Family Presence During Resuscitation and Invasive Procedures

1. Family Presence During Resuscitation and Invasive Procedures Issued April 2010

2. Expected Practice • Family members* of all patients undergoing resuscitation and invasive procedures should be given the option of being present at the bedside. (Evidence Level B) * Family members are those individuals who are relatives or significant others with whom the patient shares an established relationship. Family Presence During Resuscitation and Invasive Procedures

3. Expected Practice • Approved written practice document (i.e., policy, procedure, or standard of care) for family presence (Evidence Level D) Family Presence During Resuscitation and Invasive Procedures

4. Scope and Impact of the Problem • Family presence is beneficial to patients, families and staff. • Meeting needs in time of crisis exemplifies care driven by the patients and families. Family Presence During Resuscitation and Invasive Procedures

5. Supporting Evidence • 50% to 96% of consumers believe that family members should be offered the opportunity to be present Family Presence During Resuscitation and Invasive Procedures

6. Supporting Evidence • Only 5% of critical care unit in the U.S. have written policies allowing family presence. • Most critical care nurses have brought families to the bedside, despite the lack of formal hospital policies. Family Presence During Resuscitation and Invasive Procedures

7. Supporting Evidence —Benefits • For patients: • Almost all children want to have their parents present during medical procedures • Adult patients report that having family members at the bedside comforted and helped them. Family Presence During Resuscitation and Invasive Procedures

8. Supporting Evidence —Benefits • For family members: • Removed doubt about the patient’s condition • Witnessing that everything possible was done • Decreased their anxiety and fear • Facilitated their need to be together • Facilitated a sense of closure Family Presence During Resuscitation and Invasive Procedures

9. Supporting Evidence • 94% to 100% of families would do so again • No patient care disruptions • No negative outcomes during family presence events • No adverse psychological effects among family members Family Presence During Resuscitation and Invasive Procedures

10. Actions for Nursing Practice • Ensure that your healthcare facility has written policies and procedures that support family presence during resuscitation and invasive procedures. Family Presence During Resuscitation and Invasive Procedures

11. Actions for Nursing Practice • Policies, procedures, and educational programs should include: • Benefits of family presence. • Criteria for assessing the family. • Role of the family facilitator in preparing families. • Handling the development of untoward reactions by family members. • Support for patient’s or family members’ decision not to have family present. • Contraindications to family presence. Family Presence During Resuscitation and Invasive Procedures

12. Actions for Nursing Practice • Develop proficiency standards for all staff. • Determine your unit’s rate of compliance. Family Presence During Resuscitation and Invasive Procedures

13. Actions for Nursing Practice • If compliance is <90%, develop a plan to improve compliance: • A multidisciplinary task force or a unit core group of staff. • Re-educate staff about family presence. • Incorporate into orientation programs and annual competencies. • Develop a variety of communications strategies. • Develop documentation standards for family presence. Family Presence During Resuscitation and Invasive Procedures

14. For More Information • Practice Alerts are online at www.aacn.org. • For additional information / assistance go to the Practice Resource Network at www.aacn.org. Family Presence During Resuscitation and Invasive Procedures

15. Resources • Presenting the Option of Family Presence. Product #120632 is available online at www.aacn.org • American College of Chest Physician’s Critical Care Family Assistance Program. Product #120631 is available online at www.aacn.org Family Presence During Resuscitation and Invasive Procedures