Families at the bedside during codes? - page 2

Hi everyone! I am finishing up my ADN program and we just had to read our chapter on emergency medicine. I am especially interested in the ER, have always been, and I have an offer to work in the ER... Read More

  1. by   flashpoint
    Our rescue service recently did a code in the middle of the night in a patient's home (when else?). Most of the squad was out on a HUGE fire, so our rescouces were very limited...ended up being, 1 medic (me) and 1 EMT working the code and 1 EMT assisting the wife of the patient because she had an asthma attack and chest pain. The patient's 16 year old son ended up coming in and helping us...he relieved the EMT on compressions, suctioned, and I don't remember what else. The patient ended up surviving and his son said that he was glad we let him in the room and he was honored that we let (MADE) him help. Propbably not the most appropriate thing to let happen, but this kid made a HUGE difference in saving his dad's life...
  2. by   Rapheal
    My father died young and his death was unexptected. I got to the hospital room just as they were performing CPR. They asked me to wait outside. I asked the doctor "Please let me stay-this is the last time I will see my father alive." Somehow I just knew.

    He let me stay. It was the last time I saw my father still alive. 10 minutes after they declared him dead his skin already turned blue. I was grateful they let me stay because even for the short time they were performing CPR he still looked like my dad. As I said before 10 minutes later he looked totally different-not like my dad at all. Plus I was able to SEE that they did everything that they could to save him.
  3. by   atownsendrn
    I think family presence during a code is very appropriated under some circumstances. Many nurses I work with are uncomfortable with the family being in the room and we have had many heated discussions regarding the situation. But a ED educator (who is one of the smartest people I know) told me something when I graduated and began working in the ED as a staff nurse that has always stuck with me. #1 - That person coding does not belong to you. They belong to that family member and you have no right to keep them away if they want to be present. AND if you are uncomfortable with the family being present, you are either unsure of your skills or unsure of how you feel about death. And these are two issues you have to deal with if you're going to make it in this profession.

    I realize that it sounds harsh. But it is really the truth.
  4. by   PediERRN
    I have been a nurse in various types of ER's (rural, urban, and pediatric) for 17 years. Although I think it is important for all arrests, I think it has special importance when there is an "unexpected" death, such as in the case of trauma, etc. Anecdotally, these parents/children/other family members/friends, have a tendency to deal better with the loss. There is so much discussion about it in the literature, that I think it will really become the norm, not the exception. It is done very well at my facility with the support of Social Work, Chaplaincy Services, Child Life, the medical staff, and Nursing. There are a couple of editions of the Critical Care Nursing Journal that are dedicated to family presence at the bedside. It has been added for consideration in much of the CE type courses nurses often take - Advanced Cardiac Life Support, Advanced Pediatric Life Support, Advanced Trauma Life Support, Trauma Nursing Core Course, and Emergency Pediatric Nursing Course. It is also directly endorsed by the Embergency Nurses Association. There is a position statement posted on their website for your perusal. The only thing in the literature that does not support family presence are anecdoatl experiences that are way out of the normal.

    I will admit that it took a lot of getting used to, particularly with physicians. It often makes the healthcare providers uncomfortable, but that is not a reason to keep the family out. There is some fear of lawsuits in cases of errors, too. The literature however supports that there are many more lawsuits of those families kept out of the resuscitation room regardless of the errors being made. If you think about it, we are all more leary of those things we cannot see and understand. It only makes sense that more lawsuits would result with the unknown.
  5. by   debbyed
    Personally I think it is important to allow the families to have the choice to be present or not. I don't mind family members being present and in many cases they are the ones to initiate discussion regarding ceasing CPR. Although it is never easy to accept the death of a loved one, family members who are present usually seem to accept death easier and help other family members deal with it. They are confident when talking to other family members that every thing that could be done was being done.

    As far as who is with the family, in our facility the Nursing Supervisor responds to all codes, even in the ER and usually takes that responsibility. If she is not available it is usually the charge nurse. During daylight hours we also have an ER specific Patient Rep.
  6. by   nowplayingEDRN
    It is becoming a trend to allow the family in the room during the code, so that they know exactly what is happening and are able to make informed and independant decisions, based on information from a health care provider that is at their side during the entire scene, and they are there when the physician makes the suggestion to call the code.

    However, every facility has their own policy on this and how they handle code situations and the family involved.

    Yes, I think the family should be involved in all decisions made in a code situation, however, I have mixed e motions when it comes to allowing them in the same room as the code is occuring. Sometimes, a traumatic code might be more upsetting to the family than the code its self is. Plus, during a code the patient is not usually covered witha sheet and things get very messy and these things also upset the family.

    I personally prefer that a hospital rep stay with the family in a secluded room to provide support and comfort to them while the code team works on thier loved one, with 1 person designated to relay updates to them, to keep them informed and updated, so that their input is taken into consideration in the treatment of the patient.
  7. by   ShelleyERgirl
    Originally posted by atownsendrn
    I think family presence during a code is very appropriated under some circumstances. Many nurses I work with are uncomfortable with the family being in the room and we have had many heated discussions regarding the situation. But a ED educator (who is one of the smartest people I know) told me something when I graduated and began working in the ED as a staff nurse that has always stuck with me. #1 - That person coding does not belong to you. They belong to that family member and you have no right to keep them away if they want to be present. AND if you are uncomfortable with the family being present, you are either unsure of your skills or unsure of how you feel about death. And these are two issues you have to deal with if you're going to make it in this profession.

    I realize that it sounds harsh. But it is really the truth.
    I am not sure how to put this but your comments really touched me. I totally believe in that philosophy and how it effects others. Thank you for your statements, they really mean alot to me as both my parents are pretty ill at this time and a code is probably pretty inevitable at this point in their health and I want to be there when it does, to let them know I was there for them in life and when it comes down to it, in death. Thank you atownsendrn
  8. by   charissa
    I work at a teaching pediatric specialty hospital, and we allow families to stay. We were very wary at first, and the first instance happened by chance. The squad that brought the kid all had white shirts and blue jeans on. One of them stuck around and watched from a distance, and when the doc asked if anyone had objections to stopiing he spoke up and basically said no you tried everything thankyou. turned out he was the DAD! Thats a shock! But since it had gone so well it became a policy. One to 2 persons, usually parents have a specialy place to stand with a liason, a nurse, social worker or med prof. , and are told clearly before they go in that if there is behavior that threatens staff or interferes with care security will help them leave the room. it has worked well. I have heard that families have much the same comments already expressed earlier in the thread about having better closure and knowing that the team really cared and did everything they could. I think not allowing them there is a cop out for us sometimes, the same as waiting until there is someone doing last ditch cpr til they come in, kind of makes it look good without the effort of allowing them there the whole time.
  9. by   healingtouchRN
    sure, you bet, as long as they are not falling into the floor hindering the process. I have had the chaplain get the MRS. a chair so she could view us thru the glass doors & know we were trying to save MR to best of our ability. It also keeps the foul language a little better under control! & esp when a child codes, if parents can stand it, they will know we tried our best to save jr's life.

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