Posted at 11.29.2018
Does allowing family in to the injury room necessary or simply asking for trouble. Cardiopulmonary resuscitations are quick and traumatic medical event that frequently ends in a patients loss of life or change in patient's health status. Usually, it sometimes appears that when an individual gets cardiac arrest, the family is requested to wait in a waiting around room while life-saving actions are initiated. But recently, this traditional way has spark argument. Many family desire to be present during resuscitation efforts and want to witness the options taken by healthcare providers in order to save the lives of themselves. Family should be allowed or not in this event remains an important concern in professional medical practice. Matching to survey conducted at clinic in Lahore, 95% health care pros were against witnessed cardio-pulmonary resuscitation (Zakaria & Siddique, 2008). During my job life in Recovery unit, I ran across such situations many times, when family was quite definitely concerned and wished to stick with patient during resuscitation. Family's existence during resuscitation has its benefits and drawbacks. According to American Journal of Critical Care, staff members have articulated more cons than benefits associated with family existence (Duran at el, 2007). There have been many controversies over this problem. But I believe family shouldn't be allowed during resuscitation as it inhibits resuscitation effort, rises risk of responsibility and litigation, breaches patients privacy and confidentiality.
The first important reason why Family must not be present during resuscitation is that it interferes with resuscitation efforts. Family's existence impedes and disrupts the resuscitation process by impairing the performance of the code team (Schmidt, 2010). Resuscitation tries in such instances usually get unnecessarily prolonged because of family existence and their emotional behavior for instance crying, inquiring again and again about patient's condition, ranking at bedside etc. At an international conference of the American College of Breasts Physicians, health care professionals pointed out that families walk out control and distract them from doing their job. Additionally, performance stress also boosts and there is insufficient the option of an adequate personnel to totally support patient's people due to prime give attention to resuscitation good care (Critchell & Marik, 2007). During my job experience I, once came across a situation where husband underwent cardiac arrest and was getting resuscitated before his wife so when patient was cardiovert his wife fainted which distracted code team's attention and caused stress and anxiety. Furthermore, often doctors and nurses hesitate to discuss the patient's condition openly in the existence of family, triggering hindrance in patient's good care and delays in decision making regardless of the need of promptness at such essential times (Duran et al, 2007).
The second reason is the fact that, it increases risk of responsibility and litigation. Code room may be too traumatic for family members and in those days the team's initiatives might be interpreted as cruel by the members of the family (Critchell & Marik, 2007). Performing breasts compressions, delivering shocks to patient might be observed as an unkind activity in the event if patient expires. Also, in this essential situation, there might be chances for the errors to occur, incorrect comments to be made, and actions be misinterpreted by family. Therefore, facilitator is vital to monitor the family's reactions, translate medical jargon, and make clear the proceedings but this is not applicable because at that time, saving patient's life is the leading responsibility of medical care and attention providers. (Oman & Duran, 2010). Furthermore, the entire situation during resuscitation is too distressing for loved ones, an noticed action or remark may easily offend family, leading to a grievance. In these situations, the accountability of team rises. Studies also highlight that family viewing resuscitation would traumatize family member's and business lead to an increase in lawsuits (Wacht et al, 2010).
The third reason of debate is that it breaches patient's right of privacy and confidentiality. In this critical moment it is the probability that medical information recently as yet not known by the family may be uncovered in the chaos of an code. Patient's dignity could become compromised. As it's the moral obligation to safeguard patients confidentiality. Dignity and honesty are the essential components of ethics (Lippert et al, 2010). Since the patient is unconscious, it isn't possible to get his/her consent for witnessed resuscitation and it's unethical to allow family without knowing patient's arrangement to the witnessed resuscitation. The Medical and Midwifery Council (2008) states that "nobody is eligible for information that your patient does not want those to have". Inadequate screening process of family in those days could result in unrelated visitors attaining usage of information that could often be safeguarded. This potential breach in confidentiality can have broader implications relating to the public's rely upon the medical job (Critchell & Marik, 2007).
Supporters of family occurrence during resuscitation, claim that witnessing a code helps relatives to comprehend the patient's condition. It can help in realizing the reality of the problem and also reduces family's denial about patient's worsening condition. With this it also allows family to say last goodbyes to dying patient, permitting some form of closure. Second of all, it facilitates in creating a trusting romantic relationship between personnel and family. It allows the personnel to provide information and escalates the family's knowledge of the patient's current situation. Along with this, family would recognize that the healthcare team do its better to save the life of their loved ones and likelihood of blaming healthcare provider's decreases. Psychological support provided to family by healthcare providers in this extreme moment really helps to create a trust and patience. Finally, it satisfies the mental and religious needs of patient's family and provides sense of closure to dying patient. It also facilitates role of caretaker and motivates family to execute religious prayers by the end of life situation would alleviate patient's life.
With no concerns, witnessing patient during Resuscitation creates worry and fear among family, as they are not habitual to deal with such situations. This may lead to mental health trauma and likelihood for the family to react abruptly. Critchell and Marik (2007) highlighted a scenario of distraught mother attempting to yank back the doctor, while accomplishing cardiac massage therapy off her daughter. This delayed cardioversion but thankfully patient was kept from poor repercussions that may have occurred. People might keep insisting on doing everything possible even in a futile resuscitation. In the same way, at times individuals have asked to avoid a code, sometimes prematurely (Critchell & Marik, 2007). Alternatively, counseling the family about the patient's condition beyond your resuscitation area is more productive somewhat than counseling them before the individual being resuscitated. Describing the problem and prognosis in a peaceful environment facilitates family to make acoustics decision with respect to patient. Prayers performed in peaceful environment assists with maintaining concentration, endurance and provide internal peace to mind. Finally, the family's occurrence might involuntarily increase stress levels for staff, hinder their performance and spoil the concentration necessary to run a code. A study by Fernandez et al in 2009 2009 says that once, anticipated to a family attempting to hug the simulated patient; it required longer to provide the first defibrillation and provided shocks essential to save patient's life.
In conclusion, family shouldn't be allowed as it generates hindrance in resuscitation activity, increases risk of accountability and lawsuit, violates the patient's right of privateness and confidentiality. It might be more good for the patient and code team if family is not present during resuscitation as team can concentrate fully on the individual without the pressure. For this reason, I would suggest there should be a special nurse or medical doctor who are able to counsel patient's family during resuscitation in a counseling room somewhat than before patient. However, formerly enforcing the allowance for family witness resuscitation in the coverage, there should be test studies conducted before its execution.