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Halm MA, Ruppel H, Sexton JR, Guzzetta CE. Facilitating Family Presence During Resuscitation and Invasive Procedures Throughout the Life Span. Crit Care Nurse 2024; 44:e1-e13. [PMID: 38096905 DOI: 10.4037/ccn2023733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
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de Souza DM, Fernandes RDF, Costa CTDS, Borghi CA, Rossato LM. From theory to practice: the inclusion of hospitalized children's families in painful procedures. Rev Esc Enferm USP 2023; 57:e20230152. [PMID: 37624383 PMCID: PMC10453425 DOI: 10.1590/1980-220x-reeusp-2023-0152en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To understand nursing team professionals' strategies to include the family in painful procedures performed on hospitalized children. METHOD An exploratory-descriptive, qualitative study, carried out with nursing professionals. Data were collected through semi-structured interviews, guided by a script of topics, transcribed and submitted to thematic content analysis, in the light of Symbolic Interactionism, discussed considering the Family-Centered Care philosophy assumptions. RESULTS Two central categories emerged, "Theoretical perspective: the family as a care agent in painful procedures" and "Practical perspective: experiences, challenges and strategies in painful procedures for family inclusion", with their respective subcategories. CONCLUSION Nursing professionals have theoretical knowledge about family inclusion in painful procedures based on the assumptions: Family-Centered Care: dignity and respect; information sharing; joint participation; and family collaboration. However, knowledge is not applied in clinical practice; consequence of the interaction between beliefs and attitudes unfavorable to family presence.
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Affiliation(s)
- Danton Matheus de Souza
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | | | | | | | - Lisabelle Mariano Rossato
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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O'Connell KJ, Carter EA, Fritzeen JL, Waterhouse LJ, Burd RS. Effect of Family Presence on Advanced Trauma Life Support Task Performance During Pediatric Trauma Team Evaluation. Pediatr Emerg Care 2021; 37:e905-e909. [PMID: 28486265 DOI: 10.1097/pec.0000000000001164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
IMPORTANCE In many hospitals, family members are separated from their children during the early phases of trauma care. Including family members during this phase of trauma care varies by institution and is limited by concerns for adverse effects on clinical care. OBJECTIVE The aim of this study is to evaluate the effect of family presence (FP) on advanced trauma life support primary and secondary survey task performance by pediatric trauma teams. We hypothesized that trauma care with FP would be noninferior to care when families were absent. DESIGN We performed a retrospective video review of consecutive pediatric trauma evaluations. Family presence status was determined by availability of the family. SETTING The study was conducted at an American College of Surgeons-designated level I pediatric trauma center that serves the Washington, DC, metropolitan area. PARTICIPANTS Participants included patients younger than 16 years of age who met trauma activation criteria and were evaluated by the trauma team in our emergency department. OUTCOME MEASURES We compared task performance between patients with and without FP. RESULTS Video recordings of 135 trauma evaluations were reviewed. Family was present for 88 (65%) evaluations. Patients with FP were younger (mean age, 6.4 years [SD = 4.1] vs 9.0 years [SD = 4.9]; P < 0.001) and more likely to have sustained blunt injuries (95% vs 85%, P = 0.03). Noninferiority of frequency and timeliness of completion of all primary survey tasks were confirmed for evaluations with FP. Noninferiority of frequencies of secondary survey task completion was confirmed for most tasks except for examination of the neck, pelvis, and upper extremities. Family members did not directly interfere with patient care in any case. CONCLUSIONS Performance of most advanced trauma life support tasks during pediatric trauma evaluation was not worsened by FP. Our data provide additional evidence supporting FP during the acute management of injured children.
