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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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Dainty KN, Atkins DL, Breckwoldt J, Maconochie I, Schexnayder SM, Skrifvars MB, Tijssen J, Wyllie J, Furuta M, Aickin R, Acworth J, Atkins D, Couto TB, Guerguerian AM, Kleinman M, Kloeck D, Nadkarni V, Ng KC, Nuthall G, Ong YKG, Reis A, Rodriguez-Nunez A, Schexnayder S, Scholefield B, Tijssen J, Voorde PVD, Wyckoff M, Liley H, El-Naggar W, Fabres J, Fawke J, Foglia E, Guinsburg R, Hosono S, Isayama T, Kawakami M, Kapadia V, Kim HS, McKinlay C, Roehr C, Schmolzer G, Sugiura T, Trevisanuto D, Weiner G, Greif R, Bhanji F, Bray J, Breckwoldt J, Cheng A, Duff J, Eastwood K, Gilfoyle E, Hsieh MJ, Lauridsen K, Lockey A, Matsuyama T, Patocka C, Pellegrino J, Sawyer T, Schnaubel S, Yeung J. Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation 2021; 162:20-34. [PMID: 33577966 DOI: 10.1016/j.resuscitation.2021.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. OBJECTIVE To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation. DATA SOURCES Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020. STUDY SELECTION 3200 titles were retrieved in the initial search; 36 ultimately included for review. DATA EXTRACTION Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology. RESULTS The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority. LIMITATIONS English language only; lack of randomized control trials; quality of the publications. CONCLUSIONS Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes. PROSPERO REGISTRATION NUMBER CRD42020140363.
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Affiliation(s)
- Katie N Dainty
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada.
| | - Dianne L Atkins
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jan Breckwoldt
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ian Maconochie
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Steve M Schexnayder
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Markus B Skrifvars
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janice Tijssen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jonathan Wyllie
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Marie Furuta
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Richard Aickin
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jason Acworth
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Dianne Atkins
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Thomaz Bittencourt Couto
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Anne-Marie Guerguerian
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Monica Kleinman
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - David Kloeck
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Vinay Nadkarni
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kee-Chong Ng
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Gabrielle Nuthall
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Yong-Kwang Gene Ong
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Amelia Reis
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Antonio Rodriguez-Nunez
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Steve Schexnayder
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Barney Scholefield
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janice Tijssen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Patrick van de Voorde
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Myra Wyckoff
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Helen Liley
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Walid El-Naggar
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jorge Fabres
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Joe Fawke
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Elizabeth Foglia
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ruth Guinsburg
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Shigeharu Hosono
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Tetsuya Isayama
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Mandira Kawakami
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Vishal Kapadia
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Han-Suk Kim
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Chris McKinlay
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Charles Roehr
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Georg Schmolzer
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Takahiro Sugiura
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Daniele Trevisanuto
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Gary Weiner
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Robert Greif
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Farhan Bhanji
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janet Bray
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jan Breckwoldt
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Adam Cheng
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jonathan Duff
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kathryn Eastwood
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Elaine Gilfoyle
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ming-Ju Hsieh
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kasper Lauridsen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Andrew Lockey
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Tasuku Matsuyama
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Catherine Patocka
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jeffrey Pellegrino
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Taylor Sawyer
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Sebastian Schnaubel
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Joyce Yeung
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
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Páramo-Cano T, Ortiz MI, Gómez-Busto FJ, Espinoza-Ramírez AL. Management of Procedural Pain in Children. Curr Pediatr Rev 2021; 17:288-328. [PMID: 33820520 DOI: 10.2174/1573396317666210405150526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
In recent years, there has been increased interest in the study of pain in children and its treatment. It is known that when facing diagnostic and therapeutic procedures similar to those performed on adults, children either do not receive specific pain treatment or receive it on a significantly lower scale. However, recent research suggests a change in attitude and an improvement in the current treatment of children's pain. Although current knowledge demonstrates the falsity of many preconceived ideas about pain and its management, our results suggest that attitudinal change towards childhood pain remains slow and that real improvement in the training and practical application of the pediatrician who has to treat childhood pain is urgently needed. In this context, this manuscript has prepared standards and guidelines to improve pain management practices in a large number of national and international professional settings.
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Affiliation(s)
- Tatjana Páramo-Cano
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Mario I Ortiz
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Federico J Gómez-Busto
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Ana L Espinoza-Ramírez
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
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Parents want to attend pediatric fracture reductions. J Pediatr Orthop B 2021; 30:32-36. [PMID: 31725536 DOI: 10.1097/bpb.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric fracture reductions can create anxiety for the child and parent. While cross-cultural evidence supports parental presence during some pediatric procedures, no study addresses parental presence during fracture reductions. This study investigates parent experiences during their child's reduction and provides guidance regarding parental attendance during fracture reductions. Sixty consecutive parents were retrospectively surveyed about their experience during their child's fracture reduction. Parents were grouped according to presence or absence during the reduction and were compared. Forty parents attended the reduction and 20 parents were absent. All parents attending the reduction were satisfied with their experience. Thirty-nine parents (98%) believed their presence was helpful for their child and 36 (90%) believed it was personally helpful. Of the 20 absent parents, four (20%) were dissatisfied with their experience, five (25%) believed it was personally harmful, and two (10%) thought it was harmful to their child. All parents reporting negative experiences were prohibited from attending the reduction. When deciding about parental presence during reductions, 55 (92%) parents wanted to be included in this process. Overall, 47 parents (78%) wanted to attend the reduction and 52 (87%) would prefer to attend a future reduction. Most parents prefer to attend their child's fracture reduction and believe their presence is helpful personally and for their child. Parents in attendance report a positive experience, while parents prohibited from attending report dissatisfaction with the experience and believe their absence is harmful to themselves and their children. It is recommended that healthcare workers consider parental attendance during pediatric reductions.
