Family presence during resuscitation attempts is a relatively new topic that is being talked about more and more. First introduced in the 1980s, family presence during resuscitation was looked at as a way for patients to have loved ones nearby during life-threatening situations. For many years, family presence during resuscitation has been something that has been decided at the attending nurse’s discretion, meaning the nurse could tell family members to leave the room or stay. Leaving this decision up to the nurse, or other member of the care team has led to inconsistent practice of allowing family members to be present during resuscitation attempts. The practice of family presence during resuscitation has been seen as “sporadic, inconsistent and often paternalistic rather than collaborative” (Giles, 2016).
It is important for members of the care team to collaborate with patients’ families and work as a team. Research shows that family presence during resuscitation attempts leads to better patient outcomes. It is up to nurses to adapt to changes and have a plan set in place to allow family presence when possible.
Review of Literature: Nursing Theory
Changing attitudes toward family presence during resuscitation will be quite the task to undertake, but it is necessary to be agents of change in order to improve patient outcomes. A part of Sister Callista Roy’s theory of adaptation discusses how it is the nurse’s purpose “to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behavior and factors that influence adaptive abilities and to enhance environmental factors” (Roy, 2009, p. 12). Part of enhancing environmental factors for patients and their families can include allowing family members to be present during life-threatening situations, such as resuscitation.
Having family present during resuscitation can cut the time on resuscitation attempts in very critical situations when it seems likely that the patient will not make it, thus allowing the patient to die with dignity. This can be very difficult, but it allows for family members to collaborate with the care team in the decision-making process. Being a part of the decision-making process and having a say in what happens to their loved one has been shown to help in the healing process for family members if a resuscitation attempt fails.
Review of the Literature: Nursing Practice and Care
In the hospital setting, nurses tend to have patients several days in a row. They often develop relationships with their patients and their family members and will try to include everyone in the plan of care for the patient. In Twibble, Siela, Riwitis, Neal, and Waters (2017) study it was found that, “Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team.” It is so very important that nurses include family members when possible during resuscitation attempts because it has been found that the physician will try do what they find is best for the patient and not necessarily what the patient would have wanted.
A study by De Stefano, Normand, Jabre, Azoulay, and Adnet (2016) stated, “…nurses perceive the primary benefit of family presence as better family coping after the event.” Many nurses believe that patient families feel better about what happened with their loved one because they were there while the resuscitation attempt occurred. However, De Stefano et al. (2016) also states,” … nurses also fear that families will experience emotional trauma and disrupt resuscitation events.” It could be said that in these types of situations nurses are trying to look out for families’ best interest, but also might be looking out for the care team’s best interest as well. It is difficult to provide care for the patient, while at the same time trying to ensure that family members are cared for. It is also difficult for the care team to focus on the task at hand when family members want to be directly at the patient’s bedside. However, it is important to be as accommodating as possible.
In Powers (2017) study, it was found that patients wanted their family members to advocate for them and represent their wishes when making decisions. It was also found in Powers (2017) that patients received “…a sense of comfort through knowing their family was close by to support them and they would not die alone.” This goes back to two parts of Roy’s adaptation model, which include enhancing environmental factors for patients and allowing for the patient to die with dignity. Family members do not want to see their loved one suffer and know that their loved one would not want that either. If the family members have a say in what happens they can prevent something happening that would be against the patient’s interests. It is pertinent that the care team and family members coming together as a team to collaborate and decide what is best to do for the patient.
For family presence during resuscitation to become a standard, Twibble et al. (2017) states, “It is also vital for critical care nurses to receive education on FPDR. Education has been shown to improve nurses’ support for and invitation of FPDR, as well as ensure its proper implementation.” Education on family presence during resuscitation is something that seems to be lacking in many places. It was found in Twibble et al. (2017) that “only one-fourth of participants (25%) reported their facility or unit has a written policy on FPDR.” This was an increase from a previous study that they conducted, but it was not a significant increase. If education on family presence during resuscitation has been shown to work, then it is something that needs to be implemented everywhere.
There was an event that occurred at Community Hospital. A patient had two of her daughters visiting and she needed to use the bedside commode. The daughter of this patient noticed her mother (the patient) had a difficult time getting on the commode, stating she looked very flushed and weak. Once the patient was able to get on the bedside commode, she went slack and did not appear to be breathing. The patient’s daughter went into the hallway and got the nearest nurse and had her come in to assess her mother. It was noted that the patient was slack and half on the commode and it appeared she had defecated a large amount of blood into the commode. The nurse that was pulled into the patient’s room made the decision to initiate the Code Blue protocol, got the patient on her bed, and initiated CPR. While this was happening, the patient’s other daughter was crying hysterically and screaming at her sister to do something. The daughter who called the nurse took her sister into the hallway to help calm her down and asked someone to stay with her while she went back into her mother’s room to be with her while CPR was going on, and the Code Blue team was initiating their protocol.
