Why should family presence be allowed in the ER?

Families often want to spend the last moments of a loved ones' life with them at the bedside. Here are some thoughts.

Why should family presence be allowed in the ER?

Families are the basic unit of our society. One of the most stressful events in a family occurs when a member has a health crisis and comes to the emergency department. Family presence is often the only comfort these families can provide to their loved one who is seriously ill or critically injured.

Families should be allowed to remain with their family members during resuscitation or invasive line placement, with appropriate support mechanisms in place. “Family members are frequently not given the opportunity to remain with the patient during invasive procedures, including resuscitation efforts” (Emergency Nurses Association (ENA), 2004). Many factors influence this decision including healthcare providers’ perception that it will be too stressful on family members. The American Heart Association recommends giving family members the choice to remain with their loved ones during resuscitation efforts (Shelton, 2000). The American Nurses Association (ANA) Code of Ethics “has been acknowledged by other health care professions as one of the most complete. It is sometimes used as the benchmark against which other codes of ethics are measured” (ANA, 2005). The first part of this code states that nurses must provide services with respect for human dignity. The most undignified act all mankind experience is death. To give dignity to patients during the resuscitation process is to follow the ANA Code of Ethics (ANA, 2005). This is why family presence during resuscitation or invasive line placement is an important policy to have in place.

References:

American Nurses Association. (2005). Code of Ethics.

http://www.nursingworld.org/ethics/ecode.htm

Emergency Nurses Association. (2004). Family presence at the bedside during invasive procedures and resuscitation. http://www.ena.org/about/position/familypresence.asp

Shelton, D. (2000). The American Heart Association tackles a social-ethical issue.

http://www.ama-assn.org/amednews/2000/09/18/hll20918.htm

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traumaRUs

About traumaRUs, MSN, APRN

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Specializes in Management, Emergency, Psych, Med Surg.

My experience in the ED has been very positive with having the family members present. I find it to be most helpful. Having family members present for resuscitation was usually OK except in times when the pt had suffered great trauma and the situation was very bloody. That just did not work out well. I do feel that it is helpful to have parents with their children as often as possible. It is reassuring to the parents and the patients. I have never experienced any kind of legal action as a result of family members being in the room during an emergency.

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Specializes in ER, Teaching, HH, CM, QC, OB, LTC.

I too agree that family (SO) presence is helpful to pt and to the family in the ER. (As well as the floors or units). I dofeel strongly that an educator/advocate be on site with the family to gauge the stress levels and intervene before it gets to much if possible or at least when it does. My disabled hubby was just in an ICU post op and was not even allowed to assist with oral care. Talk about feeling helpless and impotent. Then when placed on the floor, nothing was done for him. It was expected that I would do the needed personal care. It is imprortant to involve the family in care from the start to perpare for them for the future.

fgoff

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Specializes in ER, TRAUMA, MED-SURG.

I agree also, the presence of family members in the ER does in most cases have a positive effect in many cases. I have worked trauma codes where it was just a really bad idea to have them in there, family member has asthma, labile HTN CP, that type of thing because it just gives the potential for the stress of the patient's illness/injury. IMO, if a patient is brought so severly injured, the doc has to crack the chest, then I just can't see it help a whole lot. If they can come in when most of that cricically invasive procedures are not actively in progress, not a problem.

I have coded infants and children where we do allow the patient's parents or grandparents to be with the baby, and we have gotten rocking chairs and brought them in for parent/grand to spend time with them after the code is over. I know it is heartbreaking enough to lose your baby or child, but horrible to be placed in a waiting room and not get to be near him or her, to touch them or not see that the doc is trying so very hard to take care of their little one.

Anne, RNC

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Specializes in ER, TRAUMA, MED-SURG.
My experience in the ED has been very positive with having the family members present. I find it to be most helpful. Having family members present for resuscitation was usually OK except in times when the pt had suffered great trauma and the situation was very bloody. That just did not work out well. I do feel that it is helpful to have parents with their children as often as possible. It is reassuring to the parents and the patients. I have never experienced any kind of legal action as a result of family members being in the room during an emergency.

Right. I know people do worry about that, but thank goodness, I haven't had to deal with this isssue resulting from family being in there. They do need to be gauged, maybe, and if a clergy and/or trained staff member - grief or social - there to assist.

Anne, RNC

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Specializes in Med/Surg, ER.

only 2 at a time please. and then stay out of the way.

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Specializes in ER, TRAUMA, MED-SURG.
only 2 at a time please. and then stay out of the way.

Amen to that!!! I'm all for the family wanting to be involved and being able to be there during recuss, but here in Louisiana, we had a young man, in his 40s that was a full code and arrested. two family members laid down in the middle of the floor between the patient and the door because even though the pt wanted to be coded, the family that was there didn't agree. Talk about a PIA!!

Also, here we have a wide variety of religious beliefs, you never know what to expect. In the ER, we have had people come in with the patient and do some crazy things, grief or stress related. We've had them try to lay down on the patient in the bed or stretcher while we are coding them, had them actually stand on their head and start spinning around on the floor. That just scratches the surface!

Anne, RNC

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Specializes in Nephrology, Cardiology, ER, ICU.

You illustrate good points. This is why it is imperative that there be a separate support person for the family who discusses with them what they are going to see and who has the experience and knowledge to know who should come in to the resus room and when. If there is no support person available, then again family presence must be judged on a case by case basis.

thanks.

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Specializes in ER, TRAUMA, MED-SURG.
You illustrate good points. This is why it is imperative that there be a separate support person for the family who discusses with them what they are going to see and who has the experience and knowledge to know who should come in to the resus room and when. If there is no support person available, then again family presence must be judged on a case by case basis.

thanks.

You're right. Even some of the family members who have waited in the hall or in a lounge down the hall when patients at our facility have coded have either had a syncopal episode, onset of chest pain, or the like. I had one MD who responded to the code and after the patient was pronounced, the doc wrote us an order like -

1. Release body to funeral home

2. If not allergic to med, give _____, _______, and __________ (insert the deceased pt's family members here

I actually had a wife have a seizure and code in the waiting room during the code of the patient. And you are right, you do have to evaluate on a case by case basis regarding "fit basis" to allow them entry to the code. If at all possible, we try to get the chaplin or social worker to accompany them in after explaining what they will see and why it is crucial at the time. We try to have a w/c in close proximity just in case.

Anne, RNC

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At our Level I, we have Spiritual Care, which is basically chaplains, ministers, or priests that are there 24/7. They are the ones that are the 'go between' for the family. They are skilled in their craft and I have seen some wonderful interventions with these men and women. I, too, believe that it is a case by case basis. Some family members are so hysterical that it would impede any resuscitation efforts. But, every effort is made to involve the families ASAP. In cases where there is too much blood, we clean them up first, and we even have a private room where the family can spend time with their deceased once they are presentable. The chaplains are involved in every step of this process.

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Specializes in Nephrology, Cardiology, ER, ICU.

ilovemypuppies - what type of system does your hospital have for handling family presence during codes? Are you able to staff well enough to have either a nurse or other support person be there solely for the families?

dogs4me - sounds like you have a wonderful support system. To be able to provide privacy for family viewing is awesome. I worked for 10 years in a level one trauma center and our space was at a premium 24/7. Heck, we saw people in the hallways, bathrooms, you name it. So...we had no space for priavcy. You are very lucky.

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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 :redpinkhe They are very near and dear to our hearts, for sure.

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