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Abstract
OBJECTIVES The purpose of this scoping review was to identify the extent, range, and nature of information currently available on family presence during pediatric resuscitation on resuscitation team members and their performance. DATA SOURCES A comprehensive search strategy was created and executed by identifying primary keywords in central articles, pretesting key words and combinations of them in databases to confirm articles returned fell within the search parameters, and checking that key articles were returned which confirmed the search strategy was not too narrow. STUDY SELECTION Two members of the research team independently conducted relevance screening using predetermined inclusion and exclusion parameters. Titles and abstracts of retrieved articles were reviewed using the set criteria involving. From the refined list of selected articles, full texts of each article were considered for final determination of inclusion. DATA EXTRACTION Key items of information were gathered from each article selected using a predefined extraction list. The extracted information was then sorted into themes and relevant issues. DATA SYNTHESIS Of the 3,012 studies initially identified, 48 met the inclusion criteria. Themes identified included as follows: 1) attitudes and opinions on family presence during pediatric resuscitation; 2) reasons in support of or against family presence during pediatric resuscitation; 3) education, training, and support; and 4) resuscitation performance and outcomes. Our review of the available information highlighted that the majority of work done to this point has focused heavily on healthcare provider opinions and relied mainly on survey method. CONCLUSIONS We propose that future research employ more rigorous research techniques, such as randomized control trials, place greater emphasis on healthcare provider behaviors and clinical outcomes during family presence during pediatric resuscitation, and increase exploration into the education and training needs of healthcare providers who already currently manage family presence during pediatric resuscitation.
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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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Zhang A, Yocum RM, Repplinger MD, Broman AT, Kim MK. Factors Affecting Family Presence During Fracture Reduction in the Pediatric Emergency Department. West J Emerg Med 2018; 19:970-976. [PMID: 30429929 PMCID: PMC6225943 DOI: 10.5811/westjem.2018.9.38379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Asking family members to leave during invasive procedures has historically been common practice; however, evidence-based recommendations have altered the trend of family presence during pediatric procedures. The aim of this study was to determine factors related to family members’ choice to be present or absent during fracture reductions in a pediatric emergency department (ED), and their satisfaction with that choice. Methods We administered role-specific, anonymous surveys to a convenience sample of patients’ family members in the ED of a Level I pediatric trauma center. All family members were given a choice of where to be during the procedure. Results Twenty-five family members of 18 patients completed surveys. Seventeen family members chose to stay in the room. Family member satisfaction with their decision to be inside or outside the room during the procedure (median = very satisfied) was almost uniformly high and not associated with any of the following variables: previous presence during a medical procedure; provider-reported procedure difficulty, or anxiety levels. Family member perception of procedure success (median = extremely well) was also high and not associated with other variables. Location during the procedure was associated with a desire to be in the same location in the future (Fisher’s exact test, p=0.001). Common themes found among family members’ reasons for their location decisions and satisfaction levels were a desire to support the patient, high staff competence, and their right as parents to choose their location. Conclusion Family members self-select their location during their child’s fracture reduction to high levels of satisfaction, and they considered the ability to choose their location as important.
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Affiliation(s)
- Albert Zhang
- University of Minnesota, Department of Pediatrics, Minneapolis, Minnesota
| | - Regina M Yocum
- American Family Children's Hospital, Department of Child Life Services, Madison, Wisconsin
| | - Michael D Repplinger
- University of Wisconsin, Madison, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin.,University of Wisconsin, Madison, Department of Radiology, Madison, Wisconsin
| | - Aimee T Broman
- University of Wisconsin, Madison, Department of Biostatistics and Medical Informatics, Madison, Wisconsin
| | - Michael K Kim
- University of Wisconsin, Madison, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin.,University of Wisconsin, Madison, Department of Pediatrics, Madison, Wisconsin
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Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence. Dimens Crit Care Nurs 2018; 37:167-179. [PMID: 29596294 DOI: 10.1097/dcc.0000000000000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events. OBJECTIVE This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation. METHODS By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale. RESULTS Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001). DISCUSSION These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.
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Blanco AP. How Do Healthcare Providers Feel About Family Presence During Cardiopulmonary Resuscitation? THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017282102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Jakab M, Day AZ, Kraguljac A, Brown M, Mehta S. Family Presence in the Adult ICU During Bedside Procedures. J Intensive Care Med 2017; 34:587-593. [PMID: 28502236 DOI: 10.1177/0885066617705857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To understand perspectives of family members of adult patients admitted to the medical-surgical intensive care unit (ICU) regarding their presence during procedures. METHODS Respondents completed a questionnaire about procedures the patient had undergone, their desire to be present, and their experience. Procedures of interest were endotracheal intubation; chest compressions; vascular catheter insertion; and gastric, chest, and rectal tubes. Impact of Events Scale-Revised (IES-R) was completed at the time of questionnaire completion and again 1 month later to evaluate the psychological impact of witnessing a procedure. RESULTS Ninety-seven respondents completed the questionnaire on behalf of 72 patients. More than 90% patients had at least 1 procedure. Only 29 (30%) family members were present for at least 1 procedure, and 44% to 100% wished to be present. Of the 68 respondents not present for a procedure, 18 (26.5%) wanted to be present. The IES-R was completed by 52 (95%) of 55 respondents who witnessed any procedure at time 1 and 28 (51%) of 55 respondents at time 2; mean IES-R scores were 8.0 and 8.8 ( P = .68), respectively. Only 2 participants had IES-R >33, signifying the likely presence of posttraumatic stress disorder. CONCLUSION Family members wish to be present for ICU procedures, and there are no adverse psychological effects.
