Chapter 17. Supporting relatives in resuscitation practice

Key Objectives of Supporting Relatives in Resuscitation Practice

 Enable relatives to witness resuscitation if they choose – Many family members want to be present during resuscitation attempts.
 Provide appropriate emotional and psychological support – This helps relatives cope with grief and ensures they understand the situation.
 Deliver bad news sensitively and professionally – Relatives need clear, honest, and compassionate communication.
 Address cultural and religious needs – Different cultures have specific rituals regarding death and bereavement.
 Offer follow-up support – Relatives may require counselling, legal guidance, or additional resources.

 The Role of Relatives in Resuscitation

Relatives often wish to witness the resuscitation attempt, and this should be facilitated when possible. Benefits of this include:

✔ Providing closure – Witnessing resuscitation can help families accept the reality of death.
✔ Ensuring they feel included – Relatives do not feel left out of critical decisions.
✔ Allowing them to say final words – Some believe the patient may still hear them.
✔ Seeing that everything possible was done – This can reduce guilt and regret.

However, there are also potential risks:

 Emotional distress – The resuscitation process is traumatic to watch.
 Disrupting medical care – Some relatives may interfere with treatment.
 Creating conflict – Medical staff remarks during resuscitation could offend family members.

 Best Practice: Healthcare professionals should offer the choice to observe but ensure they have support and guidance during the process.

 Communicating with Relatives During Resuscitation

✔ Relatives should be given the option to stay or leave – Avoid making them feel guilty for either decision.
✔ A dedicated staff member should support the family – This person should explain events in simple terms.
✔ Reassure them that medical professionals are doing everything possible – Reduces uncertainty and fear.
✔ Prepare relatives for what they will see – Describe procedures such as chest compressions, defibrillation, and intubation.
✔ Allow them to leave and return – Give them freedom to step out if they feel overwhelmed.

 Tip: If the resuscitation is unsuccessful, explain why the attempt was stopped and provide emotional reassurance.

 Breaking Bad News

When a patient dies, breaking the news should be done with compassion and clarity.

🔹 Who should deliver the news?

• Ideally, the person who supported the family during resuscitation.
• If not available, another experienced doctor or nurse should take responsibility.

🔹 Key principles for breaking bad news:
✔ Prepare yourself – Check your appearance (e.g., remove bloodstains), take a deep breath, and gather all necessary information.
✔ Confirm the relatives' identity – Establish who they are and their relationship to the patient.
✔ Use simple, direct language – Avoid medical jargon and state clearly that the patient has died.
✔ Pause and allow silence – Give the family time to process the information.
✔ Acknowledge their emotions – Expect reactions such as shock, anger, disbelief, or crying.
✔ Offer support – Ask if they have questions and offer pastoral or psychological care.

💡 Tip: Use words like "died" or "death" instead of phrases like "passed away" to avoid ambiguity.

 Caring for the Bereaved

Providing support after death is just as important as the resuscitation itself. Healthcare teams should:

✔ Give families time and space to grieve – Offer a private room for them to gather their thoughts.
✔ Arrange for them to view the body if they wish – Prepare them for what to expect (e.g., medical tubes, injuries).
✔ Support religious and cultural needs – Provide access to chaplains or religious leaders.
✔ Explain next steps – Inform them about death certification, coroner involvement, and funeral arrangements.
✔ Provide follow-up support – Offer counselling, contact numbers, and grief support services.

💡 Cultural Considerations: Some families prefer immediate burial (Islam, Judaism), while others focus on last rites (Hinduism, Christianity). Respect their beliefs and facilitate their needs.

 Legal and Practical Aspects of Death

Hospitals must follow specific legal procedures after a patient's death:

🔹 Reporting the death:

• The coroner or medical examiner may need to be notified in suspicious or unexplained deaths.
• The patient’s GP or hospital doctor should complete the Medical Certificate of Cause of Death (MCCD).

🔹 Post-mortem examinations:

• If the cause of death is unclear, an autopsy may be required.
• Families should be informed if a post-mortem is necessary.

🔹 Organ and tissue donation:

• If the patient was a registered donor, staff should discuss options with the family.

🔹 Returning personal belongings:

• All possessions should be listed and returned to relatives with sensitivity.

 Staff Support and Debriefing

Caring for bereaved families can be emotionally draining for healthcare providers.

✔ Hold debriefing sessions after unsuccessful resuscitations.
✔ Allow staff to discuss emotional challenges and reflect on their performance.
✔ Encourage peer support – Talking to colleagues helps process difficult experiences.
✔ Provide training on grief support – This improves communication skills and confidence in handling bereavement.

💡 Tip: Healthcare professionals should acknowledge their own emotional reactions and seek help if needed.

 Summary of Key Takeaways

✔ Relatives should be given the choice to witness resuscitation but must be prepared for what they will see.
✔ Breaking bad news should be done compassionately, using simple and direct language.
✔ Cultural, religious, and legal considerations should be respected and facilitated.
✔ Providing bereavement support reduces the long-term psychological impact on families.
✔ Staff also need emotional support through debriefing and peer discussions.