Family Presence in ED Resuscitation: Nursing Research

This is a second post in a series brought about by a challenge from Canadian nurses Rob Fraser and @TorontoEmerg to review a research article a week for a year.  This week I decided on a nursing research area, family issues related to patient care.  I have decided to focus only on nursing research from this point forward, because I recently read a thought provoking post, with a great deal of negative and true-color comments by physicians, concerning nurses roles in primary care. Many of the physicians in the comments felt that not only do nurses not need to be involved in primary care, but according to many of the physicians and medical students nurses do not need to be involved in overseeing any type of health care. Nurses are apparently only good for changing IV bags and doing demeaning work…. Residents and MD’s are really the only purveyors of good health care… Anyway… that is another post. If you want to read that blog go here.

My premise is that nurses are a critical part of health care no matter their role and much vital research would not get accomplished without us (i.e. ICU room/unit lay out, family coping with chronic illness, family presence in ICU’s, procedures, resuscitation, …etc.). From this point forward I am only going to highlight nursing research. Sorry to all other health care professions, you will just have to post your own.

So, here is installment two of research dissemination.

ARTICLE:

Hung, M. S. and Pang, S. M. (2011), Family presence preference when patients are receiving resuscitation in an accident and emergency department. Journal of Advanced Nursing, 67: 56–67. doi: 10.1111/j.1365-2648.2010.05441.x

Purpose of research:

This qualitative, interpretive phenomenological, study was completed in China with 18 family members of patients who underwent resuscitation. Researchers developed a case for this research by presenting the lack of in-depth research into family members needs and experiences during resuscitation of a loved one.  They also present that many emergency departments still do not allow family members to watch resuscitation based on the distress that might be caused to the family members.  The aims of the study were to, “illuminate the experience of family members whose relatives survived resuscitation in an accident and emergency department, and their preferences with regard to being present” (p.57), better understand family members and their desire to stay during resuscitation,  and better understand relationships between factors that affect whether a family member wants to be present.

Methods/Results:

Study site was a large 700-bed hospital in Hong Kong with 24 hour ED services.  Twenty-four interviews were conducted with family members, taped, transcribed, and analyzed. What the nursing researchers found was several strong themes that continued to emerge from the family members and these included; being emotionally connected with the patient, providing emotional support to the patient, maintaining relationship with the patient and others, recognizing the patient’s health condition, and keeping informed of what’s going on.  For example, in staying emotionally connected with and providing emotional support to the patient family members felt that being present would help the resuscitation efforts if the patient could hear them or know they were present.  In maintaining a relationship, several family members felt they needed to be present to ‘say goodbye’.  Overall, the majority of family members desired to be present, but some were conflicted with feelings of inadequacy in ability to aid their family member in medical needs. Interestingly, the interplay of variables listed above appeared to affect the strength of desire to be present.

Take away:

Being present  for resuscitation efforts is an important factor for many families.  Family members need to feel as if they are a part of the process of resuscitation and be well informed by the medical staff of what is occurring throughout resuscitation.

However, I am continually amazed by the power of qualitative research to capture stories of participants in their own words.  In empirical research we use numbers to provide strength, evidence, and power… as we should.  The story and lived experience of the person is something that is also critical and needs to be presented clearly, phenomenological research provides an important avenue for presenting the patient narrative.  This quote from one of the participants highlights the powerful nature of patient and family stories through qualitative research, “I was scared when I knew my mother was in the resuscitation room. I was frightened that she would die…. I should be with her. I would hold her hands and tell her I was there and that I love her…whether she was conscious or not. I was really down… I felt pressure on my heart… my mind was blank…” (p. 61)

Final Pearls: I do know that each of us is going to die at some point and so are our family members.  Understanding the patient and family experience builds compassion, understanding, more effective communication, and knowledge by the nurses.  Inviting family members to be a part of one of the inevitable processes of life is a powerful and important role for the nurse to play.