Families at the bedside during codes?

  1. 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 of a local hospital after graduation.

    Most of the info we were responsible for self teaching out of the book because the instructor who was to teach the material became ill.

    There was a small paragraph in my book advocating for family at the bedside during a code, as long as there was a nurse available to explain what was being done. The author felt that it helps the family to accept the situation, and facilitates the grieving process if the patient dies.

    I was just wondering if this is done anywhere, and what your opinions are. And for those who do agree with it and/or have seen it done, how likely is it that there is a nurse available to explain procedures to the family member?

    Thanks for your opinions!
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  2. 21 Comments

  3. by   Desert Rat
    From what I have seen, nurses and families handle the situation much better than anyone expects. Doctors are the ones who question families at the bedside. Families usually approach us after a code and express appreciation about how much we tried to do everything we could. It also makes it easier for the family to decide we have tried enough if they make the decision to stop treatment, or to observe that we are not stopping if that is their wish.
  4. by   altomga
    We have had a family at the code 1 time that I can think of.....the patient was an unfortunate 20 something yo that had severe medical complications after childbirth...we wanted the mother of the pt to see that we were hurting her daughter more than helping her (the pt had absolutely no chance and had already been basically brain dead....brainstem function only)..yes she could still breath on her own and had a heartbeat before she coded, but no hope at any quality of life.

    The mother was to distraught (quite understandably) and just kept telling the pt that the lord was going to make it better, not to leave her, and you know the rest...

    I felt so bad for this mother...her last memories of her daughter are going to be....her daughter basically naked for the line insertion, shocking with the defib, staff pushing on her chest, vomit coming from her mouth/nose, blood, etc.....
    I wish she had the memory of her precious daughter looking like she was sleeping peacefully with her eyes closed tucked into bed.

    The other staff on other units that have had families at the bedside said they were more of a hinderance than anything else. Got in the way of compressions, intubation, pushing meds....
    This decreases the chance of bringing the patient back...lack of oxygen, blood flow to the heart, and life saving techniques are delayed....

    I for one am not for this idea for reasons stated and many more..
    Codes can get nasty and dirty, docs and nurses yell "stuff" (ya know what I mean)...families should not have this memory of their loved one and should not be present just to get in the way.
    Someone there to "explain" is not going to help...the family is only going to see and "HEAR" what they want and then it will be tangled in their head due to the emotional heartbreak....
    opens up a new pandora's box for lawsuits.
  5. by   gwenith
    I know a facility where they will bring the parents into the room while resuscitating a SIDS and they will do this even if the baby is in rigor mortis. It is done so the parents can reassure themselves that everthing possible was done.
  6. by   angelbear
    Recently I was present for my sons intubation. The medical team knew that I was a nurse but I dont think that made a difference. They also knew that my hubby is not in the med prof. The entire time they were working on him we were allowed to stay. Yes the MD did holler and he even swore a time or two but that just convinced me that he was worried about my son and really working hard. The lead nurse was absolutely awsome even while pushing meds and assisting the MD she was explaining things in a very calm voice to my unconcious son and my hubby and me. We of course stayed out of the way and stayed calm save for a few tears. The MD even encouraged me to rub my sons feet while they were intubatiing him. I will always be eternally grateful to the entire team in how they handled my son and my hubby and me. I do think that if the family is hysterical and in the way they should not be allowed to stay after all the pt is still the first priority. I guess I can see both sides of this issue.
  7. by   ScarlettRN
    The new ACLS guidelines suggest that family be allowed to be present at the bedside during a code and also are much more vocal about knowing when to call the code and stop all that abuse we heap on that poor body. PALS also suggests allowing parents to be in the room but strongly suggests that a pastor or a nurse assigned to be liason is present to help them understand all that is going on. Hope this helps. I just finished a gruelling month of recert on both ACLS & PALS, so this is all fresh in my overloaded brain right now.
  8. by   New CCU RN
    Each family is different. Some absolutely do not want to be there. Some would like to hold their hand the entire time. We do not routinely have family members stay unless they ask to. We simply explain that lifesaving measures can be a confusing situation for the bystander because there are alot of things going on, some which appear to be very scary and rough. We tell them that if something were to happen that we would need them to step out of the room, that they would have to. We have never had a problem with family members stepping out for a code.

