Let Them In: Family Presence during Intensive Care Unit Procedures
Let Them In: Family Presence during Intensive Care Unit Procedures
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DOI：
10.1513/annalsats.201511-754oi
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发表时间：
2016-07-01
影响因子：
8.3
通讯作者：
Brown, Samuel M.
中科院分区：
文献类型：
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作者：
Beesley, Sarah J.;Hopkins, Ramona O.;Brown, Samuel M.
数十年来，家庭一直倡导全面进入重症监护病房（ICU），并与临床医生建立有意义的伙伴关系，从而逐步改善了家庭进入重症监护病房的机会以及与ICU临床医生的合作。尽管取得了这样的进步，但在侵入性床边手术期间，成人重症监护病房的家庭成员仍然通常被要求离开患者的房间，无论患者是否希望家人在场。医生可能会因为担心受训者的教育、医学上的影响、分心可能对手术技术质量的影响以及手术不育而拒绝让家庭成员在床边。来自平行环境的有限证据并不支持这些担忧。在ICU过程中，当患者和家庭成员都希望家人在场时，履行以患者为中心的护理任务。我们预计，这样的纳入将增加家庭参与，提高患者和家庭满意度，并可能根据开放式探视、儿科ICU经验和心肺复苏期间家庭在场的研究，减少患者和家庭成员的心理困扰。我们相信这些目标可以在不影响患者护理质量、显著增加提供者负担或增加诉讼风险的情况下实现。在这篇文章中，我们权衡了当前的证据，考虑了历史上对家庭成员参与ICU手术的反对意见，并报告了我们的临床实践经验。还提出了在ICU实施家庭程序存在的大纲。
Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient's room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented.