HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by MacLean, S. L. Articles by Désy, P. Search for Related Content PubMed PubMed Citation Articles by MacLean, S. L. Articles by Désy, P.

Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses

	Abstract

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 
• Background Increasingly, patients’ families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices of critical care and emergency nurses related to family presence.

• Objective To identify the policies, preferences, and practices of critical care and emergency nurses for having patients’ families present during resuscitation and invasive procedures.

• Methods A 30-item survey was mailed to a random sample of 1500 members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association.

• Results Among the 984 respondents, 5% worked on units with written policies allowing family presence during both resuscitation and invasive procedures and 45% and 51%, respectively, worked on units that allowed it without written policies during resuscitation or during invasive procedures. Some respondents preferred written policies allowing family presence (37% for resuscitation, 35% for invasive procedures), whereas others preferred unwritten policies allowing it (39% for resuscitation, 41% for invasive procedures). Many respondents had taken family members to the bedside (36% for resuscitation, 44% for invasive procedure) or would do so in the future (21% for resuscitation, 18% for invasive procedures), and family members often asked to be present (31% for resuscitation, 61% for invasive procedures).

• Conclusions Nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended.

Family presence has attracted considerable interest in publications devoted to healthcare professionals^6–11 and consumers.^12–17 This attention ignited debate on the issue among healthcare professionals and heightened awareness of the topic among consumers. Recent research^18–25 and public opinion polls^26,27 revealed that most consumers think that patients’ family members would want to be and should be allowed to be present while emergency procedures were performed on the patients and at the time of death. Several studies indicated the multiple benefits of this practice for patients’ family members: It removes doubt about what is happening to the patient and reinforces that everything possible was done^{18,20,28–32}; it reduces anxiety and fear^31,33–36; it engenders feelings of supporting and helping the patient^*; it sustains patient-family connectedness and bonding^18,20; it provides a sense of closure on a life shared together^20,30; it facilitates the grief process^{19,24,28–32,39}; and it engenders feelings of being helpful to healthcare staff.^20,34 Nearly all families involved in such an experience reported that they would make the same choice again.^{20,29,30,34,39} Despite the fears of healthcare providers that patients’ families might become emotionally upset and interfere with care, researchers found no disruptions in the operations of the healthcare team, no adverse outcomes during events at which patients’ families were present,^{19,20,23,28–31,36,39} and no adverse psychological effects among family members who participated at the bedside.^20,31,39

From the patients’ perspective, studies have indicated that almost all children preferred to have their parents present during stressful medical procedures^{33,36,40–44} and that the children thought that parental presence was the most beneficial intervention in managing the children’s pain.⁴¹ The experiences of adult patients were considered in only 1 study⁴⁵ and 2 anecdotal accounts.^31,39 The patients reported that having their family members present provided comfort and help, reminded healthcare providers of the patients’ personhood, and maintained the patient-family bond.

For healthcare providers, allowing the presence of patients’ families is a paradigm shift. Patients’ families traditionally have been excluded from such events because of a myriad of concerns,^** including fears that the families might lose emotional control and interrupt care,^53–56 lack of staff to meet families’ needs,^{30,54,57–59} insufficient room at the bedside,^{30,54,57–59} increased risk of litigation,^54,57 family-imposed limitations to the training of medical residents,⁶⁰ violation of patients’ confidentiality and privacy rights,⁵⁴ and the potential that providers’ technical skills would be affected because the providers were uncomfortable with the families’ presence.^30,53,57

On the other hand, providers with experience with family presence reported that having patients’ families present provided an opportunity to educate the families about the patients’ condition,²⁰ facilitated family participation in caring for patients^19,20,43 (eg, supporting the patient, positioning the patient, translating), reminded staff of patients’ personhood,^20,31 encouraged professional behavior and conversations at the bedside,²⁰ and helped parents in the bereavement process.⁶¹ Moreover, the presence of a patient’s family did not increase anxiety levels of healthcare providers during invasive procedures³⁶ or increase their perceived stress during resuscitations.⁶² On the basis of studies indicating the benefits of family presence for both family members and patients, it has been recommended repeatedly that to meet the needs of patients and their families, programs should be developed to offer patients’ families the option of being at the bedside during CPR and invasive procedures.^{2–5,20,29,31,50,63,64} However, little is known about the practices of critical care and emergency nurses related to family presence. Therefore, the purposes of this study were to determine the following:

• the frequency of formal and informal hospital policies on family presence in critical care units and emergency departments,
  
• the preferences of critical care and emergency nurses for having patients’ family members present during CPR and invasive procedures,
  
• the practice of critical care and emergency nurses related to family presence,
  
• the preferences of patients’ families, and
  
• the common themes of nurse respondents regarding their experiences with family presence.
  

