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Family Presence during Trauma Resuscitation: A Survey of AAST and ENA Members

Helmer, Stephen D. PhD; Smith, R. Stephen MD; Dort, Jonathan M. MD; Shapiro, William M. MD; Katan, Brian S. MD

The Journal of Trauma: Injury, Infection, and Critical Care: June 2000 - Volume 48 - Issue 6 - p 1015-1024
Annual Meeting Articles

Background The Emergency Nurses Association (ENA) has formally resolved that family presence (FP) during resuscitation and invasive procedures (TR) is the right of the patient and is beneficial for both patients and family members. Furthermore, FP during TR has been implemented at several trauma centers. Because this policy is controversial, a survey was conducted to assess the opinions of members of the American Association for the Surgery of Trauma (AAST) and ENA in regard to FP.

Methods A survey instrument regarding FP during TR was mailed to the AAST membership (n = 813) and a random sampling (10%) of ENA members (n = 2,988). Questions regarding membership (AAST vs. ENA), age, gender, years in practice, trauma experience, the patient’s right to FP during the primary survey, secondary survey, and invasive procedures, the potential effects of FP on trauma team function, and medicolegal implications were included in the survey. Qualitative and quantitative variables were analyzed by analysis of variance and χ2 analysis, respectively. Responses to questions by using a Likert Scale for degree of agreement were analyzed by using the Kruskal-Wallis test.

Results A total of 1,629 (AAST, n = 368; ENA, n = 1,261) surveys were returned (43.4% response). There were 44 surveys returned as undeliverable (1.2%). The members of the AAST were older, more likely to be male, had been in practice longer, and had greater trauma experience when compared with ENA members (p < 0.001). More AAST than ENA members (97.8% vs. 80.2%) believed that FP during all phases of TR was inappropriate (p < 0.001). Fewer AAST members believed that FP was a patient right when compared with ENA members (p < 0.0001). The AAST members were more likely to believe FP interfered with patient care and increased the stress of trauma team members (p < 0.0001). The majority of AAST and ENA members had experience with FP during TR (55.3 vs. 67.8%;p < 0.001). However, the impressions of their experiences were widely disparate, with 63.6% of ENA and only 17.5% of AAST members, indicating that the experience was beneficial (p < 0.001).

Conclusion Attitudes toward FP during TR are significantly different between AAST and ENA members. Because of these differences in opinion, implementation of an FP policy may create conflicts between trauma team members and may interfere with the effectiveness of the trauma team.

From the Department of Medical Education (S.D.H.), Division of Trauma (R.S.S., J.M.D.), and Emergency Services (B.S.K.), Via Christi Regional Medical Center—St. Francis Campus, and Department of Surgery (S.D.H., R.S.S., J.M.D., W.M.S.), The University of Kansas School of Medicine, Wichita, Kansas.

Address for reprints: R. Stephen Smith, MD, Department of Surgery, The University of Kansas School of Medicine—Wichita, 929 N. St. Francis, Wichita, KS 67214.

Submitted for publication September 25, 1999.

Accepted for publication March 1, 2000.

Presented at the 59th Annual Meeting of the American Association for the Surgery of Trauma, September 16–18, 1999, Boston, Massachusetts.

© 2000 Lippincott Williams & Wilkins, Inc.