Should Family-Witnessed Resuscitation Be Allowed in the Emergency Department?

The background information provided in the article is quite lengthy and intensive. It provides information about the perceptions of different healthcare professionals regarding family witnessed resuscitation (FWR). It also gives information on what prior research studies have discovered about the issue as well as the gaps that exist in the literature. It also provides information about the recent development of a variety of instruments that are used to measure perceptions about family witnessed resuscitation.

Literature review

The researchers do not provide a distinct section on the literature review. Instead, the literature review has been integrated into the background information section.

Discussion of methodology

The section on methodology is well discussed. The researchers discuss the sample, setting and procedure that were used in conducting the study. Most importantly, the researchers gave the inclusion criteria that were used to select the participants as well as the ethical standards that were adhered to. This section also highlights the instruments that were used in the study and the pilot testing of the instruments.

Specific data analysis

The researchers identified the specific statistical analysis techniques they used in the study. These techniques include Pearson r correlations, t-tests, ANOVA and descriptive analysis. Each of these analytical tests played a specific role.

From the analysis of the five areas identified above, it is evident that the conclusion reached is supported by the evidence presented. Specifically, Twidell et al. (2008) found that nurses have diverse opinions about the advantages and disadvantages of family witnessed resuscitation (FWR). Nurses who have professional certification and are members of professional bodies have positive attitudes towards FWR compared to their counterparts. This conclusion is arrived at following the data analysis and results from the analysis which supports the conclusion.

Several ethical issues have been highlighted in the study. To begin with, the researchers had to obtain permission from an appropriate institutional review board. Second, participation in the study was voluntary. This implies that the nurses who participated in the study were not coerced into participation but instead participated of their own free will. The participants were also assured of their privacy through anonymity. Lastly, the confidentiality of the data was ensured.

The study was purely quantitative in nature. The researchers used statistical and descriptive analyses to determine the percentage of participants who had invited family members to witness resuscitation and those who had not. The analyses were also used to identify relationships among the perceptions as well as relationships between demographic variables, risks-benefits and self-confidence. The study would be more useful if a mixed-methods approach had been used. In addition to the quantitative analysis, the researchers should have included qualitative analysis which would help explain the reasons behind the nurses’ diverse perceptions towards FWR.

Identification of Appropriate Nursing Care Problem

The problem under discussion in this paper is whether or not family members should be present during the resuscitation of a loved one in an emergency department.

Annotated Bibliography of Family Witnessed Resuscitation

Demir (2008) conducted a study to examine the opinions of nurses about family presence during resuscitation. The respondents included the opinions of 82 nurses working in emergency, cardiology and anesthesia departments. Out of the 82 nurses, Demir (2008) found that 82.6% thought it was not appropriate for family members to be present during resuscitation. Thus, the results of this study imply that majority of nurses are not comfortable with the presence of family members during resuscitation. The outcomes of the study by Demir (2008) contrast sharply with the study conducted by Meyers et al. (2004).

Meyers, Eichhorn, Guzzetta, Clark and Taliaferro (2004) conducted their study using sixty registered nurses. The aim of the study was to determine if family presence during resuscitation was comforting to the patient and if it is uncomfortable for the nurses and other healthcare providers. Meyers et al. (2004) found that registered nurses (96%) in general have more positive attitudes towards family presence during resuscitation than other healthcare providers (79% for physicians and 19% for residents). The positive attitude of nurses was based on several reasons. Nurses felt that family presence gave the family members of the patient the opportunity to see for themselves and know the efforts the resuscitation team made thereby reducing the uncertainty and anxiety both for the family and the nurses.

Perry (2009) argued that nurses who have had a previous encounter with family presence during resuscitation are more likely to have a feeling of personhood about the patient and to view him/her as part of a family. These attitudes encourage closure between the nurses and the patient’s families through open communication and promote a more professional behavior on the part of the nurses. Nurses who support family presence also argue that family members may offer assistance during the procedure which in turn encouraged them to make rational end-of-life decisions. All these benefits enhance the comfort level of nurses during resuscitations.

