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Nurses Pioneer Family Presence in the ER

Nurses Pioneer Family Presence in the ER

Heather Stringer / Monster Contributing Writer

Janine Dubina, RN, held a woman’s hand as the two watched an emergency room team try to revive the woman’s husband. Dubina, a nurse manager at University of California, San Diego (UCSD) Medical Center, explained to the wife that the team was doing CPR to help blood flow through the man’s body, and that they were giving medication to try to restart his heart. The man did not survive, but his wife was glad to have been there in his final moments.

It’s becoming more common to see relatives like this wife in the room during CPR. In fact, approximately half of 984 nurses surveyed by the Emergency Nurses Association (ENA) reported that their units allow the practice under special circumstances. However, only 5 percent of the nurses surveyed said their units have explicit policies about family presence in the ER and intensive-care unit.

ER nurses such as Dubina have witnessed firsthand the benefits of family presence for both patients and the loved ones – regardless of the outcome. As a result, nurses are leading the charge to implement this practice in hospitals. Many professional groups, such as the ENA and American Association of Critical-Care Nurses, also support the option.

Why It Works

Educating hospital staff about the benefits is one of the keys to convincing a department that family presence is a good idea.

“Allowing families at the bedside during CPR is a paradigm shift,” says Cathie Guzzetta, RN, PhD, an independent nursing research consultant. “All of us were trained that it would be too traumatic and awful for families to be there.”

Studies have shown that the opposite is true. Family members report that seeing attempts to revive their loved ones reassured them that everything possible was done.

“Having a visual experience of what was going on helps them move through the grieving process,” says Cathy Sals, RN, manager of clinical operations at Advocate Christ Medical Center. “It gives them a sense of closure. They seem more at ease with themselves.”

Getting Started

Nurses eager to offer the family presence option in their hospitals can start by finding journal articles that prove the benefits. A November 2005 article in the American Journal of Critical Care is a good place to start, Guzzetta says.

At UCSD Medical Center, one clinical nurse specialist brought journal articles about family presence to the nursing leadership. These nurses, in turn, took the idea to the hospital’s critical-care committee, which included physicians, nurses, respiratory therapists, social workers and pharmacists. The committee endorsed the practice, and now nurses can offer family members the choice of being present during resuscitation efforts after the physician has been consulted and given his approval. Although most hospitals offering family presence do so informally, Guzzetta says formal guidelines are ideal.

“Having a policy in place ensures that it’s not hit and miss,” she says. “Family presence demands that a staff be educated about how to do it right, what to do and [what] not to do.”

Nurses advocating for family presence should be prepared for some physicians to resist. Opponents argue that the practice could increase the risk of complications and litigation, but the ENA’s position statement says studies have shown that family presence does not increase technical complications or lawsuits.

Coping and Compassion

Hospital workers need to be trained to care for a relative who enters the room during CPR. Dubina holds the family member’s hand and explains what is happening during the resuscitation. She also watches for signs that the relative is not coping well.

“You can tell by a person’s facial expressions how they are doing,” she says. “In my experience, it is rare for someone to admit they can’t handle it. If they start to tremble or bow their head, I offer to get a chair or take them out.”

She is also available to talk after the resuscitation is over. She cautions nurses to avoid the temptation to talk too much as they comfort a grieving family member. Silence can be deeply comforting, Dubina says.

Even though the push for family presence is meant to benefit family members and patients, Dubina is keenly aware of how it also fulfills her calling as a compassionate caregiver.

“It is extraordinary that someone you don’t know shares one of the more intimate experiences of life with you,” she says. “It’s an honor to help them in that way.”

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