Thanks to the daughter, the Code Blue was called in time for the mother to get the immediate care she needed before being transferred to the Intensive Care Unit. She was also able to recognize her sister may have gotten in the way and was able to remove her from the situation and asked someone to stay with her. This was a prime example of teamwork and collaboration between a patient’s family member and the care team.
It seems that for many years family presence during resuscitation has been something that was left to the discretion of the care team, when in reality it should be decided by the patients’ family members. This is an issue that needs to be discussed in hospitals everywhere. Resuscitation attempts do not just happen in critical care units, they can happen in any unit in any hospital, which is why more than just critical care team members need to be educated.
In order for staff to be properly equipped to handle these difficult situations, there is a lot of education that needs to take place. One place to start would include having mandatory education for all employees involved in patient care. This includes doctors, nurses, CNAs, lab workers, etc. The education could be something as simple as a few online modules and a post-quiz explaining why it is important to ask family members if they would like to stay during resuscitation attempts. It could also include ways to help a family member calm down, diversion techniques, and the proper way to explain what might be going on with their family member. A module like this is something that could be put together fairly easily and would not cost an exorbitant amount of money. It could be put together by a small committee of volunteers, preferably including nurses and physicians that are advocates for family presence during resuscitation and have included family members during resuscitation attempts before. The learning module could be sent out annually to all those working in direct patient care.
If something like a learning module would be too much of a cost for an institution, a committee could put together a small presentation, or training session where they could discuss different ways to include family members and answer any questions or concerns that staff members may have about family presence during resuscitation attempts. The committee could attest to how beneficial it could be for family members to be present and how important it is to allow them to be there to advocate for their loved one. It could benefit staff to practice talking to each other as though they were explaining what could happen during a “Code Blue” type of situation. Small presentations, or training sessions like this could be held in the hospital’s cafeteria, auditorium if possible, or a conference room that is available. The only cost might include providing snacks and beverages and that would be a very small price to pay for the payoff of better patient and family outcomes. It would take up some time in staff members’ day, but it could be something that is mandatory for care team members that are more likely to encounter this type of situation and optional for those that work on lower level units. If this would be too much of a cost, a short informational video could be put together by a group of people that work in the hospital and have encountered family presence during resuscitation. It could educate on the benefits and possibly even have a role-playing type of section where they act out a “Code Blue” and demonstrate how staff can work with family members during resuscitation. They could include different scenarios of how to interact with different kinds of family members, including those that can be somewhat “difficult” to work with. All of these suggestions could work with a variety of budgets and they do not have to extremely well done. They just have to inform staff on the benefits of family presence during resuscitation attempts and tips on how to handle themselves if they were ever to find themselves in this type of situation.
Family presence during resuscitation has been shown to cut the time on resuscitation attempts in very critical situations when it seems likely that the patient will not make it. Family presence during resuscitation can also help decrease the number of lawsuits that happen because they were there to see everything that was done to help their loved one. This is something that should be talked about as well since it could possibly save hospitals and care team members a lot monetarily and emotionally.
Many hospitals have clinical educators that are in charge of employee education. Clinical educators could come into the units and have an in-service type of discussion with care team members discussing ways to include, speak and explain things to family members in a non-offensive way that they can understand. They could also stress the importance of including family members. This is something that could happen as needed, and at no additional cost to institutions.
There are a few extra protocols that could be initiated on units that require a higher level of care, such as Intensive Care Units and Intermediate Care Units. One way to ensure that family members are being informed and offered to stay during resuscitation attempts on these types of units is to have a group of nurses to use as a designated family liaison. They could make certain that family members are offered to stay, and they could explain everything that is going on with the patient and what the care team is doing for them. They could also be there just for emotional support. It could be beneficial at the beginning of each shift to go over which patients are in the most critical condition and which nurse(s) could be used as the designated family liaison if needed. Having a plan as simple as this allows things to happen more smoothly and it would only take just a few minutes of everyone’s shift.
There are various ways to implement change in institutions, and not at a very large cost to anyone. All the discussed educational opportunities and protocols that could potentially be put into place would cost very little money and time. Again, it is a very low price to pay, for the benefits of implementing these changes far outweighs the cost.
In conclusion, family presence during resuscitation is something that has not been practiced consistently since it was first introduced but should be practiced much more frequently. It has largely been left to the care team’s discretion and it should not be left to them to decide. Patients’ families are often considered when making a plan of care, so why should they be left out during this aspect of care for their loved one. Recently, research is showing that family presence during resuscitation leads to better outcomes for patients and their families. This is something that needs to be addressed in all hospitals so that it can be practiced more consistently. Once family presence during resuscitation is practiced more consistently and considered a standard, more research can be done to evaluate ways of bettering care team members’ support and execution of family presence during resuscitation.