A study in this regard by Ainslie Nibert, entitled, Teaching clinical ethics using a case study family presence during cardiopulmonary resuscitation, states that Critical care nurses often find themselves in the midst of challenging ethical situations that involve conflict between the needs of critically ill patients and the patients' family members and the preferences of physicians and other healthcare providers who initiate and manage resuscitation measures. Yet, many critical care nurses have reported that they received little preparation in their basic education programs to deal with these sensitive issues. (Nibert, Ainslie T. 2005)
This may constitute a moral dilemma as the study points out. "A moral conflict exists because two opposing obligations collide: an obligation to the family members who desire to be present with their loved one during CPR and an obligation to the healthcare providers who do not want patients' family members to witness resuscitation efforts." (ibid)
The study suggests that resolving this ethical dilemma lies in hospital and medical policy which would allow for clear instructions for "reinforcing the existing policy that prohibits their presence, or selectively permitting them to be present on the basis of screening according to predetermined criteria." (ibid) Nibert establishes four areas that should be taken into consideration when assessing the implications of family presence. These are (1) medical indications; (2) patients' preferences; (3) quality of life; and (4) social, economic, and health policy issues. (ibid) Another aspect is that nursing staff may find that the presence of family members may affect their authority.
Brown and Ritchie (1990) reported nurses were threatened by the perceived loss of authority that was associated with increased parent participation.
An important aspect in attempting to resolve this problem is the fact that many medical institutions do not have a firm set of policy guidelines on this issue. In a survey of 1500 members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association. It was found that "nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer that it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended. (Desy, Pierre. 2003)
Despite a growing movement in support of family presence, many healthcare professional still continue to resist adopting the practice. One of the arguments made is that "not enough research supports making a change in practice." (Mason, Diana J. 2003) There are no easy solutions to these issues. On the one hand the tendency to allow family presence is justified by factors such as family dignity and moral and psychological support. On the other hand there is also justification in the assertion that family presence may be counterproductive, not only for the nursing and medical staff but also for family members who may be emotionally traumatized. Part of the answer to this dilemma lies in the clarification of policy, as has been suggested, and in the improvement in nursing training to deal with the issue of family presence. As Nibert suggests:
Nurse educators teaching critical care courses can increase students' understanding of ethical dilemmas by having the students participate in a clinical analysis of a case study... In small groups, students can begin their analysis of the issue by reviewing the current literature on family presence. Discussion of findings with their peers helps students identify key issues within the ethical dilemma. (Nibert, Ainslie T. 2005)
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Nibert, Ainslie T. (2005) Teaching clinical ethics using a case study family presence during cardiopulmonary resuscitation. Critical Care Nurse,…