Research
Effects of Family Presence During Resuscitation and Invasive Procedures in a Pediatric Emergency Department

https://doi.org/10.1016/j.jen.2006.02.012Get rights and content

Introduction

No research exists evaluating family presence (FP) during resuscitation interventions (RIs) and invasive procedures (IPs) using ENA guidelines in a pediatric emergency department. The purpose of this study was to determine the effectiveness of an FP protocol in facilitating uninterrupted care and describe parents' and providers' experiences.

Methods

FP was offered by a family facilitator to parents of children undergoing RIs or IPs. Data were collected during 64 FP events (28 RIs and 36 IPs). Following the event, 92 providers and 22 parents completed a survey about their experiences.

Results

In 100% of FP cases, patient care was uninterrupted. Parents were positive about FP, believed it helped their child, and reported that it eased their fears. All parents described an active role during the event, and most believed they had a right to be present. Three months later, no parents reported traumatic memories. Providers also were positive about FP and reported that the presence of parents did not negatively affect care. Although most (70%) supported FP during RIs, more nurses (92%) and physicians (78%) supported it than did residents (35%, P < .05).

Discussion

The findings suggest the effectiveness of a pediatric emergency department FP protocol in facilitating uninterrupted patient care. The benefits identified for parents support implementation of FP programs.

Section snippets

Design, Setting, and Sample

This descriptive study, approved by our hospital's Institutional Review Board, was conducted in the pediatric emergency department of a 406-bed, level I trauma center in the Southwest. Written informed consent was obtained from parents at the time of the ED visit. Parents who chose to be at the bedside while their child was undergoing a RI or an IP were eligible to participate in the study. Parents had to be 18 years or older and be able to understand and speak English (because of the need to

FP Protocol

There were a total of 64 FP events with 28 (44%) in the RI group and 36 (56%) in the IP group. The mean patient age was 4.6 (± 4.7) years; patients were significantly younger in the RI group (1.6 years) than in the IP group (7.1 years; P < .001; Table 1). Patients in both groups were comparable in sex and race. Two patients in the RI group died. Most facilitators (N = 17) in the RI group were social workers, while the majority in the IP group were nurses or child life specialists. In 100% of

Discussion

Our findings, in addition to those of other studies,5 reveal that in more than 100 FP cases, family members did not interfere with patient care or impede the operations of the health care team. These results suggest that an FP protocol based on ENA's guidelines is effective in facilitating uninterrupted patient care. The results also suggest that our family facilitators were effective in identifying family members who were emotionally stable and excluding those who likely would be unable to

Limitations

Only 34% of our families were interviewed. Reasons included incorrect or changed contact information, disconnected phone service, and parents who declined to be interviewed. The generalizability of the families' responses are limited because only those parents assessed as suitable candidates who accepted the FP option were included; those who declined or were deemed unsuitable were not studied. Therefore, we do not know how representative these parents are of the population of those with a

Conclusions

The results of our study document the effectiveness of a pediatric ED FP protocol in facilitating uninterrupted patient care during RIs and IPs. Our results suggest that the benefits of FP for parents outweigh the problems. It is recommended that programs be developed to offer parents the option of bedside presence during RIs and IPs.

Acknowledgments

We thank Jean Francis, RN, MSN, Bob Wiebe, MD, Jeff Wood, RN, and Brett Giroir, MD, for their administrative support of this program; Lonnie Roy, PhD, for his assistance with statistical analyses; and Dorrie Fontaine, RN, DNSc, FAAN, Philip C. Guzzetta, MD, Alfred Sacchetti, MD, Cheri White, RN, PhD, CCRN, and Joseph L. Wright, MD, MPH, for their thoughtful review of this manuscript.

Janice Mangurten is Clinical Nurse III, Trauma/Neurosurgical ICU, Children's Medical Center, Dallas, Tex.

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Janice Mangurten is Clinical Nurse III, Trauma/Neurosurgical ICU, Children's Medical Center, Dallas, Tex.

Shari H. Scott is Psychiatric Consult Liaison Nurse, Children's Medical Center, Dallas, Tex.

Cathie E. Guzzetta is Nursing Research Consultant, Children's Medical Center, Dallas, Tex.

Angela P. Clark is Associate Professor of Nursing, University of Texas at Austin.

Lori Vinson is Clinical Educator, Emergency Center, Children's Medical Center, Dallas, Tex.

Jenny Sperry is a Social Worker, Emergency Center, Children's Medical Center, Dallas, Tex.

Barry Hicks is Professor, Pediatric Surgery, University of Texas Southwestern Medical Center at Dallas, and Director of Surgical Services, Children's Medical Center, Dallas, Tex.

Wayne Voelmeck was formerly at the University of Texas at Austin School of Nursing, Newark, Del.

Funded by the Strauss Distinguished Professorship in Pediatric Surgery, University of Texas Southwestern Medical Center at Dallas.

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