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Affiliation(s)
| | - Elizabeth A Carter
- Trauma and Burn Surgery, Children's National Health System, Washington, DC
| | | | | | - Randall S Burd
- Trauma and Burn Surgery, Children's National Health System, Washington, DC
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Family Presence Is a Right: It Is Not About Us! Pediatr Crit Care Med 2020; 21:1104-1105. [PMID: 33278224 DOI: 10.1097/pcc.0000000000002519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mark K. Family presence during paediatric resuscitation and invasive procedures: the parental experience: An integrative review: An integrative review. Scand J Caring Sci 2020; 35:20-36. [PMID: 32200563 DOI: 10.1111/scs.12829] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/08/2020] [Accepted: 02/02/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The evolvement of family-centred care has been an ongoing process since the Platt Report 1959. Family-centred care has become the modern working model in paediatrics and obstetrics. Parental participation is central to family-centred care. Whether it is applied consistently remains to be concluded. AIM The aim of the study was to describe the family experiences of being present during paediatric resuscitation and invasive procedures. METHOD The design used in this study is an integrative review by Whittemore & Knafl. Databases PubMed and CINAHL were searched for primary research concerning the parental experiences of participating in paediatric resuscitation and invasive procedures. Eighteen studies were included in the study. A quality assessment tool was applied. FINDINGS A pro-parental presence was the results of 17 of the 18 included studies. Six common themes were found: 'Being there', 'Calming child', 'Calming parent', 'Having the right', 'Do it again' and 'Seeing is believing'. CONCLUSION Including family in resuscitation and invasive procedures requires openness as a working model and demands organisational changes and the updating of guidelines. The inseparability of parent-child is attachment theory practised, an innate quality of being a child as well as a parent. Recommendations are to have a facilitator present during resuscitation and invasive procedures to alleviate stress on everyone's part, enabling family participation.
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Affiliation(s)
- Katarina Mark
- Department of Neurobiology Care Science and Society, Karolinska Institute, Huddinge, Sweden
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Stewart SA. Parents' Experience During a Child's Resuscitation: Getting Through It. J Pediatr Nurs 2019; 47:58-67. [PMID: 31048114 DOI: 10.1016/j.pedn.2019.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to elucidate the experiences of parents during their child's resuscitation in the hospital setting. DESIGN AND METHODS This qualitative descriptive study took place in a 280 bed children's hospital with parents whose children experienced resuscitation while they were present in the room or nearby. Semi-structured interviews were conducted between one and twelve months following a child's resuscitation. A rigorous thematic analysis was performed. RESULTS This study elucidates parent experience during a child's resuscitation using four overarching themes; "Overwhelming chaos", "Getting through it", "Cognitive presence" and "Joy mixed with heartache". Parents described their experience to be stressful, yet identified things that helped them get through it and make sense of the experience. CONCLUSIONS During a child's resuscitation parents perceived a sense of overwhelming chaos, yet still had an innate need to be present and know what was going on. While emotional support was appreciated, most important was to receive real time clinical information from healthcare staff and to see and feel that the team was personally invested in their child. PRACTICE IMPLICATIONS During a child's resuscitation, parents should be allowed to choose their level of presence to meet their individual needs. A clinical staff member should answer questions and share clinical information with parents. In addition, clinicians should allow themselves to connect with parents on a personal level. This research provides a foundation for further study, including parents' experience after experiencing a child's resuscitation.
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Affiliation(s)
- Stephanie A Stewart
- University of Iowa College of Nursing, Iowa City, Iowa United States of America; University of Iowa Stead Family Children's Hospital, Iowa City, Iowa United States of America.
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Fejfar LM, Rozanski EA, Mueller MK. Owner-witnessed cardiopulmonary resuscitation in small animal emergency veterinary medicine. J Am Vet Med Assoc 2019; 253:1032-1037. [PMID: 30272518 DOI: 10.2460/javma.253.8.1032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine opinions of veterinary emergency health-care providers on the topic of owner-witnessed CPR in small animal emergency medicine and to identify reasons for opposition or support of owner-witnessed CPR. DESIGN Cross-sectional survey. SAMPLE 358 surveys completed by American College of Veterinary Emergency and Critical Care diplomates and residents as well as other emergency-care veterinarians and veterinary technicians between August 14, 2016, and September 14, 2016. PROCEDURES An internet-based survey was used to collect data on respondent demographics, CPR experience, and opinions about owner-witnessed CPR. Responses were collected, and the Fisher exact test or χ2 test was used to compare distributions of various opinions toward owner-witnessed CPR among certain respondent groups. RESULTS Owner presence during CPR was opposed by 277 of 356 (77.8%) respondents, with no substantial differences among demographic groups. Respondents with ≤ 10 years of experience were less willing to allow owner presence during CPR, compared with respondents with > 10 years of experience. Respondents who worked at practices that allowed owner presence during CPR were more likely to report emotional benefit for owners. CONCLUSIONS AND CLINICAL RELEVANCE Veterinary professionals surveyed had similar concerns about owner-witnessed CPR, as has been reported by human health-care providers about family-witnessed resuscitation. However, emotional benefits from family-witnessed resuscitation in human health care have been reported, and emotional impacts of owner-witnessed CPR could be an area of research in veterinary medicine. In addition, investigation is needed to obtain more information about pet owner wishes in regard to witnessing CPR performed on their pets.
