“Family presence during CPR”… That is the question on the table. Should it occur? Should there be more family involvement? What are the consequences? Is this an ethically sound idea or is this mainly a residual effect from too much “Hollywood”? These are all sound questions and we will attempt to answer them in the context of my rant....
As a paramedic I had started to develop the idea that family involvement was just another added stress to my utopia. It seemed that whenever any family member became involved, especially during life-threatening situations, the playing field somehow just got smaller. I never allowed them in the back of the rig, because somehow they always got the impression that by being at the bedside of the patient especially if they were “circling the drain” that it gave them certain unalienable rights to interfere superceding the fact that only one of us was medically trained to handle the situation at hand. I had learned this lesson the hard way early in my paramedic career. However as a nurse, the environment and the family as institutions have changed. For one, the environment is more controlled and two—the family is more informed. In the hospital environment, the illness is no longer sudden and unexpected. The shock of illness has worn off and the nurses often find themselves in the midst of taking care of two patients instead of just the one. Family Dynamics rears its head and the foundation on which it stands has also sustained some trauma.
“Because of the effects of illness on the client and family, family dynamics often change. The nurse must view the whole family as a client under stress, planning care to help the family regain the maximal level of functioning and well-being.” (Potter/Perry 2001)
So we have established that not only are we caring for the patient but also for the family. This is particularly true during the caring of both patient and family during the resuscitative efforts. Presently there are two schools of thought for this argument. One, is this good for the patient? Is the patient getting the best care possible while under the potential microscope of a watchful family? Does the family understand what is exactly going on? Can the medical team spare someone to hold hands and interpret?
Second, is this good for the family? Is normal everyday Dick and Jane really prepared to see what goes behind closed doors? Isn’t there a reason why Dick became an accountant instead of going to medical school and becoming a trauma surgeon or pathologist?
There is a big push in the medical community to include the family during resuscitative efforts to the point that actual studies have been done to evaluate their effect…
“Several studies have shown that family presence during CPR assisted family members through the grieving process. Hanson and Strawser suggested that family presence during CPR lent a sense of reality to the crisis. This allowed family members to evade a prolonged period of denial. Eichhorn and colleagues 8 conducted a study surveying family members who had actually witnessed a CPR. This study found that more than two-thirds of family members surveyed felt grief and adjustment had been lessened by their presence during CPR, 64% felt their presence was helpful to the patient, and 94% stated that they would choose to be present if faced with the situation again. Rosenczweig found similar results in another study. Furthermore, Pugh and colleagues asserted that family members who were present during resuscitative attempts "showed improved psychological outcomes after three months."(Sanford 2002)
I personally do not believe that this serves the best interest of the family. My question is this…”If you could choose the last time that you saw your loved one, would it be a happy one with a smile and a hug or would it constitute one with tubes and invasive lines in and out of every orifice of your loved one. Or how about if an emergency thorocotomy was done, would you want your lasting memory bearing witness to your loved one having his or her chest cracked and spread wide open. Would you need to see that to believe that every thing was humanly done to spare the life of your loved one?
“In a retrospective, descriptive study conducted in the rural South, Sinclair found that 56.3% of respondents declared they would not have elected to be present in the room with a loved one undergoing CPR. These responses were dramatically different from studies conducted in urban hospitals. This theme was further supported through statements made by the participants in the study: "too stressful," "be in the way," "could not handle it," "can't cope," and "too nervous to watch." Conversely, the theme that persisted, whether family members expressed a desire to be with the patient or not, was that the families just wanted to be reassured that everything possible was done for the loved one. (Sanford 2002)
My belief is this; if everyone had wanted to see things like this, there would not be a shortage of healthcare professionals in this world. PTSD… does that word mean anything to the medical community emphasizing the presence of family during such a traumatic event?
“Learning about a medical condition under such circumstances may further traumatize family members already coping with the crisis of CPR, possible death, or actual death.”(Sanford 2002)
“In several articles, nurses voiced strong opposition to family presence during CPR. ‘Witnessing a code is an experience that is non-therapeutic, regretful, and traumatic enough to haunt the surviving family as long as he or she lives.’ “ (Sanford 2002)
I remember a scenario where as a paramedic; I had to cardiovert a 36 y/o woman whom had visions of wearing a size 3 again. She inadvertedly overdosed herself on amphetamines and developed a sustained SVT at a rate of 230. Her husband was in the bedroom and frankly with good reason. It was his house. In the end, he found the need to interfere slowing down our ability to correct the potentially fatal heart rhythm. The police intervened, we were able to accomplish our task and she survived. Unfortunately, this is an all-to-familiar scenario with most Emergency Departments also…
“When I have asked physicians why they do not want family members to be present during resuscitation efforts, they have cited the risk that family members will interfere with the efforts”. (Tsai 2002)
As far as the medical team is concerned, most providers of health care would agree that having the family present for such a stressful event would indeed add to the stress especially in this day and age of legal retribution.
“In the Foote Hospital study, 30 percent of the 21 staff members of the emergency department who responded to the survey reported that they had been hampered in their activities, mainly by anxiety about being observed or by concern about possible emotional or disruptive behavior on the part of family members.” (Tsai 2002)
It seems that there are just as many antagonists as there protagonists to this issue. My personal opinion has been previously stated. I do not believe this serves in the best interest of the patient or the family. Although some believe that being there at the end of one’s life may help some to cope, it cannot be said that it will help all. It seems that most assume that resuscitative efforts are deemed unsuccessful and maybe that is why the push for family involvement. If you think you will fail, then you have already failed. During resuscitative efforts, a certain mentality must ascert itself in each one of the providers; those would be the personality traits of self-confidence and virtue. If not allowed the freedom to ascertain this mood without the feeling of being judged or watched by the family—it is my belief that skill in intervention will suffer as will the patient in the long run and eventually the family if the resuscitation is not successful.
