[Presence of parents in the emergency room during invasive procedures: do they prefer to be present?]

Family witnessed resuscitation and invasive procedures: Patient and family opinions

BACKGROUND

Family presence during invasive procedures and cardiopulmonary resuscitation (FPDR) is a highly controversial issue, with divergence of opinion among health professionals, with clinical evidence in favor, and with barriers to its implementation in comprehensive patient care. Many international organizations support health policies for its implementation, but it is not a widespread practice. Little research has been conducted on this subject from the perspective of patients and families.

OBJECTIVE

To learn opinions, perceptions, and desires of family members and patients in terms of family presence during invasive procedures and cardiopulmonary resuscitation.

METHOD

Qualitative descriptive study, using semi-structured interviews with relatives and patients regarding their experiences and perceptions about FPDR (n = 18) from 8 October 2017 to 8 March 2018. The interviews were recorded and transcribed verbatim for later analysis using the method of content analysis.

ETHICAL CONSIDERATIONS

This study has the approval of the Clinical Research Ethics Committee of the Fundació Unió Catalana d'Hospitals and ethical considerations were carefully regarded throughout the study.

RESULTS

Three significant categories were identified: knowledge, respect for rights, and accompaniment of the patient, relating FPDR to courage, emotional support, and trust in professionals.

CONCLUSION

FPDR is an unusual practice; it is not offered to patients or their families, and it is not considered a patient's right, although most of the interviewees support it. The desire for accompaniment is conditioned by the courage and knowledge of the accompanying persons, as well as the degree of invasiveness of the procedures. The results of this study provide information for a change of vision in patient-centered care.

[Preparation of sedation-analgesia procedures in spanish paediatric emergency departments: A descriptive study]

INTRODUCTION

The objective of this study was to describe the current practice regarding the preparation of the sedation-analgesia (SA) procedures performed in the paediatric emergency centres in Spain.

MATERIAL AND METHODS

A multicentre, observational and prospective analytical study was carried out on the SA procedures that were performed on children under 18 years-old in 18 paediatric emergency departments between February 2015 and January 2016.

RESULTS

A total of 658 SA procedures were registered in 18 hospitals of Spain, most of them to children older than 24 months. The type of the procedure was: simple analgesia in 57 (8.6%), sedation in 44 (6.7%), SA for a not very painful procedure in 275 (41.8%), and SA for a very painful procedure in 282 (42.9%). Informed consent was requested in 98.6% of the cases. The written form was more frequently preferred in the group of patients that received SA for a very painful procedure (76.6%) in comparison to a painful procedure or to simple analgesia (62.9% and 54.4%, respectively, P<.001). The staff that most frequently performed the SA procedures were the paediatricians of the emergency departments (64.3%), followed by Paediatrics Residents (30.7%). The most frequent reasons for the SA were traumatological (35.9%) and surgical (28.4%). Fasting was observed in 81% of the cases. More than two-thirds (67.3%, n=480) children were monitored, the majority (95.8%) of them using pulse oximetry. The pharmacological strategy used was the administration of one drug in 443 (67.3%) of the cases, mostly nitrous oxide, and a combination of drugs in 215 (32.7%), especially midazolam/ketamine (46.9%).

CONCLUSION

The majority of the SA procedures analysed in this study have been carried out correctly and prepared in accordance with the current guidelines.

Family presence during resuscitation: A Canadian Critical Care Society position paper

BACKGROUND

Recent evidence suggests that patient outcomes are not affected by the offering of family presence during resuscitation (FPDR), and that psychological outcomes are neutral or improved in family members of adult patients. The exclusion of family members from the resuscitation area should, therefore, be reassessed.

OBJECTIVE

The present Canadian Critical Care Society position paper is designed to help clinicians and institutions decide whether to incorporate FPDR as part of their routine clinical practice, and to offer strategies to implement FPDR successfully.

METHODS

The authors conducted a literature search of the perspectives of health care providers, patients and families on the topic of FPDR, and considered the relevant ethical values of beneficence, nonmaleficence, autonomy and justice in light of the clinical evidence for FPDR. They reviewed randomized controlled trials and observational studies of FPDR to determine strategies that have been used to screen family members, select appropriate chaperones and educate staff.

RESULTS

FPDR is an ethically sound practice in Canada, and may be considered for the families of adult and pediatric patients in the hospital setting. Hospitals that choose to implement FPDR should develop transparent policies regarding which family members are to be offered the opportunity to be present during the resuscitation. Experienced chaperones should accompany and support family members in the resuscitation area. Intensive educational interventions and increasing experience with FPDR are associated with increased support for the practice from health care providers.

