The climate of the emergency room is complicated; it is a busy environment, with aggressive procedures, where everything happens very fast. Maybe, the scenario may seem very unusual for the family, which distances the family from the emergency service (G4, Health Professional 20 - Nurse). |
Climate in the emergency space |
Analysis of aspects concerning the environment and context |
[...] Sometimes, you do not even see the family around you, just because your focus is the patient (G2, Health Professional 7 - Physician). |
Philosophy of care |
We need a structure that enables greater privacy, because I believe that if the person is there, he/she is there to accompany her loved one and not the patient next door. So, this privacy is needed. If the structure does not provide this, the family will experience the care and suffering of the other one, as well (G1, Health Professional 1 - Nurse). |
Physical structure |
Today, we had a patient in the emergency room and no monitor was working! The nurses tried to change it, they messed around, but nothing worked. Will the patient die for lack of a monitor? Of course not! But, if the family witnesses this, not having materials, will they understand that? Without materials there is no way to put the family in the room (G1, Health Professional 5 - Physician). |
Medical and hospital supplies |
A little is related to the protagonist of the subject. He, as a professional, chooses whether he will maintain a posture for bringing the family closer or if will further alienate the family [...] So, it depends on the professional’s attitude (G3, Health Professional 16 - Nurse manager). |
Human resources |
[...] But you also have to remember the issue of contamination. Placing everyone inside the emergency room is critical, everything can be found there, for example, every now and then a patient suspected of having meningitis or tuberculosis (G1, Health Professional 3 – Physician). |
Infection related to health care |
The critical patient, terminally ill, you have to argue, “Am I going to invest? Will I do cardiac compression on this patient who had a cardiac arrest? “ The family member may say, “My father always said that he did not want to be intubated, that he did not want to go to an ICU.” The physician says, “Look, I need to do this” and the family says, “No, but he didn’t want to.” So we stopped here! It would be the family itself helping in clinical decisions (G2, Health Professional 14 - Physician). |
Level of complexity of the clinical condition |
Analysis of aspects concerning patients and procedures |
Sometimes the family does not disturb. The fact that they are present, does not disturb a simple procedure. As long as we evaluate and see that the parents will not be a problem. But in extreme procedures I believe that they should not be around, because it would disturb us. Here, three times I had to perform an open thoracotomy. I have the impression that no family member would want to be in an environment where this is likely to happen (G2, Health Professional 11 - Physician). |
Level of complexity of the invasive procedures |
[...]The family must be with a child patient. The mother or father should be present, and this is quite common. When attending a child is with the family on the side, it is all in front of the family (G2, Professional 07 - Physician). [...] For elderly patients, there are cases that we cannot restrain. In many cases we let them stay, so we can get information, and the elderly become less restless (G1, Health Professional 2 - Nurse). |
Patient age |
There are cases in which I am no longer very strict in order to force the patient to be alone. Because, I know this is going to cause very great stress, and possibly it will have a worsening effect on the general health. So I leave it for a moment, but if I see that the family is not collaborating, I ask them to leave (G1, Health Professional 4 - Nurse). |
Possibilities of benefit for the patient |
I think the emotion stands out. We have to be more technical and do the medicine; we cannot involve emotion and medicine. The family presence, in a sense, puts pressure on the health professionals, the family ends up getting very emotional, very upset, and this sensitizes everybody (G2, Health Professional 10 - Physician). |
Psycho-emotional impact for the team |
Analysis of aspects concerning health professionals |
[...] My clinical attitudes do not change at all, whether it is the mother, the father, or whoever. I always make the same decision. We have to be professionals prepared to act in situations of stress (G1, Health Professional 5 - Physician). |
Education and preparation of professionals |
The presence of the family gives more confidence, even for the physician, about some procedures, for example, he can ask the family member to explain to the patient what is going to happen, in an easier language (G3, Health Professional 15 - Nurse manager). |
Possibility of helping professionals |
[...] It is fundamental [the family’s presence] for them to also see that we do everything we can, everything that was to be done for the patient, we did (G2, Health Professional 8 - Nurse). |
Meeting the family needs |
Analysis of aspects concerning the family |
Many times, it’s a very aggressive relative. In this case it may be more disruptive than helpful, because we never know the reaction of a relative in a moment of stress. He/she may become violent, wanting to assault a staff person (G1, Health Professional 4 - Nurse). |
Family profile |
Usually the companions are lay people, then, when you perform a more invasive procedure, for example, intubation, I think it’s something that affects the person watching, to see it all, I think it’s a bit traumatizing (G1, Health Professional 2 - Nurse). |
Family preparation |