- Email: [email protected]
Attention Authors!
B U L L E T I N
B O A R D
Attention Authors! Sell Your Books at Convention & Contribute to AWHONN Library AWHONN has three new ways for you to contribute to y o u r profession and get your work noticed: by putting y o u r work in the AWHONN Library, by having your book reviewed in A W H O N N Lifelines, and by placing y o u r book at the AWHONN Bookstore at the upcoming annual convention, scheduled for June 7 to 10 in San Antonio, TX. W Library The AWHONN Library houses a growing resource collection of books about women’s health and newborn care. If y o u have recently authored or edited a book or chapter of a book, o r if y o u will be publishing in the future, we invite you to donate an autographed copy of your work to the Library. Contributions will be acknowledged in writing and by placement of a special bookplate in the book. Send your book to Kathie DeCeorges, AWHONN Librarian, 700 14th St. N.W., Suite 600, Washington, DC 20005, or call 202-662- 1621, or E-mail [email protected] for additional information. W Book Reviews
Secondly, with this issue,
A W H O N N Lifelines is launching “Library,” a new department dedicated to bringing you information about the latest in books, videos, and CD-ROMs about women’s health, newborn care, and nursing. For readers who want to purchase these materials, there’s a one-stop, convenient 800 number for ordering. To submit materials for review or listing in this new department, send a complete book, video, or CD-ROM to Carolyn Davis Cockey, Executive Editor, A W H O N N Lifelines, 700 14th St. February 1998
N.W., Suite 600, Washington, DC 20005-2006. Sorry, materials cann o t be returned.
nity to have their publications displayed and sold at the first-ever AWHONN Convention Bookstore. The store will be located on the exhibit floor and AWHONN resources and merchandise will be available for purchase. If you are an AWHONN member or are scheduled to speak at the 1998 AWHONN Convention and would like to have y o u r publication sold a t the AWHONN Bookstore, please call Denise Savage at (800) 6738499, ext. 1615 or (202) 662-1600, ext. 1615 for more information.
W Bookstore
AWHONN 1998 Workshops
Also, at the AWHONN 1998 Convention i n San Antonio, AWHONN members and convention speakers will have the opportu
Education to You AWHONN continues to promote excellence in nursing practice by strengthening the knowledge and
Don‘t Miss the AW H0NN Convention Mark your calendars now for the 1998 AWHONN Convention, scheduled this year for June 7 to 10 in San Antonio, TX. Among the variety of professional networking and social functions, you’ll want to take advantage of some of some of these exciting sessions: “Building o n Success: Forging New Frontiers in Women’s Health Care,” by Diana Taylor, RN, PhD, FAAN W “Genetic Frontiers in Women’s Health,” by Shirley I*.Jones, RNC, MS W “Epidural Anesthesia and Birth: An Update on the Issues,” by Judith Poole, RNC, M N W “Neonatal Skin Care: The State of the
Science,” by Carolyn H. Lund, MS, RN, FAAN W “Supporting the Care of Women and Newborns through Information Technology,” by Betty J. Skaggs, PhD, R N W “Holistic Care of Women: Has Science Let Them Down?,” by Lorraine 0. Walker, RN, EdD, CLC W “Ethics in Obstetric, Gynecologic and Women’s Health Nursing,” by Joy
H. Penticuff, RN, PhD, FAAN During the convention, participants will enjoy the exciting mix of Old South and Wild West that is San Antonio. The convention site is just steps away from the world-famous Alamo and the eclectic shops and tantalizing sidewalk cafes of the beautiful River Walk. San Antonio is the home of over 3 0 colorful attractions, including Spanish colonial missions, the local culture and cuisine of the lively Mexican market, and the world’s largest marine life theme park, Sea World of Texas. It’s a city that offers something for every taste, interest, and age. So, bring the whole family and join in the fun! For additional information, call Denise Savage, ( 8 0 0 ) 673-8499, ext. 1615 ( U S . ) , (800) 245-0231, ext. 1615 (Canada), o r ( 2 0 2 ) 662-1615, 9:OO am t o 4:45 pm EST. Lifelines
63
B U L L I T I N
B O A R D
skills of nurses caring for women and newborns. The AWHONN workshops provide in-depth education on a variety of topics in numerous sites around the country. Half-day and full-day workshops are offered in different combinations to address the specific needs of participants and work within their hectic schedules. The Friday half-day workshops will feature the expertise of AWHONN staff on topics such as “Applying Standards and Guidelines,” “Retooling Your Career Search,” “Writing for Publication,” and “Women’s Health on the Web.” On Saturdays, full-day workshops will include topics such as “Reducing C-Section Rates,” “Making the Move to Women’s Health,” “Prostaglandins and Pitocin,” “Obstetric Nursing,” “Postpartum Home Care,” and “Risk Management Issues.” Look for the workshops on the road this spring in a city near you: San Jose, CA (Feb. 20 & 21); Knoxville, T N (March 6 & 7); Spokane, WA (March 27 & 28); St. Louis, M O (April 17 & 18); and Milwaukee, WI (May 1 & 2). Don’t miss this opportunity to enhance your practice and explore opportunities for your future. For more information or to receive a brochure about the workshops, call (800) 673-8499, ext. 1631.
