Journal Scan: Reduced Post-Traumatic Stress in Family Members Witnessing Cpr
Journal Scan: Reduced Post-Traumatic Stress in Family Members Witnessing CPR
Huang, Emily MD; Lovato, Luis MD
Family Presence during Cardiopulmonary Resuscitation
2013;368(11):1008
Patients generally died at home with their loved ones before cardiopulmonary resuscitation was invented in the 1950s. For better or worse, technological advances and prehospital care have moved patients away from their homes and into the hospital during the last moments of their life. (Crit Care Nurse 2005;25[1]:38.) Now health care providers have the moral and ethical dilemma of being in control of what many consider to be an ethereal, spiritual, even sacred occasion.
Literature on the topic has grown over the past 15 years, but much of it has focused on the effect on hospital staff rather than family. Many studies were limited by small enrollment, use of convenience samples, low rates of participation, and the use of inconsistent and retrospective survey instruments. (Am J Crit Care 2005;14[6]:494.) That made it difficult to draw general conclusions about its benefits or disadvantages.
Opponents of family presence during resuscitation express concern that family may disrupt the process. Codes are unplanned, crowded, noisy, and hectic. Having family present, especially if they are hysterical, can distract staff and fuel the chaos. And it can stressful and intimidating for a provider to be put on the spot. Providers might feel performance anxiety or fear appearing inexperienced or incompetent. Others fear increased litigation risk if mistakes are witnessed. We also might be pushed to “do more” than reasonable when family members are watching, even if the process is futile, potentially prolonging unnecessary suffering for all. HIPAA enforcers might express concern about patient confidentiality because patient wishes regarding family presence are rarely known. Designated staff is often unavailable to support family members in emergency situations.
Proponents of family presence
Huang, Emily MD; Lovato, Luis MD
Family Presence during Cardiopulmonary Resuscitation
2013;368(11):1008
Patients generally died at home with their loved ones before cardiopulmonary resuscitation was invented in the 1950s. For better or worse, technological advances and prehospital care have moved patients away from their homes and into the hospital during the last moments of their life. (Crit Care Nurse 2005;25[1]:38.) Now health care providers have the moral and ethical dilemma of being in control of what many consider to be an ethereal, spiritual, even sacred occasion.
Literature on the topic has grown over the past 15 years, but much of it has focused on the effect on hospital staff rather than family. Many studies were limited by small enrollment, use of convenience samples, low rates of participation, and the use of inconsistent and retrospective survey instruments. (Am J Crit Care 2005;14[6]:494.) That made it difficult to draw general conclusions about its benefits or disadvantages.
Opponents of family presence during resuscitation express concern that family may disrupt the process. Codes are unplanned, crowded, noisy, and hectic. Having family present, especially if they are hysterical, can distract staff and fuel the chaos. And it can stressful and intimidating for a provider to be put on the spot. Providers might feel performance anxiety or fear appearing inexperienced or incompetent. Others fear increased litigation risk if mistakes are witnessed. We also might be pushed to “do more” than reasonable when family members are watching, even if the process is futile, potentially prolonging unnecessary suffering for all. HIPAA enforcers might express concern about patient confidentiality because patient wishes regarding family presence are rarely known. Designated staff is often unavailable to support family members in emergency situations.
Proponents of family presence