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Affiliation(s)
- Marnie Jakab
- 1 Department of Medicine, Mount Sinai Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
| | - Alex Z Day
- 1 Department of Medicine, Mount Sinai Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
| | - Alan Kraguljac
- 1 Department of Medicine, Mount Sinai Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
| | - Maedean Brown
- 1 Department of Medicine, Mount Sinai Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
| | - Sangeeta Mehta
- 1 Department of Medicine, Mount Sinai Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.,2 University of Toronto, Toronto, Ontario, Canada
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Chen CL, Tang JS, Lai MK, Hung CH, Hsieh HM, Yang HL, Chuang CC. Factors influencing medical staff’s intentions to implement family-witnessed cardiopulmonary resuscitation: A cross-sectional, multihospital survey. Eur J Cardiovasc Nurs 2017; 16:492-501. [DOI: 10.1177/1474515117692663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chien-Liang Chen
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Jing-Shia Tang
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Meng-Kuan Lai
- Department of Business Administration, National Cheng Kung University, Tainan, Taiwan
| | - Chiu-Hsia Hung
- Department of Nursing, Tainan Municipal Hospital, Taiwan
| | | | - Hui-Lin Yang
- Department of Nursing, Kuo General Hospital, Tainan, Taiwan
| | - Chia-Chang Chuang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Inviting family to be present during cardiopulmonary resuscitation: Impact of education. Nurse Educ Pract 2016; 16:274-9. [DOI: 10.1016/j.nepr.2015.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 11/23/2022]
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Mekitarian FFP, Angelo M. [Family's presence in the pediatric emergency room: opinion of health's professionals]. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2015; 33:460-6. [PMID: 26298660 PMCID: PMC4685567 DOI: 10.1016/j.rpped.2015.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To learn the opinion of health professionals regarding the presence of family during pediatric emergency care. METHODS Cross-sectional study, performed with 46 health professionals, members of the medical and nursing team of a pediatric emergency service. The data were collected via the application of a questionnaire composed by variables related to the opinion of professionals about the studied subject, in line with the professional category and the vocational training time, as well as invasive procedures during which the presence of family is authorized by the professionals. RESULTS The medical staff and the professionals with shorter time after graduation (<10 years) were more favorable to the presence of family during emergency procedures. Regarding the complexity of the procedures, the nursing staff proved more favorable to the presence of family during less complex procedures-peripheral venous puncture and fluid sample-whereas the consent of the medical staff was similar, regardless the performed procedure-peripheral venous puncture, fluid sample, intraosseous puncture, tracheal intubation and cardiopulmonary resuscitation. CONCLUSIONS In order to allow the presence of family in the emergency room, it is necessary to sensitize health professionals, especially the nursing staff and the longer-term acting professionals, which are more resistant to allow the family to stay with the child during the emergency 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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Angel Solà J, Sagué Bravo S, Parra Cotanda C, Trenchs Sainz de la Maza V, Luaces Cubells C. Has the presence of parents during invasive procedures in the emergency department increased in the last few years? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Angel Solà J, Sagué Bravo S, Parra Cotanda C, Trenchs Sainz de la Maza V, Luaces Cubells C. [Has the presence of parents during invasive procedures in the emergency department increased in the last few years?]. An Pediatr (Barc) 2014; 82:6-11. [PMID: 24629904 DOI: 10.1016/j.anpedi.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022] Open
Abstract
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.
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Affiliation(s)
- J Angel Solà
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - S Sagué Bravo
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - C Parra Cotanda
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - V Trenchs Sainz de la Maza
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - C Luaces Cubells
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Harvey ME, Pattison HM. The impact of a father's presence during newborn resuscitation: a qualitative interview study with healthcare professionals. BMJ Open 2013; 3:e002547. [PMID: 23535758 PMCID: PMC3612808 DOI: 10.1136/bmjopen-2013-002547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/17/2013] [Accepted: 03/04/2013] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore healthcare professionals' experiences around the time of newborn resuscitation in the delivery room, when the baby's father was present. DESIGN A qualitative descriptive, retrospective design using the critical incident approach. Tape-recorded semistructured interviews were undertaken with healthcare professionals involved in newborn resuscitation. Participants recalled resuscitation events when the baby's father was present. They described what happened and how those present, including the father, responded. They also reflected upon the impact of the resuscitation and the father's presence on themselves. Participant responses were analysed using thematic analysis. SETTING A large teaching hospital in the UK. PARTICIPANTS Purposive sampling was utilised. It was anticipated that 35-40 participants would be recruited. Forty-nine potential participants were invited to take part. The final sample consisted of 37 participants including midwives, obstetricians, anaesthetists, neonatal nurse practitioners, neonatal nurses and paediatricians. RESULTS Four themes were identified: 'whose role?' 'saying and doing' 'teamwork' and 'impact on me'. While no-one was delegated to support the father during the resuscitation, midwives and anaesthetists most commonly took on this role. Participants felt the midwife was the most appropriate person to support fathers. All healthcare professional groups said they often did not know what to say to fathers during prolonged resuscitation. Teamwork was felt to be of benefit to all concerned, including the father. Some paediatricians described their discomfort when fathers came to the resuscitaire. None of the participants had received education and training specifically on supporting fathers during newborn resuscitation. CONCLUSIONS This is the first known study to specifically explore the experiences of healthcare professionals of the father's presence during newborn resuscitation. The findings suggest the need for more focused training about supporting fathers. There is also scope for service providers to consider ways in which fathers can be supported more readily during newborn resuscitation.
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Affiliation(s)
- Merryl E Harvey
- Faculty of Health, Department of Child Health, Birmingham City University, Birmingham, UK
| | - Helen M Pattison
- School of Life Health Sciences, Aston University, Birmingham, UK
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Yacoub MI, Alkharabsheh MS, Zaitoun RSA, Al-Atiat EK. The Arabic version of the Parental Stressor Scale: psychometric properties and Jordanian parents’ stress during child admission to PICU. J Res Nurs 2012. [DOI: 10.1177/1744987112437158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper presents an exploration of the validity and reliability of the translated Arabic version of the original English version of the Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU) with a sample of Jordanian parents of children admitted to a paediatric intensive care unit. Three hundred and fifty parents were recruited to the study. The PSS: PICU was completed by parents within 15 minutes. Data were collected from parents ( N = 350) from different governmental, private and educational hospitals in Amman, Jordan. Subscales measuring stress from Child’s Appearance, Procedures, Sights and Sounds, Staff Communication, Staff Behavior, Parental Role, and Child’s Behavior and Emotions showed a range of responses and showed good internal consistency. Parents in this study perceived stress from various sources during their child’s hospitalisation. The dimensions ranked most stressful in the PICU were procedures (mean = 3.8, standard deviation, SD = 1.11), the child’s behaviors and emotions (mean = 3.72, SD = 1.04) and child’s appearance (mean = 3.71, SD = 0.75). The least listed stressful items were behaviors of professional staff in the unit (mean = 2.19, SD = 0.73), and staff communication in the unit (mean = 2.25, SD = 0.81). The reported elevated levels of parental stress underscores the importance of ongoing screening for factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in the inpatient settings. Consideration of areas of parent education regarding stressful ICU environment, and children’s behavioral and emotional reaction to hospitalisation could help reduce stress for Jordanian parents.