New Resources for Practitioners The Department of Health and Human Services has launched a national toll-free hotline to help clinicians counsel and treat health care workers with job-related exposure to blood-borne diseases and infections, including hepatitis and HIV infection. The National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline) is (888) 448-4911. W NIDA Infofax is a new information resource of science-based facts about drug abuse and addiction launched by the National Institute on Drug Abuse. Fact sheets available via its Fax-on-Demand service 64
Lifelines
cover more than 40 topics within drug abuse and are available by calling (888) 644-6432. NIDA’s research can also be found at its WWW page (http://www. nida.nih.gov).
“Why get mammograms?,” a 40page primary care provider’s pad with tear-off fact sheets on mammograms for patients, and an “Over 40? Consider Mammograms” set of posters is available to clinicians from the National Cancer Institute at (800)4-CANCER (422-6237).A comprehensive breast care booklet titled, “Understanding Breast Changes; The Facts About Breast Cancer and Mammograms,” is also available for the general public. W A new booklet, “Environmental Diseases from A to Z,” is available
from the National Institute of
Environmental Health Sciences. The booklet takes the reader on an illustrated journey through the alphabet and is targeted at helping young people understand environmentallyinduced illnesses, such as asthma and zinc deficiency. Copies are available by writing to NIEHS Office of Communications, P.O. Box 12233, Research Triangle Park, NC 27709, Attn: John Peterson, or by calling (919)541-7860. The National Eye Institute is offering a new brochure, “Don’t Lose Sight of Diabetic Eye Disease,” to help curb the trend of 25,000 people with diabetes going blind each year. For copies, write to Diabetic Eye Disease, 2020 Vision Place, Bethesda, MD 20892-3655 or visit the NEI WWW site (http://www. nei.nih.gov).
+
Save fiese Dates! DATE
LOCATION
EVENT
2/21
San Jose, CA
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, e x t 1631 (Domestic) or (8W) 245-0231, ext. 1631 (Canada)
311-314
Washington, OC
Nurse in Washington Internship; National Federation for Specialty Nursing Organizations 16091 256-2333.
3n
Knoxville, TN
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, ext. 1631 (Domestic1 or (800)245-0231. ext. 1631 (Canada)
3/27
White Plains, NV
Breastfeeding Update ‘98, WestchesterlPutnamIRocland Lactation Consortium; contact Barbara A. Hayes 19141633-0008.
3/28
Spokane, WA
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, ext. 1631 (Domestic) or (800)245-0231, ext. 1631 (Canada)
W I 3
Washington OC
Lactation Consultant Training Program; Lactation Education Resources; contact Vergie Hughes, RN, IBCLC (301) 986-5547. This course also repeats 6/1-6/5 and 11/2-11/6.
4/18
St. Louis, MO
AWHONN 1998 Educational Workshops; Jill Christopher 1800) 6738499, ext. 1631 (Oomestic) or I8W) 245-0231, ext. 1631 (Canada)
4/24-25
Las Vegas. NE
Annual Nurse Entrepreneurship & Career Alternatives Conference; National Nurses in Business Association; Liz Torres (800)331-6534.
4/3-5/2
Boston, MA
Human Teratogens: Environmental Factors Which Cause Birth Defects; Harvard Medical School; (617) 432-1525.