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Stewart SA. Parents’ Experience When Present During a Child’s Resuscitation: An Integrative Review. West J Nurs Res 2019; 41:1282-1305. [DOI: 10.1177/0193945918822479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Understanding perceptions of parents is necessary to meet parents’ needs during a child’s resuscitation. Parent presence at pediatric resuscitations has been slow to become consistent practice in all hospital settings and remains controversial. The purpose of this integrative review was to synthesize research on parents’ experience while present during a child’s resuscitation to improve understanding for health care providers and to facilitate application in practice. Nine studies met inclusion criteria, identifying four major themes. Parents experienced conflicting emotions, articulated a need for communication and support, reported that being physically present was comforting, and described their reactions to the experience. The available research on parents’ experience during presence at their child’s resuscitation offers a foundation for further detailed study. Further study is needed about parents’ perspective of support needed while present during a child’s resuscitation, as well as about any long-term effects of presence on parent stress and coping.
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Affiliation(s)
- Stephanie A. Stewart
- The University of Iowa, Iowa City, IA, USA
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Ryan M, White P, Kiley S, Reed H, Giordano C. Managing the Complex Issues of Pediatric Nonaccidental Trauma: A Simulation-Based Case of a Critically Injured Child. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10599. [PMID: 30800801 PMCID: PMC6338257 DOI: 10.15766/mep_2374-8265.10599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/21/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Trainees generally have insufficient training in managing critically ill and injured pediatric patients due to limited exposure to such patients. Patient simulation experiences allow trainees to learn management skills needed in such a crisis. Herein, we describe a case regarding a critically injured pediatric patient. This case requires trainees to use teamwork skills, medical knowledge, and technical skills to manage the patient. METHODS We developed a team-based simulation regarding the resuscitation of a critically injured child-a toddler with multiple injuries, all requiring emergent care. The case was developed for senior medical students and residents and can be completed in a single 1-hour session, including a debriefing period. We also address psychosocial issues of managing a critically injured child by having the mother and her boyfriend present for part of the case. The team must address the underlying issue of suspected nonaccidental trauma while managing a medical resuscitation. RESULTS We have performed this scenario with a cohort of 100 trainees. Through direct observations, all teams have been able to manage the patient successfully. The average response to the effectiveness of the case in terms of developing pediatric resuscitation skills was very positive, with scores of 6.7 on a scale of 1 to 7. DISCUSSION Medical simulation has been demonstrated to be a valuable tool for assessing the knowledge and skills of trainees. This pediatric simulation improved learners' general understanding of managing a pediatric resuscitation. Accordingly, this case has been incorporated as part of resident and medical student training.
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Affiliation(s)
- Matthew Ryan
- Associate Professor, Department of Emergency Medicine, University of Florida College of Medicine
| | - Peggy White
- Assistant Professor, Department of Anesthesiology, University of Florida College of Medicine
| | - Sean Kiley
- Assistant Professor, Department of Anesthesiology, University of Florida College of Medicine
| | - Heather Reed
- Assistant Professor, Department of Anesthesiology, University of Florida College of Medicine
| | - Chris Giordano
- Associate Professor, Department of Anesthesiology, University of Florida College of Medicine
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Kraus CK, Marco CA. Shared decision making in the ED: ethical considerations. Am J Emerg Med 2016; 34:1668-72. [DOI: 10.1016/j.ajem.2016.05.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022] Open
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Masterson K, Brenner M. ‘Don't put the parent out’: parents' perspectives of being present during an inter-hospital transfer. J Clin Nurs 2016; 25:1301-7. [DOI: 10.1111/jocn.13183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Kate Masterson
- School of Nursing, Midwifery & Health Systems; University College Dublin; Dublin 4 Ireland
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems; University College Dublin; Dublin 4 Ireland
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Ferreira CAG, Balbino FS, Balieiro MMFG, Mandetta MA. Family presence during cardiopulmonary resuscitation and invasive procedures in children. ACTA ACUST UNITED AC 2015; 32:107-13. [PMID: 24676198 PMCID: PMC4182989 DOI: 10.1590/s0103-05822014000100017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/27/2013] [Indexed: 12/04/2022]
Abstract
Objective: To identify literature evidences related to actions to promote family's presence
during cardiopulmonary resuscitation and invasive procedures in children
hospitalized in pediatric and neonatal critical care units. Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002
to 2012, with the following inclusion criteria: research article in Medicine, or
Nursing, published in Portuguese, English or Spanish, using the keywords "family",
"invasive procedures", "cardiopulmonary resuscitation", "health staff", and
"Pediatrics". Articles that did not refer to the presence of the family in
cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15
articles were analyzed. Data synthesis : Most articles were published in the United States (80%), in Medicine and Nursing
(46%), and were surveys (72%) with healthcare team members (67%) as participants.
