Family presence during cardio pulmonary resuscitation is obviously a debatable issue among health care specialists. However, the family takes on an extremely critical role in providing supportive health care and has the most stakes in the patient's success, progress and result. This newspaper reviews the books and highlights the huge benefits and implications of the family existence during CPR.
Benefits of family occurrence during CPR includes, providing value to patient's preference and dignity, encouraging one another in the grieving process and reducing dangers of medico legal divergence. On the other hand, outcomes of family occurrence include neglect of patient's to autonomy, breach of confidentiality, mental trauma to the family and possible legislation suits. Therefore we, as health care pros, play a pivotal role in easing the patient's stress by providing mental health support during CPR through family contribution.
Key words: Cardio pulmonary resuscitation, grieving, medico legal divergence, autonomy
Many years back, mortality was a family group unit subject, with members of the family providing mental support to the dying person. Medical breakthroughs and technical developments like Cardio-Pulmonary Resuscitation (CPR) have managed to get possible to prolong a dying person's life. Cardiopulmonary resuscitation (CPR) can be an emergency technique that is often utilized after cardiac or respiratory arrest (1).
To avail this progress technology, families started out transporting themselves more often to the clinics with the desire with their survival. However, before, hospitals had followed the practice of not allowing members of the family to witness the procedure of CPR, (3, 12) despite the fact, that people play a very critical role in patients' usage of health care in such emergencies. They will be the one's who serves the most in the patient's survival, progress and results (10). The practice of family occurrence during CPR first emerged in the 1980s from the Foote Medical center in the United States, and since then the concept has gained momentum (2). The presence of patient's immediate relative during CPR is an moral, moral, and legal issue among healthcare experts (2, 10). This paper will highlight the benefits and the consequences of the family's occurrence during CPR.
Benefits of family presence during CPR include, providing value to patient's choice and dignity, helping family in the grieving process and minimizing dangers of medico legal divergence (2). Most of the patients prefer occurrence of family when they are in stress. As Meyers, Eichhorn, Guzzetta and Klein (2000) have emphasized that if patients were provided chance to make a decision the presences with their family members, when they are battling to survive, they'll acknowledge it (3). So loved ones, who had been always the source of pleasure and strength, need to be present when the individual require them the most; the patient may feel secure and less frightened with their family's presence. It is estimated that only 10% to 15% of patients who get CPR in the hospital survive and get discharged (2). Therefore, because of the high mortality rate and patients' need to be near their family at the moment of death, it is the moral and moral responsibility of the health care company, to work as an advocate for patients' dignity by allowing family during CPR. As Snoby (2005) discovered that "60% to 80% of the public believe that members of the family should be allowed to be with their loved one during resuscitation"(4).
Family occurrence during CPR facilitates family in the grieving process (10, 12 ) and really helps to meet their psychological and psychological needs. While employed in an emergency department of a private tertiary care clinic, one of the authors (of the article) primary author of this manuscript found a patient's family who have been provided the opportunity to be with the patient during CPR. The family later expressed that this allowed them the probability for closure and provided them an opportunity to say goodbye to their cherished one. Family members who have been at the bedside during CPR process portrayed that their presence had helped them to face the truth of the situation and also facilitated in their grieving process. (5, 12). Hanson and Strawser (1992), referring to his study, mentioned that "76% presumed their modification to the death of their love one and 64% assumed their presence was good for the dying person"(1). Thus, family occurrence during CPR helps grieving with succeeding death and therefore, medical team should support family occurrence during CPR.
In addition, family existence during CPR may relieve the uncertainty which may lead to possible lawsuits. Beside this argument, family presence during CPR enhances communication which facilitates the understanding between the medical staff and the family. A report conducted at the Parkland Health and Hospital system shows that 95% of the family who had been present during resuscitation, verbalized that this helped them to comprehend the patient's grave condition and attempts that were made by health care associates to save the life of their loved ones(3). Hence, family presence eliminates uncertainties about the task and efforts made for patient success.
On the in contrast, repercussions of family presence may present certain issues such neglect of patient's right of autonomy, breach of confidentiality (10), mental stress to the family and possible law suits. (2, 9, 10)). Several medical care pros views that by allowing the family to be present during resuscitation, violation of the patients' protection under the law to autonomy and disregard to his/her confidentiality. Allowing immediate family without patient's consent contravenes his or her autonomy, personal privacy and confidentiality. Often revealing patient before family members may also cause discomfort for the survivors of CPR. As Nibert declares that some patients choose to face death alone and don't allow their relatives to invade their privacy(6).
It is also argued in books that relatives shouldn't be present at resuscitation as it generates more psychological problems throughout their bereavement (11). It could be challenging for the members of the family to deal with the memories of blood loss, needles, body fluids, intubation process, chest compressions and defibrillation types of procedures performed on the cherished one. Many people are hypersensitive to see their dear ones in stress; therefore it has been noticed that the family becomes emotionally traumatized during CPR. As Morse and Pooler allege that members of the family who continue to be with the patient have crumpled during relatively modest strategies, and were necessary to seek medical assistance and look after themselves (7). In one CPR process performed at a hospital, one of the authors of this manuscript experienced the distress of a member of family. The brother of the patient had chosen to be present and was allowed to do so. Through the procedure the brother broke out in tears and kept the room. Later he reported that he could not endure to see his sibling suffering.
It in addition has been asserted that the occurrence of relative during CPR can lead to lawsuits. Clinic management may have doubts that family can notice mistakes and take them to the courtroom. As Rattrie pointed out that, " The nurses and doctor are at threat of legal lay claim for the payment of neglectfulness (8). This debate causes the major matter for medical care experts for continuation with their job and their profession growth. Fear may be due to insufficient confidence or lack of skills of medical team members in the CPR procedure (2).
Health teams may well not prefer occurrence of members of the family as they could interrupt the task (11) by requesting either to extend or even to discontinue prematurely. In the same way, medical personnel may believe that family occurrence and their emotional reactions can cause constraints through the CPR process. Furthermore, taking into consideration the poor knowledge of the CPR method by untrained members of the family who may contemplate it an offence, the resuscitation team may finish up with a disagreement by the family during the technique (10).
In one CPR procedure in a private tertiary care clinic, it was experienced by one of the author (of this article), that a parent wanted doctors to stop CPR on the 12 yr old chronically ill child. In contrast, it is also witnessed by another author (of this article) that the family insisted to extend CPR even although patient was clinically dead.
In final result, we, as healthcare professionals, are in prime position to help ease patient's distress by giving subconscious support during CPR through family contribution. However their existence during the technique remains debatable. Medical care team comes with an ethical and moral accountability to provide liberty for family presence during CPR, rather than considering health care professionals comfort, choice (6) and anxieties. Further studies on the activities of the survivors of the CPR and their family can provide further understanding to the trend. Development of comprehensive guideline, predicated on such encounters and expert ideas, can facilitates your choice making and support the needs of patients' family and health professionals in this critical time (10) This may create a more built in and consistent approach to this sensitive aspect of specialized medical practice. (10)
