Mcgrath 2006

FAMILY COLUMN
Family Presence
during Procedures:
Breathing Life
into Policy and
Everyday Practices
By Jacqueline M. McGrath, PhD, RN, NNP, FNAP,
Column Editor
F
amily presence during procedures is an emotionally charged topic. Most
nurses and facilities advocate family-centered care somewhere in their
personal beliefs and institutional policies; yet, family presence during
invasive procedures is often not a routine practice in care of newborns and infants.
Parents often do not feel that they are partners in the caregiving of their infants.1
Decreased levels of comfort and anxiety, which could lead to procedure failure on
the part of the health care provider, have been cited as barriers to this practice.2
These beliefs are founded in tradition rather than evidence; there is no research to
support keeping families away from the bedside during invasive procedures.3
However, even with good evidence to support family presence and policies in
place in some institutions, the practice is still more uncommon than one would
hope. So, how do we incorporate family presence into a living breathing policy in
our daily practice? The only way to increase comfort levels with any protocol or
procedure is to practice it. That being said, how does one increase their level of
comfort when an audience (the family) is present?
It is well documented that venipucture for vascular access is a painful
procedure for the infant and does increase stress if not anxiety as well. This
viewpoint acknowledges that pain does exist and that previous experience with
painful procedures does effect both pain perceptions and anxiety with the
current procedure in infants.4 Parents are also stressed by procedures that must
be done to their children. Yet, just having an infant who is ill or is in the
neonatal intensive care unit is already a stressful experience. Parents are afraid
for their child’s life, and they are in an unfamiliar environment with unfamiliar
people, language (medical terminology), and technology; they are already
anxious. Research in the pediatric intensive care unit has examined parental
presence during procedures, and most parents want to be present or have the
option to be present; most parents stated that they found being present less
anxiety-producing than being asked to leave.5,6 Families who are present during
procedure believe that their presence provides them the opportunity to observe
and know that everything was being done for their child. It also allows them the
opportunity to provide comfort to their child, which increases their parental
From the Maternal Child Nursing Department,
School of Nursing, Virginia Commonwealth Uni- competence during hospitalization.
versity, Richmond, VA. When parents are included in the procedure, several steps are needed to be
Address correspondences to Jacqueline M. taken to ease their anxieties and provide them with opportunities to help the
McGrath, PhD, RN, NNP, FNAP, Virginia
Commonwealth University, Richmond, VA, USA. infant overcome the procedure. In addition, having a well-designed policy in
n 2006 Elsevier Inc. All rights reserved.
1527-3369/06/0604-0165$10.00/0
doi:10.1053/j.nainr.2006.09.008 Newborn and Infant Nursing Reviews, Vol 6, No 4 (December), 2006: pp 243-244 243
244 Jacqueline M. McGrath
place that includes parents provides the health care team members present. Most families are encouraged by new
with strategies to decrease stress for all participants during personnel because they often take more time with the
the procedure.7,8 family and are more willing to answer questions and
Steps to facilitate parental participation in invasive provide support to family members. Communication is the
key to success in these situations.
procedures:
1. Most parents feel uncomfortable being present in a

procedure because they feel uncertain about what their Conclusions
parental role should be during the procedure. Before a
procedure, parents need information about the procedure,
that is, what will happen, what are the expected responses
of the infant, and what should their role be. Providing
F amily presence cannot be taken lightly. It should be a
formal part of our practice with newborns and infants
and must be essential to the planning and implementation
parents with ways to actively participate will make the of every procedure performed with this vulnerable
process easier for all involved. Questions should also be population. Emotionally charged attitudes and opinions
encouraged during this discussion.
cannot be the guiding force in providing care that is
2. Assess parent’s stability in being able to cope and be present
for their child. Family presence should not be forced; parents
supportive during a time of stress for the infants and
should also have the option to decline to be present when they families in our care.
feel uncomfortable with the situation or unable to be
supportive of their infant. It is truly a personal decision,
and there is no wrong or right answer. If parents decide not to References
be present, they should still be provided with information
about the procedure before the procedure is done. After the
1. Heermann JA, Wilson ME, Wilheim PA. Mothers in the NICU:
procedure is completed, they should be invited back to the
outsider to partner. Pediatr Nurs. 2005;31:176 - 181.
bedside to comfort and soothe the infant. They should also be 2. Bradford KK, Kost S, Selbst SM, Renwick AE, Pratt A. Family
provided with information about the success of the proce- member presence for procedures: the resident’s perspective. Ambul
dure, other outcome information, and how the infant tolerated Pediatr. 2005;5:294 - 297.
the procedure. Just because a parent declines to be present for 3. Mason DJ. Family presence: evidence versus tradition. Am J Crit
one procedure, it should not be assumed that they do not want Care. 2003;12:190 - 192.
4. Taddio A, Katz J, Ilersich AL, Koren G. Effects of neonatal
to be present for other procedures. They should always be
circumcision on pain response during subsequent routine vaccination.
asked when another procedure needs to be performed.
Lancet. 1997;349:599 - 603.
3. Parents know their child best, and they can be asked to use 5. Mangureten J, Scott SH, Guzetta CE, et al. Effects of family
this knowledge to anticipate their child’s distress and presence during resuscitation and invasive procedures in a pediatric
intervene appropriately. During procedures, parents can be emergency department. J Emerg Nurs. 2005;32:225 - 233.
encouraged to speak to their infant, touch, comfort, and 6. Powers KS, Rubenstein JS. Family presence during invasive
soothe them while also facilitating the procedure by holding procedures in the pediatric intensive care unit: a prospective study. Arch
the child still in the appropriate position for the successful Pediatr Adolesc Med. 1999;153:955 - 958.
7. Bassler PC. The impact of education on nurses’ beliefs
completion of the procedure. Giving parents something to
regarding family presence in a resuscitation room. J Nurs Staff Dev.
do can be helpful to the family members present and the 1999;15:126 - 131.
health care team. 8. Wolfran RW, Turner ED, Philput C. Effects of parental presence
4. Instruction of less experienced nursing and medical during young children’s venipucture. Pediatr Emerg Care. 1997;13:
personnel must be done tactfully when there are family 325 - 328.

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FAMILY COLUMN

1. Most parents feel uncomfortable being present in a

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