Does allowing family into the trauma room necessary or just asking for trouble. Cardiopulmonary resuscitations are sudden and traumatic clinical event that frequently results in a patients death or change in patient’s health status. Usually, it is seen that when a patient gets cardiac arrest, the family is requested to wait in a waiting room while life-saving measures are initiated. But recently, this traditional approach has spark argument. Many family members want to be present during resuscitation efforts and want to witness the measures taken by health care providers in order to save the lives of their loved ones. Family should be allowed or not during this event remains an important issue in clinical practice. According to survey conducted at hospital in Lahore, 95% health care professionals were against witnessed cardio-pulmonary resuscitation (Zakaria & Siddique, 2008). During my job life in Recovery unit, I came across such situations several times, when family was very much concerned and wanted to stay with patient during resuscitation. Family’s presence during resuscitation has its own pros and cons. According to American Journal of Critical Care, staff members have articulated more disadvantages than benefits associated with family presence (Duran at el, 2007). There have been many controversies over this issue. But I believe that family should not be allowed during resuscitation as it interferes with resuscitation effort, increases risk of liability and litigation, breaches patients privacy and confidentiality.
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The first important reason why Family shouldn’t be present during resuscitation is that it interferes with resuscitation efforts. Family’s presence impedes and disrupts the resuscitation process by impairing the performance of the code team (Schmidt, 2010). Resuscitation attempts in such cases usually get unnecessarily prolonged because of family presence and their emotional behavior for instance crying, inquiring again and again about patient’s condition, standing at bedside etc. At an international meeting of the American College of Chest Physicians, health care professionals pointed out that families go out of control and distract them from doing their job. Moreover, performance anxiety also increases and there is lack of the availability of an adequate staff to fully support patient’s families because of the prime focus on resuscitation care (Critchell & Marik, 2007). During my job experience I, once came across a situation where husband underwent cardiac arrest and was getting resuscitated in front of his wife and when patient was cardiovert his wife fainted which distracted code team’s attention and caused anxiety. Furthermore, often physicians and nurses hesitate to discuss the patient’s condition openly in the presence of family, causing hindrance in patient’s care and delays in decision making despite the need of promptness at such crucial times (Duran et al, 2007).
The second reason is that, it increases risk of liability and litigation. Code room may be too traumatic for loved ones and at that time the team’s efforts might be interpreted as cruel by the family members (Critchell & Marik, 2007). Performing chest compressions, delivering shocks to patient might be seen as an unkind activity in case if patient expires. Additionally, in this crucial situation, there might be chances for the errors to occur, inappropriate comments to be made, and actions be misinterpreted by family members. Therefore, facilitator is essential to monitor the family’s reactions, translate medical jargon, and explain what is going on but this is not applicable because at that time, saving patient’s life is the prime responsibility of the health care providers. (Oman & Duran, 2010). In addition, the overall situation during resuscitation is too traumatic for loved ones, an observed action or remark may easily offend relatives, leading to a complaint. In these circumstances, the accountability of team increases. Researches also highlight that family viewing resuscitation would traumatize family member’s and lead to an increase in lawsuits (Wacht et al, 2010).
The third reason of argument is that it breaches patient’s right of privacy and confidentiality. During this critical moment it’s the possibility that medical information previously not known by the family may be revealed in the chaos of a code. Patient’s dignity may become compromised. As it’s the moral obligation to protect patients confidentiality. Dignity and honesty are the essential elements of ethics (Lippert et al, 2010). Since the patient is unconscious, it is not possible to get his/her consent for witnessed resuscitation and it’s unethical to allow family without knowing patient’s agreement to the witnessed resuscitation. The Nursing and Midwifery Council (2008) states that “nobody is entitled to information which the patient does not want them to have”. Inadequate screening of family at that time could result in unrelated visitors gaining access to information that could otherwise be safeguarded. This potential breach in confidentiality can have broader implications relating to the public’s trust in the medical profession (Critchell & Marik, 2007).
Supporters of family presence during resuscitation, claim that witnessing a code helps relatives to understand the patient’s condition. It helps in realizing the reality of the situation and also minimizes family’s denial about patient’s worsening condition. With this it also allows family members to say final goodbyes to dying patient, permitting some form of closure. Secondly, it assists in building a trusting relationship between staff and family. It allows the staff to provide guidance and increases the family’s understanding of the patient’s current situation. Along with this, family would acknowledge that the healthcare team did its best to save the life of their loved ones and chances of blaming health care provider’s decreases. Emotional support provided to family by health care providers in this intense moment helps to develop a trust and patience. Thirdly, it satisfies the emotional and spiritual needs of patient’s family and provides sense of closure to dying patient. It also facilitates role of caretaker and encourages family to perform religious prayers at the end of life situation would ease patient’s life.
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With no doubts, witnessing patient during Resuscitation creates panic and fear among family, as they are not habitual to deal with such situations. This could lead to psychological trauma and possibility for the family to react abruptly. Critchell and Marik (2007) highlighted a scenario of distraught mother attempting to pull back the physician, while performing cardiac massage off her daughter. This delayed cardioversion but fortunately patient was saved from poor consequences that could have occurred. Families might keep insisting on doing everything possible even in a futile resuscitation. Similarly, at times families have asked to stop a code, sometimes prematurely (Critchell & Marik, 2007). On the other hand, counseling the family regarding the patient’s condition outside the resuscitation area is more fruitful rather than counseling them in front of the patient being resuscitated. Explaining the condition and prognosis in a peaceful environment facilitates family to make sound decision on behalf of patient. Prayers performed in calm environment helps in maintaining concentration, patience and provide internal peace to mind. Finally, the family’s presence might involuntarily increase stress levels for staff, hinder their performance and ruin the concentration necessary to run a code. A study by Fernandez et al in 2009 says that once, due to a family attempting to hug the simulated patient; it took longer to deliver the first defibrillation and delivered shocks necessary to save patient’s life.
In conclusion, family shouldn’t be allowed as it creates hindrance in resuscitation activity, increases risk of accountability and lawsuit, violates the patient’s right of privacy and confidentiality. It would be more beneficial for the patient and code team if family is not present during resuscitation as team can concentrate fully on the patient without any pressure. For this reason, I would recommend there should be a specialized nurse or physician who can counsel patient’s family during resuscitation in a counseling room rather than in front of patient. However, formerly enforcing the allowance for family witness resuscitation in the policy, there should be test studies conducted before its implementation.
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