Assessment and Analysis
Resuscitation of critical care patients is not only stressful to physicians but also causes much discomfort to family members. As it is an uncommon event, the critical care teams are often not well equipped to manage resuscitation scenarios, particularly pediatric and emergency resuscitations. Usually, family members are separated from the patient before resuscitation is initiated. A nurse then frequently updates them on the patient’s status. It is important that healthcare teams are trained to carry out a competent resuscitation of critical care patients while at the same time giving compassionate care to the parents/family members. Poor communication among care teams has been identified as a major cause of adverse events in critical care (Moore, 2009). Effective communication in the multidisciplinary critical care team is essential for a successful resuscitation exercise.
Often, the team members are drawn from different specialties and disciplines. Medical resuscitation, especially when it involves a patient in trauma or emergency department (ED), requires high fidelity and support for parents/family members; and, as such, it is essential that critical aspects of communication with parents/family members are incorporated into critical care. Resuscitation teams perform many care activities. Thus, effective communication is essential not only for protecting patient needs but also for comforting family members, who may be psychologically traumatized by the exercise. Interventions to promote better communication in critical care have been shown to correlate with improved patient and family outcomes. The purpose of this research paper is to review literature conducted recently within resuscitation and acute care domains. It will identify and evaluate communication skills and suggest an intervention, which, if applied in resuscitation scenarios, would preserve patient needs and comfort parents/family parent present during a cardiopulmonary resuscitation.
Literature Review
Holistic care should be family-centric, i.e., it must meet the emotional, cultural and spiritual needs of both the patient and his or her family. A holistic, family-centered care, in a resuscitation scenario, incorporates clear communication with the family members. A study by Moore (2009) found that during a resuscitation attempt, the needs of the patient’s family are often ignored. Attempts by critical care teams (emergency nurses) to offer comfort to family members during and after CPR are affected by nursing staff shortages and limited preparedness for such situations (Moore, 2009). One way of comforting family members is by allowing family presence during a CPR event.
As Wendover (2012) points out, most people prefer to witness a resuscitation involving a family member as this helps to improve communication between parents/family and the critical care or ED staff. It also helps in making end-of-life decisions when necessary. Family-witnessed CRP also helps families to recognize and appreciate the attempts of ED staff to save the life of the patient and to cope with bereavement in case of death (Wendover, 2012). However, most nurses hold the view that family presence during a CPR event does not help the family members; rather, it causes them much psychological trauma and may even lead to disruption of resuscitation attempts (Wendover, 2012). There is also a perception that most healthcare professionals lack skills necessary to comfort family members during a resuscitation attempt or to provide follow-up care following the death of the patient (Wendover, 2012). Nursing role during resuscitation scenarios includes providing care and comfort for the patients’ families.
Health care professionals admit that during resuscitation, greater communication, support and proximity to family members is necessary. A study by Boucher (2010) found that most ED staff members believe that proximity of family members to patients during CPR is important both for the patient and family members. In this study, privacy was found to be necessary during such interactions, especially when making end-of-life decisions. However, Perry (2009) found that most ED staff lack the skills and competency to provide psychosocial support for patients’ families. The author attributes this to the lack of literature on family-centered practice. Perry’s (2009) finding reinforces Moore’s (2009) study, which established that many ED nurses’ lack skills in psychosocial support because of lack of literature on holistic, family-centered care. According to Howlett, Alexander, and Tsuchiya (2010), the scarcity of evidence on communication approaches during and after a family-witnessed CPR is due to lack of training in holistic, family-centered care in nursing schools. The author suggests that critical care nurses should seek to enhance their knowledge about family care during CPR.
Besides lack of skills and limited evidence, time constraints and lack of support prevent nurses from communicating effectively with family members. Pre- and post-CPR care for families is an emotionally demanding exercise and thus, nurses need emotional support to effectively communicate with and provide care for the emotionally distressed family members (Perry, 2009). This implies that there is need for occupational support services for nurses, particularly for ED nurses. Briefing sessions before and after CPR events could give them the emotional support to communicate effectively with patients’ families. Wendover (2012) states that experienced staff members have the confidence and competence to communicate with families compared to junior nurses during and after a CPR event. He suggests that hospitals should implement interventions that facilitate delivery of holistic care to families of patients in critical care. The interventions should also improve the communication between critical care staff and the patient’s family.
Intervention
An intervention to enhance communication between ED staff and family members during a CPR event would help deliver holistic care to family members, while simultaneously supporting the ED nurses emotionally. The proposed intervention incorporates three components; education/training of staff, debriefing sessions and follow-up care after a CPR event. Family members witnessing a resuscitation of their loved one are often too distressed to talk or even absorb communicated information (Moore, 2009). As such, nurses should use written messages when communicating with grief-stricken family members. The education/training component of the proposed intervention will entail training of nursing staff on verbal and non-verbal methods of communication, and emotional care of family members. The training will also cover aspects of holistic care, interpersonal interactions and stress coping strategies. It will also involve an assessment of the nurses’ communication skills. Thus, a training program that has all these components can improve the ability of the critical care staff to provide pre- and post-resuscitation care as well as bereavement care to family members.
Debriefing sessions in the ED or pediatric departments organized by hospital management will provide emotional support to nurses who have taken part in a resuscitation event. The debriefing sessions should incorporate occupational health and counseling services to offer support to nurses and enable them to communicate effectively with family members. Poor communication between the ED staff and family members is a causal factor of emotional stress in nursing staff. The debriefing sessions will allow emergency nurses to identify and address barriers to effective communication.
The intervention will also include a follow-up program for bereaved families or after the CPR event. From the literature review, it can be seen that, although follow-up programs play a crucial role in providing emotional care for family members, nursing shortages hinder their development. Also, the emergency services provided by hospitals emphasize more on physical care than emotional care. In this intervention, a nurse-led follow-up program will be adopted to provide greater emotional care to family members after the resuscitation exercise.
Evaluation
The intervention items will be evaluated using different approaches. Evaluation of these components will give valuable insights on nurse-family communication and holistic care during and after a CPR event. The literature review reveals that issues of education/training, practice and organizational policy affect nursing communication in critical care settings. In the proposed intervention, evaluation of education and competence will involve an assessment of each nurse’s familiarity with communication cues (verbal and non-verbal) that are critical when communicating with family members in critical care settings.
Nurse awareness of advice messages to the affected family members is a crucial aspect of communication in such contexts. Also, hospitals implementing this intervention will formulate policies that will guide the provision of family-centered care and integrate it into practice. Evaluation of this intervention strategy will be based on: the availability of occupational care services; the quality of nurse-patient communication; and the level of family members’ satisfaction with emotional care. The evaluation will ensure that the communication meets the needs of the family members and ensure a holistic care that is integrated into the practice of ED staff.
References
Boucher, M. (2010). Family-witnessed resuscitation. Emergency Nursing, 18(5), 10-14.
Howlett, S., Alexander, A., & Tsuchiya, B. (2010). Health Care Providers’ attitudes regarding family presence during resuscitation of adults: an integrated review of the literature. Clinical Nurse Specialist, 24(3), 161-74.
Moore, H. (2009). Witnessed resuscitation: staff issues and benefits to parents. Paediatric Nursing, 21(6), 22-25.
Perry, E. (2009). Support for parents witnessing resuscitation: nurse perspectives. Paediatric Nursing, 21(6), 26-31.
Wendover, N. (2012). Changing staff attitudes towards family-witnessed resuscitation. Emergency Nursing, 20(7), 21-24.
