The Effects of Family Presence during Resuscitation in Adults
According to the Society of Critical Care Medicine (SCCM), over 5.7 million patients are admitted annually to the intensive care unit (SCCM, n.d. ). Despite these high numbers, clinicians continue to debate about family presence during cardiopulmonary resuscitation (CPR). On the mist of these crisis, family members may not want to abandon their loved ones. Some would argue that families have a right to choose and ease their anxiety. Family presence during resuscitation (FPDR) comes with multiple advantages. One of the advantage of FPDR is, giving the family an opportunity to morally support their loved ones (Leske, McAndrew, & Brazel, 2013). Another benefit of FPDR is being exposed of the resuscitation process, which may help family member process their loss post-death. Despite these advantages the controversies include, the fear of the invasive procedure traumatizing families. (Leske et al., 2013).
Providing Moral Support
During unexpected situations, some would argue that family members should have a right to choose whether to remain with their loved ones during CPR. While facing the fear of the unknown, being able to see the process and simultaneously provide moral support may give families and the patient hope. According to the qualitative experiment, families were grateful for the experience of being present during CPR, some participants expressed that they “wished they could get closer” (Leske et al., 2013).
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Including the client as an expert member of the team creates an enhanced quality of care (Coad, Patel & Murray, 2014). In pediatrics, parents are often at the center of the child’s care. When asked to define what made the client care experience positive, parents stated that sensitivity, empathy and honesty were key factors (Coad, Patel & Murray, 2014). Working in healthcare, nurses can become desensitized to difficult experiences because they deal with them daily. Integrating the client and family as part of the healthcare team, allows the nurse to see the patient and family as a people first. By avoiding using illness as context, and instead using person as context, care will be more holistic (Coad, Patel & Murray, 2014). A family-focused approach helps to ensure that the whole family feels a part of the experience and is valued. In the case of bereavement, family centered care is particularly important. If the family is not included in the care from the start, it can provide barriers for grieving and impact how the family deals with loss (Jones, Contro & Koch, 2014). Nurses have an opportunity to help support the family through the grief process (Jones, Contro & Koch, 2014). Families have a significant impact on how the client heals, so by caring for the family’s needs, the nurse is indirectly caring for the patient. It is in the client’s best interest for the care to be holistic for the patient as well as the family (Jones, Contro & Koch, 2014). All
Most cultures value life and bringing persons back from the dead is a popular subject of many fictional books. However, as technology evolves and the story of Frankenstein reborn with a bolt of lighting has come true with the external or implanted defibrillators, the natural process of death slows as much of society gains the knowledge to live longer than nature intended. The Red Cross Association taught many organizations like the girl and boy scouts the methods of mouth-to-mouth resuscitation and Cardiopulmonary resuscitation or CPR, a manual manipulation of the heart, as life saving methods for drowning, electrocution or heart attacks. First aid for laypersons to save lives as well as
This early attempt to allow family members into the resuscitation area was first introduced in the United States of America (USA) in 1987 and the introduction of this idea in A&E departments in the UK began in 1994 (Mahabir and Sammy 2012). In 1995 the RCN and the British Association for Accident and Emergency Medicine (BAEM) made recommendations that family witnessed resuscitation should be considered and supported by Hospital Trusts (RCN 2002). This was also supported by the Resuscitation Council (UK) guidelines published in 1996, which recommended that “family members should be given the opportunity to be present during CPR attempts and should also be given the appropriate support throughout the experience” (Monks and Flynn
For this study patient families were randomly assigned to the intervention or control group. In the control group the interactions between the family and ICU staff, including the end-of-life conference, occurred according to the usual practices and policies in the hospital; whereas in the intervention group, the research study was conducted according to specific guidelines. A bereavement information leaflet was given to each surrogate decision maker. In this research, the independent variable can be the type of family conference received by the surrogates and the dependent variables were the level of stress, anxiety, and depression levels indicated in the 90-day follow-up interview.
For an electronic search to be successful it is important to find the right key words or concepts required to retrieve the journal articles as journal articles are indexed and entered onto the databases using keywords (Aveyard, 2014). The keywords for this literature review derived from the research question and synonyms words (Schneider, Elliott, LoBiondo-Wood and Haber, 2004). The keywords identified and retrieved used a combination of the following keywords; CPR, cardiac arrest, cardiopulmonary resuscitat*, famil* and family carer*. The keywords 'family ', 'witnessed
The article goes on to address the importance of specifically designing practices related to family centered care in the pediatric setting. Four recommendations are set forth in this guideline: family visitation, family centered rounds, family presence during CPR and invasive procedures, and family conferences. Recurrent themes in these areas are listening to and respect the family. communication of information and answering questions, education, and collaboration in developing treatment. While most of the information in this article is focused on the parents and ill child, many of the suggestions are applicable and adaptable to siblings (Meert, Clark, & Eggly, 2013).
