The core principles of family-centered care include treating patients and families with dignity; respect; open communication; patient and family participation in care; and collaboration in the delivery of care (Eckle, & MacLean, 2001). Family centered care is one of the key components of the pediatric nursing in order to fulfill the needs of the child, parents and health care professionals. Family members are the constant and primary support system of the patient. Initially, in 1993, the Emergency Nurses Association (ENA) became the first professional organization to develop evidence-based written guidelines endorsing the practice of family presence during invasive procedures and resuscitation (Moreland & Manor, 2005). In November 2004, the American Association of Critical-Care Nurses (AACN) published an evidence-based practice alert entitled ‘Family Presence during CPR and Invasive Procedures’ (AACN, 2004). Yet many hospitals do not have family presence policy system. They remain hesitant to allow parental presence during anxiety provoking times like invasive procedures. A prospective study was conducted by Powers and Rubenstein (1999) to determine whether the parental presence during invasive procedures reduces parent's anxieties and to evaluate whether the parent's presence was of any help or harmful for the child and parent or the staff. The results of the study showed that, parental anxiety related to the procedure was significantly reduced during their presence (p= 0.005), however there was no change in the condition related to anxiety.

In Pediatric Intensive Care Units, children experience many invasive procedures like needle pricks, intubation, lumbar puncture, oral and nasal suctioning etc and staffs doesn't allow the family members to participate in their child's treatment by showing inappropriate verbal and nonverbal gestures like closing the curtains and showing back to attend. In reality, parents are not given the option to stay with the patient during invasive procedures. However, this issue is important and directed to all the health care providers who are working in pediatric units, because these days people are more aware about the traditional paternalistic approach of medicine towards the family centered care approach.

Firstly, Parental presence gives a sense of security and psychological support to children when they are exposed to unknown people and environments. In the initial few years of life, children have stranger anxiety and they only tolerate brief separation from their parents. Ttherefore, children require constant sense of parental presence and during stressful procedures, parental support reduces child anxiety and gives comfort (Pruitt, Johnson, Elliott, & Polley, 2008). It also allows children to make choices when pertinent, for instance, whether they want their parents to be present or absent during the procedure or favorite color cast or bed sheets, whenever applicable. Parental presence also gives permission for children to verbalize pain, and discomfort during the procedure. But, in contrast, behavioral manifestation of discomfort may increase with parental presence. Even if it is true that child may cry or become more anxious during procedure in front of their parents, this may reflect that parental presence allow them to verbalize their feelings of discomfort and the goal is not to create a supportive child who experiences pain in silence. A Study conducted by Sacchetti, Guzzetta, and Harris, (2003) affirmed that, eight patients undergoing emergent invasive procedures reported that the family member presence provided a sense of support and safety, which better enabled them to tolerate painful procedures. 20 Other pediatric studies have demonstrated less stress in children when parents are allowed to remain at the bedside during certain procedures. However, it is important for the health care team members to do the proper assessment and prepare the child prior to the procedure so that they understand the need for appropriate behavior at the bedside.

Secondly, In order to prevent violation of the rights of informed consent, parents should be present with their children and should be informed about their child's treatment. As every individual has the right to be informed about their treatment, likewise for children who are minor, their parents have full right to be informed about the treatment or procedures so as to reduce the paternalistic approach of health care professionals and lessen the parent's agony of being left outside during the procedure which increases their emotional well being (Snoby, 2005). It also brings the sense of reality for parents regarding the treatment efforts and clinical condition of the child. According to Bartholome (1995), The American Academy of Pediatrics official policy states that, only patients who have appropriate decisional capacity and legal empowerment can give their informed consent to medical care. In all other situations, parents or other surrogates provide informed permission for the diagnosis and treatment of children with the assent of the child, whenever appropriate. On the other hand, in critical situations, intervention on child is far more important, rather than preservation of parent's right. Whereas, by giving priority to patient's life, we are doing beneficence and nonmaleficence for patient, but then parent's right has to be counted on because, parents are the ones who, if present on bedside with their child during invasive procedure, can give decision after considering risk and benefits during unexpected situations, either to continue or to discontinue the treatment. A study conducted by Mangurten et al., (2006)concluded that in 100% of family presence (FP) cases, patient care was uninterrupted. Parents were positive about FP, believing that helped their child, and reported that it eased their fears. All parents described an active role during the event, and most believed that they had a right to be present. Three months later, no parents reported traumatic memories. Providers also were positive about FP and reported that the presence of parents did not negatively affect care. Although most (70%) supported FP during RIs, more nurses (92%) and physicians (78%) supported it than did residents (35%, P < .05).

Thirdly, the parent's presence creates a calm and cooperative environment which facilitate health care professionals in the completion of the procedure smoothly. With parental presence child becomes less anxious and hence there are greater chances for the procedure to go more efficiently and smoothly (Pruitt, Johnson, Elliott, & Polley, 2008). It also persuades a more passionate and proficient impression and less nonessential gossip and humor among health care professionals, thus reducing the chances of error. Parental presence also reminds the staff to consider the patient's dignity, self-esteem, privacy and pain management requirements. In contrast, it is assumed that, family presence during invasive procedures increases staff anxiety and thus hinders the performance. There is no doubt that it is difficult for the health care providers to work in front of the audience, but building confidence in one's personality and polishing their procedural and communication skills decreases the anxiety level and does not hinder the performance when experiencing with family presence. One study evaluated the perceived stress of 96 health care providers who had performed invasive procedures or resuscitation efforts with the family members' presence. Of those surveyed, 84% believed that their performance was unaffected by the family's presence (Moreland & Manor, 2005).

As pediatric population is the one who cannot communicate effectively and function independently for themselves nurses should consider child and parents, both as our client, and parents should be offered the opportunity to be with their child during invasive procedure and there must be some hospital policy which would act as a guide for the staff to follow when dealing with the concern of parental presence during invasive procedure. Moreover, as a health care provider and being the patient's advocate, nurses should struggle for the extensive establishment of family presence and parents should be encouraged to be with their child during invasive procedures. Parental presence will not only provide comfort and soothe their child, but also plays a therapeutic role for the parents in fulfilling their right to be informed about their child treatment and also facilitate health care professionals in successful completion of the procedure during invasive interventions.