Wary of family presence? Consider these options
Have you been frustrated by colleagues resistant to family presence? Or are you sometimes uncomfortable with parents being present yourself? If so, your emergency department (ED) reflects findings of a new study, which found that 59% of ED nurses did not believe that parents should be present during a major resuscitation.1
(For more information on this topic, see "New study puts spotlight on family-centered practices: How to make your ED stand out from the crowd" in ED Nursing, January 2002, p. 29, and "Should family members be present during resuscitations?" in EDN, February 1998, p. 49.)
Many ED staff still choose to exclude family members from the treatment areas, despite research showing the benefits of this practice, says Suzanne Pugh, RN, ED nurse manager at Saint Vincents Hospital in New York City.2 "There is an assumption that the family member will be unable to handle the sights, sounds, and smells of what is happening around them," says Pugh.
Here are strategies to use if colleagues are resistant:
• Ask for feedback from the patients.
Family members may express gratitude for being present, which can help to change staff attitudes, says Katherine Scipione, RN, MS, director of emergency services at Robert Wood Johnson University Hospital in New Brunswick, NJ. She points to two examples, which show the dramatic impact that family presence has had in her ED:
— When a young girl was rushed to the ED after falling and lacerating her chin, irrigation and extensive suturing was needed. The child’s worried parents were told they could stay in the room during the procedure, and ED nurses took the opportunity to answer questions about wound care and follow-up plastic surgery treatment, says Scipione.
"The family later told us it really helped them to understand how the wound should be watched carefully for infection," she adds.
— When an elderly cancer patient was brought into the ED in cardiac arrest, she required intubation and frequent defibrillation. "The husband asked to be able to be with the patient during the resuscitation, which we supported," says Scipione.
The resuscitation was unsuccessful, but being in the room was comforting to the woman’s husband, recalls Scipione. "He thanked us and said that seeing our efforts assured him that everything possible was done for her," she says.
• Have a staff member stay with the family member.
For both of the above scenarios, family members were accompanied by a staff member who answered questions, notes Scipione, adding that this practice can increase the comfort level of staff members.
Pugh’s ED has added a patient representative to the staff during the busy evening hours to act as a liaison between family members and staff caring for the patient. Part of the representative’s job is to encourage ED staff to include the family in the patient’s care plan. She adds that the ED has a "volunteer advocate" program that supplements the position up to 20 hours per day, seven days per week.
Is death likely?
• Always allow families to be with a critically ill patient.
Even if nurses do not want parents present during a major resuscitation, some support this practice if death is likely.1 Even when chest compressions are being performed for a patient in cardiac arrest, you should allow family members to be with the patient prior to the pronouncement of death, argues Pugh. "We have found that families are usually able to do this with some degree of composure," says Pugh. "They are able to focus on the patient and not be affected by the confusion they walk into."
Family members are grateful to have been with the patient for a moment when they were still alive, regardless of the circumstances, she adds, pointing to research that shows that 97% of family members who had been present during attempted resuscitation would want to be present again.3
• Act as an example.
Pugh now is an advocate for family presence, based on her own experience. "Like many ED nurses and managers, I once believed that families should not be permitted in the treatment area, certainly not during a code," she says. "I believed that they would get in the way and just generally make our job more difficult."
Pugh’s opinion changed after her grandmother was brought to an ED in respiratory distress. When the doctor insisted Pugh go to the waiting room, she asked the nurse if she could remain in the room. "I will always be grateful to that nurse who allowed me to watch from a corner and be close to my grandmother as she died," says Pugh. "Despite my sadness and the noise and confusion, my overwhelming memory is of being with her, and I have no lingering questions."
With this in mind, Pugh set about the task of changing the perception of her ED colleagues toward family presence. "It has taken time and setting an example," she says. "I frequently bring family members to the bedside myself, stay with them, and then take them back to the waiting area."
ED staff now routinely make sure that family is permitted at the bedside, even if only briefly. "Invariably, these families leave the ED and express their gratitude for the care they and the patient received," reports Pugh.
References
1. Beckman AW, Sloan BK, Moore GP, et al. Should parents be present during emergency department procedures on children, and who should make that decision? A survey of emergency physician and nurse attitudes. Acad Emerg Med 2002; 9:154-158.
2. Eichhorn DJ, Meyers TA, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation: Hearing the voice of the patient. Am J Nurs 2001; 101:48-53.
3. Doyle CJ, Post H, Burney RE, et al. Family participation during resuscitation: An option. Ann Emerg Med 1987; 16:673-675. n
Sources
For more information on family presence, contact:
• Suzanne Pugh, RN, Emergency Department, Saint Vincents Manhattan, 153 W. 11th St., New York, NY 10011. Telephone: (212) 604-2513. Fax: (212) 604-2339. E-mail: [email protected].
• Katherine Scipione, RN, MS, Director, Emergency Services, Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901. Telephone: (732) 828-3000, ext. 8790. Fax: (732) 418-8299. E-mail: [email protected].
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