From the critical analysis, four themes related to the actions to promote family's
presence in invasive procedures and cardiopulmonary resuscitation were obtained:
a) to develop a sensitizing program for healthcare team; b) to educate the
healthcare team to include the family in these circumstances; c) to develop a
written institutional policy; d) to ensure the attendance of family's needs. Conclusions: Researches on these issues must be encouraged in order to help healthcare team to
modify their practice, implementing the principles of the Patient and Family
Centered Care model, especially during critical episodes.
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Affiliation(s)
| | - Flávia Simphronio Balbino
- Departamento de Enfermagem Pediatrica, Escola Paulista de Enfermagem, Unifesp, Sao Paulo, SP, Brasil
| | - Maria Magda F G Balieiro
- Departamento de Enfermagem Pediatrica, Escola Paulista de Enfermagem, Unifesp, Sao Paulo, SP, Brasil
| | - Myriam Aparecida Mandetta
- Departamento de Enfermagem Pediatrica, Escola Paulista de Enfermagem, Unifesp, Sao Paulo, SP, Brasil
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Family presence during resuscitation: A Canadian Critical Care Society position paper. Can Respir J 2015; 22:201-5. [PMID: 26083541 DOI: 10.1155/2015/532721] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Dudley N, Ackerman A, Brown KM, Snow SK. Patient- and family-centered care of children in the emergency department. Pediatrics 2015; 135:e255-72. [PMID: 25548335 DOI: 10.1542/peds.2014-3424] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This revised technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care.
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Abstract
OBJECTIVE The aim of this study was to observe the proportion of family members who choose to remain present during children's pediatric emergency department procedures in actual clinical situations. METHODS Family members of a convenience sample of children undergoing invasive procedures in a pediatric emergency department were observed. Data were collected on whether family members chose to remain present or leave during the procedure and family member and health care worker behaviors. Consent to participate in the study was obtained after the observation, and family members were surveyed regarding demographics, anxiety, and previous experiences. RESULTS Fifty-nine children undergoing 66 procedures and accompanied by 83 family members were enrolled. The median age of the children was 69 months; 47% were female and 73% were Hispanic. The family members consisted of 64% mothers and 24% fathers, with a median age of 33 years. The most common procedures were vascular access (25), laceration repair (11), and urethral catheterization (9). Overall, 73% of the family members stayed during the child's procedure, 18% left, and 9% showed some mixture of staying and leaving. Health care workers asked the family members to leave twice, encouraged them to leave once, and used nonverbal cues to exclude the family members twice. Caregivers helped to restrain the child 35% of the time. CONCLUSIONS Family members remain present during actual children's emergency department procedures less often than they indicate they would in hypothetical scenario surveys.
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The Effect of Intensive Care Unit Environments on Nurse Perceptions of Family Presence During Resuscitation and Invasive Procedures. Dimens Crit Care Nurs 2014; 33:34-9. [DOI: 10.1097/dcc.0000000000000010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Patient-centered and family-centered care (PFCC) has been endorsed by many professional health care organizations. Although variably defined, PFCC is an approach to care that is respectful of and responsive to the preferences, needs, and values of individual patients and their families. Research regarding PFCC in the pediatric intensive care unit has focused on 4 areas including (1) family visitation; (2) family-centered rounding; (3) family presence during invasive procedures and cardiopulmonary resuscitation; and (4) family conferences. Although challenges to successful implementation exist, the growing body of evidence suggests that PFCC is beneficial to patients, families, and staff.
