— or not to be —
in the ER
To
be
— or not to be —
in the ER
|
Should
families be present
during |
|
++++++ EMERGENCY
American College of Emergency Physicians Emergency Medicine and Primary Care Home Page Emergency Nursing World's e-mail lists and usenet groups Irish Emergency Nurses Association ++++++ What do you think? Should families be allowed to stay with the patient in the ER? ++++++
|
By
Angela Genusa Relatives of patients who die in the emergency room are often haunted long after the funeral by questions about their loved ones’ final minutes. Did they suffer? Did they say anything? Did they ask for me? Emergency room nurses and physicians, too, are often plagued by images of the faces of family members: bereaved widows, grief-stricken adult children, and shellshocked parents. "I can remember many times being part of the team that went into the waiting room to tell a family that their child had died," said Nancy Eckle, MSN, RN, clinical nurse specialist for emergency services at Children’s Hospital in Columbus, Ohio. "It’s the first time you ever see their faces, and you’re telling them the most horrible thing in the world. "It always felt uncomfortable to me, even when it was done very well, because you didn’t have any opportunity to develop a relationship with them [beforehand]." This scenario—where the critically ill or injured are carted off to trauma rooms while frightened family members are ushered into waiting rooms—is being reconsidered by hospitals across the country. New studies and pioneering practices at some hospitals suggest that allowing family members to be present during resuscitation attempts and invasive procedures can be beneficial to patients, family, and staff alike. Evidence from the ER Parkland Hospital, a 1,000-bed public facility in Dallas, is conducting a study on family presence in the emergency room funded by a grant from foundations that are affiliated with the Emergency Nurses Association and the American College of Emergency Physicians. Parkland researchers are examining the impact of family presence on patients, physicians, nurses, and family members. If the study finds the benefits outweigh the disadvantages, Parkland plans to develop a policy offering families the option to be with the patient. Expected to be completed by this fall, Parkland’s study could spur hospitals across the country to do the same. "This data is really hot," said Cathy Guzzetta, PhD, RN, FAAN, nursing research consultant for the Parkland study. "It will really give people ammunition to implement family-presence policies in their institutions. It promises to provide a lot of data that people can stick under their arms and use to either justify or not justify implementing the program." Parkland began taking a deeper look at the tradition of excluding families from the ER after Theresa Meyers, an emergency department RN who is co-investigator of the study, allowed a boy’s parents into the ER, nearly causing her to lose her job for violating the hospital’s unwritten policy. Parkland then conducted a survey of 25 family members of 20 patients who had died in the ER in 1993. More than two-thirds said they would have wanted to be in the ER with their family member, and 95 percent thought the option should be offered when a resuscitation is involved. Those responses echo a 1982 study on family presence conducted by W.A. Foote Memorial Hospital in Jackson, Michigan. In that study, 76 percent said being present helped ease their grief. Already inside Many hospitals have already informally adopted family-presence policies, said Nancy Auer, MD, president of the American College of Emergency Physicians (ACEP) and medical director of the emergency department at Swedish Medical-Ballard in Seattle, Washington. It implemented the policy on a case-by-case basis about four years ago, Auer said, and the benefits have become apparent to the staff. Family members can provide information on the illness or accident that brought the patient into the ER, as well as the patient’s medical history, she said. They can also provide emotional support to the patient, Auer said. The ACEP has not taken a stand on family presence, Auer said, and she feels the issue is not a controversial one. "I think everyone just believes this is correct," she said. Guzzetta disagrees. "It’s an emotional issue because we grew up in a setting in which families simply were not allowed in. It was thought to be too bloody, too gory, too emotional, and we would wind up paying more attention to the family member and draw care away from the patient." The dividing line between supporters and opponents of family-presence policies isn’t drawn along neat professional lines, said Eckle, who has written about the issue for the Emergency Nurses Association. The ENA passed a resolution in 1993 supporting family presence. There are nurses, chaplains, social workers, and physicians on both sides of the issue, she said. "What we really find is that after you’re in an environment where family presence occurs, the majority of the staff says it’s a good idea. People on our staff who were resistant in the beginning kind of moved over to the other side after seeing how well it worked and the benefits that the family as well as the staff got." Family-presence policies parallel other trends giving patients and families more control over end-of-life care, such as hospice and advance directives. Hospitals that adopt family-presence policies can expect a massive culture change, Eckle said, and should anticipate allotting time and resources to educate staff and the public. As more hospitals approve family-presence policies, perhaps traumatic memories of last-minute separation will become a thing of the past for both family members and ER staff. "I’ve spoken to many parents who have told me how important it was for them to be there, to be able to talk to their child and hold their hand," Eckle said. "Even when their child was unconscious, knowing they could whisper in their ear and tell them that they loved them was the most important thing of all to them." |