5/2
Milwaukee, WI
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, ext. 1631 IOomesticl or W3l 245-0231, ext. 1631 (Canada)
wav3i
Palm Beach, FL
Issues and Answers in Pediatric and Adolescent Gynecology; NASPAG (2151955-6331.
WdnO
San Antonio, TX
Forging New Frontiers; AWHONN 1998 Convention; Denise Savage (800)673-8499. ext. 1615 (Domestic) or (800)2450231. e x t 1615 (Canada)
On-going
Call for location
The AWHONN Fetal Heart Monitoring Principles and Practices Workshop; call AWHONN FAX-ON-OEMANO(800)395-7373 to reguest FAX document M10.
(To submit information for possible inclusion into this calendar, fax complete event information to ’Lifelines Calendaf’at 202-737-0575.or E-mail “Lffelines@AWNHUNN org “1
Volume 2, Issue 1
(continued @m page 72.)
seemed to be awed by the activity in the room, and frequently had to be led to the bedside and encouraged to touch and speak to their loved one. Nurses did find that family presence made it more difficult to remain distant and unemotional during the code. This was seen as having both a positive and negative
Ifthey could watc action . . . they would that the team was woj their lovei aspect. The patient was viewed more as part of a loving family and less as a clinical challenge. Clinical tasks remained a priority and staff members found that they remained able to function professionally” (Hanson & Strawser, 1992). Furthermore, “In our nine years of experience, not one instance of actual interference with resuscitation activities has occurred” (Hanson & Strawser, 1992).
litigious Concerns Staff members may express concern about the litigious aspects of family presence. They fear that the visitor might misinterpret their actions or identify a mistake or problem. They are correct in their underlying assumption that they are dealing with a s a y consumer. Contemporary media coverage has exposed the general population to a whole range of health and medical situations to which they were not formerly privy. Television shows and court room cameras expose behindthe-scenes views of controversial legal and medical issues, and actual surgical procedures are aired with close-up shots and full explanations. This has prompted the general public to insist on a less paternalistic approach from health care providers. “Too often, family members who are kept out of the room during a code can’t help but get suspicious. They may ask themselves: ‘Why 70
Lifelines
don’t they want us to see what they’re doing? Are they hiding something from us?’ That’s when they’re most likely to seek legal advice, especially if they feel that the staff failed to show compassion and concern for their situation. But if they could watch the code team in action, they’d realize that everything possible was being done. They would see
the cod?team in :eewith their own qes lingfwm&hlyto save onek life. with their own eyes that the team was working feverishly to save their loved one’s life,” (Post, 1989).
Supporting Families, Staff To facilitate a positive experience regarding the inclusion of family members during a code situation, appropriate guidance must be provided. For the visitors, a staff member must be designated as a support person. This person would remain with the family throughout the resuscitation, explaining procedures and monitoring their reactions. This person may be a nurse, doctor, clergy, or other qualified personnel. Ideally, code respondents would allot for this position and secure it as a requisite part of their code team.
evaluate patient, staff, and family response to the new practice, both immediately and long-term. These results must then be shared with and considered by those affected. Hard data will lend objectivity to this emotionally-charged and underevaluated issue. It’s widely accepted that there are innumerable emotional and psychosocial benefits for both patients and their families when support persons are encouraged to be involved in patient care. These opportunities are magnified in a critical care setting. “Grief is the natural pain of loss, and its work cannot be rushed. However, family members have reported that their presence during resuscitation efforts brought a sense of reality to their loss, avoiding a prolonged period of denial that would interfere with the normal grieving process” (Hanson & Strawser, 1992). This is particularly true in reference to neonates in the delivery room. By the time a patient gives birth, both she and her support persons have participated in one of the most emotional and revealing events of their lives. The have likely been in the same room for a number of hours and have made themselves as comfortable there as possible. Personal items used throughout the labor or discarded in the process decorate the room. Support persons may have changed into hospital attire or taken their shoes off to relax in a lounge chair at the bedside. They are familiar with the nurse’s routine. It has, by this point, become “their” room. Having
