Does witnessing resuscitation help parents come to terms with the death of their child? A review of the literature

The aim of this review is to determine if witnessed resuscitation helps parents come to terms with the death of their child. Witnessed resuscitation is a controversial subject. There is disagreement in the literature and the opinions of healthcare professionals, as to whether parents should be present during the resuscitation of their children. This is an international problem that occurs consistently, when caring for patients requiring resuscitation. Despite this, however, research indicates that the advantages of this form of resuscitation for parents far outweigh the disadvantages.Electronic searches of PubMed, CINAHL and OVID were performed, with a manual search of retrieved articles. Primary studies, which were included, examined parents’ views of witnessed resuscitation in children. Of 1038 articles, eight met the inclusion criteria. These included qualitative and quantitative studies, which explored whether parents wanted to be present. The benefits and detrimental effects were explored, in order to determine whether witnessed resuscitation helps parents come to terms with the death of their child.Of 1253 parents, 87.1% wanted to be present. All but one parent believed witnessing resuscitation should be the choice of the parent and all but one parent who was present would do so again indicating that witnessed resuscitation is beneficial to parents.Effective parental support is needed whatever their choice and policies need to be in place to support witnessed resuscitation. More research is required to establish the long term outcomes of witnessed resuscitation as no randomised controlled trials have yet been completed.     

Should relatives be denied access to the resuscitation room?

Within a health care system that promotes choice and autonomy, it no longer seems appropriate to exclude relatives from the resuscitation room. There is a growing body of research that suggests there are indeed many long-term benefits to be gained from witnessing the resuscitation of a loved one. There seems no doubt that relatives would like the opportunity to spend the last few valuable minutes with their loved one to say goodbye. However, it is the views of many staff working in the critical care setting that appear to be preventing witnessed resuscitation from becoming normal practice. This paper considers the staffs', the relatives' and the patients' perspectives on witnessed resuscitation and concludes that the majority of relatives should not be denied access to the resuscitation room.     

Benefits and pitfalls of family presence during resuscitation

The witnessing of resuscitation by a close family member is becoming increasingly common (Booth et al, 2004), yet the area remains under-researched. Findings from a limited number of studies show mixed feelings among health care staff about the benefits to the relative. However, family members who were present during the resuscitation attempt believed they had contributed in some way to the treatment. Health care providers should be aware of the benefits and pitfalls of family witnessed resuscitation (FWR) so they can make evidence-based decisions.     

Prehospital cardiac arrest--a critical analysis of factors affecting survival

During a 10-year period, 5631 cardiac arrests were treated in our paramedic system. In all, 4216 resuscitations were attempted, of which 533 (12.6%) resulted in saves, defined as hospital discharges. Patients presenting with an initial rhythm of coarse ventricular fibrillation or ventricular tachycardia were found to have significantly increased save rates in comparison to those presenting with an initial arrest rhythm of asystole/fine ventricular fibrillation or electromechanical dissociation (P less than or equal to 0.01). When controlling for witnessed arrest, 303 of 1905 (15.9%) of all witnessed arrests were saves vs. 230 of 2311 (10%) of unwitnessed arrests (P less than or equal to 0.01). Witnessed bystander/first responder external cardiac compression- cardiopulmonary resuscitation (ECC-CPR) was found not to influence save rate. One hundred eighty-one of 1248 bystander/first responder witnessed arrests (14.5%) who had external ECC-CPR initiated before paramedic advanced life support arrival were saves, compared with 38 of 252 (15.1%) who had no ECC-CPR initiated until paramedic arrival; this was not statistically significant. Advanced life support response times in saved patients with witnessed cardiac arrests were analyzed. Ninety-five percent of all saves had a response time of less than 10 min. We conclude that, when evaluating the effectiveness of CPR, the variables of witnessing of arrest, presenting arrest rhythm, and respective response times must be controlled or analyzed.     

