Family Presence During CPR and Invasive Procedures

American Association of Critical Care Nurses- November 2004 Download the .pdf

Expected Practice:

  •  Family members* of all patients undergoing CPR and invasive procedures should be given the option of being present at the bedside.
  • All patient care units should have an approved written practice document (i.e., policy, procedure, or standard of care) for presenting the option of family presence during CPR and bedside invasive procedures.
    • Family members are those individuals who are relatives or significant others with whom the patient share an established relationship.

Supporting Evidence

  • Research1-8 9,10 have found that 60% to 80% of consumers believe that family members should be allowed to be present during emergency procedures and at the time of their loved one’s death.
  • Despite support by professional organizations and critical care experts,11-17 only 5% of critical care unit in the U.S. have written policies allowing family presence.18 Surveys of nurses’ practice have found that most critical care nurses have been requested by family members to be present during CPR and invasive procedures and have brought families to the bedside, despite the lack of formal hospital policies.18
  • Studies have found the following benefits of family presence:
    • For patients: Almost all children want to have their parents present during medical procedures;19-24 children believe that parental presence was the most beneficial intervention in managing their pain;21 and adult patients report that having family members at the bedside comforted and helped them.25,26
    • For family members: Being present helped family members in removing doubt about the patient’s condition and witnessing that everything possible was being done;1,3,8,26-30 decreasing their anxiety and fear about what was happening to their loved one;19,26,31,32 facilitating their need to be together1,3 and the need to help and support their loved one;2,3,5,8,28,29,31,32 and experiencing a sense of closure3,29 and facilitating the grief process should death occur.2,6,26-31
  • Studies have found 94% to 100% of families involved in family presence would do so again.3,8,28,31
  • Studies have found no patient care disruptions, no negative outcomes during family presence events,3,5,8,19,26-29 and no adverse psychological effects among family members who participated at the bedside.3,8,26

What You Should Do:

  •  Ensure that your healthcare facility has written policies and procedures that support family presence during CPR and invasive procedures.
  • Policies and procedures, and educational programs for professional staff should include the following components:
    • Benefits of family presence for the patient and family.11
    • Criteria for assessing the family to ensure uninterrupted patient care.3,8,11,15,33
    • Role of the family facilitator in preparing families for being at the bedside and supporting them before, during and after the event, including handling the development of untoward reactions by family members.11,33,34 Family facilitators may include nurses, physicians, social workers, chaplains, child life specialists, respiratory care practitioners, family therapists and nursing students.11,15,34
    • Support for patient’s or family members’ decision not to have family members present.11
    • Contraindications to family presence (for example, family members who demonstrate combative or violent behaviors; uncontrolled emotional outbursts; behaviors consistent with an altered mental state from drugs or alcohol; or those suspected of abuse.3,8,11,15,33
  • Develop proficiency standards for all staff involved in family presence to ensure patient, family, and staff safety.
  • Determine your unit’s rate of compliance in offering families the option of family presence during CPR and invasive procedures. If compliance is ≤90%, develop a plan to improve compliance:
    • Consider forming a multidisciplinary task force (i.e., nurses, physicians, chaplains, social workers, child life specialists) or a unit core group of staff to discuss approaches to improve compliance.
    • Re-educate staff about family presence; discuss the intervention as a component of evidence-based practice.
    • Incorporate content into orientation programs as well as initial and annual competency verifications.
    • Develop a variety of communications strategies to alert and remind staff about the family presence option.
    • Develop documentation standards for family presence and include rationale for when family presence would not be offered as an option to family members.

Need More Information or Help?

  • Call the AACN Practice Resource Network at 800-394-5995 ext. 217. Practice Alerts are online at www.aacn.org.
  • Talk with a clinical practice specialist for additional information / assistance (www.aacn.org) then select PRN.
  • The guidelines for Presenting the Option of Family Presence11 during CPR and invasive procedures developed by the Emergency Nurses Association and endorsed by AACN, are suitable for adaptation to critical care units and include educational slides and handouts, a family presence department assessment tool, a staff assessment tool, an educational needs assessment tool, a sample family presence guideline, and other supporting documents. This resource (Product #120632) is available online at www.aacn.org or by calling 800-899-2226.
  • AACN endorses the American College of Chest Physician’s Critical Care Family Assistance Program. This toolkit empowers you and your team to create a family-friendly critical care environment at your hospital. This resource (Product #120631) is available online at www.aacn.org or by calling (800) 899-2226.

