Witnessed Resuscitation: Benefits and Disadvantages

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Table of Contents

Introduction
Benefits
Disadvantages
Conclusion
List of References

Introduction

Resuscitation, also known as cardiac, pulmonary resuscitation (CPR), refers to an emergency course of action for individuals experiencing cardiac arrest or respiratory arrest. Witnessed resuscitation refers to active resuscitation performed in the presence of relatives, friends, or other concerned individuals (Russell, 2000). The exercise is applicable both in and out of the hospital locale. The process involves physical maneuvers to craft man-made circulation using rhythmic chest compression, sometimes involving breathing into the victim’s mouth. PCR may involve advanced procedures involving the administration of intravenous drugs.

The process aims at restoring oxygenated blood circulation in the cardiac system and the brain. Maneuvering should continue until the victim regains heartbeat also known as “return of spontaneous circulation” or the patient is confirmed dead. The trauma team does it perfectly, but some perform it with a lot of negligence (Catherine et al, 2009). This is one of the reasons why family members may wish to attend.

Cardiac pulmonary resuscitation has got many ethical issues that surround it. One crucial question that remains unanswered is whether to allow relatives of the patient into the resuscitation room. The place of collapse usually determines whether the resuscitation is witnessed or not (Raymond & Robert, 1997). The attitudes of relatives and the service providers are mixed. There are advantages and disadvantages of allowing the non – service providers in the treatment room. Some situations are uncontrollable. Resuscitation carried out of the hospital setting e.g. roadside. The bystanders will automatically have to witness the resuscitation process.

The research has shown that there is a discrepancy between the public and healthcare providers on the notion of witnessed resuscitation. There are some views shared by both the staff and the general public including family members of the victim on witnessed resuscitation. Supporters of the opinion, witnessing the resuscitation, emphasize the human rights of the victims and their relatives. Sources reveal that barring witnesses from the scene is unwarranted since many bystanders usually witness grave events in the field (Margo, 2005).

Benefits

The requests by family members and friends to eyewitness resuscitation have achieved popularity because they have some ethical rationalization. The benefits include helping the witnesses understand the severity of the trauma. It makes them appreciate the attempts taken to save the patients. Allowing the relatives in, usually facilitate communication and understanding between the health team and the family (Alister & Andrea, 2009).

The witnesses are able to understand the condition of the patient and the effort displayed by the team coordinating the process. The most repeatedly deemed gain is the surety the relatives and the public have that the patient has received the required service. Witnesses will always be eager to confirm if the healthcare providers give the right treatment to their beloved ones. The relatives and the general public will have confidence in the services offered during resuscitation if they witness the process. Witnessing the process will leave those interested with no doubt if a patient dies in the process.

From the religious point of view, there is value in being with the loved ones during resuscitation regardless of the consequences. Permission into the resuscitation region helps in meeting the spiritual and emotional needs of relatives, and the patient. Witnesses are able to share their grief together as they watch the resuscitation process. The presence of relatives and friends will comfort the patient by giving spiritual and emotional support.

The patients who feel comfortable regain life faster than those without comfort. The immediate beloved ones are able to control their grievances in the presence of other witnesses thus giving them confidence in the process. Baring the witnesses from the scene will raise their curiosity thus triggering their emotional and spiritual conditions. The patients too need thief families next to them (Marny et al, 2004). The decision to let in witnesses will eventually reveal a sense of connectedness and presence to the patient that he or she is lived by the relatives physically and emotionally.

The public is concerned with the outcome of the resuscitation process. The research shows that people do not have confidence in cardiopulmonary resuscitation. People believe that most processes lead to death depending on the age of the patient or victim. Some doubt the procedures followed to regain the normal circulatory functionality in the body, hence is eager to observe the resuscitation areas (Kirk & Herbert, 2000).

This decision to allow in witnesses into the resuscitation area will instill confidence in the public and the importance of resuscitation. The action will give credibility to the procedure and even the person offering the service. The source of information about the survival of the PCR patients are gotten from the television and people regard it as ineffective. Witnessing will, therefore, be a breakthrough for the PCR inters of enlightening the public on its application and effectiveness (Catherine, 2001).

The witnessing teams especially the family members and friends usually provide a helping hand both to the patient and the resuscitation team. They become instrumental in the process especially when there is a deficit of personnel on the ground. This is encouraged at the out of the hospital where the shortage is more common than in the hospital setting. They can provide tissues, serviette and chairs. They can be sent or avail necessary equipment for resuscitation. The witnesses act as reliable sources of information concerning the most likely outcomes of the resuscitation. The family members are able to convey trusted information about the response of the patient to the service.

