Why should family presence be allowed in the ER?

Trauma,

(Blush) I am proud of our hospital. When I bring in a trauma alert (I'm a medic) and right after I give my report to the surgeon and trauma team, the chaplain is right on my heels with pen/paper asking me about name, family, were they there, did they see anything, any children involved, how were they coping, are they coming to the hospital, do I have a number for him to call, etc. etc.

The room they use for viewing used to be an x-ray room, but when we did some remodeling they made it into a 'family private' room. Our place is really crawling with chaplains all over the darn place...surgical waiting rooms, pt hallways, just looking for someone who wants to talk. And, the benefit for us is, they are our EAP counselors They are very near and dear to our hearts, for sure.

Hey Trauma -

I work in a busy ER that gets most of the patients from the south side and housing projects, as well as the Salvation Army homeless shelter. We are the main receiving point next to the LSU Charity hospital, so we get a lot of all the usual traumas daily. We do have some really wonderful staff, from MDs, nurses, and ER techs, and everyone is always ready to lend a hand in a crisis.

If EMS is en route with a code and we have been made aware, our secretary activates the code pager system to include resp, xray, the other usual staff and also the priest. It is a Catholic facility, so during the week on days, we usually have at least 2 clergy in house, also case mgrs and social workers. Our clergy, I feel, are just wonderful, and I have seen them arrive even before resp therapy arrives. We have a room that is kind of out of the way so to speak, from the usual ER hustle and bustle. It is nice, and can handle quite a large family. Dimly lit, and has a few couches, chairs. The clergy first talk to the family and are in and out of the code room if they can get in so they csn assess the situation, and also brief the family. Then they, or we if on nights, feels the family out as far as who would like to be in, their physical health and anxiety level at that time. They usually just take 1 at a time, and we actually don't have too many that want to go in. We keep a w/c just outside the door to the patients room, but out of the way of the staff. He will kind of explain in laymans terms what is going on and why it is being done.

One patient I remember in particular, coded and his wife was at the bedside. She refused to go in, which if they feel that way, I am more than happy to just let them stay in the family room, and get updates. This wife was just hysterical, and sobbing when I got her in the w/c. I would go in and see the status and return to the wife. and quietly talk to her "They have the tube in to help him breathe...his heart is just in a bad rhythym and the doc is foing _____ to fix it...Were giving this medicine to _____. This little lady, I felt so bad for her, she was just grief stricken and had no family at all. She looked up at me from her w/c and said, "Why are you telling me this? Is it because he is dead?!" I said, "Oh, no maam, The doctor is there and ... " And I told her, "I am coming out to let you know what they have going (what she could understand or tolerate) because that is your husband. If my husband was in there and coded, I would like to be able to know what is going on so you know how he is doing right now." She looked up at me again, eyes full of tears, and said, "You are the first person to ever do that for me. It is just so scary to just have to sit here by myself and not even know if he was alive or dead."

I kept my composure at the time, but when we were done, I had to go to the ladies room to catch a few tears that I knew were coming.

I have only had 1 patient where the family members were in the room, and we had to crack the chest. I was escorting them out and one ran up to the bedside and actually tried to put her hands inside the chest cavity while the MD was getting ready to defib with the internal paddles. Needless to say she got escorted out pretty dang fast!

Anne, RNC

You are right, it does take its toll - some of our nurses that just can not handle helping the family members during this time. For some reason, I have always been able to help explain to the family members what is happening, and I try my best if staffing permits. I am a trauma nurse by nature and enjoy being right up in it, so to speak.
I am usually the nurse that gets voluntereed to be the family advocate if the clergy and/or social workers are not readily available. When I was in college, my minor was in Sociology and I was able to take quite a few classes pertaining to death and dying. These classes were very useful and I was able to take quite a bit of knowledge that I feel has helped me assist these family members while going through the trauma.

Like most of us ER nurses, I am an adrenaline junky, and enjoy the traumas. For the most part, I have been able to keep my emotions in check until afterwards and we can have a little debriefing.

Anne, RNC

Trauma - Likewise! I had thought for quite a while that you and I feel a lot alike from reading our posts. I guess the classes I took for my Sociology minor really helped and for that reason, get nominated for the advocate pretty often.

I wish we did work in the same ER, it would be great!

Anne, RNC

I'm with you on two at a time. I've found that you have to keep monitoring the amount of familiy that try to sneek past the triage area to get to that pt's room. Don't get me wrong please. I'm a believer of letting the familiy at bedside for a code, but if they are in the way or overcrowding to the point where time is of the essence, they have got to go. Roller.

How do you deal with the obnoxious, nasty and rude family members without sounding that way yourself