Friday, June 30, 2006

The Pit and the reason there is no family in it

I was watching CNN the other night and they had a story that worried me. Letting family in the ER during treatment. And what they were talking about was not having your mom back as they put in a couple stiches in your finger, but in the TRAUMA BAYS and RESCUSSITATION ROOMS while the medical staff do what what these highly trained medical professional do. They attempt to raise the dead. Anybody who works in the Emergency field knows this is not a calm, quiet place...It is raw medicine. Tubes, cathaters, defibs, blades, fluid and blood.

So why I ask, why would we want to let the families in to witness, what they so should never witness. Whould you want to see the ER staff thumping on your family member's chest, cutting open the side of their chest to shove in a tube. I'm sorry this is just not the place for a grieving. They have a room for that it called "the family room" This is where the hand holding chaplin can support the greiving family in the proper way. Away from the blood, away from the chest thumping, away from the oranized chaos that is a trauma bay.

Also, the hospitals that are trying this are also telling us the public that there will be a nurse explaining to the pt family what is going on. WHAT! Really what ER nurse could even take the time to do this. In the many taumas I have worked the nurses are to busy "Saving the man's life" to hand-hold through a rescussitation. I am not saying that ER nurses are these hard-ass, non caring people, they aren't. They are caring, to the patient, that is bleeding to death on the stretcher. But the ER is refered to as "the Pit" for a reason.

I think people in this age of shows like "ER, House, Grey's Anatomy and now Saved" think they know whats going on behide the closed ER doors. What they see is not always what you get. The actors are always the right color and they always get brought back to life. TV is so kind. a little CPR mix in a little bit of drugs and viola they are alive. In real life, it isn't so clean cut. We could shock after shock, plunge in tube after tube. There is mangled limbs and blood. Its not the sterial world portrayed on TV. This is not the place for a hyserical family member...or even a calm one. They need to stay out.

13 comments:

Hnk76 said...

This is actually a very interesting discussion! I know I´ve read somewhere about family members who has been present during resuscitation and feel that they´ve benefited from it... I´ll look around a bit for studies and let you know if I find anything. I´ve only experienced it once and that was when we brought in a guy who got killed in an accident with a moped. He was dead when we arrived but we worked on him for the brothers´ sake who was also on the scene. He was also in the trauma room and witnessed everythin until they pronounced him dead and he was grateful that we/they let him. Ok. A bit of a rambling there in a language that is not my mother tongue. Hope you understand what I mean. Have a nice day...

hnk76 said...

OK. Here´s a couple of links...

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=3578974&dopt=Citation

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1573794&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15595585&dopt=Abstract

I hope they work...

hnk76 said...

OK. They don´t... :-)

Just google and you´ll find loads of information.

painter in hiding said...

Thanks, they do work if you cut and paste. Ill read them and get back to you
b-

Maria said...

I agree with you about NOT letting family members observe. Not only do I think it would be too traumatic for them, but also potentially distracting to the staff trying to do their job, or even dangerous to them or the patient they are working on. A distraught family member might throw themselves onto their loved one, at an inopportune moment, injuring themselves, or causing a needle stick to staff, whatever. It's just not a good idea. Besides that, what about the patient's preference? When I had a surgical procedure last year, I specifically did NOT want my husband in the room!

Dott said...

alllllllllllllllllll of the research shows that families cope best when they are there / involved / present. It takes more effort on our part and makes us more careful about how we act but apparently helps start the grief process etc....

painter in hiding said...

Honestly I don't care what the research says. The ER is not a place for grieving. It just isn't. This is not "clean" medicine. Its, like I said in the post, raw, uncensored medicine. There is a reason that even on the discovery channel the actual procedure is blurred out. The ER is absolutly not the place for a grief-stricken family memeber to witness the staff work on thier loved one. And I don't know where the hospital you work in is,but there is not the avalible staff to pay the attention that this said fanmily member needs at this point. We do have chaplins, and they are wonderful. Even I, who isn't very religious, has found solace in speaking to the chaplins. But even they, take the family away form the choas.

And this isn;t because the nurses, doctors or even us the paramedics are unfeeling, heartless, uncaring. Because we are. We work hard to save these strangers. I fell apart after a call with a certain trauma victim. But even us have a hard time holding it together during the rescustation.And the family standing there watching cannot help the staff.