	Methods

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 
Study Design and Sample
A survey design was used to determine the family presence practices of critical care and emergency nurses. The survey was mailed to a random sample of 1500 critical care nurses who were members of the American Association of Critical-Care Nurses and 1500 emergency nurses who were members of the ENA. All 3000 were registered nurses. The American Association of Critical-Care Nurses, ENA, and the institutional review board at one of the investigators’ (CEG) medical centers approved the study. To maintain the anonymity of the subjects, we included no identifying information on the surveys. Informed consent was implied by the participant’s response to the questions and return of the survey.

Instrument
A 30-item survey (see Appendix) was developed. The survey included questions about the demographic characteristics of the respondents (20 items); questions about the respondents’ practices, preferences, and hospital policies related to family presence during CPR and invasive procedures (9 items); and the option to share any comments about the respondents’ personal or professional experiences with family presence. Definitions of family presence developed for the study (Table 1) were sent to all potential participants along with the survey, a cover letter that explained the purpose of the study, a request to return the completed survey, and a guarantee of anonymity. The cover letter contained no value statements about the ENA guidelines on family presence.

Procedure
The final version of the survey was mailed to potential participants. They were asked to return the completed survey in an enclosed postage-paid return envelope. A postcard was sent to potential participants after the initial mailing to remind them to return the surveys.

Statistical Analyses
Data analysis was completed by using SPSS Version 10.1 (SPSS Inc, Chicago, Ill). Descriptive statistics were used to characterize the sample and each of the survey items. In addition, ² tests were used to determine differences in the effects of actual experience on preferences that support family presence. Significance was set at P < .01. Written responses and comments were qualitatively analyzed by one of us (SLM) by using content analysis. The constant comparison technique was used; segments of data were coded, grouped, clustered, and linked, and primary themes were identified and interpreted to discern the experiences of respondents. A final document of themes, categories, and direct quotations was sent to each of us for validation.

	Results

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 
Characteristics of the Sample
A total of 984 surveys were returned, for a response rate of 33%. Surveys were completed by 473 critical care nurses, 456 emergency nurses, and 55 nurses who either practiced in both areas or who did not provide work information. Nurses practiced in all 50 states and the District of Columbia. The mean age of the respondents was 42 years, 90% of them were women, and 50% had a baccalaureate degree (Table 2). The respondents were experienced registered nurses; 74% had more than 10 years of experience. A total of 74% worked full-time, 80% were staff nurses, and 78% spent more than 75% of their time providing direct care to patients. The characteristics of the respondents’ institutions are given in Table 3. Only 4% of the respondents cared for children; 56% worked with both adults and children. A few (5%) worked at institutions that used the ENA guidelines for the option of family presence,^1,2 but most (73%) did not know these guidelines were available.

View larger version (21K): [in this window] [in a new window]   Figure 1 Percentages of respondents who work in units or departments with written or unwritten policies allowing the option of family presence during cardiopulmonary resuscitation and invasive procedures.

View larger version (22K): [in this window] [in a new window]   Figure 2 Respondents’ preferences for written or unwritten policies allowing the option of family presence during cardiopulmonary resuscitation and invasive procedures.

View larger version (21K): [in this window] [in a new window]   Figure 3 Percentages of respondents who had taken, would take, and had not taken patients’ family members to the bedside during cardiopulmonary resuscitation and invasive procedures.

View larger version (16K): [in this window] [in a new window]   Figure 4 Respondents’ policy preferences and experience in taking patients’ families to the bedside during cardiopulmonary resuscitation and invasive procedures.

