Abstract
Allowing families to be present in the resuscitation room is an issue in sudden death situations. This study examined whether or not a class given to critical care and emergency nurses could change nurses' beliefs regarding the presence of family members in the resuscitation room. A convenience sample of 46 nurses was given a class regarding the benefits of families in the resuscitation room, present law, hospital policy, and how to implement this nursing action. The study used a quantitative, quasi-experimental study with a pre- and posttest design. It was found that nurses' beliefs regarding families in the resuscitation room during sudden death situations changed to a statistically significant level after attending a class. The study shows that an educational class can make a difference in the beliefs of nurses caring for families of sudden death victims.
Resuscitation is a frequent occurrence in healthcare institutions, done primarily to prevent sudden death. There are no national statistics to describe the number of overall resuscitation efforts; however, some statistics on sudden death are known. For example, in 1993, 362 deaths per 100,000 people in the United States were caused by heart disease, accidents and adverse effects, suicide, or homicide (U.S. Bureau of the Census, 1996). Many of these deaths occurred after unsuccessful resuscitation in the hospital, either in the emergency room or in the critical care areas. Sudden death of a family member brings with it special problems for the family, as the death is unexpected, unanticipated, and grief is acute (Davidhizar & Kirk, 1993). Families may experience sudden death as a crisis. The separation from a family member is abrupt; there is no time for anticipatory grief; and family members may be in shock and denial because they cannot believe that death has occurred (Mian, 1990).
Nurses and physicians who work in the resuscitation rooms play a considerable part in preparing the family members and initiating the grieving process. Many resuscitations to prevent sudden death occur in the emergency room. What happens in the emergency room may inhibit the mourning process later on and may prevent anger toward the staff and feelings on the part of the family that they were cheated out of the last few precious moments with their loved one, were denied a chance to say whatever they needed to say, and were not given a chance to say goodbye (Martin, 1991). Anger and the feeling of being cheated out of these last few precious moments may lead to lawsuits by the family. Many believe family members could be allowed into the resuscitation room if they request to be with their loved one or could be given the option to be present if death is imminent. McQuay (1995) stated that in an established trauma support program at a large urban hospital, the family is given this option of being present in the resuscitation room if it is deemed appropriate. The support person is encouraged to remain with the family at all times, giving explanations as to what is happening; the family may touch/talk to their loved one provided they do not disturb the resuscitation effort.
Review of the literature states that the "emotional benefits to the family outweigh the legal risks for the staff. In fact, letting the family in during a code may serve two important purposes, strengthening the bonds between staff and families because a chaplain or nurse accompanies them into the room, and alleviates many of the doubts that could prompt a lawsuit" (Brown, 1989, p. 46). Staff who care for the victims of sudden death in the resuscitation rooms often have different perceptions.
There are mixed feelings on the part of nurses and physicians as to whether or not families should be allowed into the resuscitation room. The reluctance of emergency staff is based on fears that the family members may interfere, that they may observe poor performance of delivery of medical care, or that family members will hamper the staff's performance by making staff lose concentration and making the person more "human" (Doyle et al., 1987). There has been no clinical data or studies that support these fears.
As we consider allowing families in the resuscitation room, we look to a time in history when the same issues surrounded a different situation. In the late 1970s, the medical field dealt with many of the same issues over allowing fathers into the delivery room. Many delivery room staff were afraid that fathers would faint (Allen, 1983), disrupt the procedure, or should not be allowed to view cesarean sections. Initially, family-centered care was not offered enthusiastically by the medical staff. Only after a push from the consumers of obstetric practice did the medical community reluctantly allow fathers into the delivery room (Wilson, 1984). Nurses have been instrumental in family-centered pregnancy and birth (Hanson & Bozett, 1986).
It is possible that once the obstacles to having family members present in the resuscitation room are overcome, staff members could give the family the option to be present as loved ones are dying. Even if the person is being resuscitated, many believe that loved ones have the right to be at the dying person's side.
Research has shown that preparation of nursing staff to meet the needs of suddenly bereaved family members is lacking. No research thus far has examined educational interventions for nurses and whether or not their beliefs would change regarding family members presence in the resuscitation room. The purpose of this study was to evaluate whether or not nursing beliefs toward families in the resuscitation room changed after an educational intervention.