Spotlight on Research
Tuesday, December 2, 2014
Lay presence at cardiac arrest: what does the literature say?For decades there has been debate concerning the presence of lay people during resuscitation attempts. Predominantly the focus of the research has been in-hospital although in recent years we have seen a growing body of evidence pertaining to out-of-hospital settings (Walker, 2014).Frequently this phenomenon is referred to in the literature as ‘witnessed resuscitation’ (WR) or ‘family presence during resuscitation’ (FPDR). The authors of this paper identify that although there is nothing new about this topic, there remain inconsistencies with regard to perceived benefits, barriers and enablers to this practice.The aim of the review was to examine evidence on WR in the emergency department (ED). Although the literature search looked for evidence from 1992 through to 2012, only papers from 2000 onwards were incorporated in the review itself. The paper clearly identifies the included databases and the primary search terms such as ‘family presence’, ‘resuscitation’, ‘arrest’, ‘witnessed’, ‘barriers’, ‘benefits’, ‘advantages and disadvantages’ etc.Inclusion and exclusion criteria are clearly presented. It is notable that although the focus was the ED, the researchers wanted all key stakeholders (stated as patients, general public, family members, allied health professions, nurses and doctors) to be represented and, hence, they did not restrict their included papers to just one group or profession.‘There is a dearth of research relating to WR in out-of-hospital environments which needs to be adrressed’Initially 2 036 papers were identified but ultimately only 16 original research papers met the inclusion criteria: eight from the UK; two from Australia; two from the UK; one from each of Sweden, Singapore, Ireland and Turkey. In terms of research approach, four were qualitative studies, and 12 were quantitative, with one of these being a randomised controlled trial.In relation to perceived benefits, there was recognition as to how FPDR could, for example, potentially: help with the grieving process; remind staff of the role the patient may have had in a family unit; increase the connection between family and staff. Having the choice to stay, or not, during resuscitation attempts was reported as being an important factor by family members.The authors state that from this review, five major barriers were identified by healthcare professionals: fear of litigation initiated by family members; increased levels of stress and anxiety; concern about the traumatic impact on the observers; feelings by both staff and family members that lay presence might influence the resuscitation attempt; and concerns that staff might get distracted by distressed relatives.Perhaps unsurprisingly, enablers of FPDR included the need for education and training for staff about how to support relatives and other people observing resuscitation attempts. In addition, having a designated ‘support person’ who is not actively engaged in the resuscitation was seen to be an essential component—of course that may not always be possible depending on staff resources at the event. Finally, there was an emergent theme relating to the need for production of a formal and specific policy on witnessed resuscitation and how staff should manage requests from lay people to be present. Again, this may not be quite the same for out-of-hospital resuscitation attempts where WR is likely to be a frequent and ‘naturally occurring event’ (Walker, 2014), especially when called to people's homes.In conclusion, this is an interesting paper which highlights that there are still inconsistencies in the practice of enabling WR in EDs.There is a dearth of research relating to WR in out-of-hospital environments which needs to be addressed. We should examine what lessons can be learned from ambulance staff, as they are frequently exposed to this phenomenon, and their expertise and knowledge could be transferable, potentially influencing policy development in relation to the care and management of family/friends/others during witnessed resuscitation in other healthcare environments.
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