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James Heilman a.k.a User:Doc James MD, CCFP(EM), Wikipedian Faculty of Medicine, Department of Emergency Medicine University of British Columbia

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The Team at WikiProject Medicine Doc James  (talk · contribs · email) 22:24, 12 October 2015 (UTC)

Due to the extensive formatting problems
Have removed your contributions and pasted them below for you to work on further. Best

Addition
'''Family Presence during Resuscitation'''

Resuscitation is the process by which an unconscious person is brought back to their active state. It is conducted either as a basic medical procedure or as part of an intensive care service to an acute patient. The process also varies in its length as it can last from few minutes to several months, depending on the health state of an individual. The presence of family members during the procedure has been a controversial issue for the past few decades as various studies indicate varying results. The studies carried out in the past have findings that indicate both the negative and positive effects of family presence during the resuscitation procedure (Emergency Nurse Association, 2012). This paper aims to significantly evaluate the presence of family members during the resuscitation procedure.

Nursing Research

Allowing family member’s presence during the resuscitation procedure was introduced in the early 1980s. Foote Hospital in Michigan State started a program that allowed family members to be present during resuscitation which was a response to the demands made by the families. Conventionally, in the case of a resuscitation procedure, family members and relatives were lead to a separate room in which they would be advised of the patient’s progress by an experienced nurse. Generally, relatives are rarely asked to be present during the resuscitation procedure unless they demand (Solemainpor et al. 2015).

The medical community in large has conducted several surveys to enable them better understand the concept of family presence during resuscitation (FPDR). Since the first incidence of family presence during resuscitation in Foote Hospital which was received positively by both the family and the medical staff, researchers have been involved in investigating the attitudes, and the effect of the practice to both the family and medical staff. Most of the surveys conducted have targeted the family members, patients, and the medical staff in general.

In 2012, a study was carried out on the Yale-New-Haven Hospital in which the staff was interviewed about their attitude towards family presence during resuscitation. The study involved 100 health care professionals who included technicians, nurses, physicians, chaplains, and social workers. They analyzed the qualitative data and reviewed the results to increase their validity. The results indicated that seventy-seven percent of the staff favored the presence of the family during the resuscitation procedure. Seventy-six percent believed that family members of patients would want to be present when their loved one is being resuscitated (Zohar, & Loran, 2014)

Another research was conducted that was approved by Carle Institutional Review Board. During the survey, emergency department (ED) nurses were trained on how to act like family presence facilitators. 60 ED nurses took part in the survey in which their level of understanding was measured regarding the formal and the informal policies of the presence of family in the emergency department. The nurses were also asked about their opinion regarding the family presence during the resuscitation procedure. The results of the survey indicated that of the 60 ED registered nurses, only 38 took part in the survey hence making the response rate to be at sixty-three percent. Forty-five percent of the respondents correctly reported that the emergency department lacked a written policy allowing family members presence during resuscitation. Sixty-eight percent reported correctly that the emergency department had no policy that prohibited the family presence option during a resuscitation procedure. The same percentage answered that emergency department allowed the option of family presence though it did not have a written policy. A sixty-five percent majority responded that they would prefer a written guideline policy on the family presence (Laura Keller, 2011).

In another study in 2013 published by Jabre et al. investigated the effect of allowing family members to be present when an adult patient was taken through the Cardiopulmonary resuscitation (CPR) procedure. The study was conducted on 570 families of patients who were undergoing resuscitation. Seventy-nine percent of the family members witnessed resuscitation while forty-three percent witnessed usual care resuscitation. The family members who witnessed resuscitation were accompanied by a trained professional who took them through the events of a resuscitation procedure. Family members who appeared to be in distress or thought to pose a risk to the patient were exempted to be present during the resuscitation procedure. The results did not show any significant difference in mortality rates. Four percent of patients survived until 30 days. It is, however, to be noted that there was lower post-traumatic stress order for the families that were allowed to witness the resuscitation procedure of their family members either the patient recovered or died (Simon, n.d).

In investigating the public opinion regarding FPDR, a survey was conducted in 2006 by Mazer. The survey was conducted through telephone interview in which 408 participants responded with their thoughts on FPDR. The results conducted from the survey indicated that the public was divided on the issue. 49.3% of the respondents “agree” or “strongly agree” that they would want to be present in case their loved one was being resuscitated. 46.8% “agree” or “strongly agree” that friends or family members have the right to be present when their loved is undergoing CPR. Respondents who were to receive CPR had a positive feeling about their family presence (Judy, 2010).

Another major study was conducted by various medical bodies in which they investigated the in-hospital CPR in the elderly. The study involved Medicare data recorded from 1992 to 2005 in which beneficiaries who 65 years and above and had undergone CPR in U.S hospitals were identified. Temporal trends in CPR incidences and the rate of survival after CPR were examined along with the patient and hospital-level predictors that influenced survival to discharge of the patient. Among the data collected, 433, 985 patients were identified who had undergone in-hospital CPR. 18.3% of the identified patients survived after the CPR and were discharged. There was no significant change in survival between the 1992 to 2005 period. The incidence of CPR was recorded at 2.73 events in every 1000 hospital admissions. It is, however, critical to note that the incidence varied significantly among the different races with blacks and non-whites experienced higher rates than the whites. The proportions of patients who died after CPR increased over time with high cases in non-white patients. Patients who were men, older, and had coexisting illnesses or admitted from a skilled nursing facility had lower survival rates. The odds of survival of black patients was at 23.6% while for white patients was at 95%. It is also important to note that the proportion of patients who were discharged to their homes rather than health care facility decreased over the period (William et al. 2009).