Nurses didfind thatfamily presence made it more dflcult to remain d&tantand unemotional during the code. Appropriate guidance also includes providing a forum for the hospital staff to express their feelings. Their emotions may surface more easily and dramatically when exposed to those of patients’ families. When instituting such a change, it’s important to track outcomes. Effective tools must be utilized to
shared such a personal time of their lives with the staff, they have presumably formed a relationship with their primary caregivers. These particulars are part of what makes neonatal resuscitation unique-and inclusion of family members critical. For example, consider the expectant father who has shared numerVolume 2, Issue 1
ous experiences with his wife before her hospitalization and has just undergone the labor and delivery process with her. He will be understandably upset and concerned if difficulties with their newborn infant arise. Also, due to the patient’s immediate postpartum condition, she will likely need to defer to him to assess and interpret the situation for her. If the infant is removed to another area for resuscitation and the proceedings are not visible to either parent, it will be nearly impossible for them to conceptualize what is being done for their baby. For many, the helplessness and anxiety of waiting in another room is far worse than observing the resuscitation efforts of the staff. Involvement in the resuscitation effort may help the patient and her family to come to terms with an unexpected negative
February 1998
outcome and ultimately assist them in the bereavement process. Also, removing the infant from the family’s view is a violation of the trust established during their hospitalization. Health care providers not only encourage but expect fathers to be completely involved in all of the processes that support his partner during labor. Then, suddenly, when there is an unexpected turn of events, we exclude him. This exclusion can be either physical, by closing a door or escorting the father from the room, or conceptual, by creating a wall with our backs and our silence. “AS with birth, so with death. Sequestering the family of a dying patient in a waiting room now seems as unthinkable to me as barring fathers from delivery rooms. The time has come to encourage familial bonding during the death
of a loved one, just as we encourage it at birth,” (Post, 1989). The time has also come for maternakhild nurses to join other professional specialties to address this issue and help to further the acceptance of the practice of family presence. Remember, although you may have put your heart and soul into helping to deliver that infant, it’s not yours!
+
References Hanson, C., & Strawser, D. (1992). Family presence during cardiopulmonary resuscitation: Foote Hospital’s emergency department’s nine-year perspective.Journal of Emergency Nursing 18(2):104-106. Post, H. (1989). Letting the family in during a code. Nursing 19(3):4346. Presenting the Option for Family Presence (1995) Emergency Nurses Association; Parkridge, IL: Author.
Lifelines
71
B O A R D
Attention Authors! Sell Your Books at Convention & Contribute to AWHONN Library AWHONN has three new ways for you to contribute to y o u r profession and get your work noticed: by putting y o u r work in the AWHONN Library, by having your book reviewed in A W H O N N Lifelines, and by placing y o u r book at the AWHONN Bookstore at the upcoming annual convention, scheduled for June 7 to 10 in San Antonio, TX. W Library The AWHONN Library houses a growing resource collection of books about women’s health and newborn care. If y o u have recently authored or edited a book or chapter of a book, o r if y o u will be publishing in the future, we invite you to donate an autographed copy of your work to the Library. Contributions will be acknowledged in writing and by placement of a special bookplate in the book. Send your book to Kathie DeCeorges, AWHONN Librarian, 700 14th St. N.W., Suite 600, Washington, DC 20005, or call 202-662- 1621, or E-mail [email protected] for additional information. W Book Reviews
Secondly, with this issue,
A W H O N N Lifelines is launching “Library,” a new department dedicated to bringing you information about the latest in books, videos, and CD-ROMs about women’s health, newborn care, and nursing. For readers who want to purchase these materials, there’s a one-stop, convenient 800 number for ordering. To submit materials for review or listing in this new department, send a complete book, video, or CD-ROM to Carolyn Davis Cockey, Executive Editor, A W H O N N Lifelines, 700 14th St. February 1998
N.W., Suite 600, Washington, DC 20005-2006. Sorry, materials cann o t be returned.
nity to have their publications displayed and sold at the first-ever AWHONN Convention Bookstore. The store will be located on the exhibit floor and AWHONN resources and merchandise will be available for purchase. If you are an AWHONN member or are scheduled to speak at the 1998 AWHONN Convention and would like to have y o u r publication sold a t the AWHONN Bookstore, please call Denise Savage at (800) 6738499, ext. 1615 or (202) 662-1600, ext. 1615 for more information.
