NEW YORK NURSE: October 2012
by Dr. Christopher David Kowal, BS, MSN-MOL-Ed, DNP, RN, CCRN-CMC-CSC, St. Joseph’s Hospital Health Center, Syracuse, NY
Do family members have a right to watch during resuscitation?
Your patient is dying. It is an emergency situation. Emotions are heightened. Voices are raised. It feels like chaos — sometimes controlled; sometimes wild. You feel like you are dying with your patient because there are too many people in the room. Suddenly, out of the corner of your eye you notice an elderly gentleman being escorted by your co-worker toward the doorway of your room. Someone is explaining the situation to him. He is visibly distraught, but appears coherent and understanding of what is being told to him. Simultaneously, you notice the mood of the situation calm down. There is no more yelling. A teamwork attitude has developed over the patient’s bed. Soon after the physician in attendance has spoken to the man whom you have correctly identified as your female patient’s spouse, he calmly asks the team to stop resuscitation efforts and allow the family member to have a moment with his wife.
This scenario, which may or may not happen in your hospital setting, is known as Family Presence During Resuscitation (FPDR) and although many nurses and healthcare workers may argue the merits of the risks and benefits of implementing such a concept, the jury is still out in many other healthcare organizations. Nurse research scholars argue that there are too few reliable and valid tools with which to measure nurses’ perception of FPDR events, according to key variables and indicators (Twibell, Siela, Riwitis, Wheatley, Riegle, Bousman, et al., 2008). Others, including frontline staff, proclaim that the outcomes of allowing FPDR definitely outweigh the risks (Kingsnorth, O’Connell, Guzzetta, Edens, Atabaki, Mecherikunnel, et al., 2010).
It has been found that FPDR can be implemented as a standard of care in many hospital settings, whether in the emergency department or critical care units, or anywhere in a healthcare setting without interrupting patient care (Kingsnorth et al., 2010). Some organizations utilize a family facilitator and others ensure that staff is respectful enough to explain the resuscitation process to families as it unfolds (Kingsnorth et al., 2010; Twibell et al., 2008). Staff has been noted to positively perceive that families are more understanding of the seriousness of their loved one’s condition and they are able to grieve more adaptably because they are “part of” the event (Kingsnorth et al., 2010; Twibell et al., 2008). Conversely, the literature suggests that the greatest challenges to this new concept are that families will become more anxious, less understanding, and disruptive to the process, while healthcare staff may feel less than proficient in their care delivery under the family’s watchful eyes (Fernandes, Compton, Jones, & Velilla, 2009; Kingsnorth et al., 2010; McClement, Fallis, & Pereira, 2009; Twibell et al., 2008).
Whether or not you agree that FPDR is a beneficial or risky practice, the underlying theme of relationships should be considered. Families have the right to know the status of their loved one in real-time; not after-the-fact. Our duty as healthcare providers is to not only deliver quality care to the patient, but maintain a seamless relationship with their significant others to ensure that the integrity of the patient, care treatment and situation are preserved in a respectful and judicious manner. Integrating loved ones into the process of resuscitation, life, and death might be an option that promotes relationship satisfaction within your customer base and increases stability and optimal outcomes in the care delivery process.
Fernandes, R., Compton, S., Jones, K., & Velilla, M. A. (2009). The presence of a family witness impacts physician performance during simulated medical codes. Critical Care Medicine, 37(6), 1956-1960.
Kingsnorth, J., O’Connell, K., Guzzetta, C. E., Edens, J. C., Atabaki, S., Mecherikunnel, A., & Brown, K. (2010). Family presence during trauma activations and medical resuscitations in a pediatric emergency department: An evidence-based practice project. Journal of Emergency Nursing, 36(2), 115-121.
McClement, S. E., Fallis, W. M., Pereira, A. (2009). Family presence during resuscitation: Canadian critical care nurses’ perspectives. Journal of Nursing Scholarship, 41(3), 233-240.
Twibell, R. S., Siela, D., Riwitis, C., Wheatley, J., Riegle, T., Bousman, D., Cable, S…Neal, A. (2008). Nurses’ perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. American Journal of Critical Care, 17(2), 101-111.