Currently, the ENA, the AHA, the AACN, the American Academy of Pediatrics (AAP), the National Association of Emergency Medical Technicians (NAEMT), and the National Association of Social Workers (NASW) support FWR and have implemented specific guideline recommendations (Durina, Oman, Jordan-Able, Koziel, Szymanski, 2007).   All of the above mentioned organizations recommend the development of facility-specific policies and procedures to ensure a positive FWR experience for the patient, family, and staff.

Any policy regarding FWR should include several key components; first each family is unique and therefore must be treated as such.  A designated member of the resuscitation team must assess each family before deciding weather or not FWR would be of benefit.  Time is of the essence for most resuscitations, so this screening process must be fast and effective.  If it is found that FWR is of interest to the family, the staff member must clearly verbalize that the family is not to hinder or distract the resuscitation team intentionally.

The designated staff member must also remain with the family at all times, to both provide emotional support and to explain each step and procedure that the family is witnessing.  This allows the family a reliable resource for information as well as an opportunity to develop a bond with staff.  Detailed and education appropriate level explanations of procedures also helps the family to feel that everything is being done to save their loved one.

In addition to a designated healthcare team member assigned to the family, an effective policy should include how to properly obtain and implement care according to the family’s religious or cultural background.  This will further allow the family to feel as though their presence is making a positive impact as well as allowing them to feel like a part of the resuscitation effort.  Respect for cultural differences and religious preferences is considered for all other aspects of care, therefore it is only a natural transition that advanced care professionals also start applying this to resuscitation efforts.

Providing comprehensive education as well as yearly competency training for all emergency staff members will create a greater awareness of their own actions, and promote an environment that is conducive to allowing family at the bedside of the critically ill patient.  Promotion of a holistic care approach with inclusion of the family may be difficult to initiate, however with time and practice, the emergency department will be providing an experience that is will equate to the greatest good for all.

References

American Association of Critical-Care Nurses. (2010).  Family Presence During Resuscitation

 and Invasive Procedures. Retrieved November 10, 2010 from http://www.aacn.org

American Nurses Association (ANA). (2001). Code of Ethics for Nurses with Interpretative

Statements.  Silver Spring, MD: Author Retrieved October 13, 2010 fromhttp://www.ana.org

(American Heart Association 13 Part 2: Ethical Issues)American Heart Association. (2005). Part 2: Ethical Issues. Retrieved November 10, 2010, from

 http://www.circulationaha.org 

(Ascension Health)Ascension Health. (n.d.). Health Care Ethics. Retrieved November 18, 2010, from http://www.ascensionhealth.org

 (Duran C R Oman K S Jordan Abel J Koziel V M Szymanski D 2007 Attitudes Toward and Beliefs About Famiy Presence: A Survey of Healthcare Providers, Patients' Families, and Patients)Duran, C. R., Oman, K. S., Jordan Abel, J., Koziel, V. M., & Szymanski, D. (2007). Attitudes

 Toward and Beliefs About Family Presence: A Survey of Healthcare Providers, Patients' Families, and Patients. American Journal of Critical Care, 16(3), 270-279.

(Doyle C J Post H Burney R E Maino J Keefe M Rhee K J et al 1987 Family Paricipation During Resuscitation: An Option)Doyle, C. J., Post, H., Burney, R. E., Maino, J., Keefe, M., Rhee, K. J., et al. (1987). Family

Paricipation During Resuscitation: An Option. Annals of Emergency Medicine, 16(6), 673-675.

(Halm M A 2005 Family Presence During Resuscitation: A Critical Review of the Literature)Halm, M. A. (2005). Family Presence During Resuscitation: A Critical Review of the Literature. American Journal of Critical Care, 14(6), 494-511. doi:2005;14:494-512

(Maclean S L Guzzetta C E White C Fontaine D Elchorn D J Meyers T A 2003 Family Presence During Cardiopulmonary Resuscitaiton and Invasive Procedures: Practices of Critical Care and Emergency Nurses)MacLean, S. L., Guzzetta, C. E., White, C., Fontaine, D., Elchorn, D. J., Meyers, T. A., & Desy, P. (2003). Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses. American Journal of Critical Care, 12(3), 246-257.

(Mason D J 2003 Family Presence: Evidence Versus Tradition)Mason, D. J. (2003). Family Presence: Evidence Versus Tradition. American Journal of Critical Care, 12(3), 190-192.

(McClenathan B M Torrington K G Uyehara C F 2002 Family Member Presesnce During Cardiopulmonary Resuscitaiton: A Survey of US and International Critical Care Professionals)McClenathan, B. M., Torrington, K. G., & Uyehara, C. F. (2002). Family Member Presence During Cardiopulmonary Resuscitation: A Survey of US and International Critical Care Professionals. CHEST, Official Publication of the American College of Chest Physicians, 122(6), 2204-2211. doi:10.1378/chest.122.6.2204

 (McLaughin K Gillespie M 2007 Final Question: Witnessed Resuscitation)McLaughin, K., & Gillespie, M. (2007). A Final Question: Witnessed Resuscitation. Emergency Nurse, 15(1), 12-16. Retrieved from http://emergencynurse.rcnpublishing.co.uk

(McLaughlin K Gillespie M 2007 Final Question: Witnessed Resuscitation)McLaughlin, K., & Gillespie, M. (2007). A Final Question: Witnessed Resuscitation. Emergency Nurse, 15(1), 12-16.

(Sanford M Pugh D Warren N A 2002 Family Presence During CPR: New Decisions in the Twenty-First Century)Sanford, M., Pugh, D., & Warren, N. A. (2002). Family Presence During CPR: New Decisions in the Twenty-First Century. Critical Care Nurse, 25(2), 61-66.

Emergency Nurses Association. (2005). Family Presence at the Bedside During Invasive Procedures and Cardiopulmonary Resuscitation.  Position Statement. Retrieved November 10, 2010, from http://www.ENA.org  

Emergency Nurses Association. (2005). Family Presence at the Bedside During Invasive Procedures and Cardiopulmonary Resuscitation.  White Paper. Retrieved November 10, 2010, from http://www.ENA.org  

National Association of Emergency Medical Technicians. (2000). Guidelines for Providing Family Centered Pre-Hospital Care. Retrieved November 10, 2010, from https://www.childrensnational.org/files/PDF/EMSC/PubRes/Guidelines_for_Providing_Family-Centered_Prehospital_Care.pdf

National Association of Social Workers. (1999).  Bereavement Practice Guidelines for Health Care Professionals in the Emergency Department. Retrieved November 10, 2010 from http://www.socialworkers.org/practice/bereavement.asp  

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