W Bookstore
AWHONN 1998 Workshops
Also, at the AWHONN 1998 Convention i n San Antonio, AWHONN members and convention speakers will have the opportu
Education to You AWHONN continues to promote excellence in nursing practice by strengthening the knowledge and
Don‘t Miss the AW H0NN Convention Mark your calendars now for the 1998 AWHONN Convention, scheduled this year for June 7 to 10 in San Antonio, TX. Among the variety of professional networking and social functions, you’ll want to take advantage of some of some of these exciting sessions: “Building o n Success: Forging New Frontiers in Women’s Health Care,” by Diana Taylor, RN, PhD, FAAN W “Genetic Frontiers in Women’s Health,” by Shirley I*.Jones, RNC, MS W “Epidural Anesthesia and Birth: An Update on the Issues,” by Judith Poole, RNC, M N W “Neonatal Skin Care: The State of the
Science,” by Carolyn H. Lund, MS, RN, FAAN W “Supporting the Care of Women and Newborns through Information Technology,” by Betty J. Skaggs, PhD, R N W “Holistic Care of Women: Has Science Let Them Down?,” by Lorraine 0. Walker, RN, EdD, CLC W “Ethics in Obstetric, Gynecologic and Women’s Health Nursing,” by Joy
H. Penticuff, RN, PhD, FAAN During the convention, participants will enjoy the exciting mix of Old South and Wild West that is San Antonio. The convention site is just steps away from the world-famous Alamo and the eclectic shops and tantalizing sidewalk cafes of the beautiful River Walk. San Antonio is the home of over 3 0 colorful attractions, including Spanish colonial missions, the local culture and cuisine of the lively Mexican market, and the world’s largest marine life theme park, Sea World of Texas. It’s a city that offers something for every taste, interest, and age. So, bring the whole family and join in the fun! For additional information, call Denise Savage, ( 8 0 0 ) 673-8499, ext. 1615 ( U S . ) , (800) 245-0231, ext. 1615 (Canada), o r ( 2 0 2 ) 662-1615, 9:OO am t o 4:45 pm EST. Lifelines
63
B U L L I T I N
B O A R D
skills of nurses caring for women and newborns. The AWHONN workshops provide in-depth education on a variety of topics in numerous sites around the country. Half-day and full-day workshops are offered in different combinations to address the specific needs of participants and work within their hectic schedules. The Friday half-day workshops will feature the expertise of AWHONN staff on topics such as “Applying Standards and Guidelines,” “Retooling Your Career Search,” “Writing for Publication,” and “Women’s Health on the Web.” On Saturdays, full-day workshops will include topics such as “Reducing C-Section Rates,” “Making the Move to Women’s Health,” “Prostaglandins and Pitocin,” “Obstetric Nursing,” “Postpartum Home Care,” and “Risk Management Issues.” Look for the workshops on the road this spring in a city near you: San Jose, CA (Feb. 20 & 21); Knoxville, T N (March 6 & 7); Spokane, WA (March 27 & 28); St. Louis, M O (April 17 & 18); and Milwaukee, WI (May 1 & 2). Don’t miss this opportunity to enhance your practice and explore opportunities for your future. For more information or to receive a brochure about the workshops, call (800) 673-8499, ext. 1631.
New Resources for Practitioners The Department of Health and Human Services has launched a national toll-free hotline to help clinicians counsel and treat health care workers with job-related exposure to blood-borne diseases and infections, including hepatitis and HIV infection. The National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline) is (888) 448-4911. W NIDA Infofax is a new information resource of science-based facts about drug abuse and addiction launched by the National Institute on Drug Abuse. Fact sheets available via its Fax-on-Demand service 64
Lifelines
cover more than 40 topics within drug abuse and are available by calling (888) 644-6432. NIDA’s research can also be found at its WWW page (http://www. nida.nih.gov).
“Why get mammograms?,” a 40page primary care provider’s pad with tear-off fact sheets on mammograms for patients, and an “Over 40? Consider Mammograms” set of posters is available to clinicians from the National Cancer Institute at (800)4-CANCER (422-6237).A comprehensive breast care booklet titled, “Understanding Breast Changes; The Facts About Breast Cancer and Mammograms,” is also available for the general public. W A new booklet, “Environmental Diseases from A to Z,” is available
from the National Institute of
Environmental Health Sciences. The booklet takes the reader on an illustrated journey through the alphabet and is targeted at helping young people understand environmentallyinduced illnesses, such as asthma and zinc deficiency. Copies are available by writing to NIEHS Office of Communications, P.O. Box 12233, Research Triangle Park, NC 27709, Attn: John Peterson, or by calling (919)541-7860. The National Eye Institute is offering a new brochure, “Don’t Lose Sight of Diabetic Eye Disease,” to help curb the trend of 25,000 people with diabetes going blind each year. For copies, write to Diabetic Eye Disease, 2020 Vision Place, Bethesda, MD 20892-3655 or visit the NEI WWW site (http://www. nei.nih.gov).