As seen in Figure 5, we found striking differences between the percentages of families who asked be present during CPR and invasive procedures and the number of work settings that have written policies allowing the option. Nurses’ preferences for a written policy allowing the option of taking families to the bedside were closer to the percentages of nurses who said families asked to go to the bedside.

View larger version (14K): [in this window] [in a new window]   Figure 5 Comparison of written policies on family presence, respondents’ policy preferences, respondents’ experience taking patients’ families to the bedside, and requests from patients’ family members to be present during cardiopulmonary resuscitation and invasive procedures.

• provides emotional support for patients and patients’ families,
  
• provides a positive experience for patients’ families, patients, and staff,
  
• provides guidance and increases family understanding of the patient’s situation,
  
• helps patients’ families make decisions about resuscitation,
  
• helps patients’ families know that everything was done to save their loved one, and
  
• facilitates closure and healing.
  

A small sample of the nurses’ comments on the benefits of bringing patients’ families to the bedside are presented in the following. Three nurses shared contrasting experiences:

First nurse: I was able to get an ER physician to allow parents in the room during CPR on their child. I received a letter from the parents stating how much they appreciated us allowing them to be with their child in the last minutes of his life. They said they had been with the child since he was born and wanted to be with him at death. They said their grieving process was faster because we allowed them in the room.

Second nurse: I once was traumatized during a pediatric cardiac arrest (during an outpatient procedure) where the father witnessed the arrest (of his daughter) and was not allowed in during CPR. He asked repeatedly to come in and "say goodbye" while she was still alive. He wanted to hold her hand. Not only was he kept from the room, but security was called to keep him out. The child did not survive. She was 6. No one would ever keep me from seeing my child. He just wanted to be with her when she died, and we took that away from him. How unfortunate that written policies are needed in this area.

Third nurse: Prior to becoming a nurse, I was a paramedic for 13 years in NYC. When called to a cardiac arrest in the home, the family was always there before us and I never felt right about asking them to leave. I frequently utilized significant others, if reasonably calm, to move furniture or even bag an intubated patient. I never regretted this decision. They frequently thanked me for this opportunity to help. The same opportunity should be an option in the ER.

Many nurses commented on the need to assess each situation, case by case, and described the importance of educating and preparing patients’ families for what the families would experience. The nurses thought that it was important to have a designated staff member with the family to guide, coach, and support the family. The respondents wrote that "the policy would provide equal access to all we serve" and that it was important to "have a policy in place to think and decide ahead of time how to handle requests."

Several nurses expressed concern about allowing the option of family presence. They raised questions about the following:

• patient-related issues such as privacy and limited benefits;
  
• family-related issues such as family behaviors, lack of education and understanding, emotional reactions, and family-staff relationships;
  
• staff-related issues such as staff stress and discomfort, impeding work, extra work and burden, and inadequate staffing;
  
• environmental issues such as limited space and staff, chaos and confusion, and lack of privacy; and
  
• legal issues such as lawsuits and family complaints.
  

One nurse wrote: "My experience tells me that families are not prepared for the traumatic events that are occurring before their eyes. When people learn CPR or view it on TV, we have a tendency to sanitize it as if it were a ‘clean’ procedure." Another commented: "Unfortunately, it seems that there is never enough time to evaluate education level and sensibilities of families before an invasive procedure. Certainly there isn’t enough support staff to allow for in-depth teaching with those families."

	Discussion

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 
To our knowledge, no other studies have been done on the family presence practices of critical care and emergency nurses in the United States. Nearly all of the nurses in our study worked in units that had no written policies addressing the option of family presence during CPR and invasive procedures. Although the units had no written policies, almost half of the respondents reported that their units allowed the option of family presence. This informal practice may be a result of changes in practice that reflect family-centered care and the desire to meet the holistic needs of patients and patients’ family members,⁶⁵ the increasing attention paid to family presence in the professional and public literature, or increases in the assertiveness of patients’ families.

