How to convince peers to try family presence
Many ED staff members are resistant to allowing family members to be present during invasive procedures because it’s a paradigm shift, says Theresa Meyers, RN, BSN, CEN, CCRN, nurse manager of the ED at Presbyterian Hospital of Dallas. Presbyterian allows family presence on a case-by-case basis, depending on the family member’s desire to be present and the health care team’s willingness.
"A lot of it is fear of the unknown, because they are not sure how the family is going to react," Meyers notes. "But that could be true in any critical situation."
10 strategies that work
Here are some strategies to convince others to try family presence:
• Make a comparison to the way labor and delivery was once viewed.
"You can point out that at one time, nobody was allowed in the labor and delivery room," says Meyers. Now most hospitals allow partners, as well as other family members, to be present for labor and delivery. Older colleagues who remember when this was not allowed might be more likely to consider family presence.
• Give specific examples of successful cases.
If things went well when a family member was present, talk with the physicians and ask them to relate the case to their colleagues, suggests Meyers. "If they’re hearing this from one of their peers and they supported it, that physician might influence their thinking, and they may say, Maybe I’ll give it a try.’"
You should also share the facts about cases that didn’t go well with the nursing and medical staff to determine the cause of the problem. "If there was a bad outcome, find out how you can learn from it," says Meyers. "It may be that you need to screen people more carefully." For example, if you notice that a family member is acting out verbally or physically, you probably should not allow that individual to be present, she explains.
• Show them the research.
Use recently published survey results to convince colleagues to permit family presence, recommends Eric Boie, MD, FAAEM, the study’s principal investigator and an ED physician at Mayo Clinic Rochester (MN).
"If you are trying to make a case to your medical staff for including family members, there is plenty of evidence already in the literature to support such a practice," he says. (For more information about family presence, see ED Nursing, February 1998, p. 49, and selected references, below right.)
Nearly all studies done on this topic give support to the idea of having parents/family members present, Boie notes. "Physicians as a whole tend to need evidence before they make a change. So if you can show them studies that say this is not a bad idea, they may consider it."
• Try family presence on an individual basis.
"This is not for everybody, so the key thing is to decide on a case-by-case basis," says Meyers. "When appropriate, families should be given the opportunity. But if they choose not to go in, they should be supported in their decision."
If family members are acting out and seem distraught, they may not be good candidates. "But others may be helpful and supportive and won’t interfere at all, and they are good candidates," Meyers explains.
Compromise by agreeing that not every family member can come in. "Ask physicians who are resistant to consider it, and at least agree that they will not take the position that nobody can come in," says Meyers.
• Use the Emergency Nursing Association (ENA) guidelines on family member presence.
It’s very helpful to say, Here, a national organization supports this,’" says Meyers. "It gives you something to hang onto when bringing up a foreign idea. (For information on obtaining the ENA guidelines, see source box, above right.)
• Collect literature and policies.
Network with colleagues at other facilities and share policies, Meyers recommends. "Find out how they approach certain situations," she says. "Data is power. You don’t want to lack information when you are presenting a topic to change practice."
• Conduct your own survey.
It’s a good idea to gauge attitudes of your colleagues before you ask patients, says Meyers. "If your peers are totally against it, you may not get too far. They also may feel offended if you ask patients what they want before you ask them."
Ask staff members if they’ve ever heard of it, what would they think about it, and what would they want done if it was their loved one, Meyers recommends. "Find out which of your colleagues are champions of this practice. They may help you go further to interview some of your patients in waiting rooms at a later point," she says.
• Address patient satisfaction.
If you keep families separated, both the family and the patient are not happy, says Boie.
"The sooner that you can get them back, the better," he says. Allowing families to be present during procedures takes that a step beyond, Boie explains. "So much of what parents go through in terms of the unknown is worse that what is actually happening because they tend to make up the worst case scenario," he says.
• Confront staffing issues.
A topic that always comes up in shortage of staffing, which is a legitimate issue, says Meyers.
"If there isn’t a support person, then it doesn’t work as well," she acknowledges. "There may be a shortage of nurses and you may not have social workers. So you need to come up with a way to support the practice with staff."
• Ask resistant colleagues to put themselves in the family member’s shoes.
Meyers suggests, "Say to them, Think about it: If you weren’t a physician or nurse any more, how would you feel?’"
Plant seeds of thought, she recommends. "Ask them, Even if you wouldn’t want it, do you have the right to push your opinion on people who do want it?’" she says.
The Emergency Nurses Association (ENA) has a position statement, Family Presence at the Bedside During Invasive Procedures (1996). Single copies are available at no charge. All ENA position statements can be accessed from the ENA Web site: www.ena.org. To obtain copies, contact:
• Emergency Nurses Association, 915 Lee St., Des Plains, IL 60016. Telephone: (800) 243-8362 or (847) 460-4000. Fax: (847) 460-4001. E-mail: [email protected].
Emergency Nursing World: Forum for ED nurses
Emergency Nursing World listserv and Web site is a forum for communication on any issues that ED nurses face, ranging from individual clinical cases to political, staffing, morale, and management issues.
The Web site for Emergency Nursing World, which is separate from the listserv, contains links to many resources, including 13 active Web sites for Emergency Nurses Association (ENA) state groups.
"Anyone with Internet access can read the site," says Tom Trimble, RN, the Web site and listserv’s developer and a staff nurse at University of California San Francisco Medical Center — Stanford Health Care’s ED. "It is well-featured in search engines and cited as a worthwhile resource by many authoritative organizations and Web sites."
Educational articles available
Educational articles regarding skills, knowledge, assessment, and clinical care are featured on the Web site, including such topics as "10 Commandments of Airway Management" and "IV Starts: Improving Your Odds." Humor, tips and tricks, and clinical pearls are also available. The following information is on the site:
• links to clinical resources in all specialties, professional bodies, and allied fields, including the national ENA Web site;
• announcements of meetings and educational opportunities;
• a listing of university programs with emergency nursing specialization;
• information on mailing lists usenet groups, journals, and medical search engines of interest to emergency nurses.
The California ENA Web site is accessed here, so users can be updated on the news and activities of the largest state association.
Shrinking the world
The Emergency Nursing List is an e-mail subscription list with a growing membership of 670 from 15 countries. "This has helped shrink the world, for ED nurses to exchange news, opinion, approaches, and solutions,’ says Trimble. "I feel that the Internet will do a great deal to unify emergency nursing and provide the information resources needed, without regard to time or location."
Computing skills, in coming years, are going to drive much of the organization and provision of care, notes Trimble. "They will integrate the support of hospital services and smooth the continuum from illness/injury to recovery and health maintenance. Emergency nurses will be as adept with a keyboard and information technology as with a stethoscope," he predicts.
At the 1999 ENA conference, Trimble was given special board recognition for his contributions to emergency nursing through the development of Internet resources. "The Internet is helping to erase time and distance as we work to benefit the specialty," he says.
For more information on the Emergency Nursing World listserv or Web site, contact:
• Tom Trimble, RN, 731 Montecillo Road, San Rafael, CA 94903-3135. Telephone: (415) 472-6228. Fax: (415) 472-4914. E-mail: ttrimble@ hooked.net.
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