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Affiliation(s)
- Mohammed I. Yacoub
- Assistant professor, Department of Clinical Nursing, Faculty of Nursing – The University of Jordan, Jordan
- Registered nurse, Ministry of Health, Al-Hussein Hospital, Jordan
| | - Muna S. Alkharabsheh
- Nursing educator, Al-Balqa Applied University – Salt College, Jordan
- Registered nurse, Ministry of Health, Al-Hussein Hospital, Jordan
| | - Rasha S. Abu Zaitoun
- Critical care nurse and lecturer, Arab College, Jordan
- Registered nurse, Ministry of Health, Al-Hussein Hospital, Jordan
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Abstract
Drawing on several decades of work with families, pediatricians, other health care professionals, and policy makers, the American Academy of Pediatrics provides a definition of patient- and family-centered care. In pediatrics, patient- and family-centered care is based on the understanding that the family is the child's primary source of strength and support. Further, this approach to care recognizes that the perspectives and information provided by families, children, and young adults are essential components of high-quality clinical decision-making, and that patients and family are integral partners with the health care team. This policy statement outlines the core principles of patient- and family-centered care, summarizes some of the recent literature linking patient- and family-centered care to improved health outcomes, and lists various other benefits to be expected when engaging in patient- and family-centered pediatric practice. The statement concludes with specific recommendations for how pediatricians can integrate patient- and family-centered care in hospitals, clinics, and community settings, and in broader systems of care, as well.
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Martínez Moreno C, Cordero Castro C, Palacios Cuesta A, Blázquez Gamero D, Marín Ferrer MM. [Presence of family members while performing invasive procedures. A prospective study]. An Pediatr (Barc) 2012; 77:28-36. [PMID: 22240194 DOI: 10.1016/j.anpedi.2011.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 02/22/2011] [Accepted: 11/17/2011] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- C Martínez Moreno
- Servicio de Pediatría, Sección de Urgencias Pediátricas, Hospital Universitario 12 de Octubre, Madrid, España.
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Vavarouta A, Xanthos T, Papadimitriou L, Kouskouni E, Iacovidou N. Family presence during resuscitation and invasive procedures: physicians' and nurses' attitudes working in pediatric departments in Greece. Resuscitation 2011; 82:713-6. [PMID: 21398020 DOI: 10.1016/j.resuscitation.2011.02.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/30/2011] [Accepted: 02/14/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Family presence during resuscitation and invasive procedures (FPDRAIP) has been a frequent topic of debate among healthcare personnel worldwide. This paper determines the knowledge, experiences and views of Greek physicians and nurses on FPDRAIP and examines possible correlations and factors promoting or limiting the implementation of the issue. METHODS The data for this descriptive questionnaire study were collected between March and June 2009. The study population consisted of 44 physicians and 77 nurses working in neonatal-pediatric departments and intensive care units in Patras, Greece, who answered an anonymous questionnaire. RESULTS The majority of the participants (73.6%) were not familiar with FPDRAIP, were neither educated (72.7%) nor did they agree with the issue (71.9%). No written policy on FPDRAIP existed in the hospitals surveyed. Participants who were familiar with existing guidelines on the issue, or those who had relevant personal experience (76.9%), were positive for practising it as well. The degree of invasiveness of the medical intervention was the major determinant for healthcare personnel to consent for FPDRAIP. Finally, 43.2% of physicians believed that the decision of allowing FPDRAIP should be made only by them, whereas, 40.3% of nurses thought it should be a joint one. CONCLUSIONS This study reveals that healthcare personnel in Greece are not familiar with the issue of FPDRAIP. In view of the increasing evidence on the advantages of this practice, we recommend implementation of relevant educational programs and institutional guidelines and policies.
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Family presence during invasive procedures at the emergency department: what is the opinion of Spanish medical staff? Pediatr Emerg Care 2011; 27:86-91. [PMID: 21252814 DOI: 10.1097/pec.0b013e3182094329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Family presence (FP) during invasive procedures (IPs) in children remains controversial among pediatric emergency department (PED) staff. The authors aimed to determine health care providers' attitudes toward FP during IPs in Spain, to learn whether parents are given the option of being present during different IPs, and to study which factors influence the providers' opinions. METHODS Observational study. Physicians and nurses were asked to answer a questionnaire, which was sent to 43 PEDs and was available at the Spanish Pediatric Emergency Society Web site. RESULTS We obtained 222 questionnaires from 36 Spanish hospitals. A total of 65.8% of the surveys were answered by physicians (66.4% pediatricians) and 34.2% by nurses. The median age of the respondents was 32 years, and 69.2% were women. Parents were given the option of being present during blood sampling (36.4%), intravenous line placement (32.7%), urethral catheterization (32.1%), lumbar puncture (13.5%), and resuscitation (1%). More than 60% of providers approved of FP during blood sampling, sutures, intravenous line placement, and urethral catheterization; however, only 10.8% of providers encourages FP during resuscitation. Against FP, health care staff argue procedural invasiveness (75.6%), parents' anxiety (87.6%), and worsened performance of the procedure (66%). Commonly expressed advantages were reducing patient distress (72.9%) and parent anxiety (62.3%). Physicians, especially the older ones, are more likely to encourage FP than nurses for some IPs. CONCLUSIONS The PED staff tend to prefer parents not to be present during IPs as the level of invasiveness increases. Family presence is not common in Spanish PEDs. Older physicians are more likely to support FP than nurses.
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Cloutier RL, Walthall JDH, Mull CC, Nypaver MM, Baren JM. Best educational practices in pediatric emergency medicine during emergency medicine residency training: guiding principles and expert recommendations. Acad Emerg Med 2010; 17 Suppl 2:S104-13. [PMID: 21199076 DOI: 10.1111/j.1553-2712.2010.00893.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The state of pediatric emergency medicine (PEM) education within emergency medicine (EM) residency programs is reviewed and discussed in the context of shifting practice environments and new demands for a greater focus on the availability and quality of PEM services. The rapid growth of PEM within pediatrics has altered the EM practice landscape with regard to PEM. The authors evaluate the composition, quantity, and quality of PEM training in EM residency programs, with close attention paid to the challenges facing programs. A set of best practices is presented as a framework for discussion of future PEM training that would increase the yield and relevance of knowledge and experiences within the constraints of 3- and 4-year residencies. Innovative educational modalities are discussed, as well as the role of simulation and pediatric-specific patient safety education. Finally, barriers to PEM fellowship training among EM residency graduates are discussed in light of the shortage of practitioners from this training pathway and in recognition of the ongoing importance of the EM voice in PEM.