Different effort constructs and effort–reward imbalance: effects on employee well-being in ancillary health care workers

AIMS OF THE STUDY: The present study investigates the relationship between Effort-Reward Imbalance (ERI) and employee well-being, using three different concepts of efforts (i.e. psychological demands, physical demands and emotional demands). BACKGROUND: The ERI model had been used as a theoretical framework, indicating that work stress is related to high efforts (i.e. job demands) and low occupational rewards (e.g. money, esteem and security/career opportunities). The ERI model also predicts that, in overcommitted workers, effects of ERI on employee well-being are stronger compared with their less committed counterparts. METHODS: A cross-sectional survey among 167 ancillary health care workers of two nursing homes was conducted. Multiple univariate logistic regression analyses were used to test the relationship between ERI and employee well-being. RESULTS: Results of the logistic regression analyses showed that employees with both high (psychological, physical and emotional) efforts and low rewards had higher risks of psychosomatic health complaints, physical health symptoms and job dissatisfaction (odds ratios (ORs) ranged from 5.09 to 18.55). Moreover, employees who reported both high efforts and high rewards had elevated risks of physical symptoms and exhaustion (ORs ranged from 6.17 to 9.39). No support was found for the hypothesis on the moderating effect of overcommitment. CONCLUSION: Results show some support for the ERI model; ancillary health care workers with high effort/low reward imbalance had elevated risks of poor employee well-being. In addition, results show that the combination of high efforts and high rewards is important for employee well-being. Finally, some practical implications are discussed to combat work stress in health care work.     

Witnessed resuscitation: good practice or not?

Should relatives be given the choice to witness the resuscitation of a family member? From the available literature, three main topic areas emerge: research studies that allow witnessed resuscitation, the effects on relatives of witnessed resuscitation, and A&E staff attitudes towards witnessed resuscitation. There is abundant literature on the positive effects for relatives of witnessing the attempted resuscitation of a loved-one, the main benefit being that the grieving process was made easier. However, staff attitudes are mixed, making witnessed resuscitation a controversial topic.     

Teaching is more than telling: education about prematurity in a prenatal clinic waiting room

The purpose of this article is to describe the potential of pre-natal clinic waiting rooms for delivering prematurity prevention programs. The model is adapted from the psychoeducational model of prepared childbirth with goals in three areas: (1) information about prematurity, (2) coping skills to promote behaviors that reduce prematurity, and (3) psychological support. Cornerstones of the model include content, process, and outcome components. Content is based on Moore and Freda's seminal work on prematurity prevention (1998); process is based on the classic work of Peplau on interpersonal relations (1952); and outcomes summarize the current research on expanded prenatal care services. The article concludes with implications for future research in expanding the levels of intervention to include the broader community and health policy.     

NAEMSE Abstracts 2006

Abstract

Objective. Early, high-quality, minimally interrupted bystander cardio-pulmonary resuscitation (BCPR) is essential for out-of-hospital cardiac arrest survival. However, rates of bystander intervention remain low in many geographic areas. Community CPR programs have been initiated to combat these low numbers by teaching compression-only CPR to laypersons. This study examined bystander CPR and the cost-effectiveness of a countywide CPR program to improve out-of-hospital cardiac arrest survival. Methods. A 2-year retrospective review of emergency medical services (EMS) run reports for adult nontraumatic cardiac arrests was performed using existing prehospital EMS quality assurance data. The incidence and success of bystander CPR to produce prehospital return of spontaneous circulation and favorable neurologic outcomes at hospital discharge were analyzed. The outcomes were paired with cost data for the jurisdiction's community CPR program to develop a cost-effectiveness model. Results. During the 23-month study period, a total of 371 nontraumatic adult out-of-hospital cardiac arrests occurred, with a 33.4% incidence of bystander CPR. Incremental cost-effectiveness analysis for the community CPR program demonstrated a total cost of $22,539 per quality-adjusted life-year (QALY). A significantly increased proportion of those who received BCPR also had an automated external defibrillator (AED) applied. There was no correlation between witnessed arrest and performance of BCPR. A significantly increased proportion of those who received BCPR were found to be in a shockable rhythm when the initial ECG was performed. In the home setting, the chances of receiving BCPR were significantly smaller, whereas in the public setting a nearly equal number of people received and did not receive BCPR. Witnessed arrest, AED application, public location, and shockable rhythm on initial ECG were all significantly associated with positive ROSC and neurologic outcomes. A home arrest was significantly associated with worse neurologic outcome. Conclusions. Cost-effectiveness analysis demonstrates that a community CPR outreach program is a cost-effective means for saving lives when compared to other healthcare-related interventions. Bystander CPR showed a clear trend toward improving the neurologic outcome of survivors. The findings of this study indicate a need for additional research into the economic effects of bystander CPR.     

