Family in the ER: Get out of the way or stay?

Nursing Professor Jane Leske just completed a major new study on trauma care. Findings include good news for family of critically injured patients: There are many benefits to having family present during moments of potentially lifesaving care, such as resuscitation.

A critically injured person is wheeled into the emergency room. Family  members  rush to the patient’s side. Soon, doctors and nurses begin emergency resuscitation efforts, inserting breathing tubes, pumping in blood and other fluids.

Should family members – parents, fiancées, adult children – be allowed in the room as these potentially lifesaving efforts begin?

A two-year study led by a UWM researcher has shown that family members of trauma patients – like those injured by firearms or in auto accidents – can benefit by being present during critical moments of care.

“Those who do choose to do it really want to be there,” says Jane Leske, professor of nursing. She and her research team found a number of benefits to having family members present, and no drawbacks.

“They want to watch everything and get information. It lowers their anxiety and stress to see that everything possible is being done.  Seeing is believing.”

Although this wasn’t part of this study, Leske adds that patients with conditions that may require long-term care at home– like traumatic brain injury – may benefit from having caregivers who’ve been involved early in their critical care.

Leske is an international expert on caring for families of patients in critical care situations.  With colleague Nancy C. Molter she wrote the Critical Care Family Needs Inventory, a survey tool that’s been translated into more than 20 languages to develop family-centered care guidelines in hospitals worldwide.

Leske did the study in collaboration with medical staff at a facility where families have the option of staying and observing resuscitation efforts. It was funded through a grant from the National Institutes of Health National Institute of Nursing Research.

FDPR: Controversy or best practice?

The practice of allowing families to remain in the room while patients undergo potentially lifesaving medical procedures is controversial, says Leske. Major nursing and critical care professional organizations support it. Many health care professionals and hospitals argue against it, concerned that the procedures may be too traumatic for family witnesses, or that family members may become emotionally out of control and interfere with care.

“The FPDR (family presence during resuscitation) currently remains controversial, underutilized, and not the usual practice with trauma patients,” says Leske.

The study compared outcomes for family members of patients, ages 18-93, with critical injuries from gunshot wounds or motor vehicle accidents at Southeast Wisconsin’s only Level 1 trauma center.  The center had offered FPDR for more than two years by the time Leske’s study began.

The study focused on 140 family members over age 18, divided in two roughly equal groups – those who chose the option of remaining with the victim during resuscitation; and those who chose not to, or were not able to reach the emergency department  in  time.

Researchers worked with the emergency department to find out if family members were available and willing to be surveyed and interviewed within 72 hours after the admission to the surgical intensive care unit.

The researchers used a brief survey and short interview to discuss the family’s coping  resources, communication and anxiety levels.  They also received permission to review medical records. All of the family members contacted agreed to take part, and were interviewed close to the patient’s room so they could quickly return if needed.

Seeing, sharing empowers family

“Family members are grateful to be able to ‘tell’ their story,” Leske wrote in an article about the study that was recently published in s rethe research article. “The family members’ ability to share their experience in their own words was powerful for the researchers and the individual family member participants.”

While families can benefit from being present during resuscitation, says Leske, it’s important that the hospital have policies and procedures in place on when and how to allow the option. The trauma center where the study was done, for example, has a policy allowing FPDR, except when family members are intoxicated, extremely agitated or emotionally unstable.

The research team included two senior nursing students from UWM, and it proved to be an important learning experience for them, says Leske. “When they first came into the trauma room, their eyes were as big as plates.”

Before long they were helping with surveys and interviews. “I think it’s important that they know research is not just about collecting and analyzing data. They got to see a multidisciplinary approach to patient survival  .”

Now, seeing is practicing for student researchers like Crystal-Rae Dawn Evans, who co-authored the study and now is an intensive care nurse at Froedtert Hospital.

The other co-authors were Natalie McAndrew of Froedtert’s Medical Intensive Care Unit, Annette E. Garcia of the hospital’s Cardiovascular Intensive Care Unit, and Karen J. Brasel, a physician at the Medical College of Wisconsin.