RevPaulPediatr.2015;33(4):377---378
www.rpped.com.br
REVISTA
PAULISTA
DE
PEDIATRIA
EDITORIAL
Family
presence
during
pediatric
invasive
procedures
and
resuscitation
A
presenc
¸a
da
família
durante
a
realizac
¸ão
de
procedimentos
invasivos
e
de
ressuscitac
¸ão
em
pediatria
Amélia
Gorete
Reis
FaculdadedeMedicina,UniversidadedeSãoPaulo(USP),SãoPaulo,SP,Brazil
Accepted16July2015
Thefamilypresenceduringinvasiveproceduresand resus-citationinchildrenisbecomingmorecommoninpediatric practice,althoughmostemergencyservicesinBrazildonot havestructuredprotocolstobetterguidethisconduct.The opinionofhealthcareprofessionalsandfamilymemberson thissubjecthasbeendiscussedintheliterature.1
Studies evaluating family members’ perception have
shown positive factors when they witness such
interven-tions. The family has the opportunity to realize the true
severity of the disease or trauma and observe that all
that waspossiblewasin fact done,in additiontostaying togetherinasituationofstress,increasingthechild’s com-fortandreducinganxiety.Therearereportsoffamilieswho witnessedtheirchildren’sresuscitationmaneuversand rec-ommendthisconducttoothersandtherearedeclarations thatgriefwaseasedinthecaseswhenthechilddied.2,3
Studies assessing professionals’ opinions have shown
mixed results. Among the reasons given by professionals
todisagree withthepresenceoffamilymembersare:loss ofemotional control bythefamilymembers and interfer-ence with the procedures, the professionals’ discomfort, increasingthechanceoffailure,limitationsintheteaching of trainees,and increasedrisk of legal suits. Such
justifi-cationshave been questioned,astheyarebasedmoreon
assumptionsthanonrealfacts.
DOIoforiginalarticle:
http://dx.doi.org/10.1016/j.rpped.2015.07.001 E-mail:[email protected]
Ontheotherhand,otherstudieshaveshownthatthere areprofessionalswhopreferfamilyinvolvement.Amongthe reasonsfor this preference is the opportunity to educate familiesaboutthepatient’scondition,pressing profession-alstoconsiderdignityandprivacywhencaringforthechild, aswellasbettercontrolofpainanddecreaseinsuffering.4---6
The study byMekitarian and Angelo,7 publishedin this
issue,bringsavaluablecontributionbyassessingthehealth professionals’opiniononthe familypresencein the pedi-atricemergencyroom.Inadditiontobeingapioneerstudyin thenationalliterature,itdemonstratesamethodology con-sistentwithhighscientificstringency.MekitarianandAngelo foundthatyoungerprofessionalshavebetteracceptanceof familypresenceduringinvasiveprocedures.Thisfactshould notbesurprising,astheroutineofconsideringthefamilyas anactiveparticipantinthechoiceoftreatmentinany situ-ationisa recent one.The discussionabout the autonomy of patients and families when facing therapeutic options wasintroduced at the undergraduate level in health sci-encesandmedicalresidencyandspecializationcurriculain recentyears.Professionalswithmoreseniority(longertime sincegraduation)weretaughttomakecentralized,arbitrary decisions.7
The observation, according toMekitarian and Angelo,7
thatthemedicalteamwasmorefavorablethanthenursing stafftothe familypresenceduring invasive proceduresis probablyrelatedtotheseprofessionals’practices,thatis, moreinvasiveproceduresareingeneralperformedby physi-cians,whereasthelesscomplexonesareperformedbythe nursingstaff.
378 ReisAG
TheresultsofMekitarianandAngelogreatlycontributeto thecreationoftrainingandcontinuingeducationstrategies forprofessionalsworkinginemergencyroomsinBrazil.Itis worthmentioning,however,thatcareshouldbeexercised ingeneralizingtheresults,sincethestudywascarriedout intheemergencyroomofa teachinghospital,where itis expectedthatprofessionalsbeup-to-dateandqualifiedto performinvasiveproceduresandresuscitationmaneuvers.
Manyinternationalmedicalsocietieshaverecommended
thatfamiliesbeofferedthe option ofstaying nexttothe childduringinvasiveproceduresandresuscitation;although Brazil is following this trend, any radicalismto force the adoption of this attitude by all professionals should be
avoided,aswell ascondemning familymembers who,for
severalreasons,prefernottobepresent.Thereshallbeno impositionsthatmaycompromisetreatmentitself.8
Theimplementationoftreatmentprotocolsthatinclude the option of family presence during invasive procedures
andemergencytreatmentsshouldcontributetoimproving
treatmentingeneralinemergencyrooms,sinceitwillbring moretransparencytotherapeuticconducts.9
Funding
Thisstudydidnotreceivefunding.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
References
1.HolzhauserK, Finucane J, De VriesSM. Family presence dur-ingresuscitation:arandomisedcontrolledtrialoftheimpactof familypresence.AustralasEmergNursJ.2005;21:217---25.
2.McGahey-OaklandPR,LiederHS,YoungA, etal.Family expe-riencesduringresuscitationatachildren’shospitalemergency department.JPediatrHealthCare.2007;21:217---25.
3.TinsleyC,HillJB,ShahJ,etal.Experienceoffamiliesduring cardiopulmonaryresuscitationinapediatricintensivecareunit. Pediatrics.2008;122:e799---804.
4.GoldKJ,GorenfloDW,SchwenkTL,BrattonSL.Physician experi-encewithfamilypresenceduringcardiopulmonaryresuscitation inchildren.PediatricCritCareMed.2006;7:428---33.
5.EngelKG, Barnosky AR, Berry-BoviaM, Desmond JS,Ubel PA. Providerexperienceandattitudestowardfamilypresenceduring resuscitationprocedures.JPalliatMed.2007;10:1007---9.
6.ComptonS, Madgy A, Goldstein M,Sandhu J, Dunne R, Swor R.Emergencymedicalserviceproviders’experiencewith fam-ilypresenceduringcardiopulmonaryresuscitation.Resuscitation. 2006;70:223---8.
7.MekitarianFF,AngeloM.Presenc¸adafamíliaemsalade emergên-cia pediátrica: opiniões dos profissionais de saúde. Rev Paul Pediatr.2015;33:460---6.
8.DudleyNC,HansenKW,FurnivalRA,DonaldsonAE,Van Wage-nen KL, Scaife ER. The effect of family presence on the efficiencyofpediatric traumaresuscitations. AnnEmerg Med. 2009;53:777---84.
