Families deserve the option of observing efforts
February 1, 1998 3 minutes read
Families deserve the option of observing efforts
By Janet M. Williams, RN, MSN, CCRN
Flight Nurse
University Air Care, University Hospital,
Cincinnati, OH
Can you imagine the obstetrician’s response the first time a father asked and then was present in the operating room during a C-section? Being present during the birth of a loved one is an important family milestone. It is my belief that being present during the death of a loved one is also an important family milestone. In both instances, one very happy and one very sad, the family requires support from one another.
It is up to us as patient and family advocates to help the family member determine how much, if any, family presence is suitable for them. If you have a family member who gets pale and appears faint when he or she is standing near their loved one, that person may do better sitting in a chair at the foot of the bed or in the corner of the room. Some family members may only need to stay in the room long enough to say, "I love you." Family members usually know how much they can tolerate, so you can use their cues as a gauge. The nurse can play a major role in giving the family options and helping them decide what kind of involvement, if any, would be best suited for them.
There is very little research on this topic. The initial research shows that it is beneficial to the family member’s grieving process if they are present during the resuscitation. The benefits to the family far outweigh the disadvantages to the health care provider. Family members feel that they are helpful in spirit to their loved one and somehow allow the loved one to die more peacefully, instead of being surrounded by strangers. Others state that it gives them an opportunity to say their last goodbyes. Some describe relief in the fact that they could say they were sorry and that they loved them, because their last interaction with the person was one of conflict.
Allowing the family to be present is beneficial to the health care provider because it gives them an opportunity to clearly be patient advocates. It also gives them the satisfaction of having intervened in such a way that maintains family dynamics during such a stressful time.
Health care providers are concerned about the family having knowledge of poor performance. Often family members do not know the proper sequencing of procedures and, in most cases, they are not paying that close attention to detail. What is noticeable to a health care provider may not even get the attention of a layperson who has no medical knowledge. Family members can be asked to step out of the room if invasive procedures need to be performed.
In my personal experience as a flight nurse, family members who have watched while I resuscitated their loved ones have never interfered with the resuscitation. Consistently, they have said "I couldn’t believe how hard you have worked to save my loved one." They say that they are glad everything possible was done. If families are held in the dark and are not able to see "how hard everyone is working," they are not able to reach the same conclusion.
I encourage health care providers to learn through discussions with other professionals who have experience with family presence. Reassurance is needed that families can be present and the health care provider can still function effectively in a professional manner during a resuscitation. It is rare to hear an anecdotal story in which someone describes a family that was so out of control that they created a safety issue. One possible reason is that the family would not want to interfere with the nurse or physician who may save their loved one’s life.
When an opportunity presents itself in the future, keep in mind the possibility that maybe you will encourage and allow the family members to be present and maybe it will be better for the family. Health care providers need to ask themselves the question: "If my loved one required resuscitation, would I want to be present?" Those who have experience with family members being present need to disseminate information about their experience to their peers. Nurses and physicians encourage families to be present during the birthing process and now the time has come to encourage families to be present during the dying process.
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