    When the code starts to get to the point that nothing can be done, someone will go out to the family, tell them what has been done, but that their loved ones heart still is not beating. Some families will opt to come back in and watch the last minute of CPR. When they come in and see how many people have been working, and we explain that 30minutes to an hour have gone by and their loved one still doesn't have a heart beat.... most, not all but most will say ok... we can stop.

    I can understand bringing them in at the end, if they want. But I personally do not understand allowing them to remain the entire time. Things could be misinterpreted, there is lots of yelling, and certainly no extra room. It defiintely seems like we would be opening ourselves up for a lawsuit.
  9. by   petiteflower
    The last couple of codes I worked on the ambulance, the family was present when we began the code and at the hospital were present at the end of the code. Both families came to me and told me that they were glad they were there, that they knew that everything possible had been done. At the hospital we have a nurse with the family at all times, and if at any time a family member becomes a hindrance, they are taken from the room.

    I think that if it were my husband or one of my kids, I would want to be there.
  10. by   ernurse728
    We bring the families in a lot after we have done everything and have decided that there isn't any hope. The MD goes out to talk to the family and bring them back so they can see us doing CPR. The room is usually a wreck, crash cart busted open so they can see we have done everything that we could. I have had parents in the room during peds codes. They usually sit quietly in the corner and watch..as long as they can handle it. That only happens with certain pediatricians who can calmly run a code and explain to the family what is going on at the same time.
  11. by   JohnnyGage
    We allow families to be present for many of the codes in our CVICU. Exceptions are when we do an open sternotomy or when space is too crowded. In the latter case, the family is kept out temporarily until space opens up.

    Often times a code is the last time a family can be with their loved one before death -- a very valuable experience for all parties.

    I did my student research on this specific topic. I read one occasion when a man was coded and stated afterwords that during the code he was very much aware of his wife's presence and it was that feeling that made him want to continue to live. My feeling is that if this is truly the case for even a few patients, then families at the bedside are as important as defibrillation or epinephrine.

    It also occurs to me that we do far too many codes on patients that are not good candidates for quality of life or survival. I have found that many times a family at the bedside during a code is a good way to have them stop a code that probably shouldn't have been started in the first place.

    I should also make clear that we always have a nurse (usually the supervisor or manager) with the family to explain the process. Many of the sights and sounds can be very frightening.

    These days with reality TV like "Trauma: Life in the ER" and even dramas like "ER", we have to realize that most people are familiar with the process of resucitation -- even if a bit naive about outcomes.
    Last edit by JohnnyGage on May 1, '03
  12. by   Keely-FutureRN
    One of my instructors said that at her hospital, they encourage the family to be at the bedside during a code because it shows them that everything was done to help save their loved one and decreases the amount of suits filed against the hospital.

    Keely
  13. by   zambezi
    Since I work nights, families are often not there for our codes...The one time that the patients wife was in the room, things went okay...the patient was post op valve replacement and aortic dissection...he had been extubated for a few days but when we came on shift, he just didn't look that good. His wife was always in the room, we could see that his respiratory stats was quickly declining...called the er doc up stat...we ended up reintubating the patient all the while his wife was there holding his hand. I think that it went okay with her in the room...although it was not a "surprise code" where we were defibrillating and working for a long long time or anything...i think that it definately depends on the family...for some families i think that it can work, for other families (and staff) i think that it is not such a good idea...
  14. by   CountrifiedRN
    Thanks for the replies! I wasn't sure what is common practice since we didn't get to have lecture for the Emergency care unit. It helps to hear the pros and cons, although I probably won't be able to form my own opinion until I have first hand experience.

    It's great to read about others experiences to get a sort of grasp on what to expect. Feel free to add more! Thanks again!

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