August 2009 Article of the Month
Baumhover, N. and Hughes, L. "Spirituality and support for family presence during invasive procedures and resuscitations in adults." American Journal of Critical Care 18, no. 4 (July 2009): 357-366.
SUMMARY and COMMENT: Chaplains are often involved in the question of family presence during cardiopulmonary resuscitation: sometimes in the academic debate, but frequently in the practical circumstance of supporting families while a patient receives CPR. Depending upon the institution, chaplains may be called upon to shepherd family members through the experience of observing a resuscitation effort, to usher relatives in and out, or to keep them at a distance from the scene of the crisis. For those chaplains wishing to advocate for family presence, this month's featured research suggests a helpful connection between clinicians' spirituality and openness to allowing resuscitations be witnessed.
Baumhover and Hughes, two professors of nursing, collected data from 73 nurses, 31 physicians, and 4 physician assistants (a total of 108 participants from an eligible sample of 115, for a participation rate of 94%) at a "210-bed not-for-profit Christian-based hospital located in the Southwestern United States" [p. 359]. All participants were from the emergency department, the cardiovascular intensive care unit, or the general intensive care unit. Spirituality was measured by a 28-item Spiritual Assessment Scale [--the scale items are fully listed in Table 2 on p. 360], and additional items addressed demographic and professional characteristics and views pertaining to resuscitation [--for the latter, see Table 3 on p. 361].
Among the findings:
We found a significant positive relationship between spirituality and support for family presence during resuscitative efforts in adults (r=0.24, P=.05) and a significant negative correlation between support for family presence and the age of the health care professional (r= -0.27, P= .01). ÖA significant positive correlation (r=0.33, P=.01) was found between spirituality and viewing family presence as a patientís right. A significant positive correlation (r=0.52, P=.01) was found between viewing family presence as a patientís right and viewing family presence as a familyís right. Ö[W]e found that 58% of nurses compared with 34% of physicians and physician assistants strongly agreed that family presence is a patientís right. [pp. 360-361]The authors draw connections between spirituality and a holistic perspective of medical care, and they state in sum: "The higher the scores of spirituality for the health care professionals, the more likely they were to believe that family presence is a patientís right and in the provision of holistic care" [p. 361]. They further speculate that "[p]erhaps, offering spiritual opportunities for health care professionals might foster holism, which in turn will affect the care that is provided" [p. 364]. A table [p. 359] lists "perceived benefits of family presence," which may form a good basis for constructive conversation on the subject.
This study has the effect of placing clinical chaplains fully at the table for discussion of institutional policy, practice, and education regarding family presence at resuscitations, and it opens up for research chaplains many questions for investigation [--see the section on Implications and Recommendations on p. 364]. Chaplains were excluded from the present sample because of the "lack of statistical strength in the number of these professional who could have volunteered" [p. 359], but the studyís conclusions would support a hypothesis that chaplains tend to stand with advocates for family presence --a further study that could easily be carried out within pastoral care circles.
The authors write with continuing education in mind, and the article is even paired with a CE test. There is an extensive bibliography.
One final comment: while this research found no significant correlations between any of the study variables and the related question of family presence at "invasive procedures," the article recalled for this reader the depiction of a family member witnessing surgery in Thomas Eakins' 1875 painting, The Gross Clinic. That famous work of art shows the patientís mother recoiling in horror at the scene. The image may represent well how overwhelming it can be for family members to see their loved ones being "worked on" by physicians in any circumstances, but I note that the mother appears to be completely unsupported. Perhaps an undervalued variable in the debate over family presence at resuscitations is the nature of the aid given to family members witnessing the procedure. A chaplain's support of family during CPR may not only enable relatives to cope with the stresses of witnessing the event, but it could implicitly affirm and encourage a holistic perspective for clinicians in the midst of the resuscitation.
Suggestions for the Use of the Article for Discussion in CPE:
This monthís article could open up general discussion along several lines: studentsí experiences of dealing with families during resuscitation and observations about family members preferences to be present at (or away from) the patient room, the possible burdens and benefits for family members and medical staff [--see especially Table 1 on p. 359], the role of spirituality in staff perspectives on holistic care, and differences between family presence at a resuscitation and at a routine invasive procedure. Supervisors could lead into discussion of the article by introducing the image of the mother in Eakins' The Gross Clinic, and ask students to think broadly about what the needs of that figure may be. Also, while the article focuses on adult patients, students might want to think in terms of comparisons and contrasts to pediatric or neonatal settings. From a research perspective, the article holds out the potential for discussing the SAS as a measure of spirituality [--see Table 2 on p. 360], and students could look carefully at the section on Limitations and Strengths [p. 363]. Since the piece is intended for nursing continuing education, discussion could easily be conducted in conjunction with a nursing group.
Related Items of Interest:
I. For recent articles considering the role of a chaplain in supporting family present at a resuscitation, see:
II. Other articles touching upon spiritual issues regarding family presence at resuscitations:
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