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Family member presence in the pediatric emergency department
Walter J Eppich1, Linda D Arnold
1Section of Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA. walter.eppich@yale.edu
Insights
Parents increasingly desire to witness pediatric emergency procedures, including resuscitation. However, healthcare provider opinions vary, impacting family presence policies and future research directions.
Area of Science:
- Pediatric Emergency Medicine
- Family-Centered Care
Background:
- Historically, family members were excluded from pediatric emergency procedures and resuscitation.
- Family-centered care principles are increasingly adopted in emergency departments.
- Parental presence during routine invasive procedures is now more accepted.
Purpose of the Study:
- To review the literature on family presence during pediatric emergency procedures and resuscitation.
- To examine healthcare provider perspectives on family witnessed resuscitation.
- To offer suggestions for family presence policies and identify future research needs.
Main Methods:
- Literature review from the perspective of pediatric emergency physicians.
- Analysis of survey evidence on parental desire for presence.
- Examination of factors influencing healthcare provider opinions on witnessed resuscitation.
Main Results:
- Parents overwhelmingly desire to be present during invasive procedures and resuscitation.
- Healthcare provider opinions on family witnessed resuscitation are not uniform and vary by professional factors.
- Organizational policies often support family presence, but research supporting these policies faces criticism regarding rigor.
Conclusions:
- Family presence in pediatric emergency settings is a growing trend supported by parental demand.
- Discrepancies exist between parental desire and healthcare provider acceptance of family witnessed resuscitation.
- Further rigorous research is needed to guide evidence-based family presence policies.
Abstract:
Traditionally, family members were excluded from viewing invasive procedures and cardiopulmonary resuscitation in the pediatric emergency department. The concept of family-centered care in the emergency department has now become more widespread. Consequently, family member presence during routine invasive procedures such as venipuncture, intravenous cannulation, urethral catheterization, and lumbar puncture has become more accepted. Survey evidence indicates parents' overwhelming desire to be present for invasive procedures and cardiopulmonary resuscitation. Healthcare provider opinions about family witnessed resuscitation lack similar uniformity. Variations in approval of witnessed resuscitation are influenced by occupation, level of training and experience, and prior exposure to family member presence practices. Although several organizations formally support family presence policies, citing benefits for grieving relatives, critics point to a lack of rigor in a large body of the research cited to underpin these endorsements. We review the literature from the perspective of pediatric emergency physicians, offer suggestions for family member presence, and provide directions for future study.
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