Twibell et al. (2008) conducted a descriptive study using 375 nurses with the aim of examining the effect of self-confidence in encouraging family witnessed resuscitation among nurses. “Two-thirds of the participants had never invited the family to be present during resuscitation; more than 20% had invited the family of a patient at least once but less than five times, while 7.5% had invited a family 5 times or more,” (Twibell et al., 2008, p. 106). Nurses with greater self-confidence had invited family presence more often than those with low self-confidence. They concluded that self-confidence regarding FWR is important and can be enhanced through advanced professional training and experience.

On the same note, Fisher et al. (2008) found that majority of the nurses in their study engaged in behaviors that supported family presence during resuscitation. These behaviors encompassed open communication with the family members, educating them, involving them in the procedures of care of the patient, and providing them with psychosocial support. These behaviors enhanced the relationship between the nurses and the family members which in turn increased the nurses’ comfort levels during the resuscitation procedure. This finding supports the study by Fulbrook et al. (2007) and Maxton (2008).

Fulbrook et al. (2007) conducted a literature review on studies that have examined the issue of family witnessed resuscitation in order to identify whether or not it is a beneficial practice. He found that majority of the studies supported FWR and therefore concluded that FWR is beneficial not only to patients and family members but also to healthcare professionals.

Maxton (2008) carried out a phenomenological study to examine the meaning for parents who are present or absent during their children’s resuscitation. The researcher used a sample of 14 parents of critically ill children who had been admitted to a critical care unit. He found that parents who were present during the resuscitation were less distressed by the incident as compared to those parents who were not present. He concluded that “parents have an inherent need to be present during the resuscitation of their children so as to make sense of the situation,” (Maxton, 2008, p. 3174).

Redley and Hood (1996) acknowledge that the issue of FWR is a controversial subject that has gained the attention of the healthcare system in the recent past. The researchers argued that permitting family members to be present during the last moments of their loved ones could help the family in the grieving process. The study was conducted to determine the attitude towards family presence among emergency personnel based in six Melbourne hospitals. The researchers found that general health care personnel in Australia have positive attitudes towards FWR and are more than willing to allow family members to witness the resuscitation efforts of their loved ones.

Redley, Botti and Duke (2004) conducted a literature review to distinguish between evidence and opinion surrounding FWR. The results of Redley et al.’s study indicate that allowing family members to be present during the resuscitation of their loved one is both crucial and advantageous to family members. Nevertheless, Redley et al. found that healthcare professionals have differing opinions towards family witnessed resuscitation thus acting as a major barrier to the practice. The researchers admit that the study is limited in that it lacks rigor but they suggest that the findings can be used as a platform for conducting future studies that examine the effects of FWR on patients, family members and healthcare professionals.

Holzhauser, Finucane and Vries (2006) conducted a 3-year controlled trial study to establish the effects of FWR on the patient’s family members. The study was undertaken in the Princess Alexandra Hospital’s emergency department in Queensland. Participants of the study were selected through a random sampling technique and were assigned to either the control or experimental group. The researchers found that all the participants who chose to be present during the resuscitation were happy to have been present. Open communication between the participants and the staff was also reported in the study. The level of support given to the participants in the experimental group was higher than in the control. This could explain the difference in the attitudes towards the experience between the participants in the two groups. At the end of the experiment, 96% of participants in the experimental group felt that their presence enabled them to make sense of and accept the patient’s situation while only 71.2% of participants in the control felt the same way. In general, the study supports the assertion that family presence during resuscitation is more beneficial than is harmful to family members.

Tools used in the Studies and Efficacy of Specified Therapeutic Approach

In the studies reviewed above, different tools were used to measure the variables under investigation which were similar and entailed mainly the perceptions of healthcare workers and family members towards family witnessed resuscitation. Despite the use of different tools, I think that the tools used did not affect the results of the studies in any way. This is because the tools and instruments used were pilot tested before they were applied to the main study. In addition, the tools and instruments used were tested to ensure that they were valid and reliable. Therefore, the differences observed in the studies could result from differences in the demographic, professional and socioeconomic characteristics of the participants. All the studies reviewed above made a case for the efficacy of the proposed therapeutic approach. This was done by highlighting the advantages and disadvantages of allowing family members to witness the resuscitation efforts of their loved ones and not allowing them the opportunity to witness such efforts.

