Abstract
Is the presence of family comforting to the patient, distressing to the family members observing procedures, or uncomfortable for the caregivers? Little research has been reported on the effects of families at the bedside while their loved ones undergo cardiopulmonary resuscitation (CPR) or invasive procedures (IPs). The need for this study was made clear when a future team member, Theresa Meyers, advocated having the parents of a fatally injured teenager present in the intensive care unit (ICU) while staff performed CPR. Basing our protocol for family presence (FP) on guidelines developed by the Emergency Nurses Association and using quantitative and qualitative methods, we conducted a descriptive study in the emergency department of our regional level-I trauma center. We surveyed 39 family members and 96 healthcare providers (60 registered nurses, 22 physician residents, and 14 attending physicians), following 43 instances of FP (which included 24 emergency IPs and 19 incidences of CPR), regarding the attitudes and experiences of those interviewed, including perceived benefits of and problems arising from FP. We found that families perceived visitation as a positive experience and that they believed being with the patient was their right. Family members involved in FP viewed themselves as active participants in the care process, which met their needs for knowing about, providing comfort to, and connecting with the patient. All the participating family members surveyed believed that visitation was helpful to them and noted that they would do it again. We found that family members who visited with their loved ones during emergency care suffered no ill psychological effects. The views of the healthcare providers differed significantly: more nurses (96%) and attending physicians (79%) supported FP during resuscitation, than did residents (19%) (P = .001 for both comparisons). And though 88% of our healthcare providers thought FP should be continued at our institution, the approval rate for FP was significantly higher among nurses than among residents (98% and 50%, respectively; P < .001). Thirty-eight percent of providers expressed concern about possible disruptions by family members during the visits, though no such incidents occurred during the study. We concluded that the benefits of FP justify implementing family presence programs. In November 1999, our institution, Parkland Health & Hospital System, approved a hospital-wide protocol for family presence during IPs and CPR.