family present during invasive procedures???, Help! it's a school assignment!!!

hollykate · Sep 28, 2000

I go back and forth on this issue. For Children, I think the prescence of a calm and supportive family member is super- if they aren't calm, it just adds to the child's anxiety.

For minimally invasive stuff, IV's, foley's etc. I don't mind if the family wants to stay.

I have never, though, allowed family to stay for really invasive precedures such as a percutanous bedside trach. or putting burr holes in the head. These are really delicate procedures (If we drill too far with the burr holes, we are then drilling into the brain, eek) so I think the MD needs to concentrate, and I need to be monitoring the patient. Unless there is some support person to explain things, I don't think it a good idea. As an example, a lady once fainted as we were putting in a central line in the ED- she hit her head and ended up getting a CT and becoming a patient. She was already sitting in a chair when she fainted. SO that was a bad idea.

You may find a lot of info about family present during a code, I am not so sure about the procedures things.

Even though I have not allowed this since I became a nurse, I am interested in other RN's opinions and how they handle this!

babs_rn · Sep 29, 2000

I agree with the last post and would like to reiterate the last post's point that family can be a distraction for the staff. If they are present, a support person designated just for that should be there with them to quietly explain what is going on. I was involved in a code situation in the ED not long ago in which I was recording the code and the patient's husband was allowed in. Fine, if you have someone there for HIM, but in this case he just wanted to talk about her, about her life, about her children, etc etc etc to me while I am trying to record this code, he moved up into the area in which the code team was working and got in the way. NOT an ideal situation. There should be a chaplain for that if it is to be allowed. I do think it is a positive thing for the families to witness the codes so that they can see what it is we are doing, the fact that we really are doing everything we can, and sometimes the families will ask that the code be called ( a really positive thing when the patient is 150 years old and terminal and really should have been allowed to die peacefully in the first place).

As far as simple procedures such as IVs, blood draws, and Foleys, it depends on the individual situation. I do NOT believe a parent should be involved in restraining a child for these procedures because I believe it erodes the trust the child has in the parent to be the child's protector. But since this is for a critical care course, I doubt these are the types of invasive procedures you had in mind.

Generally, for the more critical procedures, my answer to that would have to be a firm "NO". Why? Back to the fact that the team needs to be able to work without distraction, without worrying about an uninvolved person in the background (by this I mean not professionally involved, I don't mean personally) who may actually get in the way and take up space in an already cramped room. Then there's the matter of blood and body fluids flying and spattering about, sharps here there and everywhere, the possibility of a family member being injured and (No! this would NEVER happen!) filing a lawsuit for damages. Do we go into our burning buildings so we can see what the firemen are doing as they try to save our houses? C'mon! It's not about "preserving the mystique" of the "medical professional" - it's about common sense. Things DO go wrong. Let's not have the family there, not fully understanding everything, jumping to their own conclusions about what's going on. As they say, a LITTLE knowledge is a dangerous thing.

I've been in just about every field of nursing (except OR and OB - wouldn't touch those with a 10 foot pole) in my 12+ years of experience, so these observations are based on at least a little bit of experience. Good luck with your course of study and, may I say, more power to you. I hope you find the nursing field to be a friendlier place in the future than it is now. I am leaving it, and so I feel I must pass the torch, so to speak.

Be well.

Babs

McIndia · Sep 30, 2000

I have been a registered nurse in CCU since I graduated four and a half years ago(that seems like an eternity)...I do not think family should be permitted unless the patient is a child or mentally challenged. Sometimes it is hard enough to contend with the patient during certain procedures...your loyalty becomes somewhat divided between the patient-the hysterical family-the doctor-the other staff that is trying to help...etc. Do you understand where I am going? My main concern is my patient and it becomes hard to focus with 1000 people asking questions...the family can be involved asap after the procedure. The family on one hand should sometimes witness a code to help them understand what kind of damage can be done...even if the code goes by the book(haha). Then on the other hand the family may get in the way trying to "help". All I know to really tell you is good luck with school and your career............LW

[This message has been edited by McIndia (edited September 29, 2000).]

JillR · Sep 30, 2000

I have to say that babs has some very valid points. I have seen family members come to the wrong conculions with even the most basic procedure. I have had people tell me that they require anesthesia to start ALL of there IV's because someone happened to not get them once. I might have been that the person was inexperienced, or it could have been that they were very dehydrated at the time. There is also the patients who tell you that that terrible nurse didn't know what she was doing when she tried to get the IV last time because she missed.

The general public is just not able to think beyond what is happening or has happened to their family under times of stress.

I don't think I would want to be in the room during an invasive procedure with my loved one. Would I want to witness the doctor drilling a burr hole in my childs head? NO way! That would be way to stressful to everyone involved and I sure don't want anyone under any extra stress while performing such a procedure.

I have been present when a nurse inserted an IV into my two year old and even THAT was enough for me. He was very dehydrated and chunky so it took a few tries to get it. I understood that rationale for this, but when it is you child, it makes it no easier to take his cries. I was lucky because my husband waited in my sons hosp room during the IV insertion and my son has a safe person to go to after.

As for Foleys, I wouldn't want my family there when they were performing that one.

Codes, alot of times I wish I had a choice. I am also am EMT, and we don't usually get a choice. I have seen families that handle this very well and seem to accept the death very well, and I have seen families that just want to get in there and tell the patient to fight and come back to them. While I understand the need for the families to do this, I also have had to ask police officers to remove family memebers because they were getting in the way. That is a bad situation all around and one I would rather not be put in. So having said all of that, I feel that family members in a code is okay IF there is proper emotional support for them during and after the code.

As you can see, this is a very complicated issue. Much of which depends upon the emotional state of the families involved. I have seen things go both ways in the field and I have to be honest, when things go wrong, it really gets ugly. I have seen otherwise completely rational, intellegent people do some very irrational things when their loved ones are involved.

There can never be a perfect yes/no answer to this question.

Thanks.

Jill

Trauma Columnist · Oct 3, 2000

Just had to add my 2cents in also. It's an individual decision that has to be made at the time. You can't make a hard and fast rule. Every situation is different.

sonnie · Oct 3, 2000

I have to agree with trauma4us. Each patient and family member is/are different and you really can't have a blanket statement. I have worked ER, OB, M/S, OR, CCU and just about everything in between, but when my husband needed surgery and the surgeon wanted to know if I wanted to watch I said no. I knew what they would do and I didn't feel like I could handle seeing my hubby on the OR table. It was hard enough to go to recovery immediately after the procedure and see him so pale. I knew that it was sometimes normal but yet it was concerning. Children are a different story all around. Sometimes parents are a god send and other times a royal pain. We assist with circ's and sometimes the fathers want to watch, I will always try to talk them out of it but some still stay. I tell them I will answer questions before or after but not during a procedure. I hope this helps. It is an individual choice.

csdrn · Oct 4, 2000

In response to the original question of whether or not family should be present during invasive procedures performed on patients--I say absolutely not. I think with family present patients may feel that they have to act a certain way during the procedure, which could add more unecessary stress to the patient. They may feel that they have to be "strong" in front of their family. Also, family does not have the medical background to understand the procedures occuring. I think it would cause great stress and concern for the family to see their loved one going through something invasive that they don't understand. As nurses we give families brief run downs of the procedures to be performed, but do not have time to explain the details, which would be necessary in watching such procedures. Family may become alarmed and distract medical staff from the patient with questions. Hopefully this provides another perspective for you.