Patient-Family-Nurse Interactions in the Trauma-Resuscitation Room

• Background Controversy about the presence of patients’ family members in the emergency department has centered on the trauma-resuscitation room. Little is known about interactions of patients’ family members with the patients and with nurses or about the ramifications of the presence of patients’ family members at the bedside.

• Objectives To describe behavioral responses of family members of patients and the interactions of the family members with nurses and the patient in the trauma room.

• Methods A secondary analysis was done of 193 videotapes of trauma room care. Of these, 88 tapes showed the presence of patients’ family members, for a total of 42 hours. Qualitative ethology and a model of suffering as a scaffold were used to analyze verbal and nonverbal interactions between nurses, patients’ family members, and patients. Behaviors and verbal interactions of patients and their families were coded as to persons who were enduring and persons who were emotionally suffering. Categories were described.

• Results Whether a patient’s family members entered the trauma room depended on the patient’s condition, the patient’s behavioral state, and the nature of the treatments. Categories of interactions were families learning to endure, patients failing to endure, family emotionally suffering and patient enduring, patient and family enduring, and resolution of enduring. The interaction style of the nurses involved was particular to each of these states. Two instances of inappropriate interactions occurred.

• Conclusions Nurses can use the Model of Suffering as a framework to assess behavioral and emotional states and to select appropriate strategies to comfort patients’ family members.