Hastane Öncesi Acil Tıp Çalışanları Perspektifinden Tanıklı Resüsitasyonun Etik Boyutu Üzerine Bir Araştırma

Yıl 2023, , 142 - 150, 27.01.2023

Arif Hüdai Köken , Süleyman Ersoy

https://doi.org/10.31020/mutftd.1175501

Öz

Amaç: Hasta yakınları rutin olarak acil servis resüsitasyon odasından çıkarılmaktadır. Bu uygulamayı ağırlıklı olarak hastanın yararını güvence altına almak, sağlık personellerini ve hasta yakınlarını potansiyel risklerden korumak gibi nedenlere bağlamak mümkündür. Hastane öncesi acil tıp uygulamalarında tanıklı resüsitasyonu engellemek çoğu zaman mümkün değildir. Hastane öncesi acil tıp çalışanlarının tanıklı resüsitasyona etik bakış açılarını araştırmak ve araştırma sonucuna göre politika önerisinde bulunmak amaçlanmaktadır.
Yöntem: Araştırma prospektif tanımlayıcı tipte bir anket çalışması olarak tasarlanmıştır. 18 Şubat 2022 ile 18 Mart 2022 tarihleri arasında Kırşehir Sağlık İl Müdürlüğü İl Ambulans Servisi Başhekimliği bünyesinde çalışan ATT, paramedik, sağlık memuru, hemşire ve hekimlere hazırlanan anket yüz yüze uygulanmıştır.
Bulgular: Katılımcıların çoğunluğunun kadın, önlisans mezunu, ATT ve paramedik olduğu ve mesleki sürelerinin 6-10 yıl arasında olduğu bulunmuştur. ATT ve paramediklerin sorulara verdikleri yanıtlar karşılaştırıldığında sadece “Hastane öncesi alanda yaptığınız resüsitasyona hasta yakınlarının tanıklığı hastaya zarar verebilecek bir duruma neden olabilir mi?” sorusuna verilen cevapta istatistiksel olarak anlamlı farklılık saptanmıştır. Bunun yanında hastane öncesi alanda yapılan tanıklı resüsitasyonun etik boyutları aile ve aile dışı bireylerin tanıklığı, mesleki profesyonellik, hastanın mahremiyeti ve bilgi gizliliği, yas tutma süreci, sağlık personelinin güvenliği, zarar vermeme gibi başlıklar altında incelenmiştir.
Sonuç: Hastane öncesi alanda yapılan tanıklı resüsitasyonun birçok tartışmalı etik boyutu olup, bunlara ilişkin düzenlemeler ve eğitimlerin yapılması gerekmektedir.

Anahtar Kelimeler

Acil Tıp Etiği, Hastane Öncesi Acil Tıp, Klinik Etik, Tanıklı Resüsitasyon, Tıp Etiği

A Study on the Ethical Aspects of Witnessed Resuscitation from the Perspective of Prehospital Emergency Caregivers

Öz

Aim: Patients' relatives are routinely removed from the emergency department resuscitation room. One can attribute this practice primarily to reasons such as safeguarding patient welfare, protecting medical personnel and patient's relatives from potential risks. In prehospital emergency medicine, it is often not possible to prevent witnessed resuscitation efforts. Prehospital emergency caregivers responding to cardiopulmonary arrest must focus only on the patient. It is aimed to investigate the ethical perspectives of prehospital emergency caregivers on witnessed resuscitation and to make policy recommendations according to the results of the research.
Methods: The study was designed as a prospective, descriptive survey. Between February 18, 2022 and March 18, 2022, the survey prepared for EMTs, paramedics, health officers, nurses, and physicians working in the ambulance service of Kırşehir Provincial Health Directorate was applied face-to-face.
Results: The majority of the participants were women, associate degree graduates, EMT, and paramedics, and their career duration was between 6-10 years. When comparing paramedic and EMT responses to the questions, a statistically significant difference was only found in the response to question “Does witnessing the resuscitation you perform in the prehospital area cause a situation that may harm the patient?”. Additionally, the ethical aspects of witnessed resuscitation in the prehospital setting were examined under the headings such as the witness of the family and nonfamily individuals, professionalism, patient privacy and confidentiality, the grieving process, medical staff safety, and nonmaleficence.
Conclusions: Witnessed resuscitation in the prehospital setting has many controversial ethical aspects and needs regulations and training in this regard.

Anahtar Kelimeler

Emergency Medicine Ethics, Prehospital Emergency Medicine, Clinical Ethics, Witnessed Resuscitation, Medical Ethics.

