Research Report: Family Presence During Acute Resuscitation (FPDR)

This report delves into the contentious issue of family presence during acute resuscitation (FPDR), primarily focusing on research conducted in the United States over the past decade. It examines experimental studies, including randomized control trials and surveys, along with meta-analyses and systematic reviews, to assess the impact of FPDR. The report poses a PICO question to guide its analysis: Does FPDR in the emergency department enhance outcomes for both patients and their families? The research explores the arguments for and against FPDR, highlighting potential benefits such as aiding family members in accepting death, facilitating grief, and potentially reducing litigation risks for healthcare providers. Conversely, the report also acknowledges the potential drawbacks, including the lack of direct benefit to the patient, the emotional toll on family members, and potential interference with medical procedures and the healthcare team's work. The conclusion suggests that while FPDR may not directly benefit patients, there is evidence of positive psychological impacts on families, supporting its consideration in resuscitation protocols.

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PRESENCE OF FAMILY DURING ACUTE RESUSCITATION
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Presence of Family during Acute Resuscitation
Introduction
The presence of family members during the acute resuscitation of one of their family
members has been a major subject of contention in nursing and other related fields of medicine.
Due to an increasing need for Evidence-based practice (EBP), many researchers have considered
these subject and came up with various findings and recommendations (Boehm 2008). However,
these researchers did their work in different places and came up with varying levels of evidence.
This paper considers research papers of various levels of evidence conducted in the last 10 years
in America. The main research articles that this paper considers are experimental, for example,
randomized control trials and surveys. The paper also considers meta-analyses and systemic
reviews provided such papers were authored in America and provide a review of experimental
papers. The paper uses these papers to set an argument for and against family presence during
resuscitation (FPDR).
PICO question:
Does the presence of family members during the acute resuscitation of patients in the emergency
department enhance the outcomes of the resuscitation process both for the patient and their
family?
P – Patients needing acute resuscitation in the acute department.
I – Presence of family members during acute resuscitation
C – None
O – Outcomes of the resuscitation process for both the patient and their family
Family Presence during Resuscitation

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Research conducted by health professionals suggest that FPDR and invasive procedures
carried out in health care rooms help family members to understand the seriousness of the life
threatening events, support grieving, give the family a chance to see the effort put by the care
team, facilitates communication and help reduce litigation risk (Tinsley et al. 2008).
Many of the research papers show that even though many healthcare workers would
frown at it, the presence of family members during acute resuscitation of one of them is not so
bad and is something that policymakers should even encourage. First, many authors found that
the presence of family members during the acute resuscitation helped them to accept the realities
of death more easily (De Stefano et al. 2016). Further, by seeing the doctors try their best, it
would be easier for them to accept the grief as they could see their family members die despite
the extraordinary measures and efforts taken by the medical team.
Further, the presence of family members during the resuscitation process helped them to
grieve in a better way. Grief is usually a difficult time. Many family members often become
depressed or suffer from post-traumatic stress disorder (PTSD) after the death of a loved one,
especially when the death occurred in extremely traumatizing circumstances (Tinsley et al.
2008). Research evidence suggests that the rates of depression and PTSD are much lower in
family members who witnessed the resuscitation process than those who did not (Oczkowski et
al. 2015). Therefore, for its benefits to the family members, it is worth to have family members
witnessing the process of acute resuscitation.
Moreover, PFDR is advantageous to the clinician too. Most family members often file
malpractice of negligence suits against physicians or nurses after the demise of their loved ones.
However, having the family witness the process of resuscitation will help them to appreciate the
efforts, professionalism, and sacrifice that the medical team have to put in to save their loved

