Family in room during a resusitation? - page 3

What has been your experience with this? Our hospital has started encouraging the pts family to be in the room during a code. They say that they are more accepting of the outcome if they are... Read More

  1. by   traumaRUs
    Wow - what a great bunch of opinions. This just goes to show (as another poster stated) that each individual situation needs to be handled individually. There is no right or wrong to this issue.
  2. by   mother/babyRN
    Sometimes I think the discomfort level is largely due to the discomfort of the participating caregivers. After all, we don't like to see anyone suffer especially when there is little or nothing we can do for the person being coded, and by default, their family. But, I think as a family member who has been through that and been a code provider as well, I had to wrestle with my own discomfort level as a nurse not wanting the family to be there. It is ok if they cry or yell or say nothing...It is up to the family member in my opinion, however uncomfortable I may be...Both in cardiac care and infant resustitation my experience has been that when I was honest, it was my personal discomfort and not theirs that I was reacting to....They should be allowed to be there if they want. No one should have the right to throw out a family member because their presence is inconvenient or distracting. Obviously in the occasion that a family member is abusive or attempting to actually intervene by touching or moving the code team, there are other routes to go, and security should be standing by if need be, along with pastoral care or support systems when able. That can't always happen, but I think in the case of a possibly expected experience such as this, it wouldn''t hurt to talk about it and find out the family member expectations.....Never say never and never say always in my humble opinion. Each case is individual...
  3. by   mother/babyRN
    I would not allow ANYone to usher me out of a code involving my husband or children, ever. It would not be tolerated by me..I am the mom and wife...On those occasions, as I have told ICU staff when my husband was having an MI, I am SO not a nurse.....Whatever the discomfort level of the team , if present, I will tell THEM what I will do...They do work for me, afterall..
  4. by   Erin N
    Lots of material and studies show that it is bennificial for the family to be in the room during a code. But it is also necessary to have a chaplaian to explain what is happening.
  5. by   ERANGEL
    Quote from SWFlorida
    What has been your experience with this? Our hospital has started encouraging the pts family to be in the room during a code. They say that they are more accepting of the outcome if they are present. Perhaps its that they can see that everything was done. I'm not really comfortable about this. Has anyone here had a pts family in the room during a code?
    Had a pt expire a couple of days ago in the ER, son was a physician who does not practice any longer (don't know why) he started screaming defib her! defib her! but she was in asytole at the time. Made a huge scene had to be escorted out of ER Pt expired .
    Last edit by ERANGEL on Jun 24, '04
  6. by   KacyLynnRN
    I had a family member present once for a code and it was awful...the docs were telling her to leave the room but she was freaking out and wanted to stand next to the patient, well it was impossible for us to let her do that, considering there seemed to be about 20 people in the room, who all needed to be close to the patient. She was trying to push staff members out of the way!! I don't know what professional nurses organizations say about it, but from the one experience I have had, I would say it is a really bad idea.
  7. by   needsmore$
    In our ED we allow family to watch-we assign a staff member to be with the family. Their job is to explain the procedures. We also make sure they have a chair available. For themost part, they do not enter to the bedside but watch from the foot area of the bed-standing/sitting in the hall area outside the treatment room. With peds, if the code is soon to be called, we make sure the parents can hold the child's hand, speak in the ear--we have never had any scenes--but if the family interferes with the care being given, then they are escorted out of the area. They are aware of this before they are escorted back to the treatment area.
  8. by   ehresources
    Just one more opinion. I have had both good and bad experiences with having families in while a code was going on. The worst was when the family members all had different views as to what should happen - continue or stop. There is a fight you don't want to be in the middle of!

    Quote from needsmore$
    In our ED we allow family to watch-we assign a staff member to be with the family. Their job is to explain the procedures. We also make sure they have a chair available. For themost part, they do not enter to the bedside but watch from the foot area of the bed-standing/sitting in the hall area outside the treatment room. With peds, if the code is soon to be called, we make sure the parents can hold the child's hand, speak in the ear--we have never had any scenes--but if the family interferes with the care being given, then they are escorted out of the area. They are aware of this before they are escorted back to the treatment area.
  9. by   NYCRN16
    Quote from flaerman
    WE have found that when we are working a code that not going well and we know that there are family members in our "Grieving Room" that the doc or sometimes myself as charge nurse have gone in to talk with family about this and offer them the chance come into the code room that they deal with the outcome much better. This gives them the chance to see that we are doing everything we can for their loved one. We do pick up the room first if in the event of anything messy and always make sure that family are up to being a part of the code before bringing them in. I have even seen the families offering verbal support and encouragement to their loved ones in an attempt to help them come back. To date no one has passed out or feaked out on us during these times....Paul
    I personally don't agree with a general policy that family members should be present during a code. In some situations I am sure that its OK, but in others, it would not be a good idea. Thinking about how some family members want to hold the patients hand or stroke their hair...How is there room for the family members at the bedside? There is hardly enough room for members of the code team at the bedside, nevermind the family members. In my hospital we dont allow family there, but the hospital where I did my internship allowed them in Peds ER. I only witnessed one code there, and it was not pretty. The mother was attacking staff members, and had to be escorted out by the police. She pulled out the kids IO line because she didnt want them to "hurt her baby". Did the mothers actions effect the outcome of the code? Probably not, but still delayed the treatment.

