Implementing a family presence policy: Six tips to consider

1. Assign a staff member to remain with the family member. "There needs to be a support person whose only job is the parent," stresses Nancy Eckle, RN, MEN, CEN, clinical nurse specialist in the ED at Children’s Hospital in Columbus, OH. "That person’s role is to shed light on what the parent sees. They can explain why it might take two or three tries to get an IV in a really sick child, why it doesn’t always work the first time."

At Wooster, the same nurse assigned to the family during resuscitation efforts also raises the issue of organ donation in the event of the patient’s death. "That’s normally a touchy subject, but it’s easier for the family members to deal with after they’ve gone through a real emotional hump with you," says Mary Anne Belanger, RN, CEN, an emergency nurse at Wooster Community Hospital (OH).

2. Alleviate staff concerns with hard facts. When staff at Wooster expressed concerns about liability, the issue was carefully researched. "We found there was no case on the books where a family member sued because of what they observed during a code," states Belanger.

3. Get feedback. At W.A. Foote Memorial Hospital in Jackson, MI, telephone surveys are used to get input from family members who have witnessed resuscitations. "It’s the most important thing you can do to gain acceptance with staff, because the feedback is always so positive," says Donna Strawser, RN, BSN, CEN, the hospital’s education specialist. "Almost 100% of the time, they tell us they are glad to have been present. When a patient died, they often feel their presence helped them to adjust."

4. Let family members decide how much they want to observe. "You need to continually assess their body language and how they’re doing," Eckle recommends. "Sometimes parents may complete their agenda by seeing their child, and then they want to step out."

At Butterworth Hospital and DeVos Children’s Hospital in Grand Rapids, MI, onsite social workers in the ED provide guidance on when and how to step in and out of the treatment room. "The needs of both the patient and the family should be taken into account," says Nan Hunt, MSW, CSW, clinical supervisor of the medical social work department.

The appropriateness of family presence depends on what’s going on at a given time, says Hunt. "There is sometimes a flurry of activity that may be difficult for family members to observe, such as a tracheotomy, but then there may be times when there is little activity, and it may be helpful for the patient to have somebody familiar with them at that time."

5. Encourage family members to interact with the patient when possible. At Wooster, parents are encouraged to speak to their loved one during resuscitation efforts. "At first, family members are often hesitant to talk to their loved one, but we have found it to be very beneficial," stresses Belanger. "We have spoken with patients who lived through cardiac arrest, who were very aware that their spouse was standing next to them and encouraging them."

6. Deal with each situation on a case-by-case basis. Even advocates agree that family presence isn’t always appropriate. "If this physician feels that it may interfere with the medical situation, or the facilitator feels the family is too volatile, or the family members themselves say, "I don’t want to see them like that," those are all good reasons not to do it," says Strawser.