Lasting Benefit … or Haunting Memory?

Of the available outcome data, Eichhorn’s 2001 report of nine adult and teenage patients, one of whom underwent CPR, found that all were comfortable with and reassured by having their families at their bedsides.14 Clearly, this is an area in need of further research.

Hospital Experience

Beginning in 1982, Foote Hospital in Jackson, Mich., was a pioneer of witnessed resuscitation in the ED.5 A follow-up article after nine years’ experience describes its success.15 Hospital policies for chaplain and ED staff outline a case-by-case assessment. If the option is believed to be appropriate and is approved by the treating ED physician, the chaplain or nurse prepares the family, escorts selected family members into the room, and remains with them for support and information. The family members may take a place at the patient’s bedside to touch and speak with their loved one.

Having family at the bedside “helps people having trouble with closure and those who have a good grasp on it, but not everybody,” says Debra Jamieson, RN, critical care supervisor at Foote Hospital. “You don’t have to go into a lot of depth; they can see everything you’re doing.”

Regarding provider stress, “you work through your own feelings about death and dying,” she says.

Mayo Clinic Rochester has a similar policy in its ED. “At St. Mary’s Hospital in Rochester, Minn., the emergency department has had a policy for allowing family members to be present during medical resuscitations. This is true for both adult and pediatric resuscitations,” says David Klocke, MD, assistant professor of emergency medicine and medicine. “I have never seen a family member lose control or interfere with the resuscitation, though on occasion I suspect this could occur.”

The critical care units are also moving toward developing a policy, according to Critical Care Committee Chairman Rolf Hubmayr, MD.

Professional Society Support

The ENA was probably the first society to introduce guidelines (in 1995) for family presence during resuscitation. The American Heart Association, Emergency Medical Services for Children, the American Academy of Pediatrics, the American College of Emergency Physicians, and the American Association of Critical Care Nurses all recommend family presence.1 Having a trained facilitator available for family support, offering multiprofessional support, providing staff education, and creating written policies are all recommended. At last check, however, only 5% of nurses work at facilities with written policies.

Conclusions

Bringing a family to the bedside should not happen haphazardly but should be handled with careful consideration and support for all involved. Institutional policy and protocol can provide legal support and define expectations. Providers should be educated, perhaps during advanced cardiac life support (ACLS), advanced trauma life support (ATLS), fundamental critical care support (FCCS), and pediatric advanced life support (PALS) courses. The patient’s wishes should be honored whenever possible. Family presence could even be added to the advance directive discussion. Certainly, more study in this area is needed. Given current data, however, it is reasonable to consider bringing families to the bedside in emergency situations. TH

The author gratefully acknowledges Debra Jamieson, RN, and Ned McGrady of Foote Hospital Pastoral Care for the extensive materials they supplied to assist with this article.

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