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Affiliation(s)
- Kathleen L. Meert
- Department of Pediatrics, Critical Care Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA, Corresponding author.
| | - Jeff Clark
- Department of Pediatrics, Critical Care Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Susan Eggly
- Department of Internal Medicine, Karmanos Cancer Institute, Wayne State University, 4100 John R MMO3CB, Detroit, MI 48201, USA
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Griffin T. A family-centered "visitation" policy in the neonatal intensive care unit that welcomes parents as partners. J Perinat Neonatal Nurs 2013; 27:160-5; quiz 166-7. [PMID: 23618937 DOI: 10.1097/jpn.0b013e3182907f26] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Parents are important partners in the neonatal intensive care unit, collaborating with staff in caregiving and decision making for their infants. These essential and mutually beneficial partnerships between families and staff are the cornerstone of family-centered care and require that parents are welcomed to be with their baby at any time. This concept is not new and, yet, many neonatal intensive care units continue to have "visitation" policies that restrict parent's access to their infants, failing to recognize parents as partners. Changing the "visitation" policy is part of a welcoming approach in the context of family-centered care. Neonatal intensive care unit nurses may be accustomed to a more strict policy, needing communication tools and strategies to collaborate with parents and implement a family-centered "visitation" or welcoming policy.
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Affiliation(s)
- Terry Griffin
- St Alexius Medical Center, 1555 North Barrington Rd, Hoffman Estates, IL 60169, USA.
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Belpomme V, Adnet F, Mazariegos I, Beardmore M, Duchateau FX, Mantz J, Ricard-Hibon A. Family witnessed resuscitation: nationwide survey of 337 prehospital emergency teams in France. Emerg Med J 2012; 30:1038-42. [PMID: 23221456 DOI: 10.1136/emermed-2012-201626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the practices and opinions of prehospital emergency medical services (EMS) with regard to family witnessed resuscitation (FWR) and to analyse the differences between physicians' and nurses' responses. DESIGN An anonymous questionnaire (30 yes/no questions on demographics and FWR) was sent to all prehospital emergency staff (physicians, nurses and support staff) working for the 377 Mobile Intensive Care Units in France. RESULTS Of the 2689 responses received 2664 were analysed. Mean respondent age was 38 ± 8 years, the male to female ratio was 1:2. 87% of respondents had already performed FWR and 38% had offered relatives the option to be present during resuscitation. Most respondents (90%) felt that FWR might cause psychological trauma to the family; 70% thought that FWR might impact on the duration of resuscitation and 68% on EMS team concentration. In the 28% of cases when relatives had asked to be present, 59% of respondents had acquiesced but only 27% were willing to invite relatives to be routinely present. CONCLUSIONS Prehospital EMS teams in France seems to support FWR but are not yet ready to offer it systematically to relatives. Following our survey, written guidelines are currently in development in our department. These guidelines could be the first step of a national strategy for developing FWR in France. We await results from other studies of family members' opinions to compare prehospital practitioners' and family members' views to further develop our practice.
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Affiliation(s)
- Vanessa Belpomme
- AP-HP, SMUR et DAR, Hôpital Beaujon, Université Paris 7, , Clichy, France
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Family presence: not a panacea for all. Pediatr Crit Care Med 2012; 13:214-5. [PMID: 22391828 DOI: 10.1097/pcc.0b013e31822f10ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Itzhaki M, Bar-Tal Y, Barnoy S. Reactions of staff members and lay people to family presence during resuscitation: the effect of visible bleeding, resuscitation outcome and gender. J Adv Nurs 2011; 68:1967-77. [PMID: 22122510 DOI: 10.1111/j.1365-2648.2011.05883.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This article is a report on a study conducted to examine the views of healthcare professionals and lay people regarding the effect of family presence during resuscitation on both the staff performing the resuscitation and the relatives who witness it. BACKGROUND Family presence during resuscitation is controversial. Although many professional groups in different countries have recently issued position statements about the practice and have recommended new policy moves, the Israel Ministry of Health has not issued guidelines on the matter. METHODS Study design is factorial within-between subjects. Data were collected in Israel in 2008 from a convenience sample of 220 lay people and 201 healthcare staff (52 physicians and 149 nurses) using a questionnaire based on eight different resuscitation scenarios and manipulating blood involvement and resuscitations outcome. Data were analysed using one-way analysis of variance. FINDINGS Overall, both staff and lay people perceived family presence during resuscitation negatively. Visible bleeding and an unsuccessful outcome significantly influenced both staff's and lay people's perceptions. Female physicians and nurses reacted more negatively to family presence than did male physicians and nurses; lay men responded more negatively than lay women. CONCLUSIONS Changing the current negative perceptions of family presence at resuscitation requires (a) establishing a new national policy, (b) educating healthcare staff to the benefits of the presence of close relatives and (c) training staff to support relatives who want to be present.
