family presence policy
Emergency Department
Policy and Procedure
Team Members Performing: Emergency Center Staff, Respiratory Therapy in the Emergency Center
Physician Order Required: None
SCOPE: Emergency Department
PURPOSE: This policy is designed to guide the healthcare team in considering family presence during resuscitation. The healthcare team is responsible for assessing the patient/family needs and arranging for family member(s) to be with the patient affording either physical and/or visual contact should they express that option. The Medical Center of Central Georgia supports patient and family centered care. "A nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility" is the definition of caring from Kristen Swanson in her Theory of Caring. "Being with is how the nurse conveys caring. Doing for and enabling are the visible way in which the nurse enacts caring." Kristen Swanson
DEFINITIONS:
Family member: A relative or significant other with an established relationship with the patient.
Family presence: The attendance of one or two family members at their loved one's resuscitation.
Resuscitation: Life sustaining or life-saving measures.
Family Support Person: A staff member (Nurse, Clinical Technician, Customer Service Representative, Chaplain, Palliative Care staff or other healthcare provider)who is assigned to partner with the family to support the psycho-social needs of the family prior to, during and after family presence. This staff member has been trained in the FPDR policy and procedure through inservice and assessment.
PROCEDURE:
1. Any member of the healthcare team may propose that a family be screened for the option of Family Presence at the Bedside During Resuscitation. The physician leading the resuscitation agrees that if the family is deemed appropriate to allow their presence. The healthcare team involved in the resuscitation should arrive at consensus with no strong dissenting opinions.
2. Family presence will be offered once the designated family support person has been assigned.
3. The family support person will conduct the following prior to family presence:
a. Assess families desire to be present during resuscitation and their perception and understanding of the clinical situation. Cultural and spiritual needs of the family will be considered. Support will be provided ideally to one or two family members present at one time.
b. Exclusion criteria includes: emotional instability that can not be redirected, intoxication, altered mental status, combativeness, family member suspected of being the perpetrator of abuse against the patient. Special consideration should be made for those family members under sixteen years of age.
c. Explain what the family may observe to include the patient's appearance and equipment used in resuscitation.
d. Explain where family members may stand, any personal protective equipment that may be needed and behavior expectations.
e. Explain that family may leave the room at any time.
f. Inform the family that their questions and comments should be directed only to the family support person to minimize disruption of the healthcare team.
g. Families who do not wish to be present will receive emotional and spiritual support as usual.
h. Explain to families that cell phones, cameras and video recording of any kind is prohibited and will be grounds for removal from the bedside.
4. The family support person will escort the family members to the bedside. They will announce the families' presence to the healthcare team.
a. Support person will remain with the family at all times when at the bedside.
b. Provide comfort measures.
c. Allow family to see, touch and speak to the patient if situation allows.
d. Interpret medical or nursing jargon or terminology.
e. Provide information on the patient’s expected response and actual response to treatments being performed.
f. Recognize when family members should be escorted from the room (eg. disruptive behavior, severe emotional distress, family request)
5. If a member of the healthcare team determines that family members need to be removed they will be escorted to the quiet room. If they refuse to leave hospital police will be notified at 31490 for assistance.
6. Post family presence the family will be escorted to the quiet room or other appropriate area and provided emotional support and comfort measures as appropriate and necessary. Debriefing will be performed for the family.
7. Critical Incident Stress Debriefing of the healthcare team will be made available through palliative or pastoral care as requested.
References:
*Emergency Nurses Association Position Statement; Family Presence at the bedside, 1994.
*Nursing as Informed Caring for the Well Being of Others; Kristen M. Swanson, 1993.
*American Association of Critical-Care Nurses. AACN Practice Alert. Family Presence during CPR and Invasive Procedures, 2010.
*American Journal of Critical Care; Spirituality and Support for Family Presence During Invasive Procedures and Resuscitations in Adults, Baumhover and Hughes, 2009.
*American College of Emergency Physicians Issue 2002
*American Heart Association; guidelines, 2000.
*Emory Hospital- policy on Family presence and invasive procedures.
*Children's Healthcare of Atlanta- policy on Emergency Services Family Presence during Invasive Procedures, Resuscitation, Trauma.
Thank you to the Medical Center Navicent Health for allowing us to share their policy with our readers.