By Stacey Kusterbeck
Many hospitals still have not lifted restrictions on family presence during resuscitation/invasive procedures that were implemented during the pandemic, raising ethical concerns.
“Family presence has been the standard of care since the early 2000s. Sadly, but expectedly, it was interrupted during the COVID-19 pandemic,” recounts Margo Halm, PhD, RN, NEA-BC, FAAN, a Portland, OR-based nurse scientist consultant.
A year out from the end of the global pandemic, it is time for family presence to be reestablished to reflect a culture of patient and family-centered care, according to an updated practice alert from the American Association of Critical-Care Nurses.1
It is unclear how many hospitals have instituted a family presence program, either formally with a hospital policy or informally on a case-by-case basis. Some hospitals never adopted the practice to begin with. Other facilities still are adjusting to the post-pandemic world and have not made an effort either to reinstitute the practice or begin a process to bring it to their patients and families.
Another possible reason for this may be intermittent visiting restrictions that may come into play because of COVID spikes in communities, adds Halm.
“Family presence is not new — it is an evidence-based practice backed by solid research. Patients and families believe it is their right to be together in healthcare moments where they are the most vulnerable,” says Halm, author of the Practice Alert. Similarly, healthcare professionals believe they should support families who desire to be present.
From an ethical perspective, patients and families have a right to have their care preferences upheld. “When family presence is not offered as an option, these preferences are fractured. Not inviting family interrupts their autonomy in so many ways,” says Halm.
If a family member would choose to be present but is not allowed, they lose their ability to advocate for their loved one with the healthcare team. For instance, the family might have essential health information that perhaps only they know, that could benefit the team caring for their loved one.
For some family members, it is important to bear witness to clinicians doing everything possible to save their loved one’s life to be able to accept what happened should their loved one die.
“For years, healthcare professionals have voiced concerns that being present is too traumatic for families — that it is just too much to see CPR (cardiopulmonary resuscitation) and other life-saving measures in action. But the research actually shows the opposite,” says Halm.
In Halm’s clinical experience, family members are less anxious and fearful if they if they are present. Families see firsthand how hard the team is working to save or care for their loved one. They do not have to be in a waiting room or consult area wondering what is happening.
“Being barred from the comfort and support of one’s closest loved ones during vulnerable health moments — whether you are a child or an adult — is not person-centered care and may cause emotional harm,” asserts Halm. Halm says that ethicists can assist clinical teams in their family presence programs:
• by helping to develop policies and procedures for family presence;
• by participating in debriefings after family presence events — by hearing firsthand what went well or what could have gone better, ethicists can help the team navigate challenging issues that may come up during these events;
• by hosting ethical rounds showcasing recent family presence events. “Members of the healthcare team can share experiences and support one another in delivering this intervention,” suggests Halm.
- Halm MA, Ruppel H, Sexton JR, Guzzetta CE. Facilitating family presence during resuscitation and invasive procedures throughout the life span. Crit Care Nurse 2024;44:e1-e13.
