Ethical_Dilemma__Family_Presence_During_Resuscitation

Over the past decade, the family presence during resuscitation has been an increased controversial issue. Although, there are many professional organizations support the notion of family presence, the controversy still continues. Many family members were asked to leave the bedside of their loved one during resuscitation. Parents are often separated from their kids during medical emergencies. The reason behind this can be the existing fear that the family members may interfere with resuscitation efforts or it will traumatize them psychologically. A recent review of three qualitative studies about family presence during resuscitation by Bonnie Schmidt discuss that strong support is shown for the best practice of family presence during resuscitation (Schmidt, 2010). A moral conflict exists because of the existence of two opposing obligations. The obligation to the family members who wants to be present with their loved ones during medical emergencies and the obligation to healthcare providers who do not want the presence of family members to witness the resuscitation efforts. It is very important to examine the perceptions of patients, families, and health care providers when determining a solution for the family stay during medical emergencies. Often health care providers assume that the family members may interfere with the resuscitation efforts (Thomas, 2008). Another fear is that the family member may not be able to control their emotions, there by hindering the resuscitation efforts. Many organizations such as Emergency nurses Association and Associations of Critical Care nurses support the presence of family members during resuscitation. Findings from one study suggest that the family members who were not present during resuscitation had more psychological issues throughout the bereavement than those who witnessed an unsuccessful resuscitation. Experts claim that family involvement during resuscitation can help patients and families to control the fear and anguish experienced in the crisis (Thomas, 2008). Related ethical theories and principles Family presence during resuscitation can be related to theory of Utilitarianism. Utilitarianism is the moral theory that holds that an action is judged as good or bad in relation to the consequence, outcome, or end result that is derived from it. Utilitarians hold that the only factors that make actions good or bad are the outcomes, or end results, that are derived from them. Act-utilitarianism suggests that people choose actions that will, in any given circumstance, increase the overall good. Rule-utilitarianism, on the other hand, suggests that people choose rules that, when followed consistently, will maximize the overall good (Burkhardt & Nathaniel, 2008, p. 67-68). Both Act-utilitarianism and Rule-utilitarianism can explain the importance of family presence during resuscitation. Family presence can be considered as a nursing holistic view of the family centered care. Being able to say good bye to a loved one is a positive aspect of the presence. Alternatives to resolve the ethical dilemma Many families are exposed to the idea of family presence through popular television shows. These shows actually give them an idea of what to expect during resuscitation. Being present helps the family members to understand the seriousness of the patient condition and act accordingly. It also helps them to decide on patient’s code status during medical emergencies. It encourages the health care staff to behave professionally at the bedside (Thomas, 2008). In most cases, health care providers are concerned that family may interfere with resuscitation and staff may not be able to concentrate completely on patient resuscitation. Available staff may be taken away from the patient to alleviate family concerns. Presence of family members may results in the violation of patient privacy and confidentiality. The fear of increased litigation is another factor that opposes the presence of family. Health care providers often feel that the family is constantly watching them to see if they are doing the right thing. If the family members are under emotional instability, then it would not be a good idea to keep them at bedside. Instead, it would be better to keep the family away and give them the support throughout the period of resuscitation. The ethical problem of whether to allow the family during medical emergencies occurs because there is not written guidelines in many facilities about how to handle the family members during resuscitation. A written policy can help the health care providers to follow that and allow limited number of immediate family members to stay at the bedside. There should be also a supportive staff member assigned for the family members to explain them about what is being done and what can be the consequences. Health care staff should be educated about the written policies and guidelines on family presence to meet the needs of the patients and families. Education should include possible obstacles to family presence and potential benefits. Presence of combative or emotionally unstable family members should not be allowed during resuscitation. Family members should be able to sense that everything possible was done to revive the patient. Since this ethical issue of allowing family members to stay during resuscitation can cause so many problems between the health care staff and patient’s family, care should be taken to involve the family directly or indirectly during resuscitation. It would be a good idea to talk to family members about their wish to be present or not present during emergencies. If the family members wish to be present, then one or two should be allowed to be present during resuscitation. If the family members do not want to be present, there should be one assigned staff member to support the family and explains them about what is being done. Plan of Action Family presence during resuscitation has posed an ethical dilemma for health care professionals for long time and it still continues. Facilities should adopt the recommendations from various professional organizations and implement the guidelines. Guidelines should also explains about when to allow presence family members and if not what other measures to be done' Presence of family during resuscitation should be decided based on the needs. For example, in most cases presence of parents during pediatric medical emergencies often helps the kids and the parents. Staff should talk to the family members and assess their ability to be with the patient during resuscitation. If they found to be capable of staying calm, then I 1st personwould involve them in the resuscitation and provide them with all the information about what are we doing during resuscitation. If the family does not wish to be present, then I would take them to a quiet room and get an assigned supportive staff to stay with them and to keep them updated about the patient situation. If the patient condition worsens, then I would let them stay with the patient to say good bye to the patient. Conclusion I believe that the presence of family members should be done based on the needs of the patients and family. If there are no written guidelines in the facility, then family’s wishes should be considered. If the family members appear to be incompetent of staying in the bedside, then an assigned staff can support them and explains everything correctly. I believe that my above care plan is right and can be utilized in facilities where there are no written guidelines for resuscitation.