Family in room during a resusitation? - page 4

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   nursemike
    Quote from 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.
    It seems to me that a big part of the solution would be to improve nurses' education regarding managing family members. I do think many would appreciate seeing that all that could be done was being done.
    In my experience, every code I've seen had about twice as many staff members present as were necessary--you can't physically fit 20 people in our rooms. It is good, of course, if new folks can watch before they have to do, but surely 1 can be spared for the family.
    I strongly agree about the mess! Mess=Danger! I once got "caught" in a code (it was between me and the door) and I noticed the sharps box was a long way from the action, so rather than stand there and look stupid, I had a friend toss me an empty one and I collected sharps. Later got several pats on back and learned that pt was HIV+.
    I think we need to do more practice codes. I volunteer to role play the hysterical family member.
  2. by   MarcusKspn
    I had one Code in long term care where the wife was present. The patient was coming back to the home walking from his car to the door when he collapsed outside. We called the code (Not ACLS, just BSL until the ambulance arrived, just a couple LPN's with CNA's present, no doc to run the code). Everything was real quiet, I was very pround of my aides, there was no screaming, no yelling, everybody did what they needed to do, everybody ran to their assigned stations and got the necesary supplies (O2, airways, backboard, AED) I had never seen all my staff work together like this. One of the LPN's was standing with the wife, calming her, letting her know what was happening. The ambulance came and picked up the husband, and the nurse that was talking to the wife drove with her to the ER to calm her. I think seeing that we were doing all we can to save her husband made her feel at peace.

    Ironically we had some consultants that the company had hired in the building that day, trying to explain to us the concept of teamwork. They were sitting in the conference room looking out the window that faces the entrance and were watching us run the smoothest Code I have ever seen that didn't involve ACLS. After the code (which was done outside, in the sun, in very humid 100+ degree weather) I walked into the building covered in sweat, out of breath, and proud of the good job everybody did and walked up to the consultant who had a terrified look on his face (I don't think he had ever seen anybody code) and calmly asked him: "How was that for teamwork?"
  3. by   critcarenurse16
    I would not have a problem having family present during a code. But I feel there should be a member of the staff present to explain what is happening and to keep family from interfering with the code team. I have always felt bad that family members have lost their final opportunity to say goodbye simply because we feel they can't handle witnessing a code or because the staff has reservations about 'performing'for a crowd. We 'perform' for a crowd already--our peers. During a code your focus is on the patient; you may have times during the code where you don't realize the family is even there because of the intenseness of the situation. This is where a family mediator (for lack of official title) would be beneficial. Let them stay and say goodbye.
    Just my $0.02
  4. by   hospicemom
    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?
    Boy, I dont know how comfortable I would be either with the family in the room as I am doing compressions on their(lets say) 80 yr old grandmother....I think that would cause more heartache for the family in the long run.
  5. by   sjt9721
    Actually, the research on family presence during resuscitation was begun by a staff nurse that bucked the system & allowed a mother to hold her 14 year old's hand while the staff worked to save his life. The mom is still thankful for being able to be with her son when he died.



    Quote from camay1221_RN
    I understand your discomfort!!

    And who is going to hold back the frantic family member who is trying to pull a staff member off the pt who is getting chest compressions? Good grief, just what the staff needs is to worry about someone interfering with their jobs of saving the pts life!

    Wait, maybe the administration who comes up with these assinine ideas should be present to hold off the family!
  6. by   marylandnurse76
    As I was sitting here thinking about how I would feel if I were to have a family member that I loved dearly in the Hospital; ER, ICU, CCU, etc. and they were to "code" I would want to be with them especially if this were to be there last breath so at least I could be there to see them take there last breath ... I would certainly not want to be in anyones' way; I would want my family member to receive the best medical care possible especially when it comes to a "Life or Death" situation ... so I guess if there were a way to stand back so the Code Team would be able to get to the bedside and the family stand back so they could perform but if the family members become hysterical then they would be asked to leave the room ... you know this is one of those no win solutions ...
  7. by   sjt9721
    The last family member I brought into the room was an adult son. Dad had collapsed at home & the family had witnessed all the efforts by EMS on scene. Who am I to bar them just because we were now "in the hospital"? The wife was too distraught & asked the son to "go be with him". The son was shaken but calm & felt he could handle seeing the resuscitation. I moved him to the foot of the bed, he occasionally would touch Dad's feet & say "Come on Dad" or "I love you Dad".