Application to Clinical Practice

The extensive research conducted on FPDR has led to adjustments in the clinical practice in general. Various medical bodies have shown support to the FPDR practice while a good number have also expressed negativity towards the practice. The health care practitioners are therefore divided on whether to implement the practice or not. Emergency Nurses Association (ENA) and American Heart Association (AHA) have expressed their support for the practice. Due to their influence in the medical field, various health institutions should be ready to implement FPDR in their clinical practices (Judy, 2010).

With the primary role of ensuring quality care for the families and patients, health institutions should be at the forefront of adapting new best practices in the medical field. Being recommended by ENA and AHA, among the best practices for improving patient and family outcomes is based on family presence. The various healthcare organizations should be able to identify the most cost-effective, and safe way to implement this practice. In implementing the FPDR practice, standardized training for the medical staff, and developing of written policies are critical. Acute Care Nurse Practitioners who are involved actively in the resuscitation procedures can play a significant role in adopting of this practice to the patient’s bedside. It is to be noted from the surveys conducted that nurses view family presence in a positive way rather than Physicians. Therefore, the nurses have the ability to change the physician’s attitude due to their critical role in the emergency department (Jennifer, 2014).

Due to the support by several medical bodies, hospitals should be in a position to review their policies regarding the family presence or develop them if they do not have them. It is to be noted that if the program has been approved in some areas, then it should pose some beneficial factors for the patient. If the healthcare organizations continue shifting towards a patient driven focus, then it will be able to embrace more family friendly policies including that of family presence.

Various measures should be put in place to ensure that all family members are catered for during the stress situation. People act differently in stress environments and having a loved one in a critical condition can induce the stress factor. An appropriate system should be put in place to ensure that family members who respond both “appropriately” and “Inappropriately” are taken care of. It is also of importance to consider the nature of the relationship between the patient and the family members present; however, this can pose some difficulty especially during crisis time. The number of family members to be allowed in the patient’s room has to be considered by the hospital management. Managing of family members might be hectic, and therefore, outside help may be needed in ensuring that they do not interfere with the procedure in any way (Jennifer, 2014).

Extensive research in support of family presence should be done to acquire more support for the practice. Although the ENA and AHA have supported the FPDR practice, more research should be done on the same so as to convince those that are opposed to the practice that it is beneficial (Kathleen et al. n.d).. People want solid facts before they agree to anything; therefore, it is the responsibility of researchers to change the negative attitude that people have towards family presence. Researchers can do this if they can concentrate more on the family perspective; because, if the presence of family does not help them cope with the situation, then all other surveys regardless of what they say becomes ineffective. The Presence of solid evidence will help in convincing organizations that are hesitant in adopting the practice to address their concerns and move forward in adopting the practice (Judy, 2010).

Training of the medical staff on how to act like family facilitators is essential in developing the FPDR practice. The training can be offered within the hospital environments as it will offer a first-hand experience in handling the situation. Due to the different cultures of families who visit the hospital, the training should encompass on how to handle the differences in a professional and caring manner. The medical team will be taken through the procedures and will be guided on how to interact with the family members as they go through the stressing times. The training should be based on evidence-based research. The educators should use various results from surveys conducted to understand properly the concept of family presence (Jennifer, 2014). According to the ENA manual on staff education, there should be an assessment as well as slide program involving dialogue. It is also important to record events of FPDR and the frequency of occurrence. This will help in the collection of data and offer a better understanding of the program and also to obtain benefits and limits of it (Dana & Paul, 2010).

The ENA has already laid down guidelines for establishing FPDR in health institutions. The manual for ENA is titled “Presenting the Option of Family Presence”. In the manual, they have suggested a plan for implementing FPDR in the health institutions and it includes establishing a project team, assess the departments and institutions. The manual also advocates developing an implementation plan that supports FPDR, identify the champions, and be able to evaluate the effect of FPDR with families, patients, and HCPs (Martin, 2010).

Identification of project champions is essential as it seeks supporters of the FPDR program from various disciplines and even within the management structure of an organization. The champions will look for various opportunities to promote the FPDR program among their colleagues, increase its awareness, and act as role model for the family presence intervention. The main responsibility of champions is to increase awareness of the FPDR program as well as fin more support for it (Judy, 2010).

Establishing of the project team should include physicians, nurses, respiratory care practitioners, social service workers, risk management personnel, hospital care providers, and security agents. Having support from management is critical if an opposition is anticipated from other quarters or need of financial resources to implement the program. Patient representation and family members within the team may provide some logistic challenges, but it should be incorporated (Judy, 2010).

Conclusion

It is recommended that the health system should lay down clear framework and policies that monitor FPDR program. The health institutions would then be in a position to implement the program successfully without any interference on their daily operations. This would help in monitoring cases of failure and success in running the program.

The debate on the implementation of family presence during resuscitation still goes on, but more people are being drawn towards accepting the program. More surveys are still being conducted in ensuring the numbers agree with their thoughts based on FPDR. Some of the health institutions have already adopted the program and implemented it in their system with clear guidelines while others are reluctant in adopting the program. It is to be noted that with proper measures put in place, family presence during resuscitation can positively affect the patient, family members, and the medical team. With the need for better medical practices, it is not long before FPDR will be a compulsory practice in all the health institutions.