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Balancing Between Closeness and Distance: Emergency medical services personnel’s experiences of caring for families at out-of-hospital cardiac arrests and deaths
University of Borås, Sweden.ORCID iD: 0000-0001-7865-3480
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
University of Borås, Sweden.
2012 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 27, no 1, p. 42-52Article in journal (Refereed) Published
Abstract [en]

Introduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem thataffects between 236,000 and 325,000 people in the United States each year. As resuscitationattempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services(EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced byfactors other than patient clinical characteristics, such as EMS personnel’s knowledge,attitudes, and beliefs regarding family emotional preparedness. However, there is littleresearch exploring how EMS personnel care for bereaved family members, or how theyare affected by family dynamics and the emotional contexts. The aim of this study is toanalyze EMS personnel’s experiences of caring for families when patients suffer cardiacarrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviewswere conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and familycare, and sometimes failed to prioritize these responsibilities as a result of their ownperceptions, feelings and reactions. Moving from patient care to family care implied amovement from well-structured guidance to a situational response, where the personnelwere forced to balance between interpretive reasoning and a more direct emotionalresponse, at their own discretion. With such affective responses in decision-making, thepersonnel risked erroneous conclusions and care relationships with elements of dishonesty,misguided benevolence and false hopes. The ability to recognize and respond to people’sexistential questions and needs was essential. It was dependent on the EMS personnel’sbalance between closeness and distance, and on their courage in facing the emotionalexpressions of the families, as well as the personnel’s own vulnerability. The presence offamily members placed great demands on mobility (moving from patient care to familycare) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family membersto avoid additional suffering. Opportunities to reflect on these situations within a frameworkof care ethics, continuous moral education, and clinical ethics training are needed.Support in dealing with personal discomfort and clear guidelines on family support couldbenefit EMS personnel.Bremer A, Dahlberg K, Sandman

Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2012. Vol. 27, no 1, p. 42-52
Keywords [en]
out-of-hospital cardiac arrest, resuscitation, sudden death, ethics, emergency medical services, experiences, lifeworld hermeneutic
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-16284DOI: 10.1017/S1049023X12000167Scopus ID: 2-s2.0-84862087812OAI: oai:DiVA.org:lnu-16284DiVA, id: diva2:468814
Note

free article

Available from: 2011-12-21 Created: 2011-12-21 Last updated: 2019-08-28Bibliographically approved
In thesis
1. Vid existensens gräns: Etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus
Open this publication in new window or tab >>Vid existensens gräns: Etiskt vårdande och professionellt ansvar vid hjärtstopp utanför sjukhus
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
At the border of existence : Ethical caring and professional responsibility in the context of out-of-hospital cardiac arrests
Abstract [en]

Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems.

Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis.

Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families.

Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2012. p. 200
Series
Linnaeus University Dissertations ; 75/2012
Keywords
emergency medical services, ethical competence, ethics, out-of hospital cardiac arrest, lifeworld, phenomenology, professional responsibility, sudden cardiac death
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-16285 (URN)9789186983253 (ISBN)
Public defence
2012-01-27, Myrdal, Georg Lückligs väg 8, Växjö, 15:54 (Swedish)
Opponent
Supervisors
Available from: 2011-12-22 Created: 2011-12-21 Last updated: 2019-08-28Bibliographically approved

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