Emergency & Trauma Nursing: Family Resuscitation

Introduction

Research shows that family presence during resuscitation is viewed differently by different healthcare professionals. Physicians, especially interns and residents, are generally less enthusiastic about family presence during resuscitation than are other medical professionals (Mitchell & Lynch, 1997). The same is true for nurses. Some nurses view family presence during resuscitation positively, while other nurses have more negative opinions. There are three main reasons why some healthcare professionals are reluctant to include patients’ families during resuscitations. First and foremost, these healthcare professionals feel that resuscitation is an unpleasant experience that family members should not be allowed to witness. Second, healthcare professionals argue that the medical team in charge of the resuscitation may not perform well in the presence of the patient’s family. Lastly, healthcare professionals argue that the anxiety of the patient’s family may disrupt the resuscitation efforts of the medical team (Twibell et al., 2008). On the other end of the resuscitation debate, people who support family presence argue that such presence is beneficial not only to the healthcare professionals but also to the family.

Family members who witness the resuscitation get to understand the gravity of the patient’s condition. They also get to see and appreciate the efforts made by the resuscitation team. Thus, complaints of inadequate care from the family members are reduced significantly. Family members also get to receive news about the ill member relatively faster than would have been the case if they were not present. Most importantly, in the case of the death of the patient, family members get a chance to say their goodbyes, which in turn makes it easy for them to go through the grieving process. Because of all these benefits of family presence, nurses, in general, feel more comfortable when family members are present during the resuscitation of their loved ones. The issue of family presence during resuscitation and its effect on nurses’ comfort level is important not only to the families concerned but also to nurses (Henderson & Knapp, 2006).

Literature Review

Several research studies have been carried out to examine the effects of family presence during resuscitation on patients, family members, and healthcare professionals. These studies have mixed results. Demir (2008) conducted a study to examine the opinions of nurses about family presence during resuscitation. The respondents included the opinions of 82 nurses working in emergency, cardiology, and anesthesia departments. Out of the 82 nurses, Demir (2008) found that 82.6% thought it was not appropriate for family members to be present during resuscitation. The reasons given for this outcome include the possibility of family’s interference with the medical team’s performance; the trauma associated with the procedure; the possibility of family members becoming ill or faint during the procedure forcing the medical team to divert its attention; and increased pressure on the nurses which in turn may negatively affect their performance on the procedure. Thus, the results of this study imply that majority of nurses are not comfortable with the presence of family members during resuscitation. The outcomes of the study by Demir (2008) contrast sharply with the study conducted by Meyers et al. (2004).

Meyers et al. (2004) conducted their study using sixty registered nurses. The study aimed to determine if family presence during resuscitation was comforting to the patient and if it is uncomfortable for the nurses and other healthcare providers. Meyers et al. (2004) found that registered nurses (96%) in general have more positive attitudes towards family presence during resuscitation than other healthcare providers (79% for physicians and 19% for residents). In the case of family members, “one hundred percent of those interviewed believed it was their right to be present during resuscitation,” (Meyers et al., 2004, p. 68). They also felt that patients needed their presence and that their presence was comforting to them. The positive attitude of nurses was based on several reasons. Nurses felt that family presence allowed the family members of the patient to see for themselves and know the efforts the resuscitation team made thereby reducing the uncertainty and anxiety both for the family and the nurses. Nurses thus experience a higher comfort level when families are present during resuscitation than when they are absent. The positive relationship between nurses’ comfort level and family presence during resuscitation found by Meyers et al. (2004) supports other studies.

Ellison (2003), for instance, argued that nurses who have had a previous encounter with family presence during resuscitation are more likely to have a feeling of personhood about the patient and to view him/her as part of a family. These attitudes encourage closure between the nurses and the patient’s families through open communication and promote a more professional behavior on the part of the nurses. Nurses who support family presence also argue that family members may offer assistance during the procedure which in turn encouraged them to make rational end-of-life decisions. All these benefits enhance the comfort level of nurses during resuscitations.

On the same note, Fisher et al. (2008) found that majority of the nurses in their study engaged in behaviors that supported family presence during resuscitation. These behaviors encompassed open communication with the family members, educating them, involving them in the procedures of care of the patient, and providing them with psychosocial support. These behaviors enhanced the relationship between the nurses and the family members which in turn increased the nurses’ comfort levels during the resuscitation procedure. This finding supports the study by Fulbrook et al. (2005) and MacLean et al. (2003) who argued that family presence during resuscitation is advantageous not only to the family members and the patient but also to the nurses and other healthcare providers involved.