Social work and spiritual counseling: results of one state audit

Interdisciplinary care is the foundation of hospice service for the terminally ill. This model of care includes a holistic focus on the patient and family, including not only physical and medical management but also psychological and spiritual needs. The importance of social issues is acknowledged and supported through federal and state regulations requiring social work and spiritual counseling services as a part of the hospice care team. State regulatory reports were analyzed to identify compliance issues for social workers and spiritual counselors within hospice programs in a midwestern state. Problems with care planning, assessment, and bereavement services were identified in this process. Deficiencies point to the opportunities for social work educators to improve the training of future hospice social workers and the challenges involved in training spiritual counselors.     

Witnessed resuscitation: A concept analysis

BackgroundThe advance in the practice of resuscitation is globally recognised and fully sanctioned in scientific world. However, practicing family presence during resuscitation, also known as witnessed resuscitation, is yet to be endorsed by healthcare professionals. Many professional nursing and physician organisations have endorsed the practice of witnessed resuscitation by issuing guidelines. These organisations support family presence during resuscitation due to the research proving its benefit for patients and families.PurposeThe purpose of this paper is to analyse the concept of witnessed resuscitation.MethodA concept analysis was undertaken using Rodger’s (2000) evolutionary method.FindingsThe concept analysis suggests that witnessed resuscitation refers to the presence of a family member or relative during a resuscitation procedure, mostly in emergency and complex critical care areas. The defining attributes are family centred care approach, exercising patients and family rights and autonomy in end of life care decisions and involvement of family as active and passive observers during a resuscitation event.ConclusionClarity surrounding witnessed resuscitation will guide the development of a conceptual framework, expand nursing knowledge and identify the research required to advance understanding of witnessed resuscitation in practice.     

Characteristics and outcome in out-of-hospital cardiac arrest when patients are found in a non-shockable rhythm

AIM: To define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) who were found in a non-shockable rhythm. PATIENTS: All the patients included in the Swedish OHCA registry between 1990 and 2005 in whom resuscitation was attempted, who were found in a non-shockable rhythm and where either the OHCA was witnessed by a bystander or was not witnessed. RESULTS: In all, 22,465 patients fulfilled the inclusion criteria. Their mean age was 67 years, 32% were women, 57% were witnessed, 64% had a cardiac aetiology, 71% occurred at home and 34% received bystander cardiopulmonary resuscitation (CPR). Survival to 1 month was 1.3%. The following were independently associated with an increased chance of survival: 1/Decreasing age, 2/Witnessed arrest, 3/Bystander CPR, 4/Cardiac arrest outside home, 5/Shorter ambulance response time and 6/Need for defibrillatory shock. If these six criteria were fulfilled (age and ambulance response time below the median), survival to 1 month increased to 12.6%. If no criteria were fulfilled, survival was 0.15%. CONCLUSION: The overall survival among patients with an OHCA found in a non-shockable rhythm is very low (1.3%). Six factors associated with survival can be defined. When they are taken into account, survival varies between 12.6 and 0.15%.     

Witnessed resuscitation: beneficial or detrimental?

This article explores the existing literature and discusses the benefits and disadvantages of witnessed resuscitation for health professionals, relatives, and patients themselves. Keywords "witnessed resuscitation," "patient perspective," "health professionals," and "resuscitation room" were entered into MEDLINE, Medscape, and Science Direct databases. The issue of witnessed resuscitation, along with the benefits and disadvantages of its implementation, is discussed widely with increasing controversy among health professionals. Many authors accept the existence of benefits of witnessed resuscitation, but they each have reservations on certain aspects of the practice. Although witnessed resuscitation has demonstrable benefits, the dearth of research literature on the subject makes it difficult to come to a concrete conclusion about its value in practice. More studies are needed focusing on the impact of witnessed resuscitation on staff, family members, and patients. Larger sample sizes are needed in future studies, and studies are needed in which geographical, cultural, religious, and sociological factors are taken into consideration.     

