Caring for patients at death’s door

Numbers of people dying in hospital without family present could be reduced if current practices were changed, according to the findings of a Flinders University research study.

Thousands of people suffer cardiac arrest in hospital each year and approximately 90% of them die, frequently separated from family members and loved ones.

Flinders University College of Nursing and Health Sciences Senior Lecturer and research project leader Dr Tracey Giles is investigating new interventions and approaches to family presence during resuscitation (FPDR) in Australian emergency department (ED) settings.

She says FPDR has important proven benefits.

FPDR was introduced in the 1980s so family could be with their loved ones during life-threatening events and it has been practised internationally for decades.

“Yet, despite growing support from the public and endorsement from professional groups, FPDR is not practised widely in Australia and rationales for poor uptake are unclear,” Dr Giles says.

Dr Tracey Giles

“So we conducted in-depth interviews with Australian clinicians, family members and a resuscitation patient to interpret and explain their meanings and actions when deciding whether to practice or participate in FPDR.

“We found that decision-making around FPDR occurred in time-poor environments and in the absence of local institutional guidelines.”

Clinicians appeared to be motivated by doing “what’s best” for patients and families when allowing or denying FPDR.

“However, their individual interpretations of ‘what’s best’ was subjective and did not always coincide with family preferences or with current evidence that promotes FPDR as beneficial,” says Dr Giles.

“As a result, practices were inconsistent and highly variable, and some families missed the chance to be with their loved ones at the end-of-life.

“FPDR practices were impacted most by the personal preferences of individuals who were seen to be ‘in charge’ of permissions.”

Dr Giles recommends the introduction of clinical protocols and associated education as an important starting point to help establish what safe and effective practice consists of, and to ensure future practice is guided by evidence and standards for health consumer safety and welfare rather than by personal values and preferences of individuals ‘in charge’ of permissions.

Presentations on Dr Giles’s research will be presented during Flinders Health Research Week 2017. Go to the Research Week program in full here

More information in the opening addresses at the Flinders Centre for Innovation Cancer today

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