How do Patients React to Family Presence During Invasive Procedures & Resuscitation?

Abstract & Commentary

Synopsis: Patients articulated that family presence provided comfort, strength, and support and helped them understand and cope with painful events. Patients believed that providers treated them more as persons, and less as cases, when family members were present.

Source: Eichhorn DJ, et al. During invasive procedures and resuscitation: Hearing the voice of the patient. Am J Nursing. 2001;101(5):48-55.

This study was conducted to determine how patients react to the presence of family members during invasive procedures. Subjects were 9 patients (3 men, 6 women) aged 32.2 ± 15.5 years (range, 15-63 years) who underwent a variety of invasive procedures following admission to an emergency department (ED) located in a university-affiliated regional level I trauma center. The procedures were orthopedic reduction (n = 3), lumbar puncture (n = 2), cardiopulmonary resuscitation (n = 1), chest tube insertion (n = 1), central line insertion (n = 1), and open wound exploration (n = 1). Each patient was interviewed by telephone approximately 2 months after the event using a series of open-ended questions. The conversation was audiotaped and transcribed. Two investigators trained in qualitative methodology then categorized patient comments into themes. Four other co-investigators then reviewed the categorization for accuracy.

Seven themes emerged from the data. Patients related feeling comfort, strength, and support because family members were present. None reported feeling uncomfortable with family members at the bedside. Patients perceived that family members acted as their advocates during the ED event by interpreting and explaining information to them. In addition, they felt that family presence helped humanize patients for health care providers. Several patients believed family presence prompted caregivers to try harder to help them survive. All patients viewed family presence as a right, but realized that it took a toll on family members and did not wish them to be present if it interfered with their care.

COMMENT BY LESLIE A. HOFFMAN, Phd, RN

Family presence during invasive procedures, a relatively new practice, has been attracting considerable media coverage. Numerous public opinion polls and surveys have considered the intervention, mainly from the perspective of family members or health care providers. In an earlier study, Meyers and associates reported findings, supported by the work of others, that indicated that family presence during invasive procedures had many benefits for family members.1 These included knowing everything possible was being done, feeling they had helped and supported the patient, and reducing their anxiety. There was no indication that family presence was disruptive to health care providers or caused adverse psychological effects. The present study represented an extension of this work to include interviews with patients who had family members present during the original study.

Patients who participated in this intervention reported a range of benefits. They were able to articulate why and how family presence was helpful and perceived the experience in a very positive manner. However, there are a number of limitations that prevent generalizing this study’s findings to all patients who undergo invasive procedures. Family members involved were screened by a trained facilitator who evaluated their coping skills and emotional stability prior to offering the visitation option. The facilitator also prepared family members prior entry into the ED and answered questions during and after the observation. Patient reactions might have been different if such support were not available. With the exception of cardiopulmonary resuscitation, the procedures observed were predictable in duration and relatively minor. Because admission was emergent, neither patient nor family had time to prepare, a factor that may have made family presence especially important. Nevertheless, results of this study, in combination with those of similar studies, suggest there can be considerable benefit to allowing family members to be present—at least in the ED—during invasive procedures. Of importance, findings of this study led to the development of a protocol for family presence during invasive procedures used at the study institution that is now in use hospital-wide and available on the Internet (www.utsouthwestern.edu/parkland/fp/fp.htm).

Reference

1. Meyers TA. Family presence during invasive procedures and resuscitation. Am J Nurs. 2000;100:32-42.