Family presence update: What parents want
January 1, 2000 5 minutes read
Family presence update: What parents want
Is allowing family members in the room during invasive procedures, such as lumbar punctures or resuscitations, a hotbed of controversy in your ED? If so, consider this data: Two new studies have revealed that family members overwhelmingly want to be present, even when the procedure is invasive. However, as procedures get more invasive, fewer want to be present.
Previously, most research on family presence was purely anecdotal, but now there is hard evidence, reports Theresa Meyers, RN, BSN, CEN, CCRN, the study’s principal investigator and ED nurse manager at Presbyterian Hospital of Dallas.1 "The idea of family members being present with their loved ones during invasive procedures challenges current thinking of physicians or nurses. But most families, physicians, and nurses found the experience embodied more benefits than problems," she says.
Keep family needs in mind
Health care workers should explore ways to implement this program to best meet family needs, Meyers recommends. (See story on ways to convince colleagues to try family presence, p. 34.)
In one study, 39 family members and 96 health care providers (including 22 interns/residents, 14 attending physicians, and 60 nurses) were interviewed following 43 patient cases of family presence (24 invasive procedures and 19 resuscitations). All family members who were present during the procedures during the study period were surveyed.
After screening, family members of patients undergoing the procedure were taken to the bedside for visitation based on family presence guidelines. Survey questions assessed attitudes, benefits, and concerns about the experience.
Ninety-seven percent of the family members said they believed they had a right to be present with their loved one during the procedure, and 95% reported it helped them to realize the seriousness of the patient’s condition and know everything possible was done.
Families reported that the visitation was an overwhelmingly positive experience that provided the opportunity for comforting, bonding, and connectedness, says Meyers.
Family members were interviewed by researchers after a period of time had passed. "We wanted to interview them right after the event, but it was impossible because they were still dealing with the crisis. So we couldn’t ask them right then, what it felt like to be in the room," recalls Meyers.
ED staff called the family member six weeks to three months after the event and analyzed the responses.
Giving families the option of being present impacted their overall perception of the care given in the ED, notes Meyers. "They seemed to trust you more as a team when you offered them the option and considered their needs too. They felt you’d be taking better care of their family members," she says.
Seventy-six percent of health care providers said they supported family member presence. However, 38% of health care providers surveyed were concerned that families might become disruptive, although no such incidents occurred in any of the visitation cases, she says.
Parents want to be in the room
Another study looked at whether parents had a desire to be present when procedures were performed on their children.
"We focused on more invasive procedures, like full resuscitation, because those are areas where parents have traditionally been excluded," says Eric Boie, MD, FAAEM, the study’s principal investigator and an ED physician at Mayo Clinic Rochester (MN).2
Four hundred parents were surveyed about five procedures: venipuncture of the extremity, laceration repair, lumbar puncture, endotracheal intubation, and a major resuscitation. For each scenario, parents were asked if they would want to be present. (See sample of the survey introduction and questions and pictures about major resuscitation, pp. 35-36.) The findings were as follows:
• For a major resuscitation scenario, 80.7% wished to be present if their child were conscious during the resuscitation.
• If their child were unconscious during the resuscitation, 71.4% wished to be present.
• If their child were likely to die during the resuscitation, 83.4% wanted to be present.
• The number of parents who wanted to be present during a procedure performed on their child was 97.5% for venipuncture of the extremity, 94% for laceration repair, 87% for lumbar puncture, and 81% for endotracheal intubation.
• Sixty-five percent wanted to be present for all five scenarios.
For each procedure, a line drawing and description was provided, along with an explanation of the child’s likely reaction.
"We also asked who they would want to determine if they could stay, either the physician, or if they would want a part of that decision," says Boie. Only 7% wanted the physician to solely determine whether they stayed.
Even with more serious invasive procedures, parents wanted to be present, says Boie. "But as the procedures became more invasive, there was a decrease in the percentage that wanted to be present," he notes. "However, when we talked about possible death after a major resuscitation, there was a sharp rise in parents wanting to be there."
The survey results should raise awareness that parents want to be present, says Boie. "There are a lot of different variables that have to be taken into account, but you have to consider what family members want," he says. "Even in situations that you would think this child is crashing, so the parents will not want to see this,’ it turns out that is the time they really want to be back there."
References
1. Meyers TA, Eichhorn DJ, Guzzeta C, et al. Family presence during invasive procedures and resuscitation: Experiences of family members, physicians, and nurses. Presented at American College of Emergency Physicians Scientific Assembly. San Diego; October 1998.
2. Boie ET, Moore GP, Brummet C, et al. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of over 400 parents. Ann Emerg Med 1999; 34:70-74.
For more information about family presence research, contact:
• Eric Boie, MD, FAAEM, Saint Mary’s Hospital, Mayo Clinic Rochester, 200 First St. S.W., Rochester, MN 55905. Telephone: (507) 255-2216. Fax: (507) 255-9872. E-mail: boie.eric @mayo.edu.
• Theresa Meyers, RN, BSN, CEN, CCRN, Emergency Department, Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231. Telephone: (214) 345-6269. Fax: (214) 345-6486. E-mail: [email protected].
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