+
Save fiese Dates! DATE
LOCATION
EVENT
2/21
San Jose, CA
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, e x t 1631 (Domestic) or (8W) 245-0231, ext. 1631 (Canada)
311-314
Washington, OC
Nurse in Washington Internship; National Federation for Specialty Nursing Organizations 16091 256-2333.
3n
Knoxville, TN
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, ext. 1631 (Domestic1 or (800)245-0231. ext. 1631 (Canada)
3/27
White Plains, NV
Breastfeeding Update ‘98, WestchesterlPutnamIRocland Lactation Consortium; contact Barbara A. Hayes 19141633-0008.
3/28
Spokane, WA
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, ext. 1631 (Domestic) or (800)245-0231, ext. 1631 (Canada)
W I 3
Washington OC
Lactation Consultant Training Program; Lactation Education Resources; contact Vergie Hughes, RN, IBCLC (301) 986-5547. This course also repeats 6/1-6/5 and 11/2-11/6.
4/18
St. Louis, MO
AWHONN 1998 Educational Workshops; Jill Christopher 1800) 6738499, ext. 1631 (Oomestic) or I8W) 245-0231, ext. 1631 (Canada)
4/24-25
Las Vegas. NE
Annual Nurse Entrepreneurship & Career Alternatives Conference; National Nurses in Business Association; Liz Torres (800)331-6534.
4/3-5/2
Boston, MA
Human Teratogens: Environmental Factors Which Cause Birth Defects; Harvard Medical School; (617) 432-1525.
5/2
Milwaukee, WI
AWHONN 1998 Educational Workshops; Jill Christopher (800)6738499, ext. 1631 IOomesticl or W3l 245-0231, ext. 1631 (Canada)
wav3i
Palm Beach, FL
Issues and Answers in Pediatric and Adolescent Gynecology; NASPAG (2151955-6331.
WdnO
San Antonio, TX
Forging New Frontiers; AWHONN 1998 Convention; Denise Savage (800)673-8499. ext. 1615 (Domestic) or (800)2450231. e x t 1615 (Canada)
On-going
Call for location
The AWHONN Fetal Heart Monitoring Principles and Practices Workshop; call AWHONN FAX-ON-OEMANO(800)395-7373 to reguest FAX document M10.
(To submit information for possible inclusion into this calendar, fax complete event information to ’Lifelines Calendaf’at 202-737-0575.or E-mail “Lffelines@AWNHUNN org “1
Volume 2, Issue 1
(continued @m page 72.)
seemed to be awed by the activity in the room, and frequently had to be led to the bedside and encouraged to touch and speak to their loved one. Nurses did find that family presence made it more difficult to remain distant and unemotional during the code. This was seen as having both a positive and negative
Ifthey could watc action . . . they would that the team was woj their lovei aspect. The patient was viewed more as part of a loving family and less as a clinical challenge. Clinical tasks remained a priority and staff members found that they remained able to function professionally” (Hanson & Strawser, 1992). Furthermore, “In our nine years of experience, not one instance of actual interference with resuscitation activities has occurred” (Hanson & Strawser, 1992).
litigious Concerns Staff members may express concern about the litigious aspects of family presence. They fear that the visitor might misinterpret their actions or identify a mistake or problem. They are correct in their underlying assumption that they are dealing with a s a y consumer. Contemporary media coverage has exposed the general population to a whole range of health and medical situations to which they were not formerly privy. Television shows and court room cameras expose behindthe-scenes views of controversial legal and medical issues, and actual surgical procedures are aired with close-up shots and full explanations. This has prompted the general public to insist on a less paternalistic approach from health care providers. “Too often, family members who are kept out of the room during a code can’t help but get suspicious. They may ask themselves: ‘Why 70
Lifelines
don’t they want us to see what they’re doing? Are they hiding something from us?’ That’s when they’re most likely to seek legal advice, especially if they feel that the staff failed to show compassion and concern for their situation. But if they could watch the code team in action, they’d realize that everything possible was being done. They would see
the cod?team in :eewith their own qes lingfwm&hlyto save onek life. with their own eyes that the team was working feverishly to save their loved one’s life,” (Post, 1989).
