Running head: FAMILIES PRESENT DURING CODE 1

Should Families be Present During a Patient Code

Bree A. Miller
Ferris State University

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Should Families be Present During a Patient Code
In the healthcare setting there are many controversial topics among staff and patients.
One controversial topic developing forefront in multiple hospitals is having the patients family
present while the staff performs resuscitation measures. Lately there has been a push for family
centered care and involving all persons involved caring for the patient (Sak-Dankosky,
Andruszkiewicz, Sherwood & Kvist, 2014). Some countries accept the witnessing of
resuscitation measures but for others it remains controversial. Research on family presence
during resuscitation is abundant, mainly supporting a push for a change in attitudes from staff
and policies to change on making it mainstream.
Research from Oman and Duran (2010) resulted in a push to implement family presence
in all resuscitation that they choose to attend. The researchers observed and took note on what
has been controversial in the past including, family members were able to emotionally tolerate
the situation (59%), did not interfere with the care being provided to the patient (88%). In
addition, team communication was not negatively affected (88%) (p. 530). Oman and Duran
also concluded with family presence being beneficial, family presence is emotional, but a family
facilitator needs to present. A family facilitator would take the pressure off the staff in having to
explain what they are doing and focus on saving the patient. The facilitator stays with the
family, providing explanations and debriefing after it is over. Having one present has proven to
be more beneficial than not.
A descriptive, qualitative design was used to describe family experiences of being present
during resuscitation. The study resulted in support of family being present because it helps the
members build trust in health care professionals, fulfills informational needs, allows family
members to gain close proximity to the patient, and support their family member emotionally
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(Leske, McAndrew & Brasel, 2013). Lowry (2012) conducted a similar study that had similar
results. Lowry supported family presence during resuscitation because the family is able to
observe evolving events which lets the family see a loved ones condition change over time.
Having family present also validates the effort made by staff to save the life of their loved one.
His study also showed that family members were appreciative to nurses for doing everything
possible and therefore increasing the nurses confidence in the end. Lastly, nurses did not
observe any actual harm to the family members who were present during resuscitation. These
observations are contrary to what many nurses and staff perceive about the issue.
In France studies were conducted on having family present during pediatric resuscitation
resulting in unfavorable responses from doctors and nurses. Reasons opposing their observations
were, psychological traumas of parents, interfering with medical management and care team
stress (Tripn et al., 2014). Also in France an anonymous questionnaire was sent out to
physicians, nurses and support staff asking their opinions on having families present during
resuscitation. Family witnessed resuscitation (FWR) was supported but not ready to offer it
systematically to relatives (Belpomme, 2013).
Jensen and Kosowan (2011) researched in Canada finding out that family present during
cardiopulmonary resuscitation is becoming more and more prevalent. Barriers present are, lack
of support for families, the experience would be too traumatic for families, families would not
understand the procedures, fear of families physically interfering with procedures, increasing the
stress levels among staff, and tradition and politics excludes family presence. Even though less
than half of people who responded supported family presence, many endorsed development of
policies and procedures to support it.
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Jaques (2014) observed that in the United Kingdom, resuscitation guidelines allow
families to be present when it takes place in a hospital. The study resulted with relatives who
were offered the opportunity to witness resuscitation were less likely to develop symptoms of
post-traumatic stress disorder than those who were not given the chance (p. 20). Other
countries have started writing policies on implementing family presence in daily practice. There
are differing results from the foreign studies providing support on both sides but mainly in favor
of having the family present. The United States is looking at the foreign research to start a base
for policies and procedures to be implemented.
In Northern Ireland 160 emergency nurses were asked for their views on holistic family-
centered care during and after resuscitation. Results have shown that nurses knew they had a
duty to provide such care but they were often prevented from this due to lack of staff and time
(McLaughlin, Melby & Coates, 2014). Many studies have concluded with this same idea.
Nurses know that involving family in every part of the patients care is important but at the same
time there are logistics to take into account. Holistic family-centered care is the base of nursing
considering all parts of the patients life. Even though nurses embrace a holistic approach, it is
not easy when it is a life or death situation.
According to Jones (2012) a lot of nurses are not convinced of the benefits of having the
family present. In adult Intensive Care Units it is controversial. It is different in every unit, and
depends on the doctor in many institutions. It can even be different unit to unit in the same
hospital. Due to the lack of official policies be implemented in the United States, each institution
follows their own rules in this area. Chapman, Watkins, Bushby & Combs (2013) concluded that
after studying medical personnels opinion, the family presence risk-benefit was swayed towards
beneficial. Physicians and nurses supported families being present, but with provisions. The
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fact that having family present is still controversial the staff is hesitant but understanding at the
same time.
There has also been a study by Itzhaki, Bar-Tal & Barnoy (2012) on the reactions of staff
members and lay people being present during resuscitation and their reaction to visible bleeding,
resuscitation outcome and gender. Both staff and lay people perceived family presence during
resuscitation negatively. When there was a negative outcome or visible bleeding, staff and the
family were negatively affected. Female physicians and nurses reacted more negatively to
family presence compared to their male counterparts. The study concluded with a need for
education and training in order to change the negative feelings from staff.
A bibliographic review was conducted of fifteen articles on the subject of family being
present. Results concluded that culture, the healthcare professional, existing protocols, and
hospital unit are influential on the acceptance of family being present (Ana Maria Correa,
Antonio Santamaria & Jose Maria Elros, 2013). Most publications were in favor of relatives
being present but with strict guidelines and protocols (Ana Maria Correa, Antonio Santamaria &
Jose Maria Elros, 2013).
Throughout all the studies researched there were conflicting conclusions. On the family
side, there was support and almost all concluded beneficial results to family being present. On
the staff side, many are hesitant to accept the new practice and have many doubts in the risk-
benefit ratio. Having the family present for resuscitation of their loved one is a controversial
topic, but in the end it is up to physician to decide if he allows it. Research is leaning towards
the implementation of allowing family to observe and medical staff will need to be educated
about the benefits proven so far.


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References
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