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Affiliation(s)
- Robert L Cloutier
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
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Patientsʼ and relativesʼ view on witnessed resuscitation in the emergency department: a prospective study. Eur J Emerg Med 2010; 17:203-7. [DOI: 10.1097/mej.0b013e328331477e] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gamell Fullà A, Corniero Alonso P, Parra Cotanda C, Trenchs Sainz de la Maza V, Luaces Cubells C. [Are parents present during invasive procedures? Assessment in 32 Spanish hospitals]. An Pediatr (Barc) 2010; 72:243-9. [PMID: 20149769 DOI: 10.1016/j.anpedi.2009.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 11/04/2009] [Accepted: 11/06/2009] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- A Gamell Fullà
- Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Baumhover N, Hughes L. Spirituality and support for family presence during invasive procedures and resuscitations in adults. Am J Crit Care 2009; 18:357-66; quiz 367. [PMID: 19556414 DOI: 10.4037/ajcc2009759] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Many health care professionals believe that they provide holistic care. The role of spirituality, a known variable of holism, has not been explored in relation to the support among health care professionals for family presence during invasive procedures and resuscitative efforts in adults. OBJECTIVE To determine the relationship between spirituality of health care professionals and their support for family presence during invasive procedures and resuscitative efforts in adults. METHODS In this descriptive correlational study, 108 participants (physicians, physician assistants, and nurses) completed the Howden Spirituality Assessment Scale and a survey to measure their support for family presence. RESULTS A significant positive relationship was found between spirituality and support for family presence during resuscitative efforts in adults (r = 0.24, P = .05) and a significant negative correlation was found between support for family presence and the age of the health care professional (r = - 0.27, P = .01). No significant correlations were found between any of the study variables and invasive procedures in adults. CONCLUSIONS Adopting a more holistic perspective may support family presence, especially during resuscitative efforts in adults. Allowing the option for patients' families to remain present promotes holistic family-centered care.
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Affiliation(s)
- Nancy Baumhover
- Nancy Baumhover is a clinical assistant professor in adult critical care at Arizona State University in Phoenix. Linda Hughes is a professor and director of undergraduate nursing programs at Nebraska Methodist College at The Josie Harper Campus in Omaha
| | - Linda Hughes
- Nancy Baumhover is a clinical assistant professor in adult critical care at Arizona State University in Phoenix. Linda Hughes is a professor and director of undergraduate nursing programs at Nebraska Methodist College at The Josie Harper Campus in Omaha
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Should relatives witness resuscitation in the emergency department? The point of view of the Belgian Emergency Department staff. Eur J Emerg Med 2009; 16:87-91. [DOI: 10.1097/mej.0b013e32830abe17] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parra Cotanda C, Luaces Cubells C, Pou Fernández J. ¿Deberían estar presentes los padres durante los procedimientos invasivos en urgencias? An Pediatr (Barc) 2009; 70:293-6. [DOI: 10.1016/j.anpedi.2008.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 09/08/2008] [Accepted: 09/09/2008] [Indexed: 10/20/2022] Open
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Maxton FJC. Parental presence during resuscitation in the PICU: the parents' experience. Sharing and surviving the resuscitation: a phenomenological study. J Clin Nurs 2009; 17:3168-76. [PMID: 19012784 DOI: 10.1111/j.1365-2702.2008.02525.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVE To provide in-depth understanding of the meaning for parents who were present or absent during a resuscitation attempt on their child in the PICU. BACKGROUND Family presence during resuscitation remains a topic of debate with both benefits and disadvantages identified, yet few studies have asked parents of children in PICU to describe their experiences of being present or absent during this resuscitation and what this means to their understanding and coping. Additionally, minimal research has investigated parental presence during a successful resuscitation. DESIGN A qualitative design was used based upon van Manen's interpretative phenomenological approach. METHODS Fourteen parents of critically ill children from one paediatric intensive care unit in Australia, who had either survived or died following a resuscitation attempt were interviewed. RESULTS Four main themes were identified: (1) being only for a child; (2) making sense of a living nightmare; (3) maintaining hope in the face of reality; (4) living in a relationship with staff. CONCLUSIONS The findings underpin the inherent need for parents to choose to be present during resuscitation to make sense of the situation. Memories of the resuscitation were not long-lasting and distress was for the potential death of a child, rather than the resuscitation scene. Parents who did not witness their child's resuscitation were more distressed than those who did. Having the opportunity to make the decision to stay or leave was important for parents. Support during the resuscitation was best provided by experienced clinical nurses. RELEVANCE TO PRACTICE Recognition of the parents' compelling need to stay will improve nurses' understanding of how witnessing this event may assist family coping and functioning. Ways in which parents may be better supported in making the decision to stay or leave during resuscitation are identified.
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Affiliation(s)
- Fiona J C Maxton
- School of Nursing, Midwifery & Social Care, Faculty of Health, Life and Social Sciences, Napier University, Edinburgh, UK.
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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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Tinsley C, Hill JB, Shah J, Zimmerman G, Wilson M, Freier K, Abd-Allah S. Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics 2008; 122:e799-804. [PMID: 18829777 DOI: 10.1542/peds.2007-3650] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Having parents present during cardiopulmonary resuscitation is becoming a common practice in pediatrics. This study aimed to determine parents' perception of the effects of their presence during the resuscitation efforts of their child and whether they would recommend the experience to other families. METHODS This study included parents or guardians of children who underwent cardiopulmonary resuscitation, and died at least 6 months before the interview. After telephone consent was obtained, a survey questionnaire was completed. The interviewees answered whether they were asked to be present, whether they had physical contact with their child, and whether the experience frightened them or gave them and their child comfort. The interviewees were asked to express their feelings about what was helpful to them and what could be done to improve the experience. RESULTS A total of 41 interviews were conducted, and responders were divided into 2 groups: 21 in the present group and 20 in the not-present group for cardiopulmonary resuscitation. Twelve (60%) of those in the not-present group believed that their presence would have comforted the child, and 50% (10 of 20) believed that it would have helped them accept the child's death. Of those in the present group, 67% (8 of 12) believed that touching their child brought comfort, 29% (6 of 21) felt scared during cardiopulmonary resuscitation, 71% (15 of 21) believed that their presence comforted their child, and 67% (14 of 21) believed that their presence helped them adjust to the loss of the child. The majority in both groups (63% [26 of 41]) would recommend being present during cardiopulmonary resuscitation. CONCLUSIONS This study supports encouraging family presence during cardiopulmonary resuscitation. The majority of parents who had been present and those who had not been present believed that all families should be given the option to be present.
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Affiliation(s)
- Cynthia Tinsley
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA 92350, USA.