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Affiliation(s)
- Michal Itzhaki
- Department School of Health Professions, Tel Aviv University, Israel.
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DeBoer S, Seaver M. Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination. J Emerg Nurs 2011. [DOI: 10.1016/j.jen.2011.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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"It's just what we do": a qualitative study of emergency nurses working with well-established family presence protocol. J Emerg Nurs 2011; 38:329-34. [PMID: 21514648 DOI: 10.1016/j.jen.2010.12.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 11/02/2010] [Accepted: 12/18/2010] [Indexed: 11/23/2022]
Abstract
INTRODUCTION ENA has supported family presence at the bedside during resuscitation of a loved one since 1993. Limited support from health care institutions has resulted in research that includes few data from hospitals with long-term family presence experience. The study objectives were to (1) describe the benefit and harm of being present during resuscitation to family members, using perceptions of nurses who work in an emergency department with a well-established family presence protocol; and (2) define family presence using perceptions of nurse participants. METHODS A descriptive qualitative study was conducted in an emergency department that has had a written family presence protocol since 1992. Fourteen emergency nurses described their experience with family presence in face-to-face interviews using an investigator-developed, open-ended tool. Transcribed interviews were evaluated using conceptual content analysis. RESULTS Nurses perceived benefits to family members in that 1) the family is able to see evolving events, described as a family member's ability to see a loved one's condition change over time, and 2) is able to validate efforts to save the life of their loved one. Nurses also indicated that family members' appreciation that everything possible was done increased nurses' confidence that they did everything they could during the resuscitation event. No nurses described observing actual harm to family members who were present during resuscitation. DISCUSSION Emergency nurses can embrace family presence and influence benefits for family members when the practice is well established. Behavior modeling rather than written protocol may affect acceptance of family presence during resuscitation efforts among emergency nurses.
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Abstract
BACKGROUND End-of-life care for trauma patients requires unique practice guidelines because it is fraught with difficulties not encountered in end-of-life care for terminally ill patients. The purpose of this project was to analyze survey information from nurses and physicians regarding preferences for end-of-life care in trauma that would inform best-practice guidelines. METHODS A survey was sent via the US Postal Service to a convenience sample of trauma professionals, including physicians, nurses, and emergency medical technicians. Questions were designed to provide information on difficult issues related to death and dying from trauma. The general public was also surveyed, and all results were used to develop a best-practice model for end-of-life care. RESULTS Seven hundred seventy-four trauma professionals returned the survey for a response rate of 51%. This included 460 nurses and 181 physicians. Some salient findings include: (1) If a loved one required resuscitation in the emergency department, more nurses (78.4%) than physicians (38.7%) prefer to be in the treatment room rather than in the waiting room; (2) similar percentages of nurses (97.7%) and physicians (99.4%) agree that life-sustaining treatment should be withdrawn in cases in whom there is no hope of recovery; and (3) a larger percentage of nurses (58.8%) than physicians (20.6%) believe that patients have the right to demand care that physicians think is medically futile. CONCLUSIONS Nurses and physicians agree on some issues about end-of-life care in trauma but disagree on others. Education and discourse among trauma professionals are needed to bring understanding to the issues.
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Health Care Providers' Evaluations of Family Presence During Resuscitation. J Emerg Nurs 2010; 36:524-33. [DOI: 10.1016/j.jen.2010.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/09/2010] [Accepted: 06/10/2010] [Indexed: 11/24/2022]
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Pye S, Kane J, Jones A. Parental presence during pediatric resuscitation: the use of simulation training for cardiac intensive care nurses. J SPEC PEDIATR NURS 2010; 15:172-5. [PMID: 20367788 DOI: 10.1111/j.1744-6155.2010.00236.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sherry Pye
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Department of Pediatric Cardiology, Little Rock, Arkansas, USA.