Most critical care and emergency nurses in our study supported family presence. The large number of written comments supplied by the respondents further validates this finding. More than one third of the respondents preferred a written policy allowing family presence during CPR and invasive procedures (37% and 35%, respectively), and more than one third preferred an unwritten policy (39% and 41%, respectively). Thus, nearly 75% of the respondents favored some type of option for allowing family presence. This percentage is lower than but consistent with the percentages found by Meyers et al,²⁰ who reported that 96% of emergency nurses supported family presence during CPR and 88% supported it during invasive procedures. In addition, nurses are more likely than physicians to support family presence.⁵⁴ In a survey by McClenathan et al,⁶⁶ 43% of nurses and 20% of physicians favored family presence during CPR, and in a study by Meyers et al,²⁰ 96% of the nurses and 79% of the attending physicians supported family presence. Likewise, the degree of invasiveness of the procedure may influence the provider’s level of support for family presence. In a study⁶⁷ of more than 600 emergency nurses and physicians, for example, nearly all of the respondents thought that the parents of children being treated should be present for procedures such as insertion of intravenous catheters and repair of lacerations, but when CPR was considered, less than half of the respondents supported family presence.

Most of the respondents in our study had taken or would consider taking a patient’s family to the patient’s bedside during CPR and invasive procedures. Moreover, the majority who supported policies allowing family presence had previous experience with having patients’ family members present. These findings add to the mounting evidence that providers who have experience with family presence tend to support the practice. Sacchetti et al⁶⁸ reported that previous experience with family presence was the most important predictor of acceptance among emergency department providers. This finding was verified by Robinson et al,³¹ who terminated a randomized trial of family presence before the study was completed because they became convinced of the benefits of this practice for patients’ families. In addition, in the study by Meyers et al,²⁰ the nurses who supported family presence had had experience with family presence during CPR and invasive procedures, a finding that lends further support to the positive effect of actual experience with family presence on attitudes toward it. Education can also favorably affect attitudes about family presence. An educational class on family presence given to 46 critical care and emergency nurses changed the percentage of nurses who would offer the option from 11% to 79%.⁶⁹

An important finding in our study was that patients’ family members often ask to be present during invasive procedures (reported by 61% of the respondents), although the request to be present is lower for CPR (reported by 31% of respondents). Although it is unclear why families ask to be present less during CPR than during invasive procedures, families may be influenced by the invasiveness of the interventions involved in CPR or they may not know to ask. Our findings differ from those of Helmer et al,⁵⁴ who reported that 66% of 818 emergency nurses and 40% of 140 trauma surgeons had encountered requests from family members to be present during a trauma resuscitation. In addition, in that study,⁵⁴ significantly more nurses than physicians had experience with family presence and with being asked by patients’ family members if the families could be present (P < .01 for both analyses), suggesting that family presence is often driven by nurses rather than by physicians.

In the study by Meyers et al,²⁰ the intervention protocol for family presence used the ENA guidelines,^1,2 and after the study, this protocol was approved for hospital-wide use. The impact of this standardized protocol suggests the benefits of a formal family presence program in heightening awareness and changing clinical practice. However, 73% of our respondents did not know that this ENA resource was available. Moreover, our data revealed a large disparity between the number of written policies on family presence and the number of requests by patients’ families to be present. Consequently, nurses who work in units that do not support family presence or do not have clearly delineated protocols for the practice may be in a difficult position when confronted with a request by a patient’s family to be at the patient’s bedside.

	Implications for Practice and Research

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 
Our findings have several important implications for practice and research. Because many nurses receive requests from patients’ families to be present during CPR and invasive procedures and because nurses often facilitate the families’ presence, critical care units and emergency departments need to decide where they stand on the issue. Most units probably do not have formal policies on family presence because it is a controversial practice and historically families have always been banned from the bedside during such events. Soon, however, other professional organizations most likely will join with the ENA and the American Heart Association in recommending family presence during CPR and invasive procedures. As a result of the influence exerted by both consumers and professional organizations, most critical care and emergency departments will need to determine whether the departments support the practice and whether formal or informal guidelines are needed.

