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Parental presence during procedures in an emergency room: results from 50 observations
H Bauchner1, C Waring, R Vinci
1Department of Pediatrics, Boston City Hospital, MA 02118.
Insights
Parents often stay with children during pediatric emergency procedures like venipuncture. However, physician communication about parental presence is frequently lacking, impacting decisions to stay or leave.
Area of Science:
- Pediatric Emergency Medicine
- Child Health
- Medical Procedures
Background:
- Parental presence during pediatric medical procedures is common in emergency departments.
- Understanding the dynamics of physician-parent-child interactions is crucial for improving care.
Purpose of the Study:
- To examine physician-parent-child encounters during invasive procedures in a pediatric emergency setting.
- To investigate factors influencing parental decisions to stay or leave during a child's medical procedure.
Main Methods:
- Observational study of 50 children undergoing venipuncture or intravenous cannulation.
- Data collected on parental presence, demographic factors, and physician communication.
Main Results:
- Parents stayed with children in 62% of procedures; prior experience increased likelihood of staying.
- Parental decisions to stay were not linked to demographics or physician training.
- Physician communication regarding parental presence was often inadequate, with many parents not offered the option to stay or asked to leave.
Conclusions:
- Parental presence is common during pediatric venipuncture and cannulation, but often occurs without explicit discussion with physicians.
- Improved communication strategies are needed to involve parents in decisions about their presence during procedures.
Abstract:
This report describes the physician-parent-child encounter during an invasive medical procedure in a pediatric emergency department. Fifty children underwent venipuncture or intravenous cannulation performed by 22 physicians and 6 nurses. The median age of the children was 12 months. Parents remained with their children during 31 (62%) of the 50 procedures. Parents were more likely to stay if they had previously stayed when this child (P = .05) or another (P = .02) had undergone a procedure. Parental decision to stay was not related to parental age, gender, race, marital status, or level of education, nor to the residents' age, gender, or level of training. Only 43% of the parents who did stay were given that option by the residents, and of those who did not stay 37% reported that physicians asked them to leave. Nonverbal cues by the residents, such as pulling the curtain closed or turning their back toward parents, were noted in 58% of the encounters in which parents did not stay. The residents and nurses indicated that parents should stay with their child for the following procedures: laceration repair, 66%; venipuncture, 58%; intravenous cannulation, 48%; arterial blood sampling, 32%; suprapubic aspiration, 20%; and lumbar puncture, 14%. In the emergency room studied, it appears that for venipuncture and intravenous cannulation, the majority of parents stay with their children. Parental decision to stay or leave is frequently made without discussion with the physician.