Supporting Families, Staff To facilitate a positive experience regarding the inclusion of family members during a code situation, appropriate guidance must be provided. For the visitors, a staff member must be designated as a support person. This person would remain with the family throughout the resuscitation, explaining procedures and monitoring their reactions. This person may be a nurse, doctor, clergy, or other qualified personnel. Ideally, code respondents would allot for this position and secure it as a requisite part of their code team.
evaluate patient, staff, and family response to the new practice, both immediately and long-term. These results must then be shared with and considered by those affected. Hard data will lend objectivity to this emotionally-charged and underevaluated issue. It’s widely accepted that there are innumerable emotional and psychosocial benefits for both patients and their families when support persons are encouraged to be involved in patient care. These opportunities are magnified in a critical care setting. “Grief is the natural pain of loss, and its work cannot be rushed. However, family members have reported that their presence during resuscitation efforts brought a sense of reality to their loss, avoiding a prolonged period of denial that would interfere with the normal grieving process” (Hanson & Strawser, 1992). This is particularly true in reference to neonates in the delivery room. By the time a patient gives birth, both she and her support persons have participated in one of the most emotional and revealing events of their lives. The have likely been in the same room for a number of hours and have made themselves as comfortable there as possible. Personal items used throughout the labor or discarded in the process decorate the room. Support persons may have changed into hospital attire or taken their shoes off to relax in a lounge chair at the bedside. They are familiar with the nurse’s routine. It has, by this point, become “their” room. Having
Nurses didfind thatfamily presence made it more dflcult to remain d&tantand unemotional during the code. Appropriate guidance also includes providing a forum for the hospital staff to express their feelings. Their emotions may surface more easily and dramatically when exposed to those of patients’ families. When instituting such a change, it’s important to track outcomes. Effective tools must be utilized to
shared such a personal time of their lives with the staff, they have presumably formed a relationship with their primary caregivers. These particulars are part of what makes neonatal resuscitation unique-and inclusion of family members critical. For example, consider the expectant father who has shared numerVolume 2, Issue 1
ous experiences with his wife before her hospitalization and has just undergone the labor and delivery process with her. He will be understandably upset and concerned if difficulties with their newborn infant arise. Also, due to the patient’s immediate postpartum condition, she will likely need to defer to him to assess and interpret the situation for her. If the infant is removed to another area for resuscitation and the proceedings are not visible to either parent, it will be nearly impossible for them to conceptualize what is being done for their baby. For many, the helplessness and anxiety of waiting in another room is far worse than observing the resuscitation efforts of the staff. Involvement in the resuscitation effort may help the patient and her family to come to terms with an unexpected negative
February 1998
outcome and ultimately assist them in the bereavement process. Also, removing the infant from the family’s view is a violation of the trust established during their hospitalization. Health care providers not only encourage but expect fathers to be completely involved in all of the processes that support his partner during labor. Then, suddenly, when there is an unexpected turn of events, we exclude him. This exclusion can be either physical, by closing a door or escorting the father from the room, or conceptual, by creating a wall with our backs and our silence. “AS with birth, so with death. Sequestering the family of a dying patient in a waiting room now seems as unthinkable to me as barring fathers from delivery rooms. The time has come to encourage familial bonding during the death
of a loved one, just as we encourage it at birth,” (Post, 1989). The time has also come for maternakhild nurses to join other professional specialties to address this issue and help to further the acceptance of the practice of family presence. Remember, although you may have put your heart and soul into helping to deliver that infant, it’s not yours!
+
References Hanson, C., & Strawser, D. (1992). Family presence during cardiopulmonary resuscitation: Foote Hospital’s emergency department’s nine-year perspective.Journal of Emergency Nursing 18(2):104-106. Post, H. (1989). Letting the family in during a code. Nursing 19(3):4346. Presenting the Option for Family Presence (1995) Emergency Nurses Association; Parkridge, IL: Author.
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