The witnesses constantly receive briefing on the condition of their beloved, hence can predict the outcome. This normally prevents a shocking revelation when the patient dies. The ethics demand that we should always do to others what we like them to do us. The healthcare providers in a facility is considered witnesses in another facility hence, it is a vicious cycle. We would always want to be done right in every situation.

The presence of the witnesses usually helps in the litigation situations. This is common when the witnesses are not immediate family members or friends. Relatives usually file cases in the law courts when the resuscitation leads to death. The people present would be witnesses to defend the code team if at all the resuscitation was done procedurally. Healthcare team appreciate the witnesses is such cases, and prefer the inclusion of the witnesses in the resuscitation scene. The resuscitation done in the presence of family witnesses is a plus to the hospital or the organization doing it. It creates a strong bond between the facility and the witnesses. The family members feel they are part of the hospital when allowed to witness. They become free to ask questions and to obey the directives. Keeping them out may cause anxiety, suspicion, and mistrust between the two parties. This gives them an opportunity to play their part in the resuscitation process.

Disadvantages

Witnessing the resuscitation procedure comes along with several disadvantages, as opposed to advantages. The concept of preventing the general public and even family members from the witness the process is cited majorly by the healthcare providers (Marcus, 2004). The medics and the code team claim that the relatives and the public usually experience traumatic conditions after witnessing the scene of resuscitation. The scene may lead to psychological distress (Scott, 2008). The effects last for long periods, taking several months to years in some situations. The impact leads to other additional costs and poor health among the affected.

Some individuals may experience the effects for the whole of their lives (Grice et al, 2003). The discomfort experienced by such groups may in turn disturb the rescue team to attend to them leaving the initial patient. This may lead to noise thus disrupting the whole procedure, and instilling more fear in the victim. The code teams recommend that people should not be allowed in to avoid such scenarios.

Another significant problem associated with the presence of witnesses is the disruption of the code team functions. The healthcare team feels stressed in the presence of the public and relatives (Ellen, 2002). The resuscitation provider team may omit certain steps involved due to the disruption coming from the witnesses. This is usually experienced in non – hospital setting. Many bystanders give several suggestions on how to do the resuscitation. Some become rowdy and threaten to beat the healthcare team in case the resuscitation leads to death. Indiscipline witnesses may even steal from the health team if the police are not around. Loss of equipment is experienced where witnesses are many and rowdy. This may cripple the resuscitators when vital equipment gets lost.

It is disadvantageous to the health personnel when they allow family members and friends into the resuscitation room. Inadequate number of staff may be available to give support to the victim’s friends and family members (Wendy, 2007). The staffs will be concentrating on the resuscitation process and may leave the affected witnesses to their own devices. Anxiety and grievances among the witnesses may prompt the healthcare worker to leave the patient to attend to them. This will result into double work for the staff, hence compromising the required services.

The presence of the witnesses in the resuscitation scene may result into unjustified and non-evidence information. Most witnesses and bystanders do not know the procedures of resuscitation. Medics feel that maneuvering techniques and actions to help save life may not be pleasant to the witnesses. Some may feel that the chest compressions are injurious to the patient. Others may conclude that mouth to mouth procedure leads to spread of diseases (Virkkunen et al, 2006).

The overall outcome will be spread of rumors, claiming how the method was not right. Ignorance among the witnesses about resuscitation may cause quarrels between the code team and the public if the patient dies. The medic’s credibility may be thwarted unjustifiably in such scenarios. The healthcare personnel think that the present of witnesses would add to their stress.

With the limited knowledge witnesses have, they totally or partially understand what resuscitation procedure entail. Nurses and other involved persons worry of the possible litigation. This is a prime concern for the resuscitation team because they may be indicted falsely (Baren, 2005). The healthcare team charged may, in the subsequent resuscitation, not deliver what is expected of them due to the grudges they carry from the previous scenes. The witnesses may present false accusations due to their ignorance in the medical field. Such cases ate common in out of hospital scenes. The fear to incur liability is a paramount concern for the hospitals.

Some witnesses may cause disruption in the hospital is their wishes do not come to be true. False accusations arising may prompt family members to sue the organization. The hospital may then be put into task of bearing the liability if the witnesses win the case. Damage of property may also occur in some cases which is a drawback for the hospital. The credibility of the hospital as a whole may be at degraded. This will see the hospital struggling to polish its image.

