Family Presence and Resuscitation: Negative Implications

In the field of medicine, performing cardiac pulmonary resuscitation (CPR of Code) in front of family members during a traumatic moment has long been the source of controversy and debate. There have been studies and many discussions that show that there can be a somewhat psychological and physical impact on family members and medical professionals. There are many factors that come into play during this moment that can have a negative or adverse effect on all those engaged in that moment. The following will discuss potential cons to performing resuscitation in front of family members. These will deal with the psychological, emotional, and physical implications. 

According to Sanford, Pugh, & Warren (2002), “After analyzing surveys from people who witnessed CPR on a loved one, the conclusion was that what was previously thought to be an event too traumatic for family members to witness actually aided surviving family members in coping with grief” (Sanford, Pugh, & Warren, 2002, p. 62). The researchers found that “family presence during CPR and the patient’s final moments may facilitate the family members through this grief process” (Sanford, Pugh, & Warren, 2002, p. 65). Although this study, and other current research shows that this open level of communication and experience with the medical team can reassure family members of one undergoing medical treatment or an ensuing terminal illness, it is also most commonly understood from research that the impacts to this openness (as in openly performing CPR) could have an adverse effect.

In the article, Should families be present during resuscitation? (2007), RN Linda Laskowski-Jones, addresses many of the cons associated with this openness. According to Laskowski-Jones (2007), many medical professionals “argue that witnessing a futile resuscitation attempt can be psychologically damaging for relatives and may increase liability risks for caregivers” (Laskowski-Jones, p.45). Seeing something go wrong during a lifesaving event can leave the family member at a psychological loss, and could possible lead to a more serious condition like Post Traumatic Stress Disorder (PTSD). A family member who sees a mishandling of another family member mistreated during resuscitation or if the resuscitation is unsuccessful, can lose faith in the medical profession. Also, research states that “PTSD is the psychiatric disorder that can result from the experience or witnessing of traumatic or life-threatening events” (Iribarren, Prolo, Neagos, Chiapelli, 2005). Many believe that PTSD has to come from a trauma from certain events like a terrorist attack, violent crime an abuse, military combat, natural disasters, serious accidents or violent personal assaults, however PTSD can be caused by any traumatic event. Witnessing an unsuccessful resuscitation can lead to a PTSD, in addition “some people cope with anxiety, fear, or grief with anger or violence” (Lakowski-Jones, p.45), which can be prolonged as a result of this PTSD from this traumatic event, and the psychological after effects.

While watching a family member being resuscitated, one of the on looking family members can also become physically injured. An overwrought family member might faint and hurt him or herself (Laskowski-Jones, p.45), in addition to being exposed to certain bodily fluids and blood that can give a potential health threat to them. The trauma scene is a very dynamic, high stress, tense, and potentially dangerous environment for on lookers. Many times, unintentional accidents happened, because of the nature of this dangerous scene.   

In addition to having an impact of the family members watching the resuscitation, it can also have an impact on the medical professionals performing the procedure. According to Laskowski-Jones (2007), “the presence of family may distract the health care team from patient-care decisions and tasks. Possibly impairing the resuscitation attempt” (Lakowski-Jones, 2007, p.45). Many professionals may be distracted by the responses, mental, and emotional well-being of the family member during the resuscitation, and they may also be distracted with concerns of doing everything correctly to avoid potential mishandlings. These distractions may impair the quality of the procedure, could lead to unnecessarily injuries to the patient, or even death. In this instance, the medical professional and those affiliated with them are held liable.  

Another concern is that, as mentioned, “an overwrought family member might faint and hurt his or herself. Having to attend to the injured family member further diverts resources from the patient. The observer could also be accidentally exposed to blood or body fluids or contaminate equipment” (Laskowski-Jones, 2007, p.45). This could present another possible traumatic experience that requires the attention of the medical professionals, which takes from the resuscitation of the first person. In addition to this happening those family members responding to the traumatic event themselves in an angry or unruly manner, in the emotionally charged atmosphere of a resuscitation attempt, can become aggressive and jeopardize or harm staff and ultimately compromise patient care (Laskowski-Jones, 2007, p.45). 

To conclude, the cons of allowing family members to be present during the resuscitation procedures far outweighs the benefits. Although, the primary benefit found in many studies is that family presence during CPR and the patient’s final moments may facilitate the family members through the grief process, the cons are much stronger. Allowing family members to be present can lead to certain emotional, physical, and psychological issues such as PTSD or the loss of faith in medical professionals if there is a mishandling or an unsuccessful attempt. In addition, this practice also puts the medical professionals at risk of being distracted leading to possible grave mistakes, a potential physical issue that an onlooker may have can lead to extra trauma issues that the professionals have to deal with, but it could also lead to potential physical harm or danger for the medical professionals if a grieving family member is volatile. With all this evidence, it would be a mistake to allow family members to witness the resuscitation of another family member. 

References

Iribarren J., Prolo P., Neagos N., and Chiappelli F., (2005).  Post-traumatic stress disorder: evidence-based research for the third millennium. Evidence-Based Complementary and Alternative Medicine, 22. 503–512 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297500/

Laskowski-Jones, L. (2007). Should families be present during resuscitation? Nursing 2007, 37(2), 44-47.

Sanford, M., Pugh, D., & Warren, N. A. (2002). Family presence during CPR: New decisions in the Twenty-First Century. Critical Care Nurse, 25(2), 61-66.