Because our results indicate that nearly all critical care and emergency departments have no written policies or guidelines for family presence, research is needed to explore the implications of these findings. For example, studies are needed to compare institutions with and without formal, written policies on family presence to determine differences in provider support for family presence, how often patients’ families are brought to the bedside, and desired outcomes of family presence such as uninterrupted care for patients and meeting the needs of patients’ families (eg, satisfaction, comfort, and closure).⁷⁰ Practitioners need to consider and researchers need to explore differences between formal and informal policies in promoting a family-centered care environment or in supporting a delivery of care that focuses on what works best for the institution. To date, we do not know if formal or informal policies provide stability to work units and promote consistent approaches in carrying out family presence practices. For example, what are the effects of informal versus formal policies on both staff and patients’ families?

The implications of nurses’ differences about whether a written policy is needed may reflect discomfort with family presence or resistance to changing long-standing practice. A policy on family presence could be beneficial if it detailed the responsibilities of nurses during family presence. Nevertheless, researchers should explore the reasons nurses support formal or informal policies on family presence and what the nurses think are the benefits and problems with each approach.

We found that 40% of our respondents had not taken patients’ family members to the bedside. Because of the current mandate for partnership with patients and their families in an environment of family-centered care, our data suggest that the discrepancy between the requests of patients’ families to be present at the patients’ bedside and the actions of nurses who are not facilitating these requests should be explored. Researchers should target this group of nurses to better understand the nurses’ reasons for not taking patients’ families to the bedside; reasons may include personal preference, comfort level in dealing with patients’ families, lack of formal guidelines to direct the process, and peer pressure in an environment that does not support family presence. If the culture of a unit or department does not support family presence, for example, dissension among staff members is likely when the practice is supported and implemented by a minority of the healthcare providers. In our study, the respondents reported that twice as many patients’ families requested to be taken to the patients’ bedside for invasive procedures than for CPR. Invasive procedures and CPR are 2 extremely different experiences for all involved. Our results suggest that practitioners and researchers need to identify the most effective interventions and explore difference in preparing and supporting patients’ family members during CPR and invasive procedures. Differences in the families’ perceptions and concerns during these 2 events, the families’ needs during the experience, and what helps and what does not help during CPR and during invasive procedures need to be better understood.

	Limitations

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 
Our study has several limitations. Although the survey was evaluated by a panel of content experts and underwent extensive pilot testing, it did not undergo reliability testing and has no established construct validity. In addition, because only one third of the sample returned surveys, the generalizability of the findings is limited to this group. Possibly, those nurses who did not respond have different preferences for and experiences with family presence. Only members of the American Association of Critical-Care Nurses and ENA were surveyed, and their responses may not represent the preferences and experiences of critical care and emergency nurses across the United States. We did not directly examine the preferences of patients’ families for being present during CPR and invasive procedures; rather, we relied on the memory and reports of the respondents.

	Conclusions

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 
Nearly all of the respondents to our survey worked on units that had no written policy on family presence, yet three quarters of the respondents preferred that family presence be allowed. Despite the lack of written policies to support the practice, nearly half of the respondents worked on units that allow family presence, more than half have brought (or would bring) patients’ families to patients’ bedside during CPR and invasive procedures, and many have been confronted with requests from patients’ families to be present. Because of these findings and those of previously published studies indicating the multiple benefits of family presence for both patients and families, nurses working in critical care and emergency departments should consider developing written policies or guidelines on family presence to meet the needs of patients and their families and provide consistent, safe, and caring practices for patients, patients’ families, and staff.

	ACKNOWLEDGMENTS

This article is being copublished with the Journal of Emergency Nursing, where it will appear in the June 2003 issue.

To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.

^* References 18–20, 29, 30, 33–35, 37, 38

^** References 19, 20, 28, 29, 31, 32, 39, 46–52

	REFERENCES

Top Abstract Methods Results Discussion Implications for Practice and... Limitations Conclusions References

 

