Evaluation of the debate on Witnessed Resuscitation

Introduction

The presence of family members during the resuscitation of their loved one is a controversial issue and a relatively new concept in Europe. Traditionally, families have been excluded from witnessing resuscitation efforts because access to the resuscitation room is redundant of the emergency team, and support for family witnessed resuscitation has not been universally accepted among the health care profession. Recently, whilst it is not yet widespread, the practice is becoming increasingly more established. The decision to bring a family member to the bedside during the resuscitation of a loved one is complex. Contributing to this complexity are the potential benefits and risks that need to be weighed and the impact of the decision on both family members and the healthcare team.

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Preparation prior the debate

Two brief presentations portraying both potential benefits and risks of family witnessed resuscitation were presented to the participants prior the debate. The aim of the presentations was to direct the participants of the debate towards the most salient issues of witnessed resuscitation, thus granting a solid basis to a constructive and informed debate. Beyond this, the presentations helped the participants to view witnessed resuscitation as a whole and thus preventing the risk to view the notion from a single aspect of the issue e.g. relative’s point of view only or staff’s point of view only. However, since four out of six participants had a sound A&E background and potentially had directly experienced the issue several times, this was unlikely to occur.

The debate was initiated with two participants opting for witnessed resuscitation, two against and two undecided. The debaters in their first post justified their position while sharing some personal experiences or relevant literature. This lead to other posts, all substantially based by literature while contrasting others views. Participants were occasionally prompted by leaders and moderator in order to remain focused and tackle the most salient issues.

Main arguments of the debate

Witnessed Resuscitation: Helps grieving process or traumatize relatives?

The main arguments discussed in favour of the notion were numerous with the most popular benefit being, the potential of witnessed resuscitation to help in the grieving process of relatives. This was further accentuated with cited literature which concluded that the majority of relatives found WR helpful in their coping with the situation (Meyers et al. 1998). However this argument was contrasted by some debaters due the potential long-term effects on relatives. Possible psychological trauma was frequently identified as a significant risk to relatives witnessing resuscitation. Family member may be shocked or distressed by the unfamiliar sights, sounds or odours of resuscitation efforts (Laskowski-Jones, 2007). Sceptics of witnessed resuscitation sustained that WR is non-therapeutic, regretful and traumatic enough to haunt the relatives for as long as they live (Dight, 1999). Moreover Woning (1997) urged that the potential long-term effect on relatives is an aspect that requires further exploration.

Ethical and Moral issues

Ethical and moral issues surrounding witnessed resuscitation were often brought up in the discussion resulting in valid arguments both in favour and against the concept. Champions of witnessed resuscitation cited Mc Laughlin & Gillespie (2007) which argued that on the basis of ethical principles of autonomy, beneficence, non-maleficence and justice, the duty of care might be owned not only to the patients, but also to their families during resuscitation attempts. Another ethical argument for the champions of WR was that since it is the family who have the most vested interests in the outcome of the procedure, they should therefore have the authority to make the decision regarding presence (Emergency Nurses Association, 1995).

On the other hand, the debaters opposing witnessed resuscitation argued that as nurses, we are under a duty of care to our patients to act always in their best interests and refrain from doing anything which may cause them harm (UKCC, 1996). The first principle considered was that of confidentiality. No one, not even a relative, is entitled to information which the patient does not want them to have (UKCC, 1996). The participants in the discussion argued that in witnessing CPR, not only would the relative see what was happening to the patient, they would also hear information of an intensely personal nature.

Another argument contended by the critics of witnessed resuscitation is that it is ethically incorrect to let family witness resuscitation without the patient’s consent. It would be difficult to know whether allowing the relatives to observe resuscitation would really be in the patient’s best interest when little research is available which takes into account the patient’s perspective. Consequently an issue was brought up about how feasible it is to get consent from the patient to allow the family in being present during resuscitation. There was accordance around the complexity to know the patient’s will. Still, opinions diverged since critics insisted that the responsibility falls on health care professionals to determine whether or not the family will be able to tolerate the situation or not.

Perceived benefits and Potential risks for the Healthcare Team

Participants in the debate believed that family witnessed resuscitations help to diminish objectification of the patient and humanize resuscitation efforts. The presence of family members reminds the healthcare team that the patient apart from the illness or event that precipitated his/her medical emergency, was first and foremost a person who belongs to somebody (McClement et al.2009). Moreover FWR can help families to facilitate the understanding and acceptance of the team’s decision to end resuscitation efforts. Contrasting these benefits, the participants identified several concerns. The idea of family members at the bedside was seen as something anxiety producing and also increases the risk of legal liability with consequent law suits.