Kaynakça

• 1. Robinson SM et al. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet 1998;352(9128):614-617.
• 2. Rosenczweig C. Should relatives witness resuscitation? ethical issues and practical considerations. Cmaj 1998;158(5):617-620.
• 3. Grice AS, Picton P, Deakin CDS. Study examining attitudes of staff, patients and relatives to witnessed resuscitation ın adult ıntensive care units. Br J Anaesth 2003;91(6):820-824. doi:10.1093/bja/aeg276
• 4. Belpomme V, et al. Family witnessed resuscitation: nationwide survey of 337 prehospital emergency teams in france. Emerg Med J 2013;30(12):1038-1042. doi:10.1136/emermed-2012-201626
• 5. Walker WM. Do relatives have a right to witness resuscitation? J Clin Nurs 1999;8(6):625-630. doi:10.1046/j.1365-2702.1999.00290.x
• 6. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. Beauchamp TL, Childress JF, Oxford University Press; 2013.
• 7. Jabre P, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med 2013;368(11):1008-1018.
• 8. Bashayreh I, Saifan A. Family witnessed resuscitation : through the eyes of family members. J Am Sci 2015;11(3):7-15.
• 9. García-Martínez AL, Meseguer-Liza C. Emergency nurses’ attitudes towards the concept of witnessed resuscitation. Rev Lat Am Enfermagem 2018;26(3055):1-7. doi:10.1590/1518-8345.1382.3055
• 10. Erbay H. Family presence and the press effects on prehospital cardiopulmonary resuscitation: attitudes of a group of emergency caregivers. Malim J Pengaj Umum Asia Tenggara (Sea J Gen Stud) 2020;21(1):102-116. doi:10.17576/malim-2020-2101-08
• 11. Meghani S. Witnessed resuscitation: a concept analysis. Intensive Crit Care Nurs 2021;64:103003. doi:10.1016/j.iccn.2020.103003
• 12. Vincent C, Lederman Z. Family presence during resuscitation: extending ethical norms from paediatrics to adults. J Med Ethics 2017;43(10):676-678. doi:10.1136/medethics-2016-103881
• 13. Jw S, Md O, et al. Family presence during resuscitation: a canadian critical care society position paper. Can Respir J 2015;22(4):201-205.
• 14. Fernandez E de M, Martin GM, Herrera MJ. Family witnessed resuscitation and ınvasive procedures: patient and family opinions. Nurs Ethics 2021;28(5):645-655.
• 15. Giles T, et al. Factors ınfluencing decision-making around family presence during resuscitation: a grounded theory study. J Adv Nurs 2016;72(11):2706-2717. doi:10.1111/jan.13046
• 16. Demir F. Presence of patients’ families during cardiopulmonary resuscitation: physicians’ and nurses’ opinions. J Adv Nurs 2008;63(4):409-416. doi:10.1111/J.1365-2648.2008.04725.X
• 17. Abuzeyad FH, et al. Healthcare providers’ perspectives on family presence during resuscitation ın the emergency departments of the kingdom of bahrain. BMC Emerg Med 2020;20(69):1-10. doi:10.1186/s12873-020-00365-4
• 18. Grimes C. The effects of family- witnessed resuscitation on health professionals. Br J Nurs 2020;29(15):892-896.
• 19. Erogul M, et al. Post-traumatic stress disorder ın family-witnessed resuscitation of emergency department patients. West J Emerg Med 2020;21(5):1182-1187. doi:10.5811/westjem.2020.6.46300
• 20. Compton S, et al. Post-traumatic stress disorder symptomology associated with witnessing unsuccessful out-of-hospital cardiopulmonary resuscitation. Acad Emerg Med 2009;16(3):226-229. doi:10.1111/J.1553-2712.2008.00336.X
• 21. De Mingo-Fernández E, Belzunegui-Eraso Á, Jiménez-Herrera M. Family presence during resuscitation: adaptation and validation ınto spanish of the family presence risk-benefit scale and the self-confidence scale instrument. BMC Health Serv Res 2021;21(221):1-12. doi:10.1186/s12913-021-06180-2
• 22. Omran S, AL Ali N, Alshahrani H. Acute care nurses’ attitudes toward family presence during cardio-pulmonary resuscitation in the kingdom of saudi arabia. Clin Nurs Stud 2015;3(3):69-75. doi:10.5430/cns.v3n3p69
• 23. Mohammed AA, Ramos J, Ann M, Saad AR. Critical care nurses’ perspectives towards family presence during resuscitation. J Med Healthc 2019;1(1):1-29. doi:10.47363/JMHC/2019(1)101
• 24. Anderson N, Slark J, Gott M. How are ambulance personnel prepared and supported to withhold or terminate resuscitation and manage patient death ın the field? a scoping review. Australas J Paramed 2019;16:1-11. doi:10.33151/ajp.16.697
• 25. Safari R, Khashmin MM, Abdi A. The experience of pre-hospital emergency personnel ın breaking death news: a phenomenological study. BMC Nurs 2022;21(17):1-11. doi:10.1186/s12912-022-00899-x