    When it came time to tell the rest of the family that Dad had died, the son was a valuable link between us & the survivors. I think the widow was comforted by the fact that her husband didn't die alone & that their son was watching after him.

    Quote from marylandnurse76
    As I was sitting here thinking about how I would feel if I were to have a family member that I loved dearly in the Hospital; ER, ICU, CCU, etc. and they were to "code" I would want to be with them especially if this were to be there last breath so at least I could be there to see them take there last breath ... I would certainly not want to be in anyones' way; I would want my family member to receive the best medical care possible especially when it comes to a "Life or Death" situation ... so I guess if there were a way to stand back so the Code Team would be able to get to the bedside and the family stand back so they could perform but if the family members become hysterical then they would be asked to leave the room ... you know this is one of those no win solutions ...
  8. by   hospicemom
    I think we are all assuming these codes are "controlled" as the family members are watching. I have been to a fair share of codes which were absolutly uncontrolled....everything from the nurse shouting a code,nurses running for the crash cart....adrenaline pumping as we work the pts chest,feeling for pulses and yelling that we have nothing.....it is not a pretty site and I dont feel the family needs to share in this. Everything doesnt always run smoothly as we all know. and uncontrolled codes should never happen but they do.....and yes, even during these times we are always sure that a nurse stays with the family explaining what is happening....however they still see everything and sometimes it looks like a mess. I had a pt who needed a central line put in stat during a code....do we really want the family to be present for that? and at which point do we ask they not be present. this is a tough situation and I do feel even though I dont believe it is the place for ALL familis there are exceptions. I would take into consideration that emotional status of the family at that time before permitting them to watch.
  9. by   sjt9721
    I doubt that anyone in favor of family presence would endorse it in every situation. We all (should) realize that there are exceptions & extreme circumstances for every situation. Nearly all of us have a story that begins "...I remember this one patient..."

    Many say that the ED is no place for family presence for various reasons. Remember though, that much of the initial research on the topic was done at a Level I Trauma Center that consistently ranks in the top 5 busiest EDs in the nation.

    I just don't want to see the option of family presence being ignored. It can be a successful undertaking in the right situation.
  10. by   critcarenurse16
    Quote from sjt9721
    The last family member I brought into the room was an adult son. Dad had collapsed at home & the family had witnessed all the efforts by EMS on scene. Who am I to bar them just because we were now "in the hospital"? The wife was too distraught & asked the son to "go be with him". The son was shaken but calm & felt he could handle seeing the resuscitation. I moved him to the foot of the bed, he occasionally would touch Dad's feet & say "Come on Dad" or "I love you Dad".

    When it came time to tell the rest of the family that Dad had died, the son was a valuable link between us & the survivors. I think the widow was comforted by the fact that her husband didn't die alone & that their son was watching after him.
    AMEN!!!:angel2: This can be a necessary step in the healing process for the family
  11. by   andyman1216
    I THINK ITS A REAL GOOD IDEA TO HAVE FAMILY NOT ONLY IN THE ROOM, BUT AT THE BEDSIDE IF POSSIBLE. SURE IT MAKES YOU UNCOMFORTABLE, BUT SINCE WHEN WERE YOU THE IMPORTANT ONE HERE. THIS GUY IS DYING.... THATS A REAL BIG WORD, DYING. SO WHILE WE ARE THROWIN AS MANY IV'S IN AS WE CAN, AND STUFFIN A TUBE THE SIZE OF YOUR ******* THUMB DOWN A THROAT, WOULDNT YOU WANT TO BE THERE? EITHER TO SEE THAT ALL WAS DONE, OR JUST TO SAY GOODBYE.
    I REMEMBER ONCE A MAN HAD A SZ WHILE DRIVING, STERNUM HIT THE WHEEL, LESS THAN A MILE FROM THE HOSPITAL. (HE WAS ON HIS WAY TO VISIT HIS WIFE WHO WAS AN INPATIENT) SOMEONE WENT TO THE WIFES ROOM, AND SHE SAT AT HIS HEAD TALKING TO HIM THE ENTIRE TIME. I WAS 6 INCHES FROM HER DOING CPR, AND WITH EVERY PUSH, HEARING THE CRUