Introduction
Resuscitation involves the emergency procedure to restart a person’s heartbeat or breathing. The outcome of resuscitation efforts can be positive or negative. The issue of family presence during resuscitation (FPDR) has attracted much attention in nursing practice in recent years. Resuscitation is classified as a high-stakes and stressful situation in patient care. Allowing families in such a lifesaving situation has both benefits and limitations (Tennyson, 2019). The issue of allowing families to be present during resuscitation is not just a question of patient and family preference or an absolute clinical decision to be made by nursing practitioners. It is a complex ethical issue in nursing practice with different perspectives and various competing interests.
The primary question is whether the autonomous rights of family members wishing to be allowed during resuscitation outweigh the potential risks to the patient undergoing resuscitation and the potential psychological damage to the family members. The presence family members during resuscitation continue to spark heated debates among healthcare professionals, policymakers, and ethicists (Lederman, 2019). This paper aims to evaluate the ethical and moral aspects of family presence during resuscitation in nursing. The paper will examine the arguments for and against this practice, considering various perspectives and ethical principles. By examining the ethical implications of this issue, the paper aims to stimulate thoughtful reflection and discussion on this important topic in nursing ethics.
Background
Cardiopulmonary resuscitation (CPR) was first described in 1874. However, its widespread adoption only occurred after the first life-support guidelines were published in 1966. Before then, resuscitation was only performed by qualified health care professionals. The development of Advanced Cardiac Life Support courses in 1976, led to the development of bystander-administered CPR outside of the clinical setting. Bystander CPR was soon followed by the first reports of family presence during resuscitation, published in 1987 (Dainty et al., 2021). Family members reported interests in being allowed during the resuscitation of their patient. At the same time, health care professionals raised concerns that family members could interfere with resuscitation procedures. Since then, the issue of family presence during resuscitation in healthcare settings has evolved and has become a topic of significant interest and concern for nursing and healthcare professionals. The cultural shift of healthcare towards patient and family-centered care and advancements in medical technology has raised questions among healthcare professionals, bioethicists, and policymakers about the ethics of allowing family members during resuscitation efforts.
Today, the question of FPDR continues to spark debates in healthcare among the stakeholders involved. The perspectives and practices vary across healthcare institutions, regions, and countries. Some healthcare facilities have implemented policies that explicitly allow or encourage family presence during resuscitation. Others have policies that restrict or prohibit FPDR (Alzawaidah et al., 2022). There is no universally accepted approach regarding this issue, and the practice continues to evolve.
In the recent past, there has been an increase in recognition of the potential benefits of FPDR. Proponents have cited increased family satisfaction, improved communication and trust between healthcare providers and families, and potential psychological benefits for family members who are present during a critical event involving their loved one (Toronto & LaRocco, 2019). However, Opposers continue to raise concerns about potential interference with medical procedures, emotional distress for family members, and ethical considerations related to patient privacy and dignity.
Concern about nursing practice
The issue of FPDR plays a pivotal role in providing patient care. Nurses are always on the front line in providing care during resuscitation efforts. Nurses are, therefore, responsible for balancing the physical and emotional needs of the patient with the needs and preferences of the family members. Understanding the implications of family presence during resuscitation helps facilitate communication between patients, families, and the nursing team in charge of the resuscitation efforts.
The nursing code of practice dictates careful consideration of the ethical implications of family presence during resuscitation. Nurses must navigate complex ethical dilemmas related to patient-centered care and the duty to provide safe and effective care. Additionally, nursing professionals are crucial in advocating for patients and families, respecting their rights and preferences, and promoting open communication and shared decision-making.
Key Stakeholders
Patients
Patients are the central stakeholders in the issue of FPDR. They are undergoing a critical medical event, and their well-being and Autonomy should be the top priority. The major ethical principles at stake for patients are Autonomy and Beneficence. According to the principle of Autonomy, patients have the right to decide about their healthcare. This includes whether or not they want their family members present during resuscitation (Tennyson, 2019). This principle recognizes the importance of respecting patients’ wishes, values, and beliefs and upholding their right to self-determination.
According to the principle of Beneficence, nurses must promote their patients’ well-being and best interests. They should consider the possible advantages of family presence during resuscitation, such as providing emotional support and reducing patients’ stress. They should also consider how allowing family members may hinder the provision of maximum patient care.
Conflicting Ethical Principles
The ethical principle of Autonomy for patients may conflict with the ethical principle of Beneficence. Patients may desire to be alone during resuscitation or may not want their family members present, which may conflict with the potential benefits of family presence. Also, the patient may wish their family to be around during resuscitation. Still, the health professionals may feel it may be uncomfortable for the family or hinder care delivery, depending on the seriousness of the patient’s condition.
Family Members
Family members are central to any debate about FPDR. They are emotionally connected to the patient and may have their desires and concerns about being present during resuscitation. The major ethical principles at stake for family members are Autonomy and compassion. According to the principle of Autonomy, Family members have their autonomy rights. They may want to be allowed during resuscitation to support their loved one or to be informed about the care provided (Toronto & LaRocco, 2019). They may also want to participate in decision-making and have their preferences considered. According to the principle of compassion, Family members may experience emotional distress and need compassion, empathy, and support during a critical event involving their loved one. This principle recognizes the importance of showing kindness, understanding, and sensitivity toward the emotional needs of family members.
Conflicting Ethical Principles
The ethical principle of Autonomy for family members may conflict with the ethical principle of Beneficence. Family members’ desires to be allowed during resuscitation may conflict with the risks of interference with medical procedures or emotional torture they may experience.
Healthcare Providers
Nurses, physicians, and the interdisciplinary medical team are key players in determining whether family members can be present during resuscitation. They are responsible for providing safe and effective care to the patient and ensuring that the resuscitation efforts are conducted professionally and efficiently (Powers et al., 2023). The major ethical principles at stake for healthcare providers are Beneficence, non-maleficence, and Professional Integrity.
According to the principle of Beneficence, Healthcare providers have to promote the well-being and best interests of the patient. This includes timely and effective resuscitation efforts to save the patient’s life potentially. According to the principle of non-maleficence, Healthcare providers have not to harm the patient. This includes considering the potential risks and benefits of allowing FPDR and ensuring that their presence does not hinder with provision of appropriate medical care. Professional Integrity demands nursing practitioners have a responsibility to maintain their professional Integrity and adhere to the standards of nursing practice. This includes making ethical decisions based on sound professional judgment, considering the patient’s best interests, and upholding the principles of their professional code of ethics.
Conflicting Ethical Principles
The ethical principles of Beneficence and non-maleficence for healthcare providers may conflict with the ethical principles of Autonomy for patients and family members. Healthcare providers may have to make decisions that balance the potential benefits of family presence with the need to provide safe and effective resuscitation efforts (Considine et al., 2022). While the patient may have wished to be alone, the care providers may feel that the presence of family members may offer support and strength.
Both Sides of the Ethical Issue
Pros of Family Presence During Resuscitation
Emotional support. Family members being present during resuscitation provide emotional support to the patient. It offers comfort, reassurance, and a sense of presence to the patient in a critical and uncomfortable situation, which help reduce anxiety and fear.
Patient-centered care. Allowing family presence during resuscitation aligns with the goals of patient-centered care, which emphasizes the importance of involving patients and their families in decision-making and care planning (Dainty et al., 2021). It recognizes the Autonomy and preferences of patients and respects their right to have their family members present during critical medical events.
Communication and collaboration. Family members being present during resuscitation may facilitate communication and collaboration between healthcare providers and family members. It allows for real-time updates on the patient’s condition, clarifying any questions or concerns and involving family members in decision-making regarding the patient’s care. For instance, if the patient has been critically ill for quite some time, a family member will help provide essential sickness history or any other information that may facilitate or hinder care administration.
Cultural and religious considerations. Family presence during resuscitation may be important for families with cultural or religious beliefs that prioritize family involvement in healthcare decision-making or require certain rituals or customs to be performed during critical events (Harris et al., 2023). Respecting patients’ and families’ cultural and religious beliefs is an important aspect of providing culturally competent care.
Cons of Family Presence During Resuscitation
Interference with medical procedures. Family members present during resuscitation may interfere with medical procedures and the healthcare provider’s ability to provide effective care. Family members may be emotionally upset, and their presence may distract or disrupt the healthcare team, potentially compromising the quality of care provided to the patient.
Psychological impact on family members. Witnessing a loved one undergoing resuscitation can be traumatic for family members and may have a long-lasting psychological impact. It may result in emotional pain, post-traumatic stress disorder (PTSD), or other mental health issues, further complicating their ability to cope. Moreover, resuscitation does not always result in a positive outcome. Research has shown that in most cases, resuscitation results in poor outcomes. Watching a beloved one fail to respond to resuscitation efforts during the end of life can be traumatizing and painful (Considine et al., 2022). The patients may have clouded judgments at such moments and may do something that could interfere with the nurse’s procedure.
Legal and liability concerns. Presence of family members during resuscitation raises legal and liability concerns. Family members may witness medical errors or adverse outcomes, resulting in potential legal actions against the healthcare provider or facility. Some countries and states allow FPDR, while others prohibit it. It is important to consider the provisions of the State laws and organizational policies before considering FPDR.
Lack of standardized policies and protocols. There may be a need for standardized policies and protocols regarding allowing family to be present during resuscitation. This may lead to inconsistency in practice and decision-making. Healthcare providers may have different opinions, preferences, or comfort levels in allowing family presence, resulting in variability in the implementation of this practice (Alzawaidah et al., 2022). The lack of standardized policies regarding FPDR means there is no reference framework that nurses can use in making decisions. This wastes a lot of time in arguments and disagreements in the middle of the dilemma.
Philosophical Perspectives
Deontological ethics. Deontological or duty-based ethics focuses on individuals’ ethical duties and responsibilities. From a deontological perspective, allowing family presence during resuscitation is a moral duty as it respects the Autonomy and wishes of patients and their families (Porter, 2019). It upholds the principle of patient-centered care and promotes transparency and collaboration in decision-making.
Utilitarian ethics. Utilitarian ethics emphasizes the greater good for the greater number of people. From a utilitarian perspective, allowing family presence during resuscitation may be beneficial as it can provide emotional support to the patient and family, enhance communication and collaboration, and align with cultural and religious beliefs. However, potential risks and challenges, such as interference with medical procedures, psychological impact on family members, and legal concerns, should also be considered in the overall assessment of the greatest good.
ANA Code of Ethics Perspective
ANA Code of Ethics provides guidelines for ethical decision-making in nursing practice. Provision 2 of the ANA Code of Ethics, emphasizes the nurse’s primary commitment to the patient. This provision emphasizes the importance of respecting the Autonomy and dignity of the patient and involving patients and their families in decision-making (Rhonda Cornell & Powers, 2022). Nurses may consider patients’ preferences and wishes regarding family presence during resuscitation and strive to uphold patient-centered care.
Provision 3 highlights the nurse’s responsibility. The provision state that the nurse has responsibility to promote, advocate for, and protect the patient’s rights, health, and safety. Nurses may advocate for the patient’s and family’s desires for family presence during resuscitation while considering potential risks and challenges.
Provision 4 states that the nurse has authority, accountability, and responsibility for nursing practice. This provision emphasizes the nurse’s accountability and responsibility in making ethical decisions and providing safe and competent care (Walker & Gavin, 2019). Nurses may need to consider legal and liability concerns related to allowing family during resuscitation and follow established policies and protocols.
According to provision 5, the nurse owes the same duties to self as to others. This includes the responsibility to promote health and safety, preserve wholeness of individuals and Integrity, maintain competence, and continue personal and professional growth. This provision highlights the nurse’s responsibility to maintain their well-being and competence. Nurses may need to consider their emotional well-being and coping capacity when witnessing family presence during resuscitation and seek support as needed.
In some cases, the ethical principles of patient autonomy, patient-centered care, and family involvement in decision-making may conflict with the ethical principles of providing safe and competent care, protecting the rights and well-being of the patient, and adhering to legal and liability concerns (Rhonda Cornell & Powers, 2022). Nurses need to navigate these ethical dilemmas by engaging in thoughtful deliberation, seeking guidance from colleagues and ethical resources, and considering the patient’s and family’s unique circumstances and preferences.
Personal Stance and Reflection
After thorough research and careful consideration, I find it morally justifiable to support family presence during resuscitation. While valid concerns and challenges are associated with this practice, the benefits of allowing family members during resuscitation efforts outweigh the likely risks.
The primary reason why I support family presence during resuscitation is that it promotes patient-centered care and upholds the ethical principles of Autonomy and dignity. Allowing family members` presence during this critical moment can provide emotional support to the patient and the family, ease their anxiety, and foster a sense of trust and collaboration between healthcare providers and families (Lederman, 2019). Research has shown that family presence during resuscitation can positively impact the psychological well-being of both patients and families, improve communication, and facilitate shared decision-making.
Moreover, family presence during resuscitation aligns with the cultural and social changes occurring in healthcare. In modern care systems, patients and families are increasingly being recognized as active participants in their care. It acknowledges each family’s unique dynamics and respects their diverse beliefs and preferences. It also promotes transparency and open communication, which can help build a therapeutic relationship between healthcare providers, patients and families.
At first thought of being present during resuscitation, I wasn’t sure which side I would support. This is because both sides have equally compelling and logical arguments (Walker & Gavin, 2019). Legally, I think it is only fair and justice to allow family members to offer support during the resuscitation of their beloved. The question of morals and ethics, however, brings a different dilemma. This is because as much as nurses are responsible for patient safety, they are also responsible for ensuring the psychological well-being of the family members. Many people hate death. Death may break the emotionally weak family members if resuscitation doesn’t yield a positive outcome.