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ones and hence limit the possibility of them filing suits against the medical team (Jabre et al.
2013). Further, FPDR does not interfere with medical activity (Jabre et al. 2013). Considering its
advantage even to the medical team, it is worth to allow the family to witness resuscitation.
On the lower side, however, FPDR can be disastrous to the family, the patient, and the
medical team. First, since the main focus of resuscitation is the patient, anything in the
resuscitation room or any decisions that the healthcare team make should be beneficial to the
patient. The decision to allow family members to witness acute resuscitation does not benefit the
patient and should, thus, be prohibited (Brasel, Entwistle & Sade 2016).
Further, since the family members do not have medical training, they may lack the mental
toughness to witness some of the largely traumatizing procedures that the healthcare team has to
perform on the patient. Even though research may prove contrary, some of the procedures such
as cardiopulmonary resuscitation and emergency thoracotomy are extremely traumatizing and
can cause numerous long-term effects in witnesses who do not have the necessary mental
toughness to witness them (McClement, Fallis & Pereira. 2009). The witnesses can also develop
a negative attitude towards the procedure and end up signing legal documents like advanced
directives, which decree that the individuals will not undergo extreme measures. Such can be
dangerous in the long-term as such individuals will lose lives where resuscitation could have
saved them.
On the healthcare staff, having FPDR can be disadvantageous to them. First, the time of
acute resuscitation is an emotional time for the family; considering the level of emotion, the
family members might end up harming the members of the healthcare team mentally or even
physically (McClement, Fallis & Pereira. 2009). Secondly, FPDR tends to limit the space of
operation of the healthcare team and hence making their work more difficult (Köberich et al.

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2010). This factor also affects negatively on the part of the patient as they may end up not getting
the best service as the healthcare staff operates in a limited space. Furthermore, the presence of
family puts the members of the healthcare team under undue pressure to perform better. Even
worse, some of the family members maybe malicious enough to even record some of the acts
that the healthcare team do aside from protocol and use these as evidence in legal suits against
these healthcare workers in case of unfavorable outcomes. Although, family members are always
eager to be invited and be present at the deathbed of their loved ones during resuscitation, little is
known about the patients’ feelings and perception of the whole experience. Further research need
to be carried out to unmask some of these doubts in order to help patients during the procedures
done in their life-threatening events.
Conclusion
FPDR has its disadvantageous to the family and the healthcare team. Nevertheless, FPDR
does not seem to benefit the patient in any way. There is, however, no research evidence to show
that it is harmful to the patient. On the contrary, there is convincing research evidence showing
that the presence of family during acute resuscitation has advantageous long-term psychological
impacts on the family members. Considering the current evidence, it is better to have the family
present during acute resuscitation.
Moderate evidence based research suggest that family presence during resuscitation have
no serious effects on adult resuscitation outcomes and may have positive outcome on the
psychological outcomes among the family members. On the other hand, low evidence based
research suggest that family presence during resuscitation have no effect on pediatrics
resuscitation results. The generalization surrounding these findings outside the emergency room
and pre-hospital setting is limited due to lack of trial sample in other forms of health care setting.

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Bibliography
Boehm, J., 2008. Family presence during resuscitation. Code Communications Newsletter.
Brasel, K.J., Entwistle, J.W. and Sade, R.M., 2016. Should Family Presence Be Allowed During
Cardiopulmonary Resuscitation?. The Annals of thoracic surgery, 102(5), pp.1438-1443. doi:
10.1016/j.athoracsur.2016.02.011
De Stefano, C., Normand, D., Jabre, P., Azoulay, E., Kentish-Barnes, N., Lapostolle, F., Baubet,
T., Reuter, P.G., Javaud, N., Borron, S.W. and Vicaut, E., 2016. Family presence during
resuscitation: a qualitative analysis from a national multicenter randomized clinical trial. PloS
one, 11(6), p.e0156100. doi: 10.1371/journal.pone.0156100
Jabre, P., Belpomme, V., Azoulay, E., Jacob, L., Bertrand, L., Lapostolle, F., Tazarourte, K.,
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full/10.1056/NEJMoa1203366
Köberich, S., Kaltwasser, A., Rothaug, O. and Albarran, J., 2010. Family witnessed
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15(5), pp.241-250. https://doi.org/10.1111/j.1478-5153.2010.00405.x
McClement, S.E., Fallis, W.M. and Pereira, A., 2009. Family presence during resuscitation:
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https://doi.org/10.1111/j.1547-5069.2009.01288.x
Oczkowski, S.J., Mazzetti, I., Cupido, C. and Fox-Robichaud, A.E., 2015. The offering of family
presence during resuscitation: a systematic review and meta-analysis. Journal of intensive care,
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Tinsley, C., Hill, J.B., Shah, J., Zimmerman, G., Wilson, M., Freier, K. and Abd-Allah, S., 2008.
Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit.
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