BehindTheMedspeak: Would you want to witness CPR being performed on a loved one?

I sure wouldn't.

It's one of the most frightening things in the world - and I'm a doctor who participates!

I can't even imagine the trauma and stress that might result from a civilian watching.

Yet it would appear that this practice is slowly making its way into America's hospitals.

On October 12, the Wall Street Journal brought this to my attention.

It was the first I'd ever heard of such things.

I mean, I reluctantly acceded to letting parents be with their kids for anesthesia induction.

It's great - as long as it's not a thrash.

But sometimes, even with mom right there in the OR, dressed up in a cover suit, the kid goes ballistic.

And sometimes the mother does too.

So you end up applying the "full-court press" - several people forcing the screaming, thrashing, kicking child down onto the OR table with their body weight, while I hold the mask down on her face and put her under.

Horrible, and much worse when the parent is there.

But this new wrinkle strikes me as way too much.

Count me solidly against it.

Here's the story.
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Hospitals Let Families Witness Procedures

Staying With Patient in ER Or ICU Can Have Benefits, But Some Doctors Object

 
Hospitals are taking steps to alleviate one of medicine's most emotionally trying ordeals: That wait in the hall while doctors are working on a loved one.

Typically, when a patient is brought to the emergency room or operating room, family members are ushered into the hall to anxiously wait for news.

But now, an increasing number of hospitals are letting families stay in the operating room during emergencies and other major procedures.

The approach, known as "family presence," represents a significant shift in the way hospitals deal with families of very sick patients.

The move comes as a growing body of evidence shows that both patients and families can benefit by remaining near each other in stressful situations.

And proponents say that, contrary to conventional wisdom, family members aren't a hindrance to doctors and nurses, even in major medical emergencies.

A range of medical centers - from Seattle's Harborview Medical Center to Parkland Hospital in Dallas to Baystate Medical Center in Springfield, Massachusetts - now have family-presence policies that detail how and when families can be involved in care.

Some cover only certain units, such as pediatrics, where relatives may be allowed to stay with a patient undergoing anesthesia, hold a child during medical tests or administer certain medications.

Others are broader, extending to life-and-death situations in the emergency room or ICU.

In August, Boston's Dana-Farber Cancer Institute began allowing families to stay even during "codes," when someone's heart or breathing stops and doctors may need to shock the patient or open up the chest to massage the heart.

Since as many as 80% of patients die during resuscitation attempts, "we hope families who choose to remain in the room will find comfort and even closure," says Karen Conley, a pediatric nurse and patient liaison at Dana-Farber who helped set up the hospital's new policy.

Maureen Koehring, a trauma nurse at Columbus Children's Hospital in Ohio, stayed with her 12-year-old daughter when she died following heart surgery a few years ago at Columbus Children's, before Ms. Koehring started working there.

At the time, the hospital didn't allow family in the room during resuscitations.

But Ms. Koehring went in anyway and held her daughter's hand even though she realized it made the medical team "very uncomfortable."

To this day, she says, it's one of the few things that provides her comfort.

"Maybe I am the last person she heard that day or maybe that's just what I need to believe to get by," she says.

"Either way, out of all the awful things I saw, I really only remember the fact that I was able to say goodbye in my own way and on my own terms."

The medical community remains divided over the issue, with the majority of hospitals still discouraging having family members present at high-risk moments.

Critics contend that family members have been barred for good reason: Overcrowded ERs and hospital rooms can be distracting to the medical staff, who need to concentrate on the patient.

And family members can be easily overwhelmed by the graphic images they see.

"It's a very bad time to worry about how the family is feeling," says Suzanne DePalma, a critical-care nurse at the University of California Davis Medical Center in Sacramento, which allows relatives to stay only on a case-by-case basis.

In all, just 5% of hospitals have a family-presence plan, according to a survey of critical-care nurses last year, though health-industry experts say the numbers are growing.

Even in hospitals that encourage family presence, the concept isn't universally embraced.

Ron Maier, chief surgeon at Harborview Medical Center in Seattle, says he has seen family presence work well on occasion.

But he typically asks nurses to judge if a family member is in a strong enough emotional state to stay during a procedure.

Medical teams that run smoothly "could easily appear hectic and disjointed to someone who doesn't know what's going on," says Dr. Maier.

"There has to be a line."

A survey of 600 critical-care doctors and nurses released two years ago in the cardiac-care journal Chest found that 80% of physicians disapproved of having family members present during invasive procedures, while only 57% of nurses objected.

Although the American Medical Association has yet to take a position on the issue, the American Association of Critical Care Nurses and the Emergency Nurses Association both support family presence.

The shift has been largely championed by nurses, who say they see the benefits of family involvement first-hand: Families can give on-the-spot medical information to trauma doctors.

Patients often feel calmer having loved ones close at hand. The presence of family members can even inspire better behavior in the medical staff.

But perhaps the most important benefit is to the family members themselves, nurses say.

Last summer, Maureen DeNinno of Oaklyn, N.J., brought her six-week-old son, Dominic, to the ER at nearby Our Lady of Lourdes Medical Center after his fever climbed above 102°, a major concern with newborns.

Hospital staffers suggested she and her husband stay with the baby throughout his two-day stay, and allowed them to hold him as he was put through a battery of exams, including blood and urine tests and a spinal tap.

"Having visual contact with him the entire time helped keep me sane. It helped calm him too," says Mrs. DeNinno, whose son is now fine.

It isn't always clear which hospitals allow family presence, as most don't advertise it, so it's important to ask about the hospital's policy ahead of time or soon after arriving in the emergency room.

In some cases, hospitals assign a nurse or social worker to stand with the family so they can explain what is going on and make sure no one gets overwhelmed, according to trauma experts.

In 2001, a study in the American Journal of Nursing of dozens of families at a Texas hospital who had been allowed to stay with patients during invasive procedures found they were unanimously pleased with their experience.

Some said that they better appreciated the medical staff's efforts because they saw everything first hand.

Theresa Meyers, director of emergency and critical-care services at Memorial Hospital in Colorado Springs, Colorado, and the author of the Texas study, helped her hospital create one of the earliest family-presence plans during the early 1990s.

She was moved to act after breaking the rules and allowing parents of a teenage boy who was critically injured in a tree fall to say goodbye minutes before he died.

A handful of other hospitals followed, but it wasn't until several recent studies began documenting the benefits of family presence that more hospitals joined in.

Ms. Meyers says, family presence "allows people the chance to get some control during situations that are often out of control."