1. Emergency Nurses Association. Presenting the Option for Family Presence. Park Ridge, Ill: Emergency Nurses Association; 1995.
2. Emergency Nurses Association. Presenting the Option for Family Presence. 2nd ed. Des Plaines, Ill: Emergency Nurses Association; 2001. (www.ena.org).
3. Jacobs BB, Hoyt KS, eds. Trauma Nursing Core Course: Provider Manual. 5th ed. Park Ridge, Ill: Emergency Nurses Association; 2000.
4. Eckle N, Haley K, Baker P, eds. Emergency Nursing Pediatric Course: Provider Manual. 2nd ed. Park Ridge, Ill: Emergency Nurses Association; 1998.
5. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation. 2000;102(8 suppl):I1–I374. Theme issue.[Abstract/Free Full Text]
6. Solovitch S. Pulling back the curtain: nurses allow patients’ loved ones into the ER. Healthweek. April 3, 2000:21.
7. Page D. Should families be allowed to observe ED care? Emergency Medical News. June 20, 1998:1–4.
8. Genusa A. Families in the ER. DFW Healthweek. April 13, 1998:15.
9. Shelton D. Being there. American Medical News. November 17, 1997:19–22.
10. Nelson V. Nurses think families should be present in the emergency department. Nursing and Allied Healthweek-Dallas/Fort Worth. November 4, 1996;22.
11. Farella C. When kin and crash cart collide. Nurs Spectr (Wash D C). Metro edition, January 2001;2:14–16.
12. Davis R. Bedside in the ER: hospitals allowing family member access. USA Today. March 7, 2000:1A–2A.
13. Shelton D. Opening the emergency room. Washington Post. February 17, 1998: Health section:10–14.
14. Family presence. "CNN Headline News." CNN television. May 4, 2001.
15. James S. Family presence [videotape]. "Dateline." NBC television. July 30, 1999.
16. Tuller D. A debate over loved ones in the ER. New York Times. May 15, 2001;D6 Science.
17. Jennings P. Family presence. "World News Report." ABC television. June 13, 2001.
18. Bauchner H, Waring C, Vinci R. Parental presence during procedures in an emergency room: results from 50 observations. Pediatrics. 1991;87:544–548.[Abstract/Free Full Text]
19. Sacchetti A, Lichenstein R, Carraccio CA, et al. Family member presence during pediatric emergency department procedures. Pediatr Emerg Care. 1996;12:268–271.[Medline]
20. Meyers TA, Eichhorn DJ, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation: the experiences of family members, nurses, and physicians. Am J Nurs. February 2000;100:32–42.[Medline]
21. Taylor N, Bonilla L, Silver P, Sagy M. Pediatric procedures: do parents want to be present? Crit Care Med. 1996;24(suppl):131.[Medline]
22. Watt-Watson JH, Everden C, Lawson C. Parents’ perceptions of their child’s acute pain experience. J Pediatr Nurs. 1990;5:344–349.[Medline]
23. Bauchner H, Vinci R, Bak S, Pearson C, Corwin M. Parents and procedures: a randomized controlled trial. Pediatrics. 1996;98:861–867.[Abstract/Free Full Text]
24. Meyers TA, Eichhorn DJ, Guzzetta CE. Do families want to be present during CPR? A retrospective survey. J Emerg Nurs. 1998;24:400–405.[Medline]
25. Boie ET, Moore GP, Brommett C, Nelson DR. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents. Ann Emerg Med. 1999;34:70–74.[Medline]
26. NBC Dateline Poll. Should family members of patients be allowed in the emergency department during emergency procedures? August 6, 1999. Available at: http://www.nbc.com. Accessed August 17, 1999.
27. USA Today Poll. Would you want to be in the emergency department while doctors worked on a family member? USA Today. March 7, 2000. Available at: http://www.USATODAY.com.
28. Anderson B, McCall E, Leversha A, Webster L. A review of children’s dying in a paediatric intensive care unit. N Z Med J. 1994;107:345–347.[Medline]
29. Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ. Family participation during resuscitation: an option. Ann Emerg Med. 1987;16:673–675.[Medline]
30. Hanson C, Strawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department’s nine-year perspective. J Emerg Nurs. 1992;18:104–106.[Medline]
31. Robinson SM, Mackenzie-Ross S, Campbell-Hewson GL, Egleston CV, Prevost AT. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. 1998;352:614–617.[Medline]
32. Timmermans S. High touch in high tech: the presence of relatives and friends during resuscitation efforts. Sch Inq Nurs Pract. 1997;11:153–168.[Medline]
33. Turner P. Establishing a protocol for parental presence in recovery. Br J Nurs. July 24-August 13, 1997;6:794, 796–799.[Medline]
34. Powers KS, Rubenstein JS. Family presence during invasive procedures in the pediatric intensive care unit. Arch Pediatr Adolesc Med. 1999; 153:955–958.[Abstract/Free Full Text]
35. Shapira M, Tamir A. Presence of a family member during upper endoscopy. J Clin Gastroenterol. 1996;22:272–274.[Medline]
36. Wolfram RW, Turner ED. Effects of parental presence during children’s venipuncture. Acad Emerg Med. 1996;3:58–63.[Medline]
37. Bauchner H, Vinci R, Waring C. Pediatric procedures: do parents want to watch? Pediatrics. 1989;84:907–909.[Abstract/Free Full Text]
