Let Them In: Family Presence during Intensive Care Unit Procedures.
Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient's room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented.
1 Pulmonary and Critical Care Medicine.|2 Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah.|3 Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Sarah J
SJ
Beesley
1 Pulmonary and Critical Care Medicine.|2 Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah.|4 Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah.
Ramona O
RO
Hopkins
5 College of Law, University of Utah, Salt Lake City, Utah; and.
Leslie
L
Francis
6 Clinical Nursing, and.|2 Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah.
Diane
D
Chapman
7 Patient and Family Advisory Council, Intermountain Medical Center, Murray, Utah.
Joclynn
J
Johnson
7 Patient and Family Advisory Council, Intermountain Medical Center, Murray, Utah.
Nathanael
N
Johnson
1 Pulmonary and Critical Care Medicine.|2 Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah.|3 Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Samuel M
SM
Brown
D000328:Adult; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation; D004496:Education, Continuing; D005190:Family / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D011368:Professional-Family Relations; D014789:Visitors to Patients
family presence; intensive care unit procedures; patient family engagement; patient-centered care