally, presence of family members gives healthcare providers to a chance to educate the family and this has the probability of decreasing litigation. Presence of family members also allows the family to help both the staff and the patient and makes healthcare providers to be highly considerate of the privacy and dignity of the patient, and the need for management of pain (Clark, 2005).
Potential benefits of witnessed resuscitation
When a patient wakes up after a successful resuscitation and finds a close family member by his side he feels comfortable by realizing the presence of a loved family member. In addition, hearing is the last sense to die away, and several seemingly unconscious patients might have some consciousness of their surroundings. Conscious of their family’s presence and hearing their loving and encouraging words, patients might get themselves the strength to carry on with life or take more comfort if they are dying. The presence and support of the family might assist the patient to feel less vulnerable and alone amid strangers. If the patient is dying, he might prefer to see his loved family members’ faces than those of the code team (MacLean, 2003).
Creation of awareness to the family members
MacLean (2003) argues that permitting family members to be present during resuscitation has some obvious gains for the relatives because this might be their last opportunity to see and good bye to the patient while he is still alive. And even though observing a failed resuscitation is an immensely traumatic incident for the family, viewing the extraordinary attempt put fort by code team makes the family to have a feeling that the health care professional did everything they did to save their love one (Halm, 2005).
According to Rattrie (2000), when family members are shut out of the resuscitation procedure can increase the family’s feelings of anxiety, panic, guilt and helplessness. But being g capable to take care for a loved family member during his last moment, even in minute ways, and to utter a work of good bye may lessen these feelings and assist the family via the grieving process. However the presence of a family increases the emotional vulnerability of the staff but this can be beneficial to the family. The code team might want to be strong for the sake of the family, but family members appear touched when nurses or physicians display their own grief over the death of the patient (Irving, 2002). Additionally, by being present, family members are educated on the condition of the patient and also help medical practitioners by offering information or functioning as spokespersons. Family presence during resuscitation also reminds physicians of the personhood of the patient, and this is thought to encourage greater proficient behavior at bedside (Clark, 2005).
Disadvantages of witnessed resuscitation
Distress of family members
There are potential drawbacks of family members being present, for example, the actuality of resuscitation might prove distressing, especially if the family members are not informed. However, family members should be given support. According to Rattrie (2000) it is relatively possible that the relatives might have been present during the early resuscitation, and in some cases, the first ones to start the procedure of cardiopulmonary resuscitation. Under these conditions, the resuscitation might be less shocking than earlier expected. Recent evidence proposes that it is highly distressing for family members to be separated from the patient during this vital moment than to witness trials at resuscitation. In response to a question whether legal risks increase if the family member views an error or misinterprets what he or she sees. Goldsworth (1998) proposes that someone who feels uninvolved or angry is more probably to sue for malpractice, imagined or real. Through staying with a relative supporting him and explaining what he sees, might in reality help minimize the legal hazards.
Increased law suits
The potentially long term mental anguish that families may suffer in response to seeing resuscitation has ethical, as well as legal implications. Things might go wrong during a medical procedure, and the presence of family members could simply increase the anxiety of the staff and worsen matters. Relatives could sue the facility or staff for negligence or for the shock caused by witnessing the resuscitation. Nevertheless, angry relatives who are excluded from a resuscitation effort are greatly likely to initiate a lawsuit and thus offering the right form of support might really lessen legal risks. Halm (2005) notes that witnessed resuscitation entail both relatives and patients and raises ethical and legal issues. Usually, the presence of family members during resuscitation is unlikely to result to lawsuits or complaints as a consequence of the bond created between the families and staff. The family members are able to see all that could be done for the patient was perfectly performed.
Breach of the patient’s right to confidentiality
According to Stewart and Bowker (1997), a patients’ permission is needed before any medical information is disclosed to the third party. This reassurance of confidentiality generates a bond of trust that encourages the patient to reveal personal information to the healthcare professionals. However, allowing family members to into the resuscitation area might be viewed as ignoring the right to confidentiality of the patient, and health care professionals who violate this confidentiality may get themselves a subject of disciplinary actions or probable litigation.
Stewart and Bowker(1997 ) argue that between a third and a quarter of patients don’t seem to want their family members engaged in decisions on whether resuscitation must be attempted and deem that it is not likely that these patients would want their family members to witness the real procedure. It has been disputed that confidentiality is violated when family members are informed that one of their members has been admitted to a hospital and is gravely sick. Nevertheless, when the patient is not able to communicate, family members might be important in offering extra medical information. Health care professional can not assume the unconscious patient would have approved the family members’ witnessing their treatment and the unconscious individual have the similar rights to confidentiality as a conscious patient. In addition, a patient may want his family members to recall him as he appeared when he was well and alive, other than during the final moments of resuscitation (Beauchamp 2001).
Hampered medical teams and negative impacts on the resuscitation team
Another reason offered for not permitting relatives to be present during resuscitation of their family member is the impact they have upon the resuscitation team. Health care professionals experience traumatic situations when a family member interferes with their resuscitation efforts. They also feel that they are prevented from proceeding with the resuscitation procedure effectively and this has detrimental effect on the patient. There is also the anxiety that staff discussions, comments and gestures made during the resuscitation process might seem inappropriate (Ellison, 2003). According to Rosenczweig (1998), numerous health care professionals are usually anxious and the presence of family members during the procedure might increase self consciousness of the staff as a result of public awareness and potential litigation that might occur when an error is witnessed.
