Study: Observing in ER can help family members

From staff reports

NEW YORK (CNN) -- Allowing people to witness emergency-room treatment for a family member helps ease the emotional burden of having a relative badly injured or critically ill, according to the American Journal of Nursing.

By touching and talking with the patient, family members "viewed themselves as active participants in the care process, which met their needs for knowing about, providing comfort to, and connecting with the patient," researchers reported in the journal.

If the patient dies, grieving kin are helped by being near and by seeing attempts at saving the family member's life, according to the report.

"We found that family members who visited with their loved ones during emergency care suffered no ill psychological effects," the researchers wrote. They studied medical cases at Parkland Health & Hospital System, Dallas.

Permitting family members to be at the patient's bedside during invasive procedures or cardiopulmonary resuscitation is "a relatively new concept," noted the researchers, primarily nurses with managerial or teaching duties.

"Traditionally, families have been excluded during these interventions because of concerns that clinical activities might be disrupted, that the event might be too traumatic for the family to witness and that the institution's liability risk might increase," the researchers wrote.

Interviews with emergency-room workers showed that 96 percent of nurses supported family presence during resuscitation, as did 79 percent of attending physicians. However, only 19 percent of residents liked the idea.

The practice of having family members present -- with consent of the attending physician and, if conscious, the patient -- "alleviates the family's anger about being separated from the patient during a crisis, reduces their anxiety, eliminates their doubts about what was done to assist the patient, and facilitates grieving," the research team concluded.

Nonetheless, the practice remains controversial. Dr. Andrew Sama, the director of emergency medicine at North Shore-Long Island Jewish Health System in New York expressed concern that not all families would respond positively.

"It could be something as simple as fainting or being able to deal with the visual stimulus of having a very significant event occur on their loved one," he said. Some witnesses could become disoriented and combative, he added.

To prevent such problems, a "facilitator" -- a nurse, physician or another hospital staff member -- can prepare family members for what to expect if they choose to watch treatment of a critically ill or injured person, said the Dallas researchers.

The Emergency Nurses Association recommends family-presence programs. The association's position: "Ultimately the patient and the family members are the individuals who have the most vested interest in the outcome of the procedure, and therefore should have the authority to make the decision regarding presence."

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Emergency Nurses Association
American Journal of Nursing Study

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