On a closer look at the issue and a review of more literature on the same topic, I gained a broader perspective. I realized the significance of patient-centered care and the importance of considering patients’ and families’ emotional and psychological well-being in critical care situations (Tennyson et al., 2023). Evidence-based practice suggests that when implemented with appropriate guidelines and support, family presence during resuscitation can positively affect patient and family satisfaction, communication, and coping with grief and loss.
Going through the end of life is frightening. When lying on the hospital bed, everybody would wish for someone to hold their hand and reassure them that everything would be okay. The feeling that your family is right by your side gives the patient strength to fight (Powers et al., 2023). In the worst-case scenario where the patient does not recover, the presence of their family helps give the patient a happy and less frightening end of life.
Conclusion
This paper has explored the ethical issue of family presence during resuscitation in healthcare settings. Through a systematic review of historical and current perspectives, key stakeholders, and ethical principles at play, a balanced discussion of both pro and con sides, and an examination of the ANA Code of Ethics perspective, it is clear that family presence during resuscitation is a complex issue with various considerations.
The pro side argues that family presence during resuscitation promotes patient-centered care, respects Autonomy and dignity, and fosters trust and collaboration between healthcare providers and families. It recognizes patients’ and families’ emotional and psychological needs during critical care situations and can positively impact patient and family outcomes.
On the con side, concerns about interference with medical procedures, potential emotional distress, and legal and liability issues have been raised. There are also cultural, social, and professional factors may influence the acceptability of family presence during resuscitation.
Further, the philosophical perspectives of different ethical theories and the ANA Code of Ethics provide additional insights into the complexities of this issue (Harris et al., 2023). After careful consideration, it is clear that family presence during resuscitation is morally complex, with valid arguments on both sides. However, based on the evidence and principles of patient-centered care, Autonomy, and dignity, as well as the importance of fostering trust and collaboration with patients and families, family presence during resuscitation is morally justifiable with appropriate guidelines, education, and support.
The paper has provided a comprehensive evaluation of the ethical issue of family presence during resuscitation, examining various perspectives. It is important for healthcare providers to carefully consider the ethical implications and engage in shared decision-making with patients, families, and interdisciplinary teams to determine the best approach in individual cases.
References
Alzawaidah, M. J., Al-Amer, R., Amro, A. J., Alkafri, S. F., Al-Hussami, M., & Alhurani, A. (2022). Emergency Room Nurses’ Attitudes toward Family Presence during Resuscitation: A Cross-Sectional Study. Hospital Topics, 1-8.
Considine, J., Eastwood, K., Webster, H., Smyth, M., Nation, K., Greif, R., … & Janet, B. R. A. Y. (2022). Family presence during adult resuscitation from cardiac arrest: A systematic review. Resuscitation.
Dainty, K. N., Atkins, D. L., Breckwoldt, J., Maconochie, I., Schexnayder, S. M., Skrifvars, M. B., … & Yeung, J. (2021). Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation, 162, 20-34.
Harris, A., Hale, P., & Jeziorski, A. (2023). The Benefits of Family Presence During Resuscitation.
Lederman, Z. (2019). Family presence during cardiopulmonary resuscitation. The Journal of Clinical Ethics, 30(4), 347-355.
Porter, J. E. (2019). Family presence during resuscitation (FPDR): A qualitative descriptive study exploring the experiences of emergency personnel post resuscitation. Heart & Lung, 48(4), 268-272.
Powers, K., Duncan, J. M., & Renee Twibell, K. (2023). Family support person role during resuscitation: A qualitative exploration. Journal of Clinical Nursing, 32(3-4), 409-421.
Rhonda Cornell, D. N. P., & Powers, K. (2022). Advancing the Practice of Family Presence During Resuscitation. Dimensions of Critical Care Nursing, 41(6), 286-294.
Tennyson, C. D. (2019). Family presence during resuscitation: Updated review and clinical pearls. Geriatric Nursing, 40(6), 645-647.
Tennyson, C. D., Oliver, J. P., & Jooste, K. R. (2023). Developing a Decision Pathway for Family Presence During Resuscitation. Dimensions of Critical Care Nursing, 42(3), 163-170.
Toronto, C. E., & LaRocco, S. A. (2019). Family perception of and experience with family presence during cardiopulmonary resuscitation: An integrative review. Journal of clinical nursing, 28(1-2), 32-46.
Walker, W., & Gavin, C. (2019). Family presence during resuscitation: A narrative review of the practices and views of critical care nurses. Intensive and Critical Care Nursing, 53, 15-22.
write