Family Witnessed Resuscitation in Australia

The issue of family witnessed resuscitation has a shorter history in Australia as compared to the United States and the United Kingdom. As a result, few research studies have been conducted in Australia. The initial documented study was conducted by Redley and Hood in 1996 who acknowledge that the issue of FWR is a controversial subject that has gained the attention of the healthcare system in the recent past. The researchers argued that permitting family members to be present during the last moments of their loved one could help the family in the grieving process. The study was conducted to determine the attitude towards family presence among emergency personnel based in six Melbourne hospitals. The researchers found that general health care personnel in Australia have positive attitudes towards FWR and are more than willing to allow family members to witness the resuscitation efforts of their loved ones. Following the study by Redley and Hood (1996) other studies examining FWR in Australia were conducted almost a decade later.

Redley et al. (2004) conducted a literature review to distinguish between evidence and opinion surrounding FWR. The study was based on the fact that a good number of clinical staff are reluctant to allow family members to witness the resuscitation of their loved one despite the propositions given by international healthcare organizations. The literature was reviewed to determine the needs of patients and their families, the consequences of FWR on patients and families, the opinions of healthcare professionals, and the practices of FWR. The results of Redley et al.’s study indicate that allowing family members to be present during the resuscitation of their loved one is both crucial and advantageous to family members. Nevertheless, Redley et al. (2004) found that healthcare professionals have differing opinions towards family witnessed resuscitation thus acting as a major barrier to the practice. The researchers admit that the study is limited in that it lacks rigor but they suggest that the findings can be used as a platform for conducting future studies that examine the effects of FWR on patients, family members, and healthcare professionals.

Two years after the study by Redley et al. (2004), Holzhauser et al. (2006) conducted a 3-year controlled trial study to establish the effects of FWR on the patient’s family members. The study was undertaken in the Princess Alexandra Hospital’s emergency department in Queensland. Participants of the study were selected through a random sampling technique and were assigned to either the control or experimental group. The researchers found that all the participants who chose to be present during the resuscitation were happy to have been present. Open communication between the participants and the staff was also reported in the study. However, the mode of communication between the two groups was different. In the control group, the participants were informed about the situation when they arrived at the setting but the explanation of the condition was given at the end of the resuscitation. In the experimental group, communication between participants and staff was an ongoing process with the staff encouraging the participants to ask questions as the resuscitation went on. Thus, the level of support given to the participants in the experimental group was higher than in the control. This could explain the difference in the attitudes towards the experience between the participants in the two groups. At the end of the experiment, 96% of participants in the experimental group felt that their presence enabled them to make sense of and accept the patient’s situation while only 71.2% of participants in the control felt the same. In general, the study supports the assertion that family presence during resuscitation is more beneficial than harmful to family members.

Other studies that have recently been conducted in Australia include the study by Chan (2009) and Maxton (2008). These studies help to narrow the literature gap that exists on FWR in Australia. Chan (2009) conducted his study in two Western Australian emergency departments. To be specific, Chan wanted to find out the attitudes of Australian nurses towards FWR using a self-administered open-ended questionnaire. The researcher used a sample of 232 nurses. Out of the participants, 54% said that they were aware of the need for family members to stay with their loved ones during a resuscitation procedure. A further 43% indicated that they had been requested by the family members of their patient to be present during a resuscitation procedure. Upon such a request, 21% of the nurses said that they felt nervous about allowing FWR because their performance would be judged by the family members. 10% of the nurses said that they felt like they were in a quagmire while a further 43% indicated that they offered support to the family members when they requested to be present during resuscitation. A good number of the nurses felt they were worried about the family members’ inability to bear with the upsetting scenes of the resuscitation procedure. It is important to note that neither of the two facilities involved in this study had a formal policy that permits family presence during resuscitation. This fact could be a major factor influencing nurses’ attitudes towards FWR.

Maxton (2008) conducted a study to examine the perception of parents towards their presence or absence during the resuscitation of their children. The study used a sample of fourteen parents whose children were critically ill and admitted to an intensive care unit in Australia. Some of the children had survived and others had died after the resuscitation efforts. Maxton (2008) identified four major themes from his study namely: “being only for a child, making sense of a living nightmare, maintaining hope in the face of reality, and living in a relationship with staff,” (pp. 3170-3172). The researcher found that parents generally need to witness the resuscitation of their critically ill child to decipher the situation. Unlike the study by Chan (2009) which discovered that nurses were generally worried about the reaction of family members to the distressing scenes of the resuscitation, Maxton (2008) found that family members (in this case parents) were more distressed by the possibility of the patient’s death than the scenes.

