Practice Alert: Family Presence During CPR and Invasive Procedures

Families are asking to be with their loved ones during emergency procedures and resuscitation. The family is a valuable component of the health care team. They ultimately have the most stake in the patient's survival and outcomes. Families expect the health care team to do the best job possible and place a great deal of trust in them and the decisions made. Health care teams control the situation during CPR and approve or deny the presence of the family. Families are in crisis and require support and reassurance to cope. Adherence to ENA's protocols strengthens that trust in the team and the patient-family bond. Isn't this what radiology professionals want in their practice?     

The Effect of Parental Presence on Pain Levels of Children During Invasive Procedures: A Systematic Review

AimThis systematic review was conducted to determine the effect of parental presence on the child's pain intensity during invasive procedures.DesignA systematic review.MethodThe systematic review was conducted in July 2019 and updated in December 2020 to include the latest research published during the publication process by scanning the articles in English. Scopus, Pubmed, Cochrane, Science Direct, MedLine databases were used for scanning. The keywords “parental presence”, “family presence”, “parent involvement”, “invasive procedures”, “venipuncture”, “painful procedures”, “child”, “children”, “pediatric” were used in the scanning. Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol was followed to prepare the study and the report, and the systematic review was created according to the patient, intervention, comparison, outcomes (PICOS) strategy.ResultsA total of 248 articles were reached, and the full texts of 18 articles were evaluated for eligibility. After the articles excluded by the full-text search were eliminated, six studies, involving 730 children with a sample aged between 0-12 years, were included in the analysis. In 4 studies, it was determined that having a parent with the child during the invasive procedure significantly decreased the pain level, and in 2 studies, there was no statistically significant decrease in the pain level of the children.ConclusionsParental presence and parental involvement during invasive procedures effectively reduced the children's pain levels. Since the number of studies with a high level of evidence regarding the effect of family participation on pain level is limited, it is recommended to conduct more randomized controlled studies.     

Report of the National Consensus Conference on Family Presence During Pediatric Cardiopulmonary Resuscitation and Procedures.

Representatives from 18 national organizations were convened for a conference to develop recommendations regarding family presence (FP) during pediatric procedures and cardiopulmonary resuscitation. Before the conference, invitees were given a questionnaire and provided with current literature regarding FP. A modified Delphi process was used to develop consensus, including use of multiple questionnaires and breakouts for discussion of specific issues. Participants were encouraged to develop consensus recommendations based on the literature and discussions. Changes in attitude were tracked with repeat questionnaires. Results of the conference were circulated to participants for review and revision. Consensus recommendations include (1) consider FP as an option for families during pediatric procedures and cardiopulmonary resuscitation, (2) offer FP as an option after assessing factors that could adversely affect the interaction, (3) if family is not offered the option for FP, document the reasons why, (4) always consider the safety of the health care team, (5) develop in-hospital transport and transfer policies and procedures for FP, such as family member definition, preparation of the family, handling disagreements, and providing support for the staff, (6) obtain legal review of policies, (7) include education in FP in all core curricula and orientation for health care providers, (8) promote research into best methods for education; effects of FP on patients, family, and staff; best practices for FP; and legal issues regarding FP, among others. These recommendations were approved in concept by the American Academy of Pediatrics and the Ambulatory Pediatrics Association.     

Does Music Reduce Anxiety During Invasive Procedures With Procedural Sedation? An Integrative Research Review

Undergoing interventional radiology (IR) procedures with procedural sedation can be anxiety provoking. To understand more clearly if music can reduce anxiety, an integrative research review was conducted to compare music during invasive procedures or perioperatively without general anesthesia to standard care. This review reveals that music may be effective in lowering blood pressure and reducing medication requirements. Practice guidelines and suggestions for future research are offered to help IR nurses examine this intervention in more detail.     

Practicing Invasive Procedures on Students and Patients: An Ethical Dilemma in Nursing Education

Clinical teaching of nursing students has long been an integral part of the educational process for nurses. Because invasive procedures encompass complex nursing techniqes usually performed by the professional nurse, teaching of these important skills seems essential. The author discusses the best and safest method to teach invasive clinical nursing skills to nursing students.     

Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria,Australia

IntroductionFamily Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR.MethodsOne rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study.ResultsSeventeen adult presentations (Metro n = 9, Rural n = 8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication.ConclusionDuring 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education.     

Effects of Distraction on Reducing Pain During Invasive Procedures in Children with Cancer: A Systematic Review and Meta-Analysis

BackgroundDistraction is a known behavioral intervention that is widely used for pain management in the pediatric population. However, there is a shortage of reviews reporting the efficacy of distraction for procedural pain reduction in pediatric oncology settings.AimTo determine the current evidence on the effects of distraction on procedural pain in children with cancer.DesignThis systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelinesSettingsSix different databases from 1990 to June 2019.MethodA literature search was conducted to identify the effects of distraction on procedural pain reduction in children with cancer. A meta-analysis was undertaken along with applying a mixed effect model to quantify the standardized mean difference in the 95% confidence interval (CI) as the overall effects.ResultsTen randomized controlled trials were included. Distraction during an invasive procedure had a large effect on pain intensity (–0.92, 95% CI –1.48 to –0.36, p = .001) and on needle insertion as well (–1.12, 95% CI –1.52 to –0.72, p = .000), but only a moderate effect on lumbar puncture procedures (-0.57, 95% CI -1.02 to -0.12, p = .012). Uncertain effects on pain relief showed up in a virtual reality (VR) distraction (-0.93, 95% CI -2.63 to 0.76, p = .28) and during active distraction (-0.72, 95% CI -1.48 to 0.03, p = .06).ConclusionsDistraction is an efficacious intervention to reduce procedural pain during needle insertion or lumbar puncture procedures in children with cancer. However, the efficacy of active distraction and VR remain uncertain. Future research should focus on specific comparisons of different forms of distractions with larger sample sizes.     

侵入性操作和心肺复苏时病人家属在场的影响的研究进展

在进行侵入性操作 (ｉｎｖａｓｉｖｅｐｒｏｃｅｄｕｒｅ,ＩＰ)或心肺复苏(ＣＰＲ)时 ,允许家庭成员留在病人床旁 (ｆａｍｉｌｙｐｒｅｓｅｎｃｅ ,ＦＰ)是一种新观点。近年来在国外 ,媒体对ＦＰ展开了热烈的讨论[1] ,美国急诊护士协会 (ＥＮＡ)支持ＦＰ ,并于 1995年制定了有关常规[2 ] ;2 0 0 0年美国心血管协会首次制定原则[3 ] 规定医务人员应该询问病人家属是否愿意在心肺复苏和其他急性心脏病发病期陪同在病人身边。目前国内文献中尚未有类似的研究 ,现将国外ＦＰ研究进展综述如下。1　ＦＰ的有关规则1 1　ＦＰ中的术语1.1.1　侵入性…     

The Use of Transesophageal Echocardiography During Cardiac Arrest Resuscitation: A Literature Review

We propose that transesophageal echocardiography (TEE) can be used to guide cardiac arrest resuscitation. We undertook a literature search (Medline and EMBase) to assess articles on that topic. Our search yielded 55 articles falling into 3 categories: TEE used in operating rooms, TEE used in emergency departments, and TEE used in other settings. In many cases, TEE changed the direction of the resuscitation; however, it is unclear whether TEE changed patient‐oriented outcomes, such as neurologically intact survival. Few adverse events related to TEE have been documented. There is growing evidence that physicians can learn to use TEE during resuscitations and apply the findings to clinical decisions.     

Parental Presence During Pediatric Resuscitation: The Use of Simulation Training for Cardiac Intensive Care Nurses

Sherry Pye, Janie Kane, and Amber Jones
Column Editor: Bonnie Gance-Cleveland Family-Centered Care provides a forum for sharing information about basic components of caring for children and families, including respect, information sharing, collaboration, family-to-family support, and confidence building.