title: Parent presence during invasive procedures and resuscitation: evaluating a clinical practice change.
abstract: BACKGROUND
  Parent presence during invasive procedures and/or resuscitation is a relatively underdeveloped and controversial practice. Much of the concern stems from the apprehension of the medical community.
  
  
  OBJECTIVE
  To evaluate whether implementation of formal practice guidelines and corresponding interprofessional education would improve clinicians' sense of preparation and comfort in providing parents with options during their children's procedures.
  
  
  METHODS
  Multiphase pre-post survey of (1) clinician perceptions and (2) practice from the perspective of clinicians and parents experiencing the same procedure. Data were collected over 4 years from a cardiovascular and critical care program in one U.S. children's hospital.
  
  
  RESULTS
  More than 70% of clinicians participated in the perception surveys (n = 782) and 538 clinicians and 274 parents participated in the practice surveys. After the intervention, clinicians reported that parents were present during more invasive procedures and reported higher levels of comfort with the practice of providing options to parents during resuscitative events. Levels of comfort were higher in clinicians who had practiced skills in a simulated learning environment. During both phases, few clinicians reported that parent presence affected their technical performance (4%), therapeutic decision-making (5%), or ability to teach (9%). During the post phase, clinicians reported more active parent behaviors during procedures. Parents who reported receiving information to help them prepare for their children's procedures reported higher levels of procedural understanding and emotional support.
  
  
  CONCLUSIONS
  Implementation of practice guidelines and interprofessional education had a positive impact on clinicians' perceptions and practice when providing parents with options and support during their children's invasive procedures and/or resuscitation.
authors.affiliation: Cardiovascular and Critical Care Programs, Boston Children’s Hospital, Boston, Massachusetts, USA. curley@nursing.upenn.edu
authors.forename: Martha A Q
authors.initials: MA
authors.lastname: Curley
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Meyer
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Scoppettuolo
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGann
authors.forename: Bethany P
authors.initials: BP
authors.lastname: Trainor
authors.forename: Christine M
authors.initials: CM
authors.lastname: Rachwal
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hickey
mesh_terms: D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration; D003430:Cross-Sectional Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods* / Q000523:psychology; D018709:Statistics, Nonparametric; D014789:Visitors to Patients / Q000523:psychology*