The beginning of life is celebrated. Books and resources are shared among friends and family in preparation for becoming a new parent. So, what happens as one approaches the end of life? Unfortunately, the same care and sharing rarely occurs in those circumstances and many face the prospect of dying unprepared. Though most people state they would prefer to die at home, this is often not where death occurs. Many Americans spend their last days attached to medical apparatus that keeps the body alive, but it does not allow for communication with family and often requires heavy sedation. Additionally, this level of treatment comes at a high price. As a society, we must become as comfortable in addressing the end of life process as we
DNACPR orders are of considerable concern to ambulance staff, the patient and their families in tackling requests at the end of life (NHS End Of Life Care Programme 2007). A study by Stone et al. (2009) showed nearly all participants had questioned whether interventions performed were correct for the patient when using cardiac life support on patients they thought were terminal. When a patient requires resuscitation and a DNACPR is in place immediate sharing of information is critical. At certain points in the patient care pathway incompatible systems may mean DNACPR requests are not being followed and inappropriate resuscitation being attempted.
An important aspect involved in critical appraisal of a study involves identifying and evaluating the study framework. This allows the reader to determine whether it is appropriate to apply the study findings to nursing practice. The author of this study identified the specific perspective from which the study was developed. More specifically, the author sought to provide insight into the phenomenon of lay presence during adult CPR specifically from the perspective of ambulance staff and
It is important to remember that care of the patient does not end when the patient dies. After the death there is still work to be done in the form of comforting the bereaved family members. It has been reported that some
According to Erlingsson and Brysiewicz (2015), family is considered a core, social institution and is our first interaction with human beings. When viewing the family as a context, the nurse assesses the patient that is in need of care while in the background, there are the family members of the patient. According to Kaakinen, Coehlo, Steel, Tabacco & Hanson (2015), the source of support to the patient is his or her family members. Usually family members are in attendance with the patient. This approach is used when a mother is admitted to the intensive care unit after falling and sustaining head trauma. The patient is the mother. The nurse is focused on the mother and care was directed
Most people believe that it is their right to be present during a loved-one’s resuscitation, should they so desire. Contrary to the fears of the medical community, family members who have been present during a resuscitation report that the experience was not traumatic for them and would in fact opt to witness it again. Also, being present seems to provide a sense of closure and security in knowing that everything possible was done to save their loved one’s life (Critchell et al 2007).
Elizabeth Kübler-Ross was a Swiss-born psychiatrist who spent two years of her professional career gathering information from terminally ill patients to create the premise for On Death and Dying. “It is not meant to be a textbook on how to manage dying patients, nor is it intended as a complete study of the psychology of dying.” (Kübler-Ross, 1969). This book was written as a call-to-action; to raise awareness of the voice of the dying. Not only is there stigma surrounding the topic, but also numerous misconceptions concerning the emotional journey of the terminally ill. The Kübler-Ross Model creates a framework for those interacting with dying persons, to help caretakers better understand the transitions that are taking place, resulting in higher-quality care. This model is comprised of five stages, which can be experienced in a variety of combinations. Prior to the first stage, the patient must be delivered the news of their illness or the severity of their illness, which usually results in shock. Denial is the first stage noted by Kübler-Ross. Denial and isolation are normal responses to overwhelming emotions and serve as a temporary response until the individual is ready to accept reality. Although this defense mechanism is normative, it is important to note that it isn’t necessarily healthy, and that some never move past this stage. As reality sets in, pain beings to emerge and manifests itself in the next stage: anger. Rationality takes a
Data was collected over two years in a level one trauma center with trauma patients that had one family member present and were admitted to the surgical intensive care unit after resuscitation. The family member was interviewed two days later for an average of ten to thirty minutes in a quiet room away from the patient. The sample size of the study was twenty eight and the majority of the sample was female. The results showed that the majority of family members that were present felt that there role was to be supportive and protect the patient during the trauma. They felt that being present was comforting to them and the patient, regardless of the outcome. Another common theme was that the family felt comforted knowing that everything possible was done for their family member.
A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.