Parents and Clinical Practice Council

Parents Present During Invasive Procedures – Take it to your Clinical Practice Council.

When working for a family practice physician, I learned the significance of maternal or fraternal presence with an invasive procedure.  This physician was emphatic that the father of the infant be present during a circumcision.  He would allow the mother to stay in the waiting room but the father must be with his newborn son during the circumcision.

We told the father what we will do and what he, as the father, would do to comfort the infant.   It became the father’s job to talk to his child and use the pacifier during the procedure.  Therefore, the father stayed at the head of the baby and doctor and nurse at the feet of the baby.  The father usually didn’t look at what we were doing and, therefore, did not have an anxiety attack.  The infant responded so well.  The infant was less stressed than the infants without parental presence.

I was convinced!! Children should have a parent beside them during frightening and painful procedures.  Parents should be told what to expect and how to respond to their child. It is all about the approach.  If done with concern for the child and parent, the event will occur without incident.

To implement this practice you will need to take it to hour practice council of your hospital. The practice council develops, reviews, and disseminates clinical nursing policies, guidelines and practice alerts.  This council contributes toward shaping nursing practice to ensure that nursing practice documents are based on the lasts research and other levels of evidence and then collaborate with unit leadership to educate the staff nurses about the nursing practice changes.

The road to new practices begins with

• Brainstorming and identifying clinical important issues of bedside problems
• Generates literature that is applicable to selected topics
• Collecting evidence based data
• Discussing the evidence based data with the level and appraisal of evidence
• Formulating a document sand sending it to the nursing policy committee for appraisal
• Collaborating and disseminating the policy in sub groups
• Present the new policy to the unit.

I have researched the data on “Parents Present for Invasive Procedures” and there is ample research on this issue.  You can find data regarding the following issues on PubMed.com which is published by the US national Library of Medicine:

• Parental presence during invasive procedures in children – what is the physician’s perspective.
• Do parents want to be present during invasive procedures?
• Parents coping in child distress during invasive procedures.
• Is there evidence to support intervention to facilitate parent presence during invasive pediatric procedures and resuscitation?

The phenomenon of Family-Centered Care within pediatric hospitals has evolved over the past several decades. It is now well accepted that pediatric care should be provided within the context of families, with parents considered essential participants in their child’s care. In fact, PICUs are now designed to include space that is devoted exclusively to accommodating the needs of parents. PICU clinicians extend their compassionate care to include parents of critically ill children with the goals of helping them to successfully cope with the stress of parenting their children and making decisions on behalf of their child.

In many outpatient and hospital settings, parents are commonly present during some of their child’s invasive procedures such as the insertion of a peripheral intravenous or Foley catheter or a lumbar puncture.  At some institutions, parents are present during the induction of elective anesthesia for invasive procedures or surgery.  One of the last bastions of this evolving phenomenon is rethinking the practice of routinely asking parents to leave the bedside during more-invasive procedures acute care setting, such as central venous cannulation, chest tube insertion, endotracheal intubation and/or cardiopulmonary resuscitation.

Sources:

Parent Present During Complex Invasive Procedures and Cardiopulmonary Resuscitation: A Systematic Review of the Literature by R. Scott Dingemen MD, Elizabeth A Mitchel, Elaine C. Meyer, RN PhD, Martha A.Q. Curley RN, PhD, FAAN.