Using Evidence to Inform Clinical Decision Making
Using Evidence to Inform Clinical Decision Making
There were three given scenarios but for my assignment, I chose the third scenario – whether family members should be allowed in an acute care setting during the resuscitation of a loved one. Doctors and medical practitioners are constantly faced with the dilemma of whether to allow a patients’ family members during the resuscitation process of their loved one. The key words used to narrow down the research included; “cardiopulmonary resuscitation”, “family witnessed resuscitation” ,”family present resuscitation”, “cardiac arrest” among other substitutes. During investigations, I used Medline and CINAHL databases. Moreover, to strengthen the evidence, the reference research articles were not more than five years old 5. One of the systematic review articles I found for this study is ‘Family Presence during Resuscitation (FPDR): Perceived benefits, barriers and enablers to implementation and practice.’ This article is a qualitative systematic review article together with other three available references selected for this study. Additionally their relevance to acute care setting for instance; ICU, critical Care, and emergency department means they match as perfect research references in this study. In the end, this study will compare the health care professions’ perspective before making a decision.
Generally, most high level research papers show that positive results are achieved when families are allowed to be present during their patient’s resuscitation procedure ( Ferreira et al. 2014; Salmond 2014). Moderate-quality evidence claims that offering family presence during resuscitation improves family members’ psychological outcomes, but that it does not affect patient’s outcomes. Salmond (2014), the review which covered more than 83 studies, mixed with descriptive surveys, randomized controlled trials and matched cohort designs. The results are showing that families who had witnessed the CPR would like to participate again, as it allowed them to feel less anxious when they stayed near the family member. Moreover, both patients and family members want the option to be present resuscitation (Salmond 2014).
The comparable result of children was found in Ferreira et al. (2014), with 15 scientific articles included and participants were generally members of the healthcare team (67%) and family (33%). The studies focused on children hospitalized in paediatric and neonatal ICU with qualitative content analysis. The data was collected worldwide, including Australia, Europe, and United States. The data has shown that when resuscitation is required for a child, it is important for parents to witness what is going on during the resuscitation (Ferreira et al. 2014). In addition, it improved family members’ understanding of the procedure of resuscitation. And if the patient does not survive, at least it would guarantee the family to have last moment of life of the child (Ferreira et al. 2014).
According to Yoder (2014) and Oczkowski et al. (2015) the resuscitation team (both nurses and doctors) have concerned about it. The main issues are lack of policies of family presence during resuscitation and views of resuscitation team members (Yoder 2014). Moreover, the reason that nurses and emergency staffs are concerned is because of the legal consequences due to most of family members’ lack of knowledge regarding the resuscitative procedure. It is a concern that when CPR is unsuccessful family members may see the treatment as a failure (Yoder 2014). But other than that, the study also agrees that family’s presence during resuscitation may have the potential to increase patient and family members’ outcome and the future study and family education may reduce resuscitation teams concerned of FPDR (Yoder 2014). Another element that needs to pay attention to is culture factor. Sak-Dankosky et al. (2013) review paper has collects fifteen articles which focus on emergency departments, intensive care units and cardiac departments and majority of studies are focus on nurses with quantitative studies methods. The studies have found that cultural background was the key element that influenced nurses and physicians’ decision on allowing family members to be present during resuscitation. Furthermore, the support evidence also shows that the FPDR model is not practically working in the Asian society, and it lead to Asian healthcare professions are greater opposing the idea of FPDR than Western countries (Sak-Dankosky et al. 2013). Sak-Dankosky et al. (2013) Also suggested that many studies lack theoretical and operational definitions and the studies only are in the English language. It may result in essential outcomes being ignored. But beside those problems, the study articles that are used for this review still possible to detect key features of FPDR (Sak-Dankosky et al. 2013).
Further, positive results of family presence during resuscitation are as product of having detailed controls. (Oczkowski, et al., 2015. These controls are aimed to cater for the need of patients, healthcare teams and family members. First, there is need for a trained specialist for example a social worker, nurse or physician who will offer guidance during resuscitation to the family members and other people involved (Oczkowski et al. 2015). It is of importance to note that, some of the family members were forbidden to witness the resuscitation and they include violent family members, drug users of those whose self-control was weak. (Oczkowski et al. 2015). Moreover, due to its delicate nature, the resuscitation process should allow only a small number of family members (Oczkowski et al. 2015). It is significant for staff members to be educated. Finally, the staff members must have highest level of knowledge concerning the FPDR program and this will help them to practice FPDR effectively (Oczkowski et al. 2015).
In conclusion, after the comparison of the reviewed articles and different perceptions from patients, medical team, and family members, proved that family presence during resuscitation process should be an open decision and it should be done in a safe environment and the feelings of the patients and their family members should be considered. It was evident that in some settings for example the acute care setting, there was inadequate information among some of the family members (Ferreira et al. 2014). By making the FPDR program knowledge available it can be used to help family members comprehend what it expected during the resuscitation process, as well as a specialist taking their questions and them and explaining the steps taking place (Oczkowski et al. 2015). Generally, more qualitative research is needed to survey the effect and outcome of FPDR, but more realistically, the positives of the outcome far outweigh the negative results when parents and family members are allowed into the emergency room during the resuscitation procedure. The reason being that it will help reduce family members worry, ease tension, and create a healthy relationship between the patient’s family and the team members (Oczkowski, et al., 2015).