According to Meyers (2000) resuscitation is a demanding clinical process and institutions that have tried to permit presence of relatives have at first encountered resistance from nurse and physicians. Several nurses fear that presence of relatives will cause more stress for them and family members. Even nurses who support offering family members an option might be unwilling to do so in practice.
Weighing the benefits and disadvantages of family presence during resuscitation
It is hard meet all needs of each person involved in the resuscitation effort. Overall, majority of those who have studied this matter deem that in spite of the potentially traumatizing and frightening aspects of a resuscitation attempt, family presence presents more benefits than drawbacks. Irving (2002) notes that the patient normally takes to priority, but within the broader view, the family is a portion of the patient. Real holistic care takes into consideration the patient and also his family during an incident as vital as resuscitation. Although the patient can not be consulted during resuscitation, he is more probably to feel comforted by hearing the voice of a close family member than that of medical staff shouting to one another over his bed (Irving, 2002).
Mangurten (2005) states that by being present, family members have a chance to say good bye to the patient and this reduces guilt, and anxiety, and also gets firsthand knowledge of the medical team’s effort resuscitate , and probably a greater straightforward process of grieving, and all these benefits outweigh the probable emotional trauma of the family. Because of limited space and the need of the staff for control and order in the resuscitation room, the number of relatives present is usually limited (Mangurten, 2005)
Since presence of family members during resuscitation has greater benefits than disadvantages, it should thus be encouraged in every health care setting and educational programs form the medical staff implemented to teach nurses the way to offer continuing support fro the family members, assisting them understand what processes they are witnessing and the way the patient is responding. Health facilities are supposed to commit to having trained nurses to take this position during resuscitation (Schwarz, 2000).
According to Bassler (1999), the support staff can inform family members of the patient’s appearance and the procedures to be performed on him and recognize the value of the helping or support role that the family members by asking them to talk to or touch the patient if appropriate. The also be trained on the way to offer psychological and emotional support to the family members and act as liaison with the family and medical support , which may involve advocacy for family presence (Bassler, 1999).
Witnessed resuscitation has both benefits and drawbacks. The presence of family members during resuscitation increases the comfort of the patient when he wakes up and finds his loved ones on the bed side. By being g present, relatives are able to observe, learn and understand every procedure that the patient is undergoing and they are also able to discover and endorse the efforts made by the medical staff in an attempt to save the life of the patient. However, witnessing resuscitation is emotionally traumatizing to family members and also interferes with the confidentiality of the patient when he reveals his personal information in presence of family members. Family presence during resuscitation also increases the emotional anxiety of the medical team and worsens this traumatic event.
Victoria University of Wellington, New Zealand. At their side: family-witnessed resuscitation,Irving, A, 2002,
; 314: 145.British Medical JournalStewart, K. & Bowker, L, 1997, Might lead to a complaint for breach of confidentiality (letter).
; 309: 406.British Medical JournalSchilling, J, 1994, No room for spectators (letter).
158: 5, 617-620.Canadian Medical Association Journal;Rosenczweig, C, 1998, Should relatives witness resuscitation? Ethical issues and practical considerations.
; 100, 32-43.American Journal of NursingMeyers, T., Eichhorn, D., Guzzetta, C. et al (2000) Family presence during invasive procedures and resuscitation.
; 14, 177-185.Critical Care Nursing Journal AmericaTucker, T, 2002, Family presence during resuscitation.
Oxford University Press New York. of Biomedical Ethics. PrinciplesBeauchamp T, 2001,
Halm, M, 2005, Family Presence During Resuscitation: A Critical Review of the Literature. American Journal of Critical Care. 2005; 14: 494-511
Stewart K & ,Bowker L (1997) Resuscitation witnessed by relatives. Might lead to a complaint of breach of confidentiality. British Medical Journal. Jan 11; 314:144
Goldsworth J (1998) Your patient is undergoing resuscitation: Where’s the family? Nursing 28: 53 (2)
Bradley, D, Melech, A, Lensky, C, et al Family Presence during resusctitation Retrieved on August 30, 2011 from <http://www.eperc.mcw.edu/fastFact/ff_232.htm>
MacLean, S., et al. 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.
14(24):32-35. Nursing Standard.Rattrie, E., 2000, «Witnessed Resuscitation: Good Practice or Not?»
>http://www.socialworkers.org/practice/behavioral_health/mbh0904, Retrieved on August 30, 2011 from <Family presence in resuscitative and treatment proceduresWalsh, K, 2004,
. 100(2):61-64. A Merican Journal of Nursing Schwarz J, 2000, Have we forgotten the patient?
14: 494-513.American Journal of Critical CareHalm, A, 2005, Family presence during resuscitation: a critical review of the literature.
29: 515-521.Journal of Emerging NursingEllison, S, 2003, Nurses’ attitudes toward family presence during resuscitative efforts and invasive procedures,
15(3): 126- 131.Journal of Nurses Staff DevelopmentBassler, C, 1999, The impact of education on nurses’ beliefs regarding family presence in a resusctitation room.
105(5): 40-48.American Journal of NursingMangurten, A, et al, 2005, Family presence: Making room.
. 17: 23-32.Crit Care Nurs Clin North AmClark, P, Guzzetta, E, Aldridge, D, et al, 2005, Family presence during cardiopulmonary resuscitation.
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