References:

  1.  Bauchner H, Waring C, Vinci R. Parental presence during procedures in an emergency room: Results from 50 observations. Pediatrics. 1991;87:544-548.
  2. Sacchetti A, Lichenstein R, Carraccio CA, et al. Family member presence during pediatric emergency department procedures. Pediatr Emerg Care. 1996;12(4):268-271.
  3. Meyers TA, Eichhorn DJ, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation: The experiences of family members, nurses, and physicians. Am J Nurs. 2000;100(2):32-42.
  4. Taylor N, Bonilla L, Silver P, Sagy M. Pediatric procedures: Do parents want to be present? Crit Care Med. 1996;24(suppl):131.
  5. Bauchner H, Vinci R, Bak S, Pearson C, Corwin M. Parents and procedures: A randomized controlled trial. Pediatrics. 1996;98:861-867.
  6. Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present during CPR? A retrospective survey. J. Emerg Nurs. 1998;24:400-405.
  7. Boie ET, Moore GP, Brommett C, Nelson DR. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents. Ann Emerg Med. 1999;34(1):70-74.
  8. Mangurten J, Owens J, Vinson L, et al. Family presence during resuscitation interventions and invasive procedures in a pediatric emergency department: Attitudes and experiences of healthcare providers and family members. Unpublished data. Dallas, TX: Children’s Medical Center of Dallas; 2004.
  9. NBC Dateline Poll. Should family members of patients be allowed in the emergency department during emergency procedures? Available at: http://www.nbc.com. Accessed August 17, 1999.
  10. USA Today Poll. Would you want to be in the emergency department while doctors worked on a family member? USA Today. Available at: http://www.usatoday.com. Access March 7, 2000.
  11. Emergency Nurses Association. Presenting the Option of Family Presence. 2nd ed. Des Plaines, IL: Emergency Nurses Association; 2001 (www.ena.org), pp 1-87.
  12. Jacobs BB, Hoyt KS, eds. Trauma Nursing Core Course: Provider Manual. 5th ed. Park Ridge, IL: Emergency Nurses Association; 2000.
  13. Eckle N, Haley K, Baker P, eds. Emergency Nursing Pediatric Course: Provider Manual. 2nd ed. Park Ridge, IL: Emergency Nurses Association; 1998.
  14. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Part 6: advanced cardiovascular life support: 7D: the tachycardia algorithms. The American Heart Association in collaboration with the International Liaison committee on resuscitation. Circulation. 2000;102 (suppl 8):I158-I165.
  15. Clark AP, Aldridge MD, Guzzetta CE, et al. Family presence during cardiopulmonary resuscitation. In press.
  16. Guzzetta GE. Critical Care Research: Weaving a Body-Mind-Spirit Tapestry. Am J Crit Care. 2004;13(4):320-327.
  17. Knight KA. Intensive caring – 24/7 access in the ICU. Nurs Spectr. January 12, 2004. Available at: http://community.nursingspectrum.com/magazinearticles/article.cfm?aid=11204. Accessed March 22, 2004.
  18. MacLean SL, Guzzetta CE, White C, Fontaine D, et al. Family presence during cardiopulmonary resuscitation and invasive procedures: Practices of critical care and emergency nurses. Am J Crit Care. 2003;12:246-257 and J Emerg Nurs. 2003;29:32-42.
  19. Wolfram RW, Turner ED. Effects of parental presence during children’s venipuncture. Academic Emerg Med. 1996;3(1):58-63.
  20. Gonzalez JC, Routh DK, Saab PG, et al. Effects of parent presence on children’s reations to injections: Behavioral, physiological, and subjective aspects. J Pediatr Psycho. 1989;14:449-462.
  21. Jerrett MD. Children and their pain. Child Heaslth Care. 1985;14(2):83-89.
  22. Ross DM, Ross SA. A study of the pain experience in children. Final report. Bethesda, MD: National Institute of Child Health and Human Development; 1984.Ref No 1 R01 HD 13672-01.
  23. Fiorentini SE. Evaluation of a new program: Pediatric parental visitation in the postanesthesia care unit. J Post Anesthe Nurs. 1993;8:249-256.
  24. Diniaco MU, Ingoldsby BB. Parental presence in the recovery room. AORN Journal. 1983;38:685-693.
  25. 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(5):26-33.
  26. Robinson SM, Mackenzie-Ross S, Campbell-Hewson GL, et al. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. 1998;352:614-617.
  27. Anderson B, McCall E, Leversha A, et al. A review of children’s dying in a paediatric intensive care unit. N Z Med J. 1985;107:345-347.
  28. Doyle CJ, Post H, Burney RE, et al. Family participation during resuscitation: an option. Ann Emerg Med. 1987;16:673-675.
  29. Hanson C. Strawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department’s nine-year perspective. J Emerg Nurs. 1992;18:104-106.
  30. Timmermans S. High touch in high tech: The presence of relatives and friends during resuscitation efforts. scholarly Inq Nurs Pract. 1997;11:153-168.
  31. Powers KS, Rubenstein JS. Family presence during invasive procedures in the pediatric intensive care unit. Arch Pediatr Adolesc Med. 1999;153:955-958.
  32. Shapira M. Tamir A. Presence of family members during upper endoscopy. J Clin Gastroenterol. 1996;22:272-274.
  33. Mangurten J, Scott SH, Guzzetta CE, et al. changing conventional practice: Implementing family presence during resuscitation interventions and invasive procedures. Am J Nurs. In press.
  34. Clark AP, Calvin AO, Meyers TA, Eichhorn DJ, Guzzetta CE. Family presence during cardiopulmonary resuscitation and invasive procedures: A research-based intervention. Crit Care Nurs Clin N Am. 2001;13(4):569-575.