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It is 7:30 a.m. and I'm walking into the surgical suite with my 11-month-old son. We're only here for a minor procedure, but I feel like I'm on eggshells with anticipation. I'm told not to worry, but that's not much comfort—as an intensive care unit (ICU) nurse, I almost know too much. My son's name is called and I walk into the surgical suite with him in my arms. The nurse asks me to sit down, puts vital signs monitors on him and places a mask over his face so he can breathe in the anesthetic. "It's laughing gas," says the anesthetist. I begin talking to him very quietly, telling him, "Mommy's here, don't worry, you're fine." Very quietly, he falls asleep, I place him on the table, and the nurse says, "Give him a kiss." I do and walk out with my heart in my throat. Even though I'm concerned about my son, I stop to think of how well that went. There were no tears (either from me or my son) and I felt comforted by the fact that I could be there at his side and was the last face he saw before falling asleep.
Over the past 17 years as an ICU nurse, I have cared for hundreds of families in the most dire of circumstances. Translating my experience with my son, I wonder how parents with a child in the ICU must feel when their child is having a procedure, or, the worst case scenario, cardiopulmonary resuscitation (CPR). I don't pretend to know how utterly gut-wrenching this must be or whether being present at the bedside, as I was, is the right decision for them. However, I do remember many parents wanting to be able to make the choice.
There are different beliefs about whether parents belong at the bedside of their children during crisis. There is increasing support in the literature that says that parents' presence, if desired, may be beneficial to both the patient and family, when they are supported correctly. Simply put, if a parent chooses to stay, a trained staff person is at the bedside to support the family and the medical team by providing information.
Children's Parent Presence During Procedures and Resuscitation Facilitator Education Program was developed to do just that: create a safe environment for the medical team, provide parents support at the bedside and improve the quality of care.
The facilitator plays an incredibly important role, so training for it must comprehensive. Creating this training program was a truly collaborative process: One that was built by many professionals throughout Children's Critical Care Cardiovascular Program, Program to Enhance Relational and Communication Skills (PERCS) and Medical Simulation Program. The result was a four-hour class that provides a short background lecture on the research behind parent presence, but mainly offers hands-on practical experience of supporting a family during a crisis.
This is enhanced by using medical simulation and professional actors in the role of the parents. Medical simulation is an innovative method of training that combines realistic medical scenarios and induced medical changes in a computerized "patient" mannequin that a medical team needs to respond to. After the scenario, each participant evaluates his or her performance during the crisis and talks about what went well and what could be improved. In this case, the medical scenario was not the focus of training, it was the "facilitator's" communication with the parents while they were watching the event unfold.
As one of the instructors, watching the facilitator support the actor parents through the experience is powerful and realistic. As much as the event is staged, the responses by the actors are believable. They will be stressed and ask questions that the facilitator needs to respond to. I have witnessed the same scenarios many times over and am so impressed by how beautifully staff supports parents in these training sessions. The most amazing thing to me is how everyone who participates is so different in their approach, yet ultimately each style has worked. As much as I am the instructor during these courses, I often find myself being a student, learning from the actors and the other caregivers. I expected that when the program started we were going to teach facilitator skills. What I found was that we really improved confidence and shared stories about alternative ways to get our message across.
Finally, I see a larger benefit to the program. Staff can witness through this training that having a parent stay can, in most cases, actually benefit the patient and family without compromising the focus of the team. As our group plans future facilitator trainings, I will always think back to when this first began.
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