Participants who were not supportive to WR expressed concern that family members could compromise their own safety and that of others. In this regards Mc Clement et al. (2009) argued that the presence of one or two additional family members into an already tight quarters have a potential to impede nurses to work at the bedside.

Factors influencing the debate

Portraying the main elements both in favour and against the notion prior the debate permitted the participants to focus on the relevant issues. This influenced the debate since the participants constructed their posts upon the material presented previously by the forum leaders.

Another factor influencing the debate was having a perfect equilibrium amongst those undecided, in favour and against Witnessed Resuscitation in the preliminary vote. Those taking a stance on the notion influenced the debate with solid arguments in prospect of their opinion and also defended their view when contrasted. On the other hand since the undecided participants were more flexible and open in their posts, they addressed a vaster amount of issues thus providing a better insight of the notion while being less focused on a single line of reasoning.

Changing subject, the fact that four out of six participants have a strong A&E background could have influenced their opinion on Witnessed Resuscitation since they had probably lived both negative and positive experiences around the issue. In fact most of the participant had at least once referred to a personal experience. Moreover given that all participants were healthcare professionals influenced the debate by making it easier to those defending nurse’s views and harder to those advocating relative’s views.

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Section 2 – Academic online debating

Background

The rapid advancement of Internet and computer technology has not only influenced the way we live, but also the way we learn. Many developed countries such as England, Germany and the United States have gradually integrated information technology into educational settings to support teaching and learning since the 1980s (Starr & Milheim, 1996). To date internet and computer technology had become one of the most powerful tools for engaging student in dialogues with each other and with the larger society.

Academic online debating

In this section I will discuss and describe my personal outcomes and observations through this online learning experience. Having experienced online learning previously helped in comparing learning outcomes and also in identifying determinant factors that enhances learning outcomes.

Communication of Learning Outcomes

My first line of thought goes to the criteria for assessment of the online debate posted on the beginning of the program. Clear communication of expected learning outcomes facilitated meaningful student interactions. When students comprehend the outcomes that have been established for the course, they can immediately begin to direct their learning to achieve those outcomes. Halstead & Coudret (2000) in this regards argues that online courses should be fully designed prior to implementation. When this occur both faculty and students can understand how the completion of individual learning assignments will facilitate the overall achievement of learning outcomes.

Small discussion groups

I attribute the success of our debate to the relatively small discussion groups. After experiencing online debating both in a large group and in a small discussion group I believe that as class increases, the amount of online postings increases and become a time management issue for students and faculty alike to read and process the resulting volume of responses. Students connected more quickly with each other in the smaller learning groups and the quality of the discussion was higher.

Critical Thinking

There is a universal agreement among educators and the recognised organisations for nursing education that developing the critical thinking skills of students is a necessity if we wish to produce competent nurses skilled in decision making (Martin, 2002). I believe that online debating when engaged properly provides a unique opportunity to enhance critical thinking in students. Online debating provides a social context for learning that gives learners time to think about their contributions and organize their thoughts prior responding. Harvey (2002) stated that the power of online technology is that it allows for the widespread distribution of knowledge and discussion among learners.

In my opinion factors that enhanced critical thinking in our debates were assigning student roles, clarifying a concept etc. These factors were briefly described below.

Assigning student roles

Assigning students roles as leading a discussion and summarize one ensured higher level thinking. Students had to assume responsibility for initiating discussion on a self-selected topic. Leading a debate allowed me to have some flexibility in the topic I chose so my individual learning needs were met while summarizing the debate required me to share insight gained from debating with the other participants. Moreover leading a debate encouraged me to process the content and increase my sense of accountability to the other group members. Now I have completed the online debate, I am aware how strategies as assigning student roles can develop higher level thinking.

Concept Clarification

Clarifying a concept helped me to develop a deeper understanding of the given concept under study. In regards Halstead (2005) argues that by requiring students to actively examine concept components and relationships, students are asked to engage in an analytical activity that promotes critical thinking. Being asked to share a presentation on the concept with the other students introduced the element of collaborative learning with opportunities for critique and feedback.