Discuss about the Involvement of Family Members in Resuscitation of Their Loved Ones.
This research is a literature review study that focusses on analysing The National Centre for Biotechnology Information the existing research findings on the approaches used by nurses to deal with family members during the resuscitation of a loved one. The nursing profession has nursing theories and models that define the process and steps that practitioners need to take to address the issues that revolve around families and their loved ones (Polit & Beck 2010, p. 12). This study utilised research finding from The National Centre for Biotechnology Information being one of the websites that advances science and health by providing access to biomedical and genomic information. The resource has several journals that deal with different topics captured within it. Key words for the research were role of family in resuscitation and acute care settings, ways of involving family in resuscitation, nurse approaches in resuscitation and lastly, resuscitation strategies in Australia. The findings from this journals highlight empirical evidence gathered on the trends that nurses have adopted when dealing with the issue of family members during critical situations of their loved ones. The articles for the study were carefully chosen to ensure that they capture the required information on the family member involvement in resuscitation process.
Research studies of involvement of family members during resuscitation
Resuscitation is the process of correcting physiological disorders in acute patients in intensive care unit. Such patients rely more on life support since some of them cannot manage simple life necessities on their own. According to Balaban (2000, p. 196) the role of family ones and their presence during such situations has been debated several times by scholars and professionals. However, most literature points on the need to involve loved ones. Goldberger, et al. (2015, p. 229) study indicators that there is no major difference in involving family members or not in clinical in resuscitation of their loved ones. In a study that involved analysis of the National Registry of Cardiopulmonary Resuscitation where patients eighteen years or older with cardiac arrests were analysed, through determining whether the hospital had a documented policy on family presence during the process. Through evaluation of the primary and secondary outcomes of the research, the direct impact of involvement of family members in the process was analysed. The direct impact of the process was examined to determine how it leads to achievement of quality of care. The three outcomes of quality of resuscitation, aggressiveness of the process and self-reported potential system errors during the process. The sample of this study entailed 41, 568 patients in 252 hospitals where 13, 470 patients in 80 facilities were in hospitals with family involvement policy (Goldberger, et al. 2015, p. 332). The study reported differences in adoption of family inclusion policies but the results showed that there is no significant difference in hospitals with the policy and those without the policy.
Lederman & Oren Wacht (2014, p. 72-85) study on the presence of family members during resuscitation at Yale-New Haven hospital focused on the role of family members in the care of patients. The researchers wanted to understand the attitudes that the emergency department staff had had towards the presence of family members. The study entailed 100 healthcare professionals. Through a list of four open-ended qualitative research questions, the researchers gathers appropriate data for the study which indicated that seventy-seven percent of the staff members favored and were comfortable with family members being present during the process (Lederman & Oren Wacht 2014, p. 79). This study therefore concluded that there should e protocols and proper policies that are put in place to define the role that family members can play during critical moments of their love ones. However, the findings from the hospital indicate that the staff had more tolerance to family involvement as compared to other hospitals which may have favored the results. This study is complemented by Basol, et al. (2009, p. 240) who reported that drafting of proper protocols in the process of family involvement can yield positive results that lead to healing and increased results. However, Hanson & Strawser (2002, p. 105) adds that the policy or strategy should be individualised to every facility rather than generalised. This means that each healthcare system needs to develop their own resuscitation family involvement policies.
Oczkowski, et al. (2015, p. 1-11) did a meta-analysis of the presence of family members during resuscitation of their loved ones. The authors suggest that different views have been proposed on whether family memers would be present during intensive care treatment of their loved ones. According to Oczkowski, et al. (2015, p. 3) family members participation exposes them to high cases of psychological harm when they see what their loved ones go through. These study reported that family presence does not affect adult resuscitation outcomes and leads to improved psychological outcomes of both the family member and the patient. Dudley, et al. (2009, p. 781), suggests that there is little evidence indicating the effects that the presence of family members has on the outcome of the patient. However, little evidence was reported pointing to the effects that family members may have on patient outcome. However, the findings of this study cannot be generalised to other situations and hospitals since the trials only worked in one setting. The findings complement the results of Lederman & Oren Wacht (2014, p. 70) which indicated that the application of family presence policies should allow facilities to design their own mechanisms on how they can involve patients in resuscitation situations.