    Another question...Who stops to pick up garbage off the floor or clean the patient in the middle of a code???

    If you "clean up the mess" before the family who insists that they want to see the code, then they really arent getting the real picture of what the code entails. Lets say you do clean up the mess before they come in, and now you have to do something that will make another mess, do you try to shield the family from that too?

    Please dont take this like I am attacking you or your ER, I am sure that many ER's that allow families to attend codes also do this. I just dont agree with it in all cases.
  10. by   TinyNurse
    As an ER nurse, I don't have a problem with family being present at codes, usually we have a chaplin, RN, or patient rep that talks to the family during the code. I have always been pro family in the room.
    Then a few weeks ago my dad with no heart history went into vtach in a small community ER, the doc said "you have to leave now". I said " i am not going anywhere". nothing else was said. i stood outside of the room, curtain open, and watched.
    The other times ( several) that my father coded in OSU med center ........the docs and nurses allowed my sister and I in the room. As a family member/daughter, i felt reassured that everything possible was being done. sure, it was painful especially for my little sister(24), but it helped me to see that everyone was working so hard, and doing the right things to help my dad.
    I agree with the ENA, as an ER nurse I agree, and as a family member who has experienced it i also agree that family presence during resusicitation is extremely important.
    thanks, jen
  11. by   NYCRN16
    Quote from TinyNurse
    As an ER nurse, I don't have a problem with family being present at codes, usually we have a chaplin, RN, or patient rep that talks to the family during the code. I have always been pro family in the room.
    Then a few weeks ago my dad with no heart history went into vtach in a small community ER, the doc said "you have to leave now". I said " i am not going anywhere". nothing else was said. i stood outside of the room, curtain open, and watched.
    The other times ( several) that my father coded in OSU med center ........the docs and nurses allowed my sister and I in the room. As a family member/daughter, i felt reassured that everything possible was being done. sure, it was painful especially for my little sister(24), but it helped me to see that everyone was working so hard, and doing the right things to help my dad.
    I agree with the ENA, as an ER nurse I agree, and as a family member who has experienced it i also agree that family presence during resusicitation is extremely important.
    thanks, jen

    I am happy that this experience was a good one for you, but being that you work in healthcare and understand what is going on, you are able to remain calm and not interfere. If you placed a family in the same situation who knew nothing about how a code is run, the reaction may be very different.
  12. by   NYCRN16
    Just some food for thought..

    This situation occured in Peds, but could also easily be applied to adults.

    One of my co-workers was working in Peds ED a few years ago when a parent carried in a lifeless child. (I dont know what the cause of the arrest was). Child placed on monitor, in asystole. PALS protocol followed, and the father became irate, started screaming "you need to shock him, I watch ER, I know that they shock them when they are trying to save the patient". Father almost assaulted MD participating in the code.

    Point being: The families may expect the code itself or the patient outcome to be like it is on TV. Ex: shock everything, frequent recoveries, ect.

    "If they saw it on ER, it must be the way it really is!" :angryfire
  13. by   traumaRUs
    I am still a strong advocate for family presence IF:

    they want to be present
    they have been briefed beforehand about everything that is occurring
    there is a knowledgeable and qualified RN at their side
    we limit it to two family members at a time
    we tell them there is no right or wrong - whatever they want to do is fine with us and they are free to come and go as they please

    With these caveats - we have had great success. Not everyone wants to be in the code with the family member and that is okay too. We provide frequent RN-directed updates.

    As to the poster who was concerned about the mess - I work in a very busy trauma center and even when we intubate, put in chest tubes or even crack a chest - there is no reason that the mess can't be kept to the minimum. After all, we usually have another trauma coming in within the next 10-15 minutes. It is a very individual thing though and staffing has to be able to support a dedicated-RN to the code.

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