FAMILY appearance DURING INVASIVE ...

FAMILY appearance DURING INVASIVE PROCEDURES AND RESUSCITATION T A Meyer et al American Journal of Nursing Vol 100 (February 2000) 32-42

Customarily, patients' family members have not been allowed to be ready during invasive procedures or cardiopulmonary resuscitation (CPR) because of make anxiouss that clinical activities may be compromised, that witnessing the result may be too traumatic for family members, and that the potential risk of liability may be increased. In 1995 the pass Nurses Association (ENA) developed a position statement onward family presence and national guidelines for family vicinity during invasive procedures and CPR Presenting the Option for Family neighborhood published in 1995, is ENA's guideline for developing a family vicinity program.

During the past three years, the conception of family presence has attracted considerable professional and media attention. Little research has been reported forward the effects of a family's demeanor during invasive procedures or CPR and this is the first investigation to describe the family carriage experience using the ENA's guidelines. The final cause of this descriptive study was to identify attitudes, benefits, and question s experienced by family members and health care providers participating in a family's personality during invasive procedures and CPR

Methodology. This reflection was conducted in the exigency department of a 940-bed, academic, level-one trauma center in the Southwest. Using the two qualitative and quantitative methods, a convenience sample of 39 family members and 96 health care providers (ie, 60 RN 22 resident physicians, 14 attending physicians) was take a view ofed after 43 instances of family port which included 24 emergency invasive practices and 19 incidences of CPR

Family members were defined as those living bodys who share an established relationship (ie, relative, significant other) with the patient. Additional criteria of 18 years of age or older; the ability to speak English; and the absence of combativeness, greatest emotional instability, or behaviors suggestive of altered mental state (eg intoxication) also were established for inclusion in the research Health care workers involved in the care of the patient during invasive processs and CPR also were invited to participate. A family nearness protocol was developed based in succession the ENA guidelines.

Attitudes regarding perceived benefits and question s of family presence were measured using a 37-item family member measure and estimate and a 33-item health care provider take a view of These surveys contained a family carriage attitude scale modeled after a four-point Likert-type scale (ie, ranging from single in kind strongly agree, to four, firmly disagree) to measure respondents' agreement with statements about the benefits and point in disputes of family presence. Semistructured questions were included to gather additional quantitative and qualitative data. Instrument validity and reliability were calculated through Cronbach [Alpha], indexes of 92 for the family review and .91 for the health care provider inspect indicating a high internal consistency of one as well as the other instruments.

The family being at hand was defined as the attendance of a family member in a location that afforded visual or physical contact with the patient during invasive manner of proceedings or CPR. A nurse or chaplain trained as a family facilitator assessed family members' suitability for inclusion in the close attention Family facilitators prepared family members for the experience (eg what to anticipate value of supportive role to patient). Family neighborhood was restricted to three to five minutes for CPR No predetermined time limit was stake for invasive procedures. Health care providers were given the observe to complete within 72 hours of the marked occurrence Approximately two months after the family mien experience, an investigator conducted follow-up audiotaped interviews using the family member survey

flows Forty-three cases were studied--24 (56%) invasive acts and 19 (44%) CPR conducts All but five events occurr in the exigency department, with an overall mortality rate of 56% The mostly frequent invasive procedures performed included endotracheal intubation, central line placement, lumbar pierce chest tube placement, and orthopedic reduction. No significant differences were noted in the demographics of family members. Of the 121 health care providers who participated in family, air 96 (79.3%) completed and reverted the survey. Sixty (62.5%) of the sample were pampers and 36 (37.5%) were physicians (ie, 22 residents, 14 attendings).

A mean score of 154 was obtained onward the family members' surveys, indicating a positive attitude toward family air Most family members (97.5%) indicated they had a right and obligation to be ready during the procedure. Health care providers' mean score was 191 indicating a positive attitude toward family mien Nurses reported a significantly more positive attitude than did resident physicians. suckles and attending physicians were comparable in their responses