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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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Beckman AW, Sloan BK, Moore GP, Cordell WH, Brizendine EJ, Boie ET, Knoop KJ, Goldman MJ, Geninatti MR. Should Parents Be Present during Emergency Department Procedures on Children, and Who Should Make That Decision? A Survey of Emergency Physician and Nurse Attitudes. Acad Emerg Med 2008. [DOI: 10.1197/aemj.9.2.154] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Andrew W. Beckman
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Brian K. Sloan
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Gregory P. Moore
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - William H. Cordell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Edward J. Brizendine
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Eric T. Boie
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Kevin J. Knoop
- Department of Emergency Medicine, Naval Medical Center, Portsmouth, VA
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Effect of emergency department care on outcomes in pediatric trauma: what approaches make a difference in quality of care? ACTA ACUST UNITED AC 2008; 63:S136-9. [PMID: 18091205 DOI: 10.1097/ta.0b013e31815acd19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Deriving evidence-based best practice for each phase or setting of trauma care is necessary to maximize best outcomes. There is a paucity of studies examining the association of provider training on pediatric trauma outcomes. Pivotal decisions (whether and where to transfer, diagnostic workup, and initial resuscitation) occur in this setting, yet there is little evidence relating to best practices in those areas. Classic process-performance measures such as time intervals during care (e.g., time to computerized tomography scan, time to operating room, etc.) or utilization measures (American College of Surgeons designation) are commonly used in the trauma center certification process, yet process-outcome links relevant to children are lacking. Although great advances have been made in the trauma care delivered to children, scientific proof is lacking and much more needs to be done to establish the evidence-based need to deliver the highest quality of pediatric trauma care.
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Dingeman RS, Mitchell EA, Meyer EC, Curley MAQ. Parent presence during complex invasive procedures and cardiopulmonary resuscitation: a systematic review of the literature. Pediatrics 2007; 120:842-54. [PMID: 17908772 DOI: 10.1542/peds.2006-3706] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We conducted a systematic review of the literature on parent presence during complex invasive pediatric procedures and/or resuscitation. We identified 15 studies that met our inclusion criteria. All studies were summarized chronologically according to level of evidence. The studies all demonstrated that parents prefer to have the choice about whether they remain at their child's side during complex invasive procedures and resuscitation, but they also revealed that apprehensions and controversy abound among clinicians regarding this practice. Despite the endorsements of the American Academy of Pediatrics and the Society of Critical Care Medicine and the recommendations of the American Heart Association, few pediatric institutions have drafted guidelines, conducted clinical education, or committed sufficient staff resources to fully support this practice. We present this review not only to illustrate the various perspectives of parents/guardians, clinicians, and pediatric patients themselves that have been reported to date but also to encourage more research so that the practice can be performed safely and benefit parents, their children, and clinicians alike.
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Affiliation(s)
- R Scott Dingeman
- Children's Hospital Boston, Department of Anesthesiology, Perioperative and Pain Medicine, 300 Longwood Ave, Boston, MA 02115, USA.
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Nigrovic LE, McQueen AA, Neuman MI. Lumbar puncture success rate is not influenced by family-member presence. Pediatrics 2007; 120:e777-82. [PMID: 17908735 DOI: 10.1542/peds.2006-3442] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OVERVIEW The presence of a family member during invasive pediatric procedures such as lumbar puncture has been shown to reduce patient anxiety. However, family presence might also affect clinicians' stress and anxiety, with uncertain consequences for procedural success. OBJECTIVE Our goal was to evaluate the association between family-member presence and lumbar puncture success rates. DESIGN/METHODS We performed a prospective cohort study of all children who underwent a lumbar puncture in a single pediatric emergency department between July 2003 and January 2005. The presence of a family member was documented by the physician who performed the lumbar puncture. Success rates were assessed by using 2 main outcomes: (1) the rate of traumatic (cerebrospinal fluid red blood cells > or = 10,000 cells per microL) or unsuccessful lumbar puncture (no cerebrospinal fluid sent for cell counts) and (2) the number of lumbar puncture attempts. Multivariate analyses were adjusted for patient age, race, time of day, physician experience, use of local anesthetic, catheter stylet removal, and patient movement during the procedure. RESULTS Of the 1474 eligible lumbar punctures, 1459 (99%) were included in the analysis. A family member was present for 1178 (81%) of the procedures studied. A total of 1267 (87%) lumbar punctures were nontraumatic, and 192 (13%) were traumatic or unsuccessful. Neither the rate of traumatic or unobtainable lumbar punctures nor the number of lumbar puncture attempts differed based on whether a family member was present for the procedure. CONCLUSIONS The presence of a family member was not associated with an increased risk of traumatic or unobtainable lumbar puncture, nor was it associated with more attempts at the procedure. The benefits of having a family member present during the procedure were not counterbalanced by adverse effects on procedural success.
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Affiliation(s)
- Lise E Nigrovic
- Division of Emergency Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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O'Connell KJ, Farah MM, Spandorfer P, Zorc JJ. Family presence during pediatric trauma team activation: an assessment of a structured program. Pediatrics 2007; 120:e565-74. [PMID: 17766498 DOI: 10.1542/peds.2006-2914] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE When a child presents to a trauma center with a serious injury, family members are often excluded from the initial trauma team evaluation. The objective of this study was to evaluate the outcomes of a structured program of family presence during pediatric trauma team activations by measuring (1) the need for termination of family presence, (2) times to completion of key parts of the trauma evaluation, and (3) the opinions of staff surveyed immediately after conclusion of family presence. METHODS This was a cross-sectional study that combined prospectively obtained data and surveys from trauma team evaluations in which family presence occurred, with retrospective chart review of all trauma activations during an 18-month study period. The study was conducted at a level 1 pediatric trauma center with a preestablished family presence program that assigns a staff member to screen family members for family presence, provide support, and record events. Times to completion of key components of the trauma evaluation were calculated and compared for cases with and without family presence. Cross-sectional surveys were performed immediately after each trauma team evaluation. RESULTS A total of 197 family members participated in family presence. There were no cases of interference with medical care by family members. Seven family members were asked to leave the trauma area by staff after initiation of family presence for various reasons. Times to completion of key components of the trauma evaluation did not differ significantly between enrolled patients with family presence and those without family presence. Surveys were completed for 136 cases, and the majority of providers reported that family presence either had no effect on or improved medical decision-making (97%), institution of patient care (94%), communication among providers (92%), and communication with family members (98%). CONCLUSIONS This prospective study suggests that there is an overall low prevalence of negative outcomes associated with family presence during pediatric trauma team evaluation after implementation of a structured family presence program. Excluding family members as a routine because of provider concerns about negative impact on clinical care does not seem to be indicated.