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Kingsnorth J, O'Connell K, Guzzetta CE, Edens JC, Atabaki S, Mecherikunnel A, Brown K. Family presence during trauma activations and medical resuscitations in a pediatric emergency department: an evidence-based practice project. J Emerg Nurs 2010; 36:115-21. [PMID: 20211401 DOI: 10.1016/j.jen.2009.12.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 11/13/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The existing family presence literature indicates that implementation of a family presence policy can result in positive outcomes. The purpose of our evidence-based practice project was to evaluate a family presence intervention using the 6 A's of the evidence cycle (ask, acquire, appraise, apply, analyze, and adopt/adapt). For step 1 (ask), we propose the following question: Is it feasible to implement a family presence intervention during trauma team activations and medical resuscitations in a pediatric emergency department using national guidelines to ensure appropriate family member behavior and uninterrupted patient care? METHODS Regarding steps 2 through 4 (acquire, appraise, and apply), our demonstration project was conducted in a pediatric emergency department during the implementation of a new family presence policy. Our family presence intervention incorporated current appraisal of literature and national guidelines including family screening, family preparation, and use of family presence facilitators. We evaluated whether it was feasible to implement the steps of our intervention and whether the intervention was safe in ensuring uninterrupted patient care. RESULTS With regard to step 5 (analyze), family presence was evaluated in 106 events, in which 96 families were deemed appropriate and chose to be present. Nearly all families (96%) were screened before entering the room, and all were deemed appropriate candidates. Facilitators guided the family during all events. One family presence event was terminated. In all cases patient care was not interrupted. DISCUSSION Regarding step 6 (adopt/adapt), our findings document the feasibility of implementing a family presence intervention in a pediatric emergency department while ensuring uninterrupted patient care. We have adopted family presence as a standard practice. This project can serve as the prototype for others.
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Affiliation(s)
- Jennifer Kingsnorth
- Emergency Medicine and Trauma Center Nurse Manager, Children's National Medical Center, Washington, DC, USA.
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Moving evidence into practice in the pediatric intensive care unit: how it saved one child's life. AACN Adv Crit Care 2009; 20:328-33. [PMID: 19893371 DOI: 10.1097/nci.0b013e3181ac22a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Funk RN, Farber JS. Partners in care: implementing a policy on family member passengers. Air Med J 2009; 28:31-36. [PMID: 19131023 DOI: 10.1016/j.amj.2008.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 04/19/2008] [Accepted: 06/22/2008] [Indexed: 05/27/2023]
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Abstract
Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care. This technical report has been endorsed by the Academic Pediatric Association (formerly the Ambulatory Pediatric Association), the American College of Osteopathic Emergency Physicians, the National Association of Emergency Medical Technicians, the Institute for Family-Centered Care, and the American College of Emergency Physicians. This report is also supported by the Emergency Nurses Association.
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Beckstrand RL, Smith MD, Heaston S, Bond AE. Emergency nurses' perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care. J Emerg Nurs 2008; 34:290-300. [PMID: 18640407 DOI: 10.1016/j.jen.2007.09.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/20/2007] [Accepted: 09/02/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Emergency nurses care for dying patients daily. The process of dying in an emergency department can be complicated. Research on specific obstacles that impede the delivery of end-of-life care in emergency departments and behaviors that support it is limited. METHODS A 70-item questionnaire was mailed to randomly selected ENA members. Subjects were asked to rate items on the size, frequency, and magnitude of obstacles and supportive behaviors that relate to end-of-life care for ED patients. RESULTS The perceived obstacles with the greatest magnitude were as follows: (a) ED nurses' work loads being too high to allow adequate time for patient care, (b) poor design of emergency departments, and (c) family members not understanding what "life-saving measures" really mean. The three highest-scoring supportive behaviors were as follows: (a) allowing family members adequate time to be alone with the patient after he or she has died; (b) having good communication between the physician and RN; and (c) providing a peaceful, dignified bedside scene for family members once the patient has died. DISCUSSION It is hoped that the results of this study will help increase and facilitate the discussions regarding end-of-life care in emergency departments. Realistic initial implications include finding ways to decrease workloads of emergency nurses and increase direct patient care. Another important implication would be the improvement of ED designs. Further research in the area of end-of-life care in emergency settings is recommended.
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Affiliation(s)
- Renea L Beckstrand
- Brigham Young University, College of Nursing, 422 SWKT, PO Box 25432, Provo, UT 84602-5432, USA.