38. Berns R, Colvin ER. The final story: events at the bedside of dying patients as told by survivors. ANNA J. 1998;25:583–587.[Medline]
39. Belanger MA, Reed S. A rural community hospital’s experience with family-witnessed resuscitation. J Emerg Nurs. 1997;23:238–239.[Medline]
40. Gonzalez JC, Routh DK, Saab PG, et al. Effects of parent presence on children’s reactions to injections: behavioral, physiological, and subjective aspects. J Pediatr Psychol. 1989;14:449–462.[Abstract/Free Full Text]
41. Jerrett MD. Children and their pain. Child Health Care. 1985;14:83–89.
42. Ross DM, Ross SA. A Study of the Pain Experience in Children: Final Report. Bethesda, Md: National Institute of Child Health and Human Development; 1984. Publication 1 R01 HD 13672–01.
43. Fiorentini SE. Evaluation of a new program: pediatric parental visitation in the postanesthesia care unit. J Post Anesth Nurs. 1993;8:249–256.[Medline]
44. Diniaco MU, Ingoldsby BB. Parental presence in the recovery room. AORN J. 1983;38:685–693.[Medline]
45. Eichhorn DJ, Meyers TA, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation: hearing the voice of the patient. Am J Nurs. May 2001;101:26–33.[Medline]
46. Adams S, Whitlock M, Higgs R, Bloomfield P, Baskett PJ. Should relatives be allowed to watch resuscitation? BMJ. 1994;308:1687–1692.[Free Full Text]
47. Rosenczweig C. Should relatives witness resuscitation? Can Med Assoc J. 1998;158:617–620.[Abstract]
48. Eichhorn DJ, Meyers TA, Guzzetta CE. Family presence during resuscitation: it is time to open the door. Capsules Comments Crit Care Nurs. January–March 1995;3:8–13.
49. Chalk A. Should relatives be present in the resuscitation room? Accid Emerg Nurs. 1995;3:58–61.[Medline]
50. Mitchell MH, Lynch MB. Should relatives be allowed in the resuscitation room? J Accid Emerg Med. 1997;14:366–369.[Abstract/Free Full Text]
51. Van der Woning M. Should relatives be invited to witness a resuscitation attempt? Accid Emerg Nurs. 1997;5:215–218.[Medline]
52. Redley B, Hood K. Staff attitudes towards family presence during resuscitation. Accid Emerg Nurs. 1996;4:145–151.[Medline]
53. Eichhorn DJ, Meyers TA, Mitchell TG, Guzzetta CE. Opening the doors: family presence during resuscitation. J Cardiovasc Nurs. July 1996;10:59–70.[Medline]
54. Helmer SD, Smith RS, Dort JM, Shapiro WM, Katan BS. Family presence during trauma resuscitation: a survey of AAST and ENA members. J Trauma. 2000;48:1015–1022.[Medline]
55. Malone R. The ethics of exclusion and the myth of control. J Emerg Nurs. April 1993;19:33A–34A.[Medline]
56. McGahey PR. Family presence during pediatric resuscitation: a focus on staff. Crit Care Nurse. December 2002;22:29–34.[Free Full Text]
57. Post H. Letting the family in during a code. Nurs 89. March 1989;19:43–46.
58. Redheffer GM. Letting the family in during a code: a trauma nurse’s opinion [commentary]. Nurs 89. March 1989;19:45.
59. Reynolds D. Death as a shared experience. ED Manag. 1992;14:177–181.
60. Proehl JA, Smith SS. Should family members be present during codes? Physician’s Weekly. May 8, 2000;17:1.
61. Jarvis AS. Parental presence during resuscitation: attitudes of staff on a paediatric intensive care unit. Intensive Crit Care Nurs. 1998;14:3–7.[Medline]
62. Boyd R, White S. Does witnessed cardiopulmonary resuscitation alter perceived stress in accident and emergency staff? Eur J Emerg Med. 1998;7:51–53.
63. Eichhorn DJ, Meyers TA, Guzzetta CE, Clark AP, Calvin AO. Family presence during invasive procedures and CPR: when pigs fly. In: Mason DJ, Leavitt JK, Chaffee MW, eds. Policy and Politics in Nursing and Health Care. 4th ed. Philadelphia, Pa: WB Saunders Co; 2002:345–361.
64. Clark AP, Calvin AO, Meyers TA, Eichhorn DE, Guzzetta CE. Family presence during CPR and invasive procedures: a research-based intervention. Crit Care Nurs Clin North Am. 2001;13:569–575.[Medline]
65. Henneman EA, Cardin S. Family-centered critical care: a practical approach to making it happen. Crit Care Nurse. December 2002;22:12–19.[Free Full Text]
66. McClenathan BM, Torrington KG, Uyehara FT. Family member presence during cardiopulmonary resuscitation. Chest. 2002;122:2204–2211.[Abstract/Free Full Text]
67. Beckman AW, Sloan BK, Moore GP, et al. Should parents be present during emergency department procedures on children, and who should make that decision? A survey of emergency physician and nurse attitudes. Acad Emerg Med. 2002;9:154–158.[Medline]
68. Sacchetti A, Carraccio C, Leva E, Harris RH, Lichenstein R. Acceptance of family member presence during pediatric resuscitation in the emergency department: effects of personal experience. Pediatr Emerg Care. 2000;16:85–87.[Medline]
69. Bassler PC. The impact of education on nurses’ beliefs regarding family presence in a resuscitation room. J Nurs Staff Dev. 1999;15:126–131.
70. Boudreaux ED, Francis JL, Loyacano T. Family presence during invasive procedures and resuscitation in the emergency department: a critical review and suggestions for future research. Ann Emerg Med. 2002;40:193–205.[Medline]