Evidence Summary

The question under consideration is whether family witnessed resuscitation in the emergency department should be allowed. In order to answer this question, two groups of studies have been reviewed. The first group consists of studies that support FWR while the second group consists of studies that oppose FWR. The studies that supported family witnessed resuscitation based their arguments on the fact that family presence is comforting to patients, it enables the family members to see firsthand the efforts put in by the medical team which in turn prevents blame game, later on, it enables the family members to take part in the procedure which in turn helps them to make rational end-of-life decisions, and it enhances the relationship between nurses and family members which in turn provides comfort to the nurses during the resuscitation. On the other hand, studies that did not support family witnessed resuscitation based their arguments on the fact that FWR puts pressure on the resuscitation team and thus may negatively affect the results. In addition, FWR is stressful not only to the medical team but also to the witnessing family members. Overall, the evidence presented supports FWR because more benefits than harm have been identified.

Recommendation of a Specific Nursing Strategy

Witnessing the resuscitation of a loved one is emotionally traumatic for anyone. Based on the evidence presented above, the family witnessing resuscitation should be encouraged. This is because it provides more benefits than harm for the family members. Nevertheless, some precautions should be taken before FWR is allowed. To begin with, healthcare professionals who work in the emergency and critical care units and departments should be trained on how to act professionally towards family members who are present during the resuscitation of their loved ones. Second, healthcare professionals should be trained on effective communication strategies that they should use towards family members who are present during a resuscitation effort. Communication between the healthcare staff and family members should begin prior to the resuscitation and should be an ongoing process. This means that the family members should be encouraged to ask questions about what is going and to take active participation in the process.

Importance of Theoretical Model for Nursing Research

A theoretical model gives direction to nursing research. It is the foundation upon which research questions are formulated, the research design is constructed, and data is analyzed and interpreted. In the absence of a theory, a researcher would not be able to come up with a study that makes sense and which adds value to current literature. A research that is guided by theory is therefore crucial for providing evidence-based nursing practice.

Reference List

Demir, F. (2008). Presence of patients’ families during cardiopulmonary resuscitation: physicians’ and nurses’ opinions. Journal of Advanced Nursing, 63(4), 409-416.

Fisher, C., Lindhorst, H., Matthews, T., Munroe, D., Paulin, D., & Scott, D. (2008). Nursing staff attitudes and behaviors regarding family presence in the hospital setting. Journal of Advanced Nursing, 64(6), 615-624.

Fulbrook, P., Albarran, J., Latour, J., Graaf, W., Lynch, F., Devictor, D., et al. (2007). The presence of family members during cardiopulmonary resuscitation. The World of Critical Care Nursing, 5(4), 86-88.

Holzhauser, K., Finucane, J., & Vries, S. (2006). Family presence during resuscitation: A randomized controlled trial of the impact of family presence. Australasian Emergency Nursing Journal, 8(4), 139-147.

Maxton, F. (2008). Parental presence during resuscitation in the PICU: the parents’ experience. Journal of Clinical Nursing, 17, 3168-3176.

Meyers, T., Eichhorn, D., Guzzetta, C., Clark, A., & Taliaferro, E. (2004). Family presence during invasive procedures and resuscitation: The experience of family members, nurses, and physicians. Topics in Emergency Medicine, 26(1), 61-73.

Perry, S. (2009). Support for parents witnessing resuscitation: nurse perspectives. Pediatric Nursing, 21(6), 26-32.

Redley, B., Botti, M., & Duke, M. (2004). Family member presence during resuscitation in the emergency department: An Australian perspective. Emergency Medicine Australasia, 16(4), 295-308.

Redley, B., & Hood, K. (1996). Staff attitudes towards family presence during resuscitation. Accident and Emergency Nursing, 4(3), 145-151.

Twibell, R., Siela, D., Riwitis, C., Wheatley, J., Riegle, T., Bousman, D., et al. (2008). Nurses’ perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. American Journal of Critical Care, 17(2), 101-111.