Family Presence During Resuscitation: Benefits and Challenges

Introduction: The Case for and Against Family Presence

When considering the presence of family members in the resuscitation room, various factors must be taken into account. If the patient does not respond to resuscitation measures, it is likely that the next of kin will be affected by the experience, potentially leading to traumatic repercussions. Moreover, by allowing family members to be present, staff are expected to ensure a minimum level of support. However, given that resuscitation requires the concentration of all available forces and efforts on the patient, there may be no staff available to support the family—particularly when no trained facilitators have been delegated that responsibility. Some hospitals may also lack the resources to address this issue adequately.

This is why family presence during resuscitation is not always recommended: it can affect relatives negatively. On the other hand, it has long been acknowledged that family presence in the resuscitation room carries real benefits. Being present should be an option—families ought to be given the right to choose whether or not they wish to attend cardiopulmonary resuscitation. However, hospitals should reserve the right to ask relatives to leave in cases where emotional interference could disrupt or jeopardize the resuscitation process.

Support Structures and Institutional Guidelines

In relation to the above, it is necessary—if not imperative—that hospitals develop specific guidelines and policies to address this issue. Many institutions, however, have no defined strategies or formal policy statements that speak to family presence during resuscitation. Consequently, whether family presence is permitted often comes down to the individual decision of whoever happens to be in charge at a given moment.

Educational programs would provide basic training and theoretical knowledge in this area. Facilitators would typically address the protocol with families, answering whatever questions they may have and thereby reducing the anxiety associated with cardiopulmonary resuscitation and sudden death situations. Time should also be allocated to offering informative guidance to patients, where possible, as well as to their family members. Both positive and undesired outcomes should be discussed so that patients and families alike are aware of the full range of implications.

Benefits of Family Presence: Evidence and Outcomes

A survey conducted in 1985, when family presence programs first began to be considered a valuable option, revealed that many respondents who had been present during resuscitation were willing to recommend the experience to others (Doyle et al., 1987, p. 108/674). It has been acknowledged ever since that participation allows family members to experience closure in cases where their loved one does not survive despite all interventions. From this perspective, whenever the patient has not indicated otherwise, there is little reason family members should be denied attendance.

There is also positive feedback from attendees regarding the reassurance they receive that medical staff did everything possible for the patient. Because family members have witnessed the process firsthand, medical staff are less likely to face concerns or accusations about the implementation of resuscitation measures. Relatives who observe the process are reassured that every effort was made to save their loved one, making concerns about incorrect procedures far less likely. Thus, permitting family presence reflects positively on the relationship between staff and the family.

While some healthcare providers have suggested that family presence raises issues of patient confidentiality, this need not be the case if appropriate measures are taken in advance. Both patients and families should receive information covering the full range of possible outcomes, so that all parties enter the situation with realistic expectations.

Conclusion: Balancing Rights and Responsibilities

It is acknowledged that, while family members should be allowed in the trauma-intervention room, this is subject to various factors that enable a positive outcome of the experience. It is equally acknowledged that allowance does not guarantee that every experience will result in beneficial outcomes for all involved. However, insofar as the number of outcomes reflecting benefits for families and staff outweighs those resulting in negative conditions for relatives, family presence during resuscitation should remain an available and actively offered option. So long as family behavior during the process remains composed and restrained, this is an option that all families should be presented with.

References

Doyle, C. J., Post, H., Burney, R. E., Maino, J., Keefe, M., & Rhee, K. J. (1987). Family participation during resuscitation: An option. Annals of Emergency Medicine, 16(6), 673–675.

Mian, P., Warchal, S., Whitney, S., Fitzmaurice, J., & Tancredi, D. (2007). Impact of a multifaceted intervention on nurses' and physicians' attitudes and behaviors toward family presence during resuscitation. Critical Care Nurse, 27(1), 52–61.