CONCLUSIONS

FPDR should be considered to be an important component of patient and family-centred care.

[Has the presence of parents during invasive procedures in the emergency department increased in the last few years?]

INTRODUCTION

In the recent years, parents are playing an important role in Pediatric Emergency Department (PED), and wish to be present when invasive procedures (IP) are performed.

OBJECTIVES

1) To compare the presence of parents during IP in PED in Spain between 2008 and 2012. 2) To compare the arguments to restrict the presence and problems arising from this, and 3) To determine whether the views of health personnel have changed on this subject.

METHODOLOGY

A descriptive multicenter comparative study was conducted in 2008 and 2012. A total of 42 questionaires were sent by email to PED managers, with the responding hospitals being included in the 2 periods of the study.

RESULTS

A total of 22 hospitals participated in the study. The presence of parents in the PED increased between 2008 and 2012 for all IP, significantly in the blood test and urine catheterization. In 2012, managers state that children are not so nervous, and anxiety of the parents and staff fear of a poorer performance, as an argument to restrict family presence. There were few problems during the 2 periods, with the poor behavior of the children decreasing. According to managers, the opinion of health personnel has not changed in the last four years.

CONCLUSIONS

The presence of parents during the IP in the PED has increased in the last four years, although the presence is low for more invasive procedures. Managers argue the presence of fewer behavior problems to restrict family presence. The opinion of the staff has not changed in the last four years, although more studies are required on this issue.

[Presence of family members while performing invasive procedures. A prospective study]

INTRODUCTION

Family members of child patients have traditionally not been allowed to be present during invasive procedures.

OBJECTIVES

To evaluate the level of satisfaction of family members, healthcare professionals, and the patients themselves, when family members are present during invasive procedures carried out in the pediatric emergency department.

MATERIALS AND METHODS

A prospective observational study was carried out, which included a questionnaire containing demographic information, the details of the procedure, and the level of satisfaction of the patient, their family members, and the healthcare professionals present.

RESULTS

Data was obtained from 75 procedures. In 5 of these, family members chose not to be present during the procedure. The most frequent procedures were lumbar punctures (44%), laceration repairs (22,7%) and venopunctures (17,3%). All (100%) the children who were asked wanted their family members to be present. 90% of family members and 57% of healthcare professionals were of the opinion that the presence of family members facilitated the procedure. Furthermore, 90% of family members and 76% of healthcare professionals thought that family presence was beneficial to the patient. 95% of family members and 71% of healthcare professionals thought that the option to be present during invasive procedures should be given to family members. 73% of healthcare professionals were satisfied with the presence of family members. On a scale of one to ten, overall satisfaction of family members was 9.5.

CONCLUSIONS

In our experience, family presence during invasive procedures is possible, and we have found this to be beneficial to the child. We also found that both family members and healthcare professionals were accepting and also satisfied with this new practice policy.

[Are parents present during invasive procedures? Assessment in 32 Spanish hospitals]

INTRODUCTION

Parental participation in medical decisions involving their children is essential and family presence during invasive procedures (IP) is fundamental.

OBJECTIVES

1) To determine the frequency of parental presence during different IP in Spanish Paediatrics Emergency Departments (PED). 2) To assess the reasons for restricting parental presence. 3) To evaluate the agreement of health care professionals with regards to parental presence.

MATERIALS AND METHODS

Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED.

RESULTS

Thirty-two out of 43 questionnaires were replied. Family presence during IP is never allowed in 11 hospitals. In the rest, this varies depending on the type of IP: blood sampling (15 hospitals), wound suture (14), urethral catheterization (9), lumbar puncture (7), intubation (1) and cardiopulmonary resuscitation (1), with no significant differences between hospitals. The main arguments for restricting parental presence are parental anxiety (26/30) and a lower performance by health personnel (23/30). Occasional problems, such as nausea (22/28), have arisen due to family presence. The interviewed physicians in charge think that health care professionals' agreement rates for parental presence decrease significantly with the increasing invasiveness of the procedure. Two hospitals have a working group and one a specific protocol to address parental presence.

CONCLUSIONS

Parental presence during IP is limited in Spanish PED, due to parental anxiety and is detrimental to the success of the procedure. Physicians and nurses disagree with family presence, especially during the most invasive procedures.