Nursing Capstone Portion Review of Literature

Nursing Capstone Portion Review of Literature

In Review of Literature

(Transition paragraph)
As indicated in the earlier context, less than 5% of the hospitals in the United States have definite policies relating to the presence of family members during resuscitative procedures. The conflicting views between the family members and the nurses/care givers have not hastened the forming or implementation of such policies. Policies are meant to strike the balance between the two parties. A study conducted in Malaysia led to the findings identifying the unexplored phenomenon of family presence in resuscitative and invasive procedures not only in Malaysia, but other Asian countries as well. In the Asian cultures, family members prefer their loved ones to die in their arms rather than in a strange area (hospital) (Sheng Lim & Rashidi, 2010). Incorporating policies that support the presence of family members rather than during such a process not only enhances a supportive treatment environment, but it also incorporates the culture of the people in question. This literature review assess the policy, the staff attitude towards the presence of family members in such procedures and the family response towards the same. Coming up with a suitable policy towards this part of healthcare provision should assess these three perspectives.

Policy

Policies give guidance. They set rules that facilitate the provision of healthcare to the people. Blair (2004) reminds institutions that as much as the presence of family members is relevant as indicated, there should be a limit. Family members range from the ones in a nuclear environment to the ones in the extended family. Although this whole range could be present in the hospital, it would not be logic to allow them all in the emergency room. The policies set the guidelines as to the protocol to be followed in the presence or absence of the family members. Doolin et al (2011) indicates that implementing procedures and policies which allow family presence makes facilities to grow and change in a family-oriented and holistic atmosphere. When reviewing literature relating to family presence during resuscitative procedures, Halm (2005) notes about the situation’s legal aspect. Hospitals should avoid litigation actions as much as possible. Failure to have such defined policies as evidenced in over 95% of the hospitals paves a loophole for sites relating to the presence or absence of a family member.

Hergott, Pell and Voelzing (2011) emphasize on the nurses’ role in the giving of a holistic family centered care. The same aspect is supported by the Nursing Theory. Both materials prove that by having policies that are clear in the presence or absence of the family members, nurses will be true to the family when they say that they did everything they could (Current Nursing, 2012). Such policies will allow the family to experience this action at first-hand.

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Staff Attitude

Basol et al (2009) indicates a thin line between staff who felt that it would be better if only family members with health education were allowed to be present during such procedures instead of having any kind of family. In fact, both sides of the argument had equal members. Further, 41.1% of the respondents indicated that family members interfered with the nurses’ work. In a study conducted by Gunes and Zaybak (2009), the nurses’ view of the presence of family members during a code situation was negative. The nurses pointed out that their presence led to interference with the code process, increased litigation and the sight of a loved one in a traumatic situation. In order to eliminate this negative perception, it was recommended that the nurses be educated on the same. Additionally, the incorporation of such organizations as Emergency Nurses Association was advised.

In a study conducted by Oman and Duran (2010), the findings indicated something contrary to the many views of the staff relating to the presence of family members. The study indicated that more than 50% of healthcare providers found it beneficial when the family was present during a code situation. Additionally, almost none of the participants in the study saw the family members as interference to their work.

Many nurses, if not all, agree to the need for a facilitator in the room during this code situation. Having been a nurse and family member at the same time, Fell (2009) presents a situation that has a witness who has been on both sides. Fell states that she was once called to the emergency room where she found her aunt as the patient (being coded) and her wide-eyed and scared uncle (family member) watching over. Fell’s role as the facilitator was pivotal as her uncle expressed later, even though her aunt did not survive. As Fell continues to note, having a facilitator allows the family member to feel as though they are included in the process of saving their loved ones’ lives. Facilitation also shows that the duty of the healthcare provider is not limited to the patient, but it also extends to the patient’s family.

Staff feelings towards the presence or absence of a family member during code situations are sometimes dependent on the staff members own experiences. Information gathered by Davidson et al (2011) identified that staff members that have ever experienced the code of their own family members tended to favor the presence of family in such situations. In this study, the healthcare providers in the level 1 trauma room tended to put the situation as though “it were me.” However, the danger of making the scenario too emotional is a concern raised by many healthcare givers. The members are usually in tears and in panic. Since healthcare providers are also human, they may be overwhelmed by the emotions, thus making the providers prone to mistakes or biased decisions. There are code situations that need the healthcare provider to go beyond the normal steps taken. Such situations may be interfered by such emotions for inexperienced staff.

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Family Response

Majority, if not all of the families appreciate being present during code situations. It also applies to the patients, once they recover. It makes more sense when the patient in question is a child. The analysis done by Maxton (2008) concerning the feelings of a parent when it was a child in the situation brought forth four main themes. Parents saw their presence as important as they were there from birth and so being there at such a situation incase they failed to survive was important. The parents who failed to be present were overwhelmed with guilt as they felt that they failed their children at their point of need. The family’s presence also allowed them to make sense of the situation they were in (considered a nightmare by many). The presence of the family facilitates the relationship between the staff and the family members.

Hagan (2008) also supports the themes presented in the above context. Code situations lead to either survival or death. In case of death, having family present allows the family to stay with the deceased a while longer before further steps are taken. This scenario is recommended even more in the pediatric field. Linder, Suddaby and Mowery (2004) ask whether it is a hindrance or help when the parents are present during resuscitative measures. They found out that their presence aided in the process. Although their presence could be overwhelming as indicated earlier, it was beneficial for the patient, healthcare provider and the family member. Plouff et al (2007) also appreciate that the presence of parents or family members in the pediatric arena during the resuscitative process is sometimes hindering. However, children are more sensitive than adults are sensitive. Having them allows the room to have a familiar face, especially if the patient is conscious after a successful resuscitative procedure.

