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Providing Emotional Support to the Family

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Providing Emotional Support to the Family During Resuscitative Efforts in Cardiac Arrest

In the past, family members have often been excluded from being present during the attempted resuscitation of a child or other relative. Surveys suggest that healthcare providers hold a range of opinions about the presence of family members during resuscitative attempts.1-12 One theoretical concern is the potential for family members to become disruptive, interfere with resuscitative procedures, or develop syncope, and another is the possibility of increased exposure to legal liability; however, these are not reported in the literature.

Several surveys suggested that most family members wish to be present during a resuscitative attempt.5-9 Family members with no medical background have reported that being at a loved one’s side and saying goodbye during the final moments of life was comforting.5,6,10 Family members have also reported that it helped them to adjust to the death of their loved one,11,13 and most indicated that they would do so again.10 Several retrospective reports note positive reactions from family members,1-3 many of whom said that they felt a sense of having helped their loved one and of easing their own grieving.4 Most parents surveyed indicated that they wanted to be offered the option of being present during the resuscitative effort for their child.4,14-22

In the absence of data documenting harm and in light of data suggesting that it may be helpful, offering select family members the opportunity to be present during a resuscitation is reasonable and desirable (assuming that the patient, if an adult, has not raised a prior objection). (Class IIa, LOE C for adults and Class I, LOE B for pediatric patients)

Parents and other family members seldom ask if they can be present unless they are encouraged to do so by healthcare providers. Resuscitation team members should be sensitive to the presence of family members during resuscitative efforts, assigning a team member to remain with the family to answer questions, clarify information, and otherwise offer comfort.9

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Providing Emotional Support to the Family After Termination of Resuscitative Efforts in Cardiac Arrest

Notifying family members of the death of a loved one is an important aspect of a resuscitation that should be performed compassionately, with care taken to consider the family‘s culture, religious beliefs and preconceptions surrounding death, and any guilt they may feel associated with the event or circumstances preceding the event.23

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References

  1. Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present during CPR? A retrospective survey. J Emerg Nurs. 1998;24:400–405.
  2. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. 1998;352:614–617.
  3. Boie ET, Moore GP, Brummett C, Nelson DR. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents. Ann Emerg Med. 1999;34:70–74.
  4. Adams S, Whitlock M, Higgs R, Bloomfield P, Baskett PJ. Should relatives be allowed to watch resuscitation? BMJ. 1994;308:1687–1692.
  5. Boyd R. Witnessed resuscitation by relatives. Resuscitation. 2000;43:171–176.
  6. Hampe SO. Needs of the grieving spouse in a hospital setting. Nurs Res. 1975;24:113–120.
  7. Offord RJ. Should relatives of patients with cardiac arrest be invited to be present during cardiopulmonary resuscitation? Intensive Crit Care Nurs. 1998;14:288–293.
  8. Shaner K, Eckle N. Implementing a program to support the option of family presence during resuscitation. The Association for the Care of Children's Health (ACCH) Advocate. 1997;3:3–7.
  9. Eichhorn DJ, Meyers TA, Mitchell TG, Guzzetta CE. Opening the doors: family presence during resuscitation. J Cardiovasc Nurs. 1996;10:59–70.
  10. Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ. Family participation during resuscitation: an option. Ann Emerg Med. 1987;16:673–675.
  11. Barratt F, Wallis DN. Relatives in the resuscitation room: their point of view. J Accid Emerg Med. 1998;15:109–111.
  12. Compton S, Madgy A, Goldstein M, Sandhu J, Dunne R, Swor R. Emergency medical service providers' experience with family presence during cardiopulmonary resuscitation. Resuscitation. 2006;70:223–228.
  13. Beckman AW, Sloan BK, Moore GP, Cordell WH, Brizendine EJ, Boie ET, Knoop KJ, Goldman MJ, Geninatti MR. Should parents be present during emergency department procedures on children, and who should make that decision? A survey of emergency physician and nurse attitudes. Acad Emerg Med. 2002;9:154–158.
  14. Dudley NC, Hansen KW, Furnival RA, Donaldson AE, Van Wagenen KL, Scaife ER. The effect of family presence on the efficiency of pediatric trauma resuscitations. Ann Emerg Med. 2009;53:777–784. e773.
  15. Tinsley C, Hill JB, Shah J, Zimmerman G, Wilson M, Freier K, Abd-Allah S, Tinsley C, Hill JB, Shah J, Zimmerman G, Wilson M, Freier K, Abd-Allah S. Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics. 2008;122:e799–e804.
  16. Mangurten J, Scott SH, Guzzetta CE, Clark AP, Vinson L, Sperry J, Hicks B, Voelmeck W. Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department. Journal of Emergency Nursing. 2006;32:225–233.
  17. McGahey-Oakland PR, Lieder HS, Young A, Jefferson LS, McGahey-Oakland PR, Lieder HS, Young A, Jefferson LS. Family experiences during resuscitation at a children's hospital emergency department. Journal of Pediatric Health Care. 2007;21:217–225.
  18. Jones M, Qazi M, Young KD. Ethnic differences in parent preference to be present for painful medical procedures. Pediatrics. 2005;116:e191–e197.
  19. Andrews R, Andrews R. Family presence during a failed major trauma resuscitation attempt of a 15-year-old boy: lessons learned.[see comment]. Journal of Emergency Nursing. 2004;30:556–558.
  20. Dill K, Gance-Cleveland B, Dill K, Gance-Cleveland B. With you until the end: family presence during failed resuscitation. Journal for Specialists in Pediatric Nursing: JSPN. 2005;10:204–207.
  21. Gold KJ, Gorenflo DW, Schwenk TL, Bratton SL, Gold KJ, Gorenflo DW, Schwenk TL, Bratton SL. Physician experience with family presence during cardiopulmonary resuscitation in children. [see comment]. Pediatric Crit Care Med. 2006;7:428–433.
  22. Duran CR, Oman KS, Abel JJ, Koziel VM, Szymanski D. Attitudes Toward and Beliefs About Family Presence: A Survey of Healthcare Providers, Patients' Families, and Patients. Am Journal of Critical Care. 2007;16:270–279.
  23. Iserson KV. Notifying survivors about sudden, unexpected deaths. West J Med. 2000;173:261–265.
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