The issue of privacy is extremely controversial in the witnessed resuscitation scene. Some patients in unconscious conditions may blame the healthcare providers for allowing relatives to witness when they recover. Patient privacy is truly imperative. Some may not want the family to see their bodies. Resuscitation usually involves exposing bodily parts, and this may offend the client plus some relatives.

Chest compression and kiss of life may be offending to some relatives. It may be an abomination to some traditions when body parts of their relatives are touched in their presence. Patients who can consent at the start of resuscitation may stipulate the witnesses to be allowed in the room. Some witnesses may get into the room mischievously when they are not among to get in the room. This may later cause blames on the medics. Withdrawal of consent is another possible outcome in a witnessed resuscitation scene, hence leading to legal matters. The relatives may withdraw consent if they feel that the procedure is harsh.

In the summary of the disadvantages, relatives themselves may not like witnessing the resuscitation. This is because the process is too upsetting, and the last impression may be poor (Marcus et al, 2007). Some would prefer receiving sad information than watching their loved ones dying in the process. Watching the scene may make them have permanent attitude towards resuscitation, healthcare workers and the facility. The resuscitation in their presence may not make any difference to them. This results in the waste of time and other resources. Some relatives may anticipate possible mistreatment by the staff conducting the resuscitation. Such mistreatment includes failure to answer witness’ questions, telling them to go out unnecessarily and many others.

Conclusion

The debate on whether to have witnesses or not is exceedingly complicated. It has several ethical considerations in the medical field. Some medics prefer it while others refute it. It has both benefits and disadvantages. It is hard to predict a disadvantage during resuscitation in the presence of a witness. It is, therefore, a call for the code team, medics and other paramedical personnel involved in the resuscitation conduct a study. They should evaluate the possible psychological effects on the witnesses because it is not possible for the healthcare workers to predict such occurrences. The matter of consent is immensely challenging because some patients may be too unconscious to consent to the services. A social survey may give some solutions on the issues surrounding consent (Wendy, 2007).

List of References

Alister N, & Andrea P 2009, Family presence during resuscitation and invasive Procedures, Journal of the Royal College Of Nursing Australia, Volume 16, Issue 3, 101-118..

Baren D 2005, Family Presence during Procedures, Academic Emergency Medicine Journal, Vol.12, No. 5, 463-465.

Catherine A. at el, 2009, Ethical Issues of Cardiopulmonary Resuscitation, Comparison of Emergency Physician Practices from 1995 to 2007, Academic Emergency Medicine, 2009, 16, 270–273.

Catherine A 2001, Resuscitation Research: Future Directions and Ethical Issues, Academic Emergency Medicine, Volume 8, Number 8, 839-841.

Ellen T. 2002, Should Family Members Be Present during Cardiopulmonary Resuscitation? The New England Journal of Medicine, 346, 1019-1021.

Grice a. et al, 2003, Study examining attitudes of staff, patients and relatives to Witnessed resuscitation in adult intensive care units, British Journal of Anaesthesia, 820-824.

Kirk J. & Herbert G. 2000, Public Expectations of Survival Following Cardiopulmonary Resuscitation, Academic Emergency Medicine, Volume 7, Number 1, 48-53.

Marcus E 2004, Asian medical staff attitudes towards witnessed resuscitation, Official Journal of the European Resuscitation Council, Volume 60, Issue 1, 45-50.

Marcus E. et al, 2007, Comparing attitudes of the public and medical staff towards Witnessed resuscitation in an Asian population, Official Journal of the European Resuscitation Council, Vol.73, Issue1, 103-10.

Margo A. 2005, Family Presence during Resuscitation, A Critical Review of the Literature. American Journal of Critical Care, 14: 494-511.

Raymond E &, Robert A 1997, Who Gets Bystander Cardiopulmonary Resuscitation In a Witnessed Arrest? Journal of Academic Emergency Medicine, Volume 4, Issue 6, 540-543.

Russell B 2000, Witnessed resuscitation by relatives, Official Journal of the European Resuscitation Council, Volume 43, Issue 3, 171-176.

Scott C 2008, Post-Traumatic Stress Disorder Symptomology Associated with Witnessing Unsuccessful Out-of-hospital Cardiopulmonary Resuscitation, Academic Emergency Medicine 2009; 16:226–229.

Virkkunen S, et al, 2006, Bystander mouth-to-mouth ventilation and regurgitation During cardiopulmonary resuscitation; Journal of Internal Medicine, 260, 39–42.

Wendy W 2007, Accident and emergency staff opinion on the effects of family Presence during adult resuscitation: critical literature review, Journal of Advanced Nursing, volume 61, issue 4, 348–362.

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