In the work presented by Dougal et al (2011), it is relevant to handle each situation uniquely. Dougal indicates that one size does not fit all. Each family member handles the situation differently and so such policies should be able to provide a balance and neutral grounds. In supporting the findings indicated in earlier researches, Hung and Pang (2010) identified the relevance of having family members during the resuscitation process in the accident and emergency department. Despite the outcome of situation, family members were happy that they were present at the time of their loved ones’ need. Maclean et al (2003) interviewed various healthcare providers who stated that the hospitals they worked in did not have clear procedures on the presence or absence of family members during invasive and resuscitative procedures. Majority, if not all of the family members, appreciated their presence in a room with their loved ones during these situations.

(Conclusive paragraph)

It is agreed upon that there are no suitable policies regarding the presence of family during code situations in many hospitals. However, this does not mean that it is too late to instill some policies relating to the same. Although many healthcare providers may argue on the position of the family members during this process, all the staff agree that the presence of a facilitator is most beneficial. This latter perception was also welcomed by family members. Majority of the family members are positive about their presence during such situations. Contrary to many opinions, there are not as many staff members against family presence as there are those who are for it. Policies allowing the presence of family members should be set in consideration of all parties.

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References

Basol, R.; Ohman, K.; Simones, J. and Skillings, K (2009). Using research to determine support for a policy on family presence during resuscitation. Dimensions of Critical Care Nursing. Vol. 28(5) pp 237-247. Accessed July 30, 2013 from Ovid Database

Blair, P. (2004). Is family presence practical during emergency resuscitation? Nursing Management.      Vol.. 20, 23, 53. Accessed 30 July, 2013 from Proquest database

Carter, A and Lester, K. (2008). Protocol implementation of family presence during cardiopulmonary resuscitation and procedures in an adult ICU.  Critical Care Nurse. Vol. 28(2)e41.  Accessed 30 July, 2013 from CINAHL Plus database.

Current Nursing. (2012).  Theory of Interpersonal Relationships.  Copyright January 31st, 2012.  Accessed July 30, 2013 from <http://currentnursing.com/nursing_theory/interpersonal_theory.html>

Davidson, J.; Buenavista, R.; Hobbs, K. and Kracht, K. (2011). Identifying factors inhibiting or enhancing family presence during resuscitation in the emergency department.  Advanced Emergency Nursing Journal. Vol. 33(4) pp 336-43.  Accessed 30 July, 2013 From Ovid database

Doolin, C.T., Quinn, L.D., Bryant, L.G., Lyons, A.A. and Kleinpell, R.M. (2011). Family presence during cardiopulmonary resuscitation: Using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines. Journal of American Academy of Nurse Practitioners, Vol 23: 8-14.

Dougal, R.; Anderson, J.; Reavy, K. and Shirazi, C. (2011). Family presence during resuscitation and/or invasive in the emergency department: One size does not fit all. Journal of Emergency Nursing. Vol. 37(3) pp 152-157. Accessed 30 July, 2013 from Ovid database

Fell, O. (2009). Family presence during resuscitation efforts. Nursing Forum. Vol. 44(2). pp 144-150.  Accessed 30 July, 2013 from Proquest Database

Gunes, UY and Zaybak, A. (2009). A study of Turkish critical care nurses perspective regarding family witnessed resuscitation. Journal of Clinical Nursing. Vol 18(20): 2907-15.  Accessed 30 July, 2013 from CINAHL Plus database

Hagan, L. (2008). Caring Practices: family presence during resuscitation in the PICU.  Critical Care Nurse. Vol. 28(2) e23.  Accessed 30 July, 2013 from CINAHL Plus database

Halm, M. (2005). Family presence during resuscitation: A critical review of the literature.  American Journal of Critical Care. Vol .14(6) pp 494-511. Accessed 30 July, 2013 from Proquest database

Hergott, S.; Pell, L. and Voelzing, L. (2011). Family presence during resuscitation in intensive care- a collaborative effort promotes holistic family centered care.  Dynamics of Critical Care. 1 June  Accessed  30 July, 2013 from CINAHL Plus database

Hung, M. and Pang, S. (2010). Family presence preference when patients are receiving resuscitation in an accident and emergency department. Journal of Advanced Nursing. 16 July  Accessed July 30, 2013 from CINAHL Plus database

Linder, C.; Suddaby, E. and Mowery, B. (2004). Parental presence during pediatric resuscitation: Help or hindrance? Pediatric Nursing. Vol 30(2) pp 126-127.  Accessed 30 July, 2013 from Proquest database

Maclean, S.; Guzzetta, C.; White, C. and Fontaine, D. (2003). Family presence during cardiopulmonary resuscitation and invasive procedures: Practices of critical care and emergency nurses. American Journal of Critical Care. Vol. 12(3) pp 246-257.  Accessed 30 July, 2013 from Proquest database

Maxton, F.J. (2008). Parental presence during resuscitation in the PICU: The parent’s experience. Journal of Clinical Nursing. Vol. 17(23) 3168-76.  Accessed 30 July, 2013 from CINAHL    database

Oman, K and Duran, C. (2010). Healthcare provider’s evaluations of family presence during      resuscitation. Journal of Emergency Nursing. Vol  36(6) pp 524-532.  Accessed 30 July, 2013 from Ovid Database

Plouff, J; Cooper, H; Launder, S; and Fraser, K. (2007). Family presence in pediatric resuscitation.  Dynamics of Critical Care. Summer. Accessed 30 July, 2013 from CINAHL Plus Database

Sheng, C.; Lim, C. and Rashidi, A (2010). A multi-center study on the attitudes of Malaysian emergency health care staff towards allowing family presence during resuscitation of adult patients.  International Journal of Emergency Medicine. Vol. 3:287-291. Accessed 30 July, 2013 from Proquest database

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