Family Presence in the Emergency Setting
As the environment in the emergency
department continues to evolve, the presence of family members
during resuscitation and other invasive procedures has become
an issue of change for emergency physicians. Traditionally, families
were asked to wait outside the treatment area because such procedures
were thought to be too traumatic for family members to witness.
Another aspect of the conventional thinking is that the family
members may become upset and attempt to interfere in the treatment.
Today many emergency departments are reconsidering
the issue of family presence during invasive procedures and resuscitations.
With careful planning, family presence can actually be a positive
experience for the patient and the relatives in the midst of a
very distressing situation. Family presence can be reassuring
for both the patient and the family, regardless of the outcome.
If the patient does not survive the illness or injury, the family
members have the comfort of knowing that everything possible was
done, that they were with him or her at the time of death, and
that they were given the opportunity to say goodbye.
Family members may also be able to provide
valuable information for patients who are unable to speak for
themselves. For example, a family member may be able to provide
the patient's medical history, or explain the events immediately
preceding the illness or injury which resulted in the emergency
department visit. In cases where time is critical, having a family
member nearby to immediately answer questions can be invaluable.
What measures should an emergency department
take in advance to allow for family presence? A clearly defined
protocol should be developed by the institution. Many emergency
departments designate a staff member such as a nurse or chaplain
who is trained in such circumstances to accompany the family and
act as the family liaison. The family liaison or facilitator can
help the family understand the patient's medical condition and
what treatments will be rendered, when it may be necessary for
the family to step outside, as well as possible outcomes. The
family liaison can also judge when the family or patient has become
too upset for the family to remain in the treatment area.
The protocol should also provide for staff
members offering the family as well as the patient the option
of the family remaining in the treatment area. For some persons,
witnessing invasive procedures is simply too upsetting and should
not be forced. For other persons, the choice of being in the room
for a brief amount of time and being able to leave when they feel
they must is also comforting.
Some health care professionals may balk
at family presence during invasive procedures for various reasons,
including the possibility of increased malpractice liability.
On the contrary, many families have reported feeling informed
and reassured about the treatments because they were able to see
for themselves what was being done for their loved one. Other
staff members may hesitate to perform their duties with a family
member observing and perhaps distracting them or interfering,
but such situations can be addressed when the protocol is developed.
If a family member does interfere with the treatment, the family
liaison can step in and escort the relative away from the treatment
area.
Perhaps the most important reason for family
presence in the emergency department is to reinforce for the patient
and his or her family that the staff recognizes their needs and
that the patient is being given the best care possible.
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