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Affiliation(s)
- Karen J O'Connell
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 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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Ryan G, Treston G. Do family members interfere in the delivery of care when present during invasive paediatric procedures in the emergency department? Emerg Med Australas 2007; 19:234-40. [PMID: 17564691 DOI: 10.1111/j.1742-6723.2007.00962.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether family members interfere with patient care when present during invasive procedures performed on their children in the ED. METHODS A prospective observational study of consecutive cases of procedural sedation of children aged between 12 months and 16 years was conducted between March 2002 and March 2006 in the ED of a secondary-level regional hospital in south-east Queensland. Procedures performed included laceration repair, fracture reduction, foreign body removal and abscess incision and drainage. Parents/primary caregivers were encouraged to stay with their child. A stepwise explanation of the procedure and sedation to be used was undertaken, informed consent obtained and telephone follow up attempted 5-14 days post procedure. RESULTS Six hundred and fifty-two patient encounters with parents or primary caregivers present for the procedure were included for a total of 656 procedures: 234 laceration repairs, 250 fracture reductions, 85 foreign body removals, 33 abscess incision and drainages, 14 dislocation reductions and 40 other procedures. Telephone follow up was successful in 65% (424) of cases. The mean age was 6.5 years. Family member interference occurred in one case (0.15%, 95% confidence interval 0-0.73%). In 17 cases (2.68%, 95% confidence interval 2.1-5.9%) family members present expressed concerns about the procedure during the telephone follow up but had not interfered at the time of the procedure. There were no significant differences between the concerned parents at follow up and the study group across key patient variables such as child's age (P = 0.369), weight (P = 0.379), respiratory rate (P = 0.477), sex (P = 0.308), procedure indication (P = 0.308) and airway manoeuvres (P = 0.153). CONCLUSION When family members are encouraged to stay for invasive procedures performed on their child, and careful explanation of the procedure, sedation, possible complications, choice of medication for sedation and possible side-effects is undertaken, family member interference is extremely rare.
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Affiliation(s)
- Glenn Ryan
- Redcliffe District Hospital, Redcliffe, Queensland, Australia.
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Duran CR, Oman KS, Abel JJ, Koziel VM, Szymanski D. Attitudes Toward and Beliefs About Family Presence: A Survey of Healthcare Providers, Patients’ Families, and Patients. Am J Crit Care 2007. [DOI: 10.4037/ajcc2007.16.3.270] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Although some healthcare providers remain hesitant, family presence, defined as the presence of patients’ family members during resuscitation and/or invasive procedures, is becoming an accepted practice. Evidence indicates that family presence is beneficial to patients and their families.
Objectives To describe and compare the beliefs about and attitudes toward family presence of clinicians, patients’ families, and patients.
Methods Clinicians, patients’ families, and patients in the emergency department and adult and neonatal intensive care units of a 300-bed urban academic hospital were surveyed.
Results Surveys were completed by 202 clinicians, 72 family members, and 62 patients. Clinicians had positive attitudes toward family presence but had concerns about safety, the emotional responses of the family members, and performance anxiety. Nurses had more favorable attitudes toward family presence than physicians did. Patients and their families had positive attitudes toward family presence.
Conclusions Family presence is beneficial to patients, patients’ families, and healthcare providers. As family presence becomes a more accepted practice, healthcare providers will need to accommodate patients’ families at the bedside and address the barriers that impede the practice.
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Affiliation(s)
- Christine R. Duran
- Christine R. Duran was a Kidney and Pancreas Transplant Nurse Coordinator and Virginia M. Koziel was a nurse in the emergency department at the University of Colorado Hospital; Duran is now a clinical nurse coordinator in the Hematological Malignancies and Blood and Marrow Transplant Program and Koziel is a nurse in the postanesthesia care unit at the University of Colorado Hospital, Denver, Colo
| | - Kathleen S. Oman
- Kathleen S. Oman is a research nurse scientist in the Professional Resources Department, Deborah Szymanski is an emergency department nurse, and Jenni Jordan Abel is a nurse in the surgical intensive care unit at the University of Colorado Hospital, Denver, Colo
| | - Jenni Jordan Abel
- Kathleen S. Oman is a research nurse scientist in the Professional Resources Department, Deborah Szymanski is an emergency department nurse, and Jenni Jordan Abel is a nurse in the surgical intensive care unit at the University of Colorado Hospital, Denver, Colo
| | - Virginia M. Koziel
- Christine R. Duran was a Kidney and Pancreas Transplant Nurse Coordinator and Virginia M. Koziel was a nurse in the emergency department at the University of Colorado Hospital; Duran is now a clinical nurse coordinator in the Hematological Malignancies and Blood and Marrow Transplant Program and Koziel is a nurse in the postanesthesia care unit at the University of Colorado Hospital, Denver, Colo
| | - Deborah Szymanski
- Kathleen S. Oman is a research nurse scientist in the Professional Resources Department, Deborah Szymanski is an emergency department nurse, and Jenni Jordan Abel is a nurse in the surgical intensive care unit at the University of Colorado Hospital, Denver, Colo
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Mian P, Warchal S, Whitney S, Fitzmaurice J, Tancredi D. Impact of a Multifaceted Intervention on Nurses’ and Physicians’ Attitudes and Behaviors Toward Family Presence During Resuscitation. Crit Care Nurse 2007. [DOI: 10.4037/ccn2007.27.1.52] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Patricia Mian
- Patricia Mian is a psychiatric clinical nurse specialist, Susan Warchal and Susan Whitney are staff nurses, and David Tancredi is an attending physician in the emergency department at Massachusetts General Hospital, Boston, Mass. Joan Fitzmaurice is director of the Office of Quality and Patient Safety at Massachusetts General Hospital
| | - Susan Warchal
- Patricia Mian is a psychiatric clinical nurse specialist, Susan Warchal and Susan Whitney are staff nurses, and David Tancredi is an attending physician in the emergency department at Massachusetts General Hospital, Boston, Mass. Joan Fitzmaurice is director of the Office of Quality and Patient Safety at Massachusetts General Hospital
| | - Susan Whitney
- Patricia Mian is a psychiatric clinical nurse specialist, Susan Warchal and Susan Whitney are staff nurses, and David Tancredi is an attending physician in the emergency department at Massachusetts General Hospital, Boston, Mass. Joan Fitzmaurice is director of the Office of Quality and Patient Safety at Massachusetts General Hospital
| | - Joan Fitzmaurice