It makes is hard for the staff to work with a family member distracting them. It makes it harder for us to make that much needed jump from "this is someones loved one" to "this is a person who needs me..us..to save him"

We, as caregivers, are very conscious of what we are doing and how what we do will affect the surviving family whether the family is there or not. I just can;t have them in my face while I'm doing CPR on a thier child. Its hard enough for me to get past, this is a child, a child that needs me to sometime do almost violent looking things to, like chest tubes, intubation, defib. IVs

I don't want to bear witness to that, but I have to, its my job to save them the best I know how. Not to coddle the family. it sound cold, but honestly that is the Chaplins job outside of the ER door.

Dotttt said...

girrrrr...

Im assuming that you are new to the industry. Before you totally debunk what Im saying go and review the all available research first.

I work as a Paramedic and also as an ED charge nurse in a metro trauma centre. Often I have found those with the biggest hangups abt having family present have huge insecurities abt their practice or are unsure abt how to interact appropriately with families.

You can be the most technically competent medic/RN but if you cant interact with families and demystify the chaos around them then you may as well have stayed at home. Having said that the decision to have family present at a resus is made by agreement of the team and family members present. Facilitating family presence is even more important if their only experience of healthcare is through the discovery channel !

All this being said I would encourage you to review the literature and reflect on your own communication style. I dont intend this to turn into a blog based slinging match - but can you produce any evidence against having family present ?

painter in hiding said...

I am fairly new...4 years in a trauma center as a ED tech and 4 years in an urban EMS system as a paramedic. I've been doing it since I was 18...and I am a daughter of a 33 year veteran RN, who also worked in the same trauma center, and in an attached Pediatric ED...an ER which I have known since I was about 15. I have read the research and I still cannot believe that the middle of a chaotic, bloody, mangled trauma is the place for an already distraught family member. It has nothing to do with my compentancy as a medic.

Now with that said, children are different. I can see letting a parent come back if the staff believes it would be a comfort the to the child and parent. I also say let the parent of the chronicalally sick kid in the resuscitation area, especially if the child is going to die, because most likely this parent knows about the child's illness and knows what to expect as far as medically.

As for being "insecure" I am not. I am very aware of my surroundings and have no problems talking to or providing comfort if thats what they need at the time, to the families that I deal with on an almost daily basis, nor do I as you put it, feel that I have "hangups" with how I practice my medicine or how I interact with said families. I am confident in my own skills as a medic to let just about anyone witness what I do when I work.

Joan said...

We used to use the same arguements about not letting husbands in the delivery room - they can't handle it, we are busy with the mother, they shouldn't see her this way. Turns out it wasn't about what was good for the patient it was about what was good for us. Then of course we said, maybe for a natural birth but not for c sections unless you are a medical student. Times change. We all learn. Now almost every birth is attended by a family member.

It would be nice not to have cut and dried rules but to be able to use some judgement. I worry when we get to make decisions that are more about power than medicine.

As awful as it might be, it can be helpful to some people to see a team working hard and struggling to save their loved one. They will believe that everything was done.

painter in hiding said...

Now, when I wrote this, I was speaking generally. Generally, family should not be in the trauma bays.

Now as Joan said above me, "It would be nice not to have cut and dried rules but to be able to use some judgement. I worry when we get to make decisions that are more about power than medicine." I do belive that it could be taken case by case. Alot of factors can come into play. How is the family coping intially? How is the family coping now? I have quietly asked a police officer to take a "freaking out" family member into another room and explain what we are doing and hopefully calm them down while I tubed, shocked and started lines. because at that time I was busy doing my job and could not give the support that I would have if my hands weren;t full trying stablize and package the patient. I'm just not that good. (this, mind you is while we are still in the house not at the hospital) Does the staff working belive that it would be a comfort to the patient? ( again, this is a big thing with children) How messy is it going to get? Are they cracking chests open or just difibing and giving drugs (which can be less traumatic to witness)

And I also belive with what Joan is saying about it "can be helpful to some people to see a team working hard and struggling to save their loved one. They will believe that everything was done."

But the big word in that sentance is SOME. She isn't saying ALL. And she isn't saying in every circumstance.

And she makes a great point about the father in the delivery room, a practice that is fairly new. Slightly diffrent OB and ER but thay use most of the same tactics.

painter in hiding said...

I also wanted to add, I made this post to hear what every ones opinion in on this, I knowing full well it could get a little heated. A little civilized discussion on a tough topic. So keep em coming, I enjoy reading what everyone has to say.

Maria said...

Oh, man, bringing up the delivery room thing is interesting! When I was preparing to have my son, I did not want any drugs whatsoever. Unfortunately, during labour, my squeemish husband BEGGED and BEGGED me to have some pethidine, because HE couldn't handle my perfectly natural pre-birth noises! If he had not been present, I would've had the "natural" childbirth I wanted so much.