Dying, sudden cardiac death and resuscitation technology

Many nurses will be familiar with the demanding role of caring for a patient who requires cardiopulmonary resuscitation following a sudden, life-threatening illness or event. This paper examines the phenomenon of sudden cardiac death and in particular, focuses on the medical-technical discourse of dying and death in the context of resuscitation for the victims of sudden cardiac arrest. The process of dying is distinguished from the end point of death by drawing upon biomedical determinants and definitions of death. Comparison is made between the use of resuscitation techniques in an attempt to reverse 'clinical death' and the notion of a 'natural death' that is proffered as a means to a 'good' or 'ideal' death. The humanistic versus technological imperative is further deliberated by examining the role of the emergency team in end of life care and includes consideration of the effects that medical dominance may have on the dying process. The practice of family witnessed resuscitation is recognised as one way in which a holistic approach to emergency resuscitative care may be achieved.     

Eating disorders as addictive behavior. Integrating 12-step programs into treatment planning

To be effective in treating eating-disordered individuals, we must be open to working with an electric model of treatment. Often health care providers have difficulty with the addiction model of treatment, even though many eating-disordered patients will attest to the assistance and support they receive from these programs. It will be useful for both health care professionals and 12-step programs to avoid taking competitive positions. It is far more useful for professionals to have a working knowledge of how these programs work and how they can be of use to the individuals with eating disorders. Knowledge of local resources will also be of great value. Given the assistance that the clients tell us they receive at these programs, it makes more sense to understand and use these programs more, not less. There is evidence that eating disorder behaviors are addictive behavior, both from a psychological and physiologic perspective. Use of a 12-step program will assist with the practical details of helping individuals to stop employing self-destructive behaviors as well as provide support and decrease feelings of isolation and depression. It is important to integrate the 12-step program components into an overall treatment program to make the best use of both programs and decrease the competition usually inherent in both programs.     

The Effect of Family Presence During Resuscitation and Invasive Procedures on Patients and Families: An Umbrella Review

IntroductionThe concept of family presence during resuscitation and invasive procedures is a controversial issue and has not been universally adopted by health care providers. Owing to the sheer number of studies in this field, we conducted this umbrella study to provide an overview of this concept with the aim of investigating the impact of family presence on patients, families, and resuscitation and invasive procedures.MethodsIn this review, using the Joanna Briggs Institute levels of evidence umbrella methodology guidelines, the authors searched PubMed, Google Scholar, Embase, MEDLINE, Web of Science, Scopus, and the Cochrane database for systematic review and meta-analysis studies that evaluated the presence of family during resuscitation and invasive procedures without time limit until July 2020. The following key words were used for the search: family presence; family witness; parent presence; parent witness; and resuscitation.ResultsA total of 254 articles published between January 1967 and July 2020 were screened. Five articles (1 meta-analysis and 4 systematic reviews) met the inclusion criteria. The review showed that family presence during resuscitation or invasive procedures does not have negative effects on family members, patients, or the resuscitation or invasive intervention process. Family members focus on the patients, not the ongoing treatment. The presence of family members is beneficial for both family members and health care staff. None of the reviewed studies reported a negative effect on family members.DiscussionThe presence of parents and other immediate family members during resuscitation and invasive procedures has positive impacts on patients, families, and health care staff.     

Correlation of mental health problems with psychological constructs in adolescence: final results from a 2-year study

In recent years, it has been widely witnessed that a surprising number of adolescents suffer emotional and mental health problems, and such turmoil is very often carried over into adulthood with serious implications for adjustment during the post-adolescent years. On this point, mental health problems in Korea are only now being considered crucial factors in the health status of adolescents and important public and social issues. It is also true that studies concerning the link between adolescents' mental health problems and their psychology are limited. The purposes of this study were to investigate mental health problems of Korean adolescents, to reveal factors affecting their negative mental health and to explore a possible relationship between mental health problems and psychological variables. 2052 Korean adolescents selected randomly from junior high and high schools in Seoul, Korea were surveyed. Korean Symptom Checklist, Health Locus of Control Scale, Self-efficacy Scale and Self-esteem Scale were used to identify mental health problems and psychological variables of adolescents. Results indicated that Korean adolescents showed high prevalence in interpersonal sensitivity, depression, anxiety and hostility. In addition, the findings revealed that there were significant differences in adolescents' mental health problems between gender and age. Furthermore, results revealed that the adolescents' mental health problems were statistically correlated with psychological variables. This study provides significant information for the relatively unstudied Korean adolescents and also has the potential to influence the development of better mental health programs for adolescents.