- Patricia Mian is a psychiatric clinical nurse specialist, Susan Warchal and Susan Whitney are staff nurses, and David Tancredi is an attending physician in the emergency department at Massachusetts General Hospital, Boston, Mass. Joan Fitzmaurice is director of the Office of Quality and Patient Safety at Massachusetts General Hospital
| | - David Tancredi
- Patricia Mian is a psychiatric clinical nurse specialist, Susan Warchal and Susan Whitney are staff nurses, and David Tancredi is an attending physician in the emergency department at Massachusetts General Hospital, Boston, Mass. Joan Fitzmaurice is director of the Office of Quality and Patient Safety at Massachusetts General Hospital
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Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med 2007; 35:605-22. [PMID: 17205007 DOI: 10.1097/01.ccm.0000254067.14607.eb] [Citation(s) in RCA: 857] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines for the support of the patient and family in the adult, pediatric, or neonatal patient-centered ICU. PARTICIPANTS A multidisciplinary task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM) to include representation from adult, pediatric, and neonatal intensive care units. EVIDENCE The task force members reviewed the published literature. The Cochrane library, Cinahl, and MedLine were queried for articles published between 1980 and 2003. Studies were scored according to Cochrane methodology. Where evidence did not exist or was of a low level, consensus was derived from expert opinion. CONSENSUS PROCESS The topic was divided into subheadings: decision making, family coping, staff stress related to family interactions, cultural support, spiritual/religious support, family visitation, family presence on rounds, family presence at resuscitation, family environment of care, and palliative care. Each section was led by one task force member. Each section draft was reviewed by the group and debated until consensus was achieved. The draft document was reviewed by a committee of the Board of Regents of the ACCM. After steering committee approval, the draft was approved by the SCCM Council and was again subjected to peer review by this journal. CONCLUSIONS More than 300 related studies were reviewed. However, the level of evidence in most cases is at Cochrane level 4 or 5, indicating the need for further research. Forty-three recommendations are presented that include, but are not limited to, endorsement of a shared decision-making model, early and repeated care conferencing to reduce family stress and improve consistency in communication, honoring culturally appropriate requests for truth-telling and informed refusal, spiritual support, staff education and debriefing to minimize the impact of family interactions on staff health, family presence at both rounds and resuscitation, open flexible visitation, way-finding and family-friendly signage, and family support before, during, and after a death.
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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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Fulbrook P, Latour JM, Albarran JW. Paediatric critical care nurses' attitudes and experiences of parental presence during cardiopulmonary resuscitation: a European survey. Int J Nurs Stud 2006; 44:1238-49. [PMID: 16836999 DOI: 10.1016/j.ijnurstu.2006.05.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 04/07/2006] [Accepted: 05/18/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although recent resuscitation guidelines are supportive of family presence during cardiopulmonary resuscitation literature from the last decade suggests that it is often discouraged, and the subject remains a controversial issue. OBJECTIVES To determine the experiences and attitudes of European paediatric critical care nurses about parental presence during the resuscitation of a child. DESIGN A survey design was employed. PARTICIPANTS A convenience sample of European paediatric critical care nurses was used. METHODS A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a 5-point Likert scale. Differences in attitudes were explored in three areas: decision-making, processes and outcomes of resuscitation. RESULTS The results from this survey suggest that European paediatric nurses are very supportive of parental presence during cardiopulmonary resuscitation. Only a few nurses reported that their unit had a policy that covered parental presence during cardiopulmonary resuscitation and most nurses did not support the use of a dedicated nurse to look after the parents during resuscitation. CONCLUSIONS Compared with previous studies relating to adult cardiopulmonary resuscitation, paediatric nurses experience family member presence more frequently than adult critical care nurses and appear to be more supportive of relatives' presence. It is recommended that paediatric intensive care units establish local policies that cover parental presence during cardiopulmonary resuscitation.
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Affiliation(s)
- P Fulbrook
- School of Nursing and Midwifery, Australian Catholic University, Brisbane Campus, PO Box 456, Virginia, Qld 4014, Australia.
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Egemen A, Ikizoğlu T, Karapnar B, Coşar H, Karapnar D. Parental presence during invasive procedures and resuscitation: attitudes of health care professionals in Turkey. Pediatr Emerg Care 2006; 22:230-4. [PMID: 16651911 DOI: 10.1097/01.pec.0000210178.86504.80] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES An agreement among physician, nurse, and family on the issue and a solution developed by all will improve the quality of work. The aims of this study were to determine health care professionals' (physicians and nurses) attitude toward parental presence during invasive procedures and toward parental participation in this decision and to investigate the difference between the approach of physicians and nurses. METHODS This study was performed on the physicians and nurses of the Medical Faculty of the Department of Pediatrics of Ege University between December 2003 and March 2004. The questionnaire delivered was completed by 49 (94%) of 52 nurses and 51 (89%) of 57 physicians. RESULTS Parental presence during blood sampling, simple wound repair/suture, lumbar puncture, and bone marrow aspiration/biopsy was approved by 72.5%, 27.5%, 66.7%, and 82.4% of the physicians and 53.1%, 57.1%, 81.6%, and 85.7% of the nurses, respectively. None of the health care professionals preferred parents to attend during any kind of resuscitation. Attitudes of the nurses and physicians were found to be similar between the 2 groups except for simple wound repair. Major determinants of the decision about the agreement for parental presence were procedural invasiveness for physicians (reported by 82.5%) and level of sedation for nurses (reported by 75.5%). The mean ages of both groups of health care professionals who did not approve parental presence during invasive procedures were lower than that of the ones who approved for all procedures. CONCLUSION The physicians and nurses in the study population tended to prefer parents not to be present during procedures as the level of invasiveness increased. An agreement between the attitudes of physicians and nurses toward parental presence during invasive procedures is essential for improving quality of service, especially in the dynamic environment of the emergency department.
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Affiliation(s)
- Ayten Egemen
- Faculty of Medicine, Social Pediatrics Department, Ege University, Izmir, Turkey.
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