This article has been cited by other articles:

				N. Baumhover and L. Hughes Spirituality and Support for Family Presence During Invasive Procedures and Resuscitations in Adults Am. J. Crit. Care., July 1, 2009; 18(4): 357 - 366. [Abstract] [Full Text] [PDF]

				J. K. Kuzin, J. G. Yborra, M. D. Taylor, A. C. Chang, C. A. Altman, G. M. Whitney, and A. R. Mott Family-Member Presence During Interventions in the Intensive Care Unit: Perceptions of Pediatric Cardiac Intensive Care Providers Pediatrics, October 1, 2007; 120(4): e895 - e901. [Abstract] [Full Text] [PDF]

				C. R. Duran, K. S. Oman, J. J. Abel, V. M. Koziel, and D. Szymanski Attitudes Toward and Beliefs About Family Presence: A Survey of Healthcare Providers, Patients' Families, and Patients Am. J. Crit. Care., May 1, 2007; 16(3): 270 - 279. [Abstract] [Full Text] [PDF]

				C. E. Guzzetta and A. P. Clark Restrictions on Family Presence in the ICU JAMA, December 8, 2004; 292(22): 2721 - 2722. [Full Text] [PDF]

				C. E. Guzzetta Critical Care Research: Weaving a Body-Mind-Spirit Tapestry Am. J. Crit. Care., July 1, 2004; 13(4): 320 - 327. [Abstract] [Full Text] [PDF]

				D. J. Mason Family Presence: Evidence Versus Tradition Am. J. Crit. Care., May 1, 2003; 12(3): 190 - 192. [Full Text] [PDF]

This Article Abstract Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by MacLean, S. L. Articles by Désy, P. Search for Related Content PubMed PubMed Citation Articles by MacLean, S. L. Articles by Désy, P.