From a research done by Brasel, et al. (2017, p. 1438–1443) indicated that the importance of family members presence outweighs the harms that the family members can cause for the process. Here they argue that there are situations when patients fail to make their opinion due to the condition that they are facing thus allowing the family members can improve quality of decisions or opinions that the patient makes. Further, the study reported that patients are assured of their safety and increased comfort since their family members can assist in making any other decision. The psychological benefit of the presence include reduced grief and early acceptance of family members if the patient dies. Jabre, et al. (2014, p. 985) study indicators that inclusion of family members reduces PTSD syndromes due to the psychological effects of not witnessing resuscitation of their loved ones. However, Brasel, et al. (2017, p. 141) finishes by indicating that there ois need to document proper policies and ensure that health practitioners like nurses accompany family members to give them any support that they require during the process.
Lastly, Masa’Deh, et al. (2014, p. 72-85) study on family stressors and needs during resuscitation indicators that some facilities push out family members during the process despite the increase presence of literature indicating the importance of involving family members. However, opinions on family presence during resuscitation vary across cultural beliefs that people have. This study was conducted in six hospitals involving families with the experience of being present during resuscitation of relatives. From the study Masa’Deh, et al. (2014, p. 84) reported that family members had three needs: need for reassurance, need for proximity and need for support. The need for update on patient status was the most that patients had which indicators that the presence if family members during the process can reduce the psychological burden that family members suffer from. This study concluded that involvement of family members offers most benefits that allow them to stay updated of the status of their loved one thus reducing the burden of psychological trauma and PTSD.
The presence of family members during resuscitation offers benefits to both the patient and the family members. Although some studies have suggested that presence of family members delays the process and leads to psychological harm to the patient, the studies above indicate that indeed the presence of family members creates better conditions for both the patient and the family members. Facilities need to develop policies that determine the way family members need to be involved in the process to increase the psychological benefits of the process. Facilities that have established proper policies and offer support to family members report increased outcomes and reduced psychological effects to family members like PTSD.
Balaban, R. B. 2000 A Physician's Guide to Talking About End-of-Life Care. Journal of General Medicine, 15(3), pp. 195-200.
Basol, R., Ohman, K., Simones, J. & Skillings, K., 2009 Using research to determine support for a policy on family presence during resuscitation. Dimensions in Critical Care Nursing, 28(5), pp. 237-247.
Brasel, K., Entwistle, J. & Sade, R. M., 2017 Should Family Presence Be Allowed During Cardiopulmonary Resuscitation?. Annual Thorac Surgery, 102(5), p. 1438–1443.
Dudley, N. C. Hansen, K.W. Furnival, R.A. Donaldson, A.E. Van-Wagenen, K. L. 2009 The effect of family presence on the efficiency of paediatric trauma resuscitations. Annals of Emergency Medicine, 53(6), pp. 777-784.
Goldberger, Z. D. Nallamothu, B. K. Graham, N Chan, P. S. Curtis, R. Cooke, C.R. 2015 Family presence during resuscitation and patterns of care during in-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes, 8(3), p. 226–234.
Hanson, C. & Strawser, D. 2002 Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department's nine-year perspective. Journal of Emergency Care, 18(2), pp. 104-106.
Jabre, P. Tazarourte, K. Azoulay, E. Borron, S.W. Belpomme, V. Jacob, L. Bertrand, L. Lapostolle, F. Combes, X. M., Galinski. Pinaud, V. C., Destefano. Normand, D. Beltramini, A.; Assez, N. Vivien, B. Vicaut, E. Adnet, F.2014. Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment. Intensive Care Medicine, 40(7), pp. 981-987.
Lederman, Z. & Oren Wacht, 2014 Family Presence During Resuscitation: Attitudes of Yale-New Haven Hospital Staff. Yale Journal of Biology and Medicine, 87(1), pp. 63-72.
Masa’Deh, R. Saifan, A. Timmons, S. & Nairn, S. 2014 Families’ Stressors and Needs at Time of Cardio-Pulmonary Resuscitation: A Jordanian Perspective. Global Journal of Health Science, 6(2), pp. 72-85.
Oczkowski, S. J. Mazzetti, I. Cupido, C. & Fox-Robichaud, A. E. 2015 The offering of family presence during resuscitation: a systematic review and meta-analysis. Journal of Intensive Care, 3(41), pp. 1-11.
Polit, D. & Beck, C. 2010 Essentials of Nursing Research: Appraising Evidence for Nursing Practice. 7th ed. China: Lippincott Williams & Wilkins.