Maxton (2008) also found that parents who were present during the resuscitation efforts were less distressed than those who chose to be absent. In addition, it was discovered that memories of the resuscitation were temporary and that nurses provided the greatest support to the family members witnessing the resuscitation of their loved ones. These findings offer support to the findings of the studies discussed earlier. The positive outcome of the family witnessed resuscitation particularly on the family members could be as a result of the social support they receive from the healthcare professionals, the opportunity to bid their loved one goodbye in case of death, and the opportunity to witness firsthand the efforts made on their loved one hence lack of lingering doubts as to what could have been done by the medical team to save the patient.

Summary of the Family Witnessed Resuscitation Debate

The Pros of Family Witnessed Resuscitation

The literature review has indicated that witnessed family resuscitation has many benefits. First and foremost, it strengthens the bond between the patients, their families, and healthcare professionals. Family members feel as if their presence offers support and is comforting to the patient. Healthcare professionals, particularly nurses, feel as if involving the family enables them to understand what is going on with the patient particularly if the nurses are there with them throughout the entire process. In case of death, the presence of family members during the resuscitation allows them to say their final goodbyes which in turn facilitates their grieving process. Most importantly, family members who are present during the resuscitation of their loved one can witness the efforts the medical team made towards the survival of the patient. This eliminates doubts about the competence of the medical team (Chan, 2009).

The Cons of Family Witnessed Resuscitation

Arguments made against FWR mainly center on the negative impact of the distressing scenes of the resuscitation procedure. Secondly, it has been argued that having family present during resuscitation can hinder the effective performance of the medical team. While these disadvantages hold, they can be reduced or eliminated by the giving of social support to the present family members by the nurses. Because of their accessibility and availability, nurses are best suited to offer support to the family members by openly communicating with them and explaining to them about the situation or what is happening to the patient throughout the resuscitation procedure. This reduces the anxiety of the family members and helps them to make the best decision for their critically ill loved one (Sheldon, 2009).

Conclusion

The family literature witnessed resuscitation in Australia is severely limited as compared to other countries such as the United States and Britain. However, various research studies have been conducted in the recent past to study this important phenomenon. Irrespective of the country under investigation, the studies reviewed in this paper show that the merits of family witnessed resuscitation far outweigh the demerits. Nevertheless, obstacles to this practice remain and revolve around the attitudes of healthcare professionals. The establishment of an evidence-based guideline could help reduce these barriers and enhance the positive outcomes of family witnessed resuscitation.

Reference List

Chan, C., 2009. Nurses’ attitudes towards family witnessed resuscitation in Western Australian emergency departments. Curtin: Curtin University of Technology.

Demir, F., 2008. Presence of patients’ families during cardiopulmonary resuscitation: physicians’ and nurses’ opinions. Journal of Advanced Nursing, 63(4), pp.409-416.

Ellison, S., 2003. Nurses’ attitudes toward family presence during resuscitative efforts and invasive procedures. Journal of Emergency Nursing, 29(6), pp.587-594.

Fisher, D. et al., 2008. Nursing staff attitudes and behaviors regarding family presence in the hospital setting. Journal of Advanced Nursing, 64(6), pp.615-624.

Fulbrook, P. Albarran, J. & Latour, J., 2005. A European survey of critical care nurses’ attitudes and experiences of having family members present during cardiopulmonary resuscitation. International Journal of Nursing Studies, 42, pp.557-568.

Henderson, D. & Knapp, J., 2006. Report of the National Consensus Conference on Family Presence during Pediatric Resuscitation and Procedures. Journal of Emergency Nursing, 32, pp.23-29.

Holzhauser, K. Finucane, J. & Vries, S., 2006. Family presence during resuscitation: A randomized controlled trial of the impact of family presence. Australasian Emergency Nursing Journal, 8(4), pp.139-147.

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, pp.246–256.

Maxton, F., 2008. Parental presence during resuscitation in the PICU: the parents’ experience. Journal of Clinical Nursing, 17, pp.3168-3176.

Meyers, T. et al., 2004. Family presence during invasive procedures and resuscitation: The experience of family members, nurses, and physicians. Topics in Emergency Medicine, 26(1), pp.61-73.

Mitchell, M. & Lynch, M., 1997. Should relatives be allowed in the resuscitation room? Journal of Accident and Emergency Medicine, 14(6), pp.366-369.

Redley, B. Botti, M. & Duke, M., 2004. Family member presence during resuscitation in the emergency department: An Australian perspective. Emergency Medicine Australasia, 16(4), pp.295-308.

Redley, B. & Hood, K., 1996. Staff attitudes towards family presence during resuscitation. Accident and Emergency Nursing, 4(3), pp.145-151.

Sheldon, L., 2009. Communication for Nurses: Talking with patients. London: Jones & Bartlett Publisher.

Twibell, R. et al. 2008. Nurses’ perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. American Journal of Critical Care, 17(2), pp.101-111.