As I was reviewing the discussion forum, I came across an interesting subject. The topic focused on family members in the procedure room. Initially, the topic addressed "allowing family members, who work in the medical field, to observe procedures." This opens a variety of subjects related to this topic. For instance, who should or should not be in the procedure room? Who has the right to be in the procedure room? Is family presence the decision of the patient, the staff, the physician, or the institution? If it is okay for family members to be present, should they be a spouse, a child, or a parent? What about an unmarried significant other? I wonder if the same rules apply to medical sales representatives who wish to view procedures to see how the products work or to help the endoscopist through the initial use of a new piece of equipment. What about nursing students, medical students, and residents?
Some discussion forum members noted family members were not allowed in the procedure rooms. Others said that their institutions did allow family members in the admission area and the recovery areas. This was especially true if the patient was a child or perhaps an elderly or a confused patient.
A discussion of the pros and cons of the family members being present during the procedures bears some merit. On the pro side, a patient may feel more comfortable and relaxed with their family present. The family member will immediately know the findings and visually may be able to understand the patient's diagnosis because of witnessing the procedure. Often, when family members are taken to a waiting area, it seems they are there for long periods of time before they hear the procedure is completed and the patient is doing okay. The fear of the unknown or thinking that something has happened is very frightening. If the family is in the room, family members know when the procedure commenced and how long it took.
Also, if the family is present and this results in decreased patient anxiety, the patient may not need as much medication to sedate. A discussion forum member wrote that in their institution, family members were allowed in the procedure room for code situations and many studies cited increased patient and family member satisfaction when the family is allowed to view what is happening.
On the con side of this situation is the concern of what may happen when "an outsider" is allowed in the procedure arena. When you have someone there who does not know the rules of the institution or the flow of the endoscopy unit, will it impede the procedure or distract the staff? Many times when we have a family member in pain, we cannot look at it as objectively as in case of a stranger. Would we tend to overmedicate because we do not want the family to think we are hurting the patient? What if the family member faints? Who is responsible for keeping an eye out for the family member to make sure they are doing okay? What if the family wants to be right up at the bedside? This could be problematic as typically the nursing staff must be moving around the patient's stretcher to check the vital signs and work with an accessory equipment such as cautery or apply abdominal pressure. Will the family be in the way? What if they talk nonstop and ask lots of questions? Will this cause a distraction causing the endoscopist to frequently turn away from the monitor to answer the questions? When there are unexpected findings, is the practitioner prepared to explain everything to the family at that time? What about a complication such as a decrease in blood pressure, cardiac or respiratory arrest, or bleeding? Do you want the family to be present there?
Some discussion forum members noted it was written in their policy manuals that family members were not allowed in the procedure rooms. Some said the decision was up to the discretion of the physician. Others said it was decided on a case-by-case basis. If the family members are not allowed in the operating room, then why is the endoscopy unit different, especially as many endoscopy units utilize anesthesiologists or nurse anesthetists for sedation? A manager I spoke with said their institution had a policy that did not allow family members in the procedure room. If a sales representative was there to demonstrate a new piece of equipment, then they must adhere to the same safety and infection control practices as the staff. For instance, the sales representative must be able to show evidence of current purified protein derivative (PPD) skin test results, hepatitis B vaccinations, and so forth.
We have been looking at this discussion from the aspect of a patient desiring the presence of a family member in the endoscopy suite but the staff not desiring their presence. What about the other side of the coin in which the staff wants to bring in another person such as a sales representative or a medical student? Are not the concerns still the same? Will they impede the flow of the staff or cause a distraction? Is this written in the policy manual along with the details as to who decides who may be present?
We often know people who work in healthcare are not treated in the same way as the naive patient. Many times it is assumed by the staff that other healthcare workers possess a certain amount of knowledge and there is no need to explain things, stating, "we probably already know that." As a patient, we even sometimes take liberties that a regular patient may not do. We may not show up early for our procedure or we may leave a little sooner than what the protocol dictates. We may alter the preparation a bit as we know what will work. Often, it has been said doctors and nurses make the worst patients. There are advantages and disadvantages of a bit of knowledge.
When working in the endoscopy area, we want everything to run smoothly for the patient and for the flow of the unit. As a patient or the family member of a patient, we would want to be there to look out for our loved ones' needs as we feel no one can show the interest or concern that the family does. If Dr. Smith is allowed to be there for her spouse's colonoscopy, should you be allowed to be there for your spouse or parents? These are the considerations we need to discuss in order to develop polices in the best interest of all involved.