Family Witnessed Cardiopulmonary-Resuscitation - the Suitability and Impacts Towards Relatives in Malaysia

Published: 2021-09-14 10:15:10
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Family witnessed cardiopulmonary-resuscitation (CPR): The suitability and impacts towards relatives in Malaysia.Being as an Assistant Medical Officer (AMO) whose engaged in the PHC services was full of excitement and challenging due to the roles as a first-provider in any emergency cases out-of-hospitals settings. Based on my vast experienced using the Gibbs’ reflective cycle (Appendix-C), I’ve always attended life-threatening cases of cardiac arrest which required the CPR-procedure. Normally, it has been a practice to excluding relatives from present during the procedure based on our clinical-guidance and traditional-believes that there will be more harm than benefits for them be involved. However in some cases, when the CPR attempt has failed to restored a client live, some of them have questioned my ability to conduct the procedure and intentionally causes a death, while some of them are preferred to be present with an intention to spend their last moments together. It is so unfortunate that despite of my intensity has left me with mixture feelings of disappointment, sadness, anger and incompetent in my role. Nonetheless, it has also highlighted a positive side of me to examine myself and the existing approach of the care.For centuries, since Banner (1984) (Appendix-D) developed the skill acquisition theory, added by the usage of traditional-believes, intuition and guidelines (Parahoo, 2006 p.4), it has been a main guidance to support our clinical-practices. However, I was argued with the capability to be relied on those sources as it probably will harm the practitioners, endanger the clients and evoking dissatisfaction feelings among the relatives because they are occurred without any dependable basis and was not safely-effective based on the evidence-based practice (EBP) (Mantzoukas, 2007). Despites abundance of definitions, Melynk et al. (2009) has nicely-described EBP as the substantial consolidation between the best available evidence of patient’s desire and values combined with well-designed research and scientific consideration of practice towards any clinical problem-solving. Based on my understandings with under-taken the common core in the published literatures, the philosophy of EBP was a process of thinking, questioning, searching, appraising, applying, evaluating and disseminating (Appendix-E) scientific evidence which comes from a well-designed and robust research as a guidance in any clinical-decision making with an aim to underpin the practice with the most suitable methods available.  However with millions of accessible evidences, I was wondering which of those are prevails as the best scientific evidence. According to Booth (2010), stages of hierarchy pyramids which designed based on the methodological of studies (Appendix-F) will helps clinical-practitioners in sifting through a number of research and meet with the best available evidence. Commonly it is constructed with the most susceptible to eliminate bias at the top, followed by the most prone to have a bias at the bottom of the pyramid. Traditionally, randomised controlled trial (RCT) has been a “gold-standard” in clinical studies. It is a comparative, quantitative control experiment involving multiple groups who underwent an experiment to evaluate an intervention with a reliable outcome of results (Sackett et al., 1997).

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