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Families in Critical Care: Christine R. Duran, Kathleen S. Oman, Jenni Jordan Abel, Virginia M. Koziel, and Deborah Szymanski Attitudes Toward and Beliefs About Family Presence: A Survey of Healthcare Providers, Patients’ Families, and Patients Am J Crit Care 2007; 16: 270-279 [Abstract] [Full text] [PDF]

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Experience with Family Presence: Debriefing

Cheryl L. Birmingham, Hollywood, Florida   (20 June 2007)

A Comment on Further Recommendations

Jennifer M. Woods   (12 May 2007)

Experience with Family Presence: Debriefing 20 June 2007
Cheryl L. Birmingham, Nurse Manager SICU Memorial Regional Hospital, Hollywood, Florida Send letter to journal: Re: Experience with Family Presence: Debriefing johnjbirmingham{at}bellsouth.net Cheryl L. Birmingham, et al.	The idea of family presence has come to fruition. I applaud Duran and colleagues on their presentation of a comprehensive study on the topic. This issue is extremely controversial and carries a potentially emotional impact when implemented. Professional organizations including but not limited to the Emergency Nurses Association, American Association of Critical-Care Nurses, and the American Heart Association support family presence. These are organizations that heavily influence nursing practice in all areas of healthcare. I have not had a personal experience with family presence, but I have had a professional one. It was a typical day in our busy trauma unit when the page overhead went off, indicating a trauma alert. We prepared the trauma room and waited for a call from the emergency department. A young male soon arrived; immediately his heart rate deteriorated and we started cardiopulmonary resuscitation. The clinical manager of the surgical intensive care unit told the trauma team we were going to get the family and bring them back. One team member, a surgical resident, objected, saying the family would not want to see their loved one in this condition. We took some time to educate the resident on the benefits of family presence and this person relented. We never leave the family alone; they always must have a registered nurse with them. We brought the patient’s loved one back to be with him during our resuscitative efforts. Although we did not offer a debriefing session, Laskowski-Jones (1) recommends debriefing following such a family presence event. Scant literature supports this recommendation, but it does allow family members to ask questions and express their feelings. The research by Duran and colleagues clearly outlines the benefits of family presence. Although our family presence program is in its infancy stages, we're not waiting for the crisis to occur so we can attempt to figure it out then. We are being proactive with the evidence that supports family presence and have developed a detailed plan to implement. It will not be our decision to implement family presence next time around ... it will be the decision of the next trauma victim’s loved one. Reference 1. Laskowski-Jones L. Should families be present during resuscitation? Nursing. 2007;37(5):44-47.
A Comment on Further Recommendations 12 May 2007
Jennifer M. Woods, Clinical Nurse Specialist Send letter to journal: Re: A Comment on Further Recommendations jwoods{at}nnadoc.com Jennifer M. Woods	The authors of this article recommend further research into the beliefs and attitudes of patients and family members with respect to family presence. In September 2004 I published a research article titled "Lived Experience of Critically Ill Patients' Family Members During Cardiopulmonary Resuscitation" in the American Journal of Critical Care (1). Although my study was small, the conclusions were comparable to family needs studies previously conducted by Molter (2), Leske (3,4), and others. As I indicated in my own study, family members have 2 specific needs: information and proximity to the patient. Family members also place an enormous amount of trust in the healthcare team that controls the situation (eg, cardiopulmonary resuscitation). As a result, families lose autonomy and the ability to provide protection to their loved ones. In an effort to cope effectively, families require reassurance and information. I support future research in this area as the findings are necessary to provide specific interventions to meet the needs of not only the patients in crisis, but their families as well. In addition, any further research in this area will support the advancement of family presence protocols, as Duran and colleagues note. References 1. Wagner JM. Lived experience of critically ill patients' family members during cardiopulmonary resuscitation. Am J Crit Care. 2004;13(5):416-420. 2. Molter NC. Families are not visitors in the critical care unit. Dimens Crit Care Nurs. 1994;13(1):2-3. 3. Leske JS. Comparison of family stresses, strengths, and outcomes after trauma and surgery. AACN Clin Issues. 2003 Feb;14(1):33-41. 4. Leske JS. Interventions to decrease family anxiety. Crit Care Nurse. 2002;22(6):61-65.