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Family Presence During CPR in the Emergency Department: A Nurse’s Reflection

Amanda L. Buisman, RN, BSN

Washburn University

School of Nursing

Introduction

 In today’s dynamic and ever-changing health care arena, providing care according to current evidence remains the goal of every well-informed advanced practice provider.  Using evidence-based practice to define best practice measures is not a new concept.  In fact, almost every health care facility uses these terms to define policies and procedures for daily operational procedures.  Well-informed advanced practice providers, learn early on in nursing education the importance of first reading, then understanding, and accepting new care standards according to the supporting research.  When an advance practice provider is in a situation where personal beliefs are in conflict with current practice recommendations despite evidence pointing to the contrary he or she can experience ethical distress.

Discussion 

 The issue of personal beliefs conflicting current practice recommendations is an infrequently discussed topic among advanced care providers yet; it is defining and shaping how care is delivered.  One such issue in today’s emergency departments is the concept of family presence during cardio-pulmonary resuscitation (CPR), (Duran, Oman, Jordan Abel, Koziel, & Szymanski, 2007), (MacLean et al. 2003), (Mason, 2003), (McLaughlin & Gillespie, 2007), (Sanford, Pugh, & Warren, 2002).  While it appears that evidence clearly indicates positive outcomes from family witnessed resuscitation (FWR), a majority of emergency departments fail to effectively implement or even institute policies regarding FWR , (MacLean et al. 2003).

So what is the reason for the discrepancy between recommended practice and actual practice?  In order to accurately answer that question, one must understand the history and controversy surrounding FWR.  The first published article regarding FWR was in 1987 (Doyle, et al 1987), which was, a descriptive survey used to determine attitudes of staff and patients’ families that had participated in FWR.  The study concluded that 94% of family members would want to be present again for the resuscitation of a loved one, 76% of family members felt that adjusting to the loss of a loved one was easier, and 64% felt their presence was beneficial to their dying family member. (Doyle, et al 1987)

A descriptive survey conducted in 2000 (Myers, et al 2000) investigated attitudes and beliefs of patients’ families and ER staff members about FWR.  The survey reported that 98% of patients’ families indicated that they had a right to be present and would do it and would participate in FWR again; 100% of family members said that FWR was helpful to them, and 95% said it was helpful for the patient. It also showed that 70% of professionals surveyed after their participation in FWR actually produced a higher level of “professional” behavior along with a more “professional” bedside dialog amongst the health care team.  The survey also indicated that having the family in the resuscitation room prompted the staff to take the patient’s dignity, privacy, and need for pain management into greater consideration when compared to an un-witnessed resuscitation effort. (Myers, et al 2000)

A descriptive survey of US and international critical care professionals (McClenathan, Torrington, & Uyehara, 2002) found that attitudes toward FWR were in strong opposition.  According to the survey, 78% of health care professionals surveyed (physicians, nurses, allied health-care providers) reported being opposed to FWR for adults.  In a further analysis of the data, it was found that a greater percentage of physicians (80%) then nurses (57%) were opposed to FWR.   Participants of the survey indicated in the short answer section of the survey that, FWR would violate patient confidentiality, distract staff members from performing their jobs, evoke performance anxiety, and expose family to unnecessary psychological trauma.  (McClenathan, Torrington, & Uyehara, 2002)

  While this survey indicates that more nurses then physicians have a positive attitude toward FWR, a majority of emergency departments do not have written guidelines or an established policy regarding FWR.  A 30-item descriptive survey (MacLean et al, 2003) of randomly selected registered members of the American Association of Critical-Care Nurses (AACN) and the Emergency Nurses Association (ENA), in regards to policy and procedure practices involving FWR demonstrated that only 5% of 984 respondents worked on a unit with an established policy.  The survey also found that 37% of respondents preferred to have a written policy in support of FWR, though 45% of respondents reported they have participated in a FWR without a written policy.  Of the respondents that supplied their personal experiences with FWR, their comments indicated the following benefits of family presence; provides emotional support for the patient, allows staff to provide guidance and increase family understanding of the patient’s situation, helps patient’s families know that everything was done to save their loved one, and it facilitated closure and healing. (MacLean et al, 2003) 

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