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Twibell RS, Siela D, Riwitis C, Wheatley J, Riegle T, Bousman D, Cable S, Caudill P, Harrigan S, Hollars R, Johnson D, Neal A. Nurses’ Perceptions of Their Self-confidence and the Benefits and Risks of Family Presence During Resuscitation. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.2.101] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables.Objectives To test 2 instruments used to measure nurses’ perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses’ self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence.Methods Nurses (n = 375) completed the Family Presence Risk-Benefit Scale and the Family Presence Self-confidence Scale.Results Nurses’ perceptions of benefits, risks, and self-confidence were significantly and strongly interrelated. Nurses who invited family presence during resuscitation were significantly more self-confident in managing it and perceived more benefits and fewer risks (P < .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P < .001). Data supported initial reliability and construct validity for the 2 scales.Conclusions Nurses’ perceptions of the risks and benefits of family presence during resuscitation vary widely and are associated with how often the nurses invite family presence. After further testing, the 2 new scales may be suitable for measuring interventional outcomes, serve as self-assessment tools, and add to conceptual knowledge about family presence.
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Affiliation(s)
- Renee Samples Twibell
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Debra Siela
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Cheryl Riwitis
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Joe Wheatley
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Tina Riegle
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Denise Bousman
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Sandra Cable
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Pam Caudill
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Sherry Harrigan
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Rick Hollars
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Doreen Johnson
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
| | - Alexis Neal
- Authors are affiliated with Ball Memorial Hospital, Muncie, Indiana; Ball State University, School of Nursing, Muncie, Indiana; or Air-Evac EMS, West Plains, Missouri
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Abstract
The benefits of family presence (FP) during resuscitation have been well documented in the literature for the past 20 years. However, many hospitals lack written guidelines to direct staff members during a resuscitation event. A structured approach affords staff a uniform and organized way to offering FP, avoiding any interference with patient care. The purpose of this paper is to provide evidence-based practice guidelines to offering FP during resuscitation in the emergency department. The guidelines illustrate a practical step-by-step approach that staff members can follow every time a patient is being evaluated and/or treated in the resuscitation room.
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Affiliation(s)
- Mirna M Farah
- Division of Emergency Medicine, Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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McGahey-Oakland PR, Lieder HS, Young A, Jefferson LS. Family experiences during resuscitation at a children's hospital emergency department. J Pediatr Health Care 2007; 21:217-25. [PMID: 17606158 DOI: 10.1016/j.pedhc.2006.12.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 12/01/2006] [Accepted: 12/02/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Family presence (FP) during resuscitation is a timely and controversial topic. Family members are becoming part of the resuscitation process. Study objectives included: (1) describe experiences of family members whose children underwent resuscitation in a children's hospital emergency department; (2) identify critical information about family experiences to improve circumstances for future families; and (3) assess mental and health functioning of family members. METHODS This descriptive, retrospective study involved a 1-hour audio-taped interview of 10 family members using the Parkland Family Presence During Resuscitation/Invasive Procedures Unabridged Family Survey (FS) and investigator-developed questions. Mental and health functioning were assessed using the Brief Symptom Inventory, the Short Form Health Survey version 2, and the Post Traumatic Stress Disorder Scale. Seven family members were present during resuscitation, and three were not present. RESULTS Five thematic categories were identified: (1) It's My Right to Be There; (2) Connection and Comfort Make a Difference; (3) Seeing is Believing; (4) Getting In; and (5) Information Giving. Family members voiced that it was their right to be present, indicating they had a special connection to the child. Seeing or not seeing the events of the resuscitation affected family members' ability to believe the outcome. Measures of mental and health functioning were similar to population norms. DISCUSSION Instituting guidelines that facilitate FP may provide mechanisms to ensure that the needs of patients, family members, and health care providers are met during a stressful event.
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Abstract
Despite improved education and prevention initiatives, trauma remains the leading cause of death in children. A variety of preventative measures have been developed to decrease the morbidity and mortality, and the financial burden on the health care system. This article discusses injury prevention strategies, issues in prehospital care, and key points of initial resuscitation. In addition, the major injury patterns are described with attention paid to the diagnosis and management of patients with multiple traumatic injuries.
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Affiliation(s)
- Kim G Mendelson
- Division of Pediatric Surgery, Department of Surgery, University of Louisville, 233 East Gray Street, Suite 708, Louisville, KY 40202, USA
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Mangurten J, Scott SH, Guzzetta CE, Clark AP, Vinson L, Sperry J, Hicks B, Voelmeck W. Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department. J Emerg Nurs 2006; 32:225-33. [PMID: 16730277 DOI: 10.1016/j.jen.2006.02.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Janice Mangurten
- Trauma/Neurosurgical ICU, Children's Medical Center, Dallas, Texas 75235, USA.
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