Cardiopulmonary resuscitation (CPR) is an important skill often performed in the midst of life-and-death situations. It is necessary, but it is an invasive and potentially stressful procedure to witness. Allowing families to be present during resuscitation, without compromising patient care, demonstrates the importance of patient-family care. Patient safety should always be at the forefront of resuscitation efforts.
Family-witnessed resuscitation has both benefits and risks. The benefits and risks are matters of great importance and should be analyzed to best benefit patients, family members, and healthcare workers. Lets talk about the benefits and negative consequences of family-witnessed resuscitation, and how to make the process more positive for those families who witness a resuscitation.
Benefits
There is a vast array of benefits for allowing family members of a patient to be present during CPR and other lifesaving interventions.
Providing Information: Family members can help provide critical information that pertains to the resuscitation. This can include what medications a patient may or may not have taken, events leading up to cardiac arrest or other medical emergencies, medical history, and known allergies. Information such as this is a catalyst for a more efficient resuscitation and provides key details that may even potentially dictate what medical care is needed during the resuscitation attempt.
Decision Making and Recognizing Effort: Family members who are present during resuscitation efforts can be part of the team and can help with decision-making by helping to determine if life-saving measures should be stopped. Being involved can address the uncertainty for individuals surrounding the death, help them recognize that everything was done medically to prevent the fatality, and that potentially any further intervention would not change the outcome. It also allows them to recognize the measures and efforts put forth in the resuscitation attempt by healthcare workers.
Facilitates the Grieving Process: For some family members, being present during the final moments of a loved ones life is very important and can allow the grieving process to begin. Witnessing the deterioration of the individual can provide closure that otherwise might be lacking. Not all family members may choose to be present, but for many, this is a very much wanted and needed aspect of their coping. It allows them to be present at the time of death, rather than seeing a loved one who may have died after all efforts have been made.
Negative Consequences/Risks
While there are many positive aspects of family-witnessed resuscitation, there are also negative risks associated that are important to be aware of.
Emotional Toll: CPR and other resuscitation procedures can be quite invasive and naturally violent. Resuscitation often involves aggressive chest compressions, removing clothing, leaving the patient exposed, and rapid intubation. It is a difficult and emotionally taxing experience as a healthcare provider doing the resuscitation, and especially for a family member witnessing someone they care about go through such an ordeal. Due to the invasive and high-stress environment during a resuscitation, family members may remember the last moments of their loved ones life as stressful and disturbing. Some would rather have their last interaction be positive.
Potential Intervention: Family members can potentially intervene in a negative manner during medical treatment. Watching a resuscitation can be emotionally taxing and extremely stressful for a family member as a bystander, and they may feel helpless or upset. At times, family members may prevent or delay necessary medical care because of a desperate attempt to be close to a loved one or to assist with patient care. They could also potentially put the patient and healthcare workers at risk of harm if emotions cause physical intervention.
Potential Distraction: Such an emotional situation can cause individuals to react in a variety of ways. Some may be silent in fear; others may react by yelling at healthcare professionals. They can potentially become a distraction to those providing life-saving measures because of the intense emotions they are experiencing. Emotional responses to watching a difficult procedure performed on a loved one are not unnatural or unexpected, yet can be potential distractions to healthcare workers and prevent them from doing their job to the greatest capacity. Patient safety must always be maintained and prioritized.
How to Support the Family
For family members who are present during a resuscitation, it can be a stressful ordeal, and there may be confusion as to what has happened and what is happening during quick-paced medical interventions. Designating an individual, such as a nurse, tech, or social worker, to be with family members can be a great asset. This can be done either in the patient's room or outside the door, whichever is most appropriate and will not interfere with medical efforts. This may vary depending on the number of family members present, the size of the room, and how much equipment and medical personnel may be needed at the bedside. These designated individuals can serve as emotional support but can also explain what is happening during the resuscitation attempt and provide insight as to why certain procedures are needed.
Knowledge is empowering when fear and the unknown surround a situation. When a resuscitation is not successful, allow the family time and a place to grieve and process what they have witnessed. It is also appropriate to answer any questions that may arise. Supporting the family through postmortem care and explaining what to expect and the next course of action helps to provide guidance in a potentially unfamiliar situation. Also, recognize that family members may react in a variety of ways. Some may be reluctant to stay with their deceased family members, some may process what they have witnessed more internally, while others can be quite vocal, calling out for a loved one to come back, and wanting to remain by the individual to process the death.
Recognizing that individuals process grief differently can help prepare healthcare professionals to best assist the family during a difficult experience. For resuscitation attempts that do have a positive outcome and the patient experiences return of spontaneous circulation (ROSC), the family will have a lot of concerns and questions about the unknown. Providing support and giving updates is appropriate.
Conclusion
Family-witnessed resuscitation can be beneficial to patients, families, and healthcare providers if executed in an appropriate manner that maintains patient safety as the top priority. The benefits of family-witnessed resuscitation include providing closure for the family, the family gets to work as part of the resuscitation team to make decisions, and family members can serve as information providers and keepers regarding the event. The risks include family members having traumatic experiences witnessing the resuscitation, potential intervention, and the possibility of distracting healthcare professionals as they perform needed medical procedures. Designating a specific individual to serve as the family support person during a resuscitation can be a great help to family members.
Understanding how to better include family members in resuscitation attempts without interfering with life-saving measures can be very beneficial to those involved. Being aware of the benefits and risks allows healthcare providers to be better prepared to support those who are involved and to prepare to have an efficient resuscitation while overcoming potential negative risk factors.
References
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Chapman, R., Bushby, A., Watkins, R., & Combs, S. (2014). Australian Emergency Department health professionals' reasons to invite or not invite Family Witnessed Resuscitation: a qualitative perspective. International emergency nursing, 22(1), 1824. https://doi.org/10.1016/j.ienj.2013.03.008
Dougal, R. L., Anderson, J. H., Reavy, K., & Shirazi, C. C. (2011). Family presence during resuscitation and/or invasive procedures in the Emergency Department: one size does not fit all. Journal of emergency nursing, 37(2), 152157. https://doi.org/10.1016/j.jen.2010.02.016
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About the Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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