Term Paper on "CPR Procedures and Family Presence"

Term Paper 10 pages (2604 words) Sources: 5 Style: APA

[EXCERPT] . . . .

Problem Statement

Recent trends in intensive care have lead to a change in the way that

medical personnel see the presence of family members during episodes of

medical treatment, even in crisis and intervention settings. Family

members are often considered to be extraneous elements in the medical care

settings. Now, family members are seen more as important parts of the care

of the patient in all settings - and by this we mean taking part in the

patient's diagnosis, treatment, recovery and in some cases even the

patient's death, as an active or passive process. In this case, it must be

considered whether the typical past practice of having family members leave

the room in a situation where intervention or resuscitation are being

administered is being rethought. Should families be allowed the option to

stay in the room when resuscitation is being provided for loved ones? What

will the presence of family members in the room during therapeutic

intervention do to change the outcomes? Will it make any effect on the

process? How will the presence of family members affect the staff members?

Are there any legal ramifications? Do family members in the room improve

or impair the resuscitative attempts?

Related Research and Literature Review

Allowing family members to stay in the room during resuscitation processes

began in the early 1980s. Foote Hospital in Jackson, Michigan was the

first to study the option. The family members of 18 patients who had died

in the emergency department had been asked if they would have chosen to be

present in the room while resuscitative measures were taken, had that been

given as an option. For many years, the staff had considered what the

ethical and emotional considerations surrounding removing family members

would be, and decided ask the question (Hansen & Strawser, 1992). When

seventy-two percent of the families questioned reported they would like to

be present in the room, the hospital created a program in which families

would be given this choice and then followed the outcomes. Thirty separate

events were evaluated and the findings indicated that that the presence of

family members in the room tended to be associated with more positive

outcomes and appeared to cause no interruption in the critical care of the

patient.

The project at Foote Hospital was of interest to several organizations,

most proactive of which was the Emergency Nurses Association (ENA). In

1993, the ENA supported the concept of encouraging all health care

professionals to offer families the option of being present during

cardiopulmonary resuscitation (CPR). The ENA were active in developing

guidelines in the development of policy and procedure surrounding the

process. The ENA even provided educational booklets for family. Studies of

the pros and cons for the process have been ongoing over the last twenty

years. A study reported in the European Journal of Cardiovascular Nursing

(2005) reviewed positive and negative experiences, attempting to establish

a reason for the differences. This was done via a literature review. In

this study, most patients and relatives who had been present during CPR

administration has reported that the presence of the family has been a

positive experience for them, reporting increased feelings of support and

connectedness between family members, the patient and the care team. It

appeared that in this study, being present was helpful in the grieving

process. It is interesting to note that in this study, staff members who

were polled felt the presence of family members in the room during CPR

caused an increased degree of psychological stress for the family, to be

dealt with on top of the grief and loss they had to feel. The first formal

research study was done by Meyers et al (1998) in which the responses of

family members were evaluated. Via a retrospective telephone survey, the

families of patients who had died secondary to traumatic injury and treated

at a hospital in Dallas were queried as to whether they had any beliefs,

desires or concerns regarding the presence of family members in the room

when CPR was being administered. Of the 25 families who responded to the

survey, eighty percent of the families said they would have wanted to be in

the room, ninety-six percent reported that they felt it was their right to

be present. Another sixty-eight percent of the family members that

responded to the survey reported they felt their presence would have been

helpful to the family member and sixty four percent of participants felt

their presence in the room would have been useful in dealing with grief.

Concerns reported from families mostly surrounded the significance or

seriousness of the patient's condition, and whether the patient would

survive the resuscitative efforts. Ultimately, though a small study, the

results were primarily supportive of at least providing family members with

the option to be present during the administration of CPR.

Arguments against the practice include the fact that there is not enough

research to support this change in practice. Most studies only evaluate

very small numbers of patients and are based on retrospective survey. It

is also feared that family members in the room increases the chance that

their will be malpractice suits. Some healthcare providers feel the

presence of the family will make the providers nervous. There has also not

been a large study on the psychosocial impact on the family of witnessed

arrest intervention. There is also concern that the presence of family

members in the room violates a patient's right to privacy and usually

surrounds the care of unconscious patients.

Even before the changes at Foote Hospital, it has longer been the practice

in the pediatric community to allow family members to be present during

resuscitative events. Many family members and staff feel more comfortable

if, during the resuscitative event, it were possible for as escort to be

present (Grice, Picton & Deacon, 1993). The escort is used to explain the

process, prevent interference in the process on the part of the family and

to provide emotional support. .

The opinions and feelings of staff are also to be considered in this

situation. (Redily & Hood, 1998). A study from Australia reviewed the

experiences of staff in this situation. In general, healthcare staff was

supportive of the concept of family presence in the room during

resuscitation, and saw it as an opportunity for the family to help the

loved one die with dignity and surrounded by familiar faces. While

advocates believe the process quite helpful, the low survival rates that

follow CPR sometimes make health care providers uncomfortable. A study by

Helmer, et al, evaluated the members of the American Association for the

Surgery of Trauma (AAST) about how they felt about the patients' family

members being present. More AAST members reported belief that the presence

of family members in the room during all phases of resuscitation and

invasive procedure was inappropriate. This number was greater than a

similar number of members of ENA who has also been polled. Primary

reasons for not wanting family members in the room were the beliefs that

family presence interfered with patient care and significantly increased

patient stress. Another survey done of attendant at the American College

of Chest Physicians in 2000 (McClennathen, Torrington, Uryhara, 2000)

reported that nurses were more likely to encourage family member presence

in resuscitative situations than their physician colleagues.

Healthcare providers also expressed concern regarding physical assault from

family members if outcomes were negative. There were also fears about

liability and litigation, or a feeling of loss of control over the code

situation. Families and healthcare providers both expressed concern that

the presence of the family in the room may result in prolonged and

ultimately futile resuscitative efforts since the team may be less likely

to suspend a code they felt futile in the presence of family members. For

this reason, the main focus of this research study will surround a

relatively under evaluated element of the question, and the examination of

issues of concern to intensivists, emergency room and critical care

workers, those who are most likely to be involved in the administration of

CPR with family present.

Objectives

Since the mid-1990s, the exclusion of family members from the resuscitation

room has become less likely and medical settings in which resuscitative

care may be administered. Because of this, more emergency departments and

intensive care units have developed guidelines for family presence in

resuscitation. While public support for this process is strong, little is

known about the support of this process by staff members. Over 100,000

resuscitation attempts occur in this country every year. For the purpose

of our study we will interview patients, family members, and staff members

to evaluate their feelings surround witnessed resuscitation events.

Research Procedure Methods

An emergency department is a difficult place to administer a survey, and

follow-up may be difficult for reasons of patient confidentiality. For

this reason, this study will be conducted primarily on the patients and

staff of an intensive care unit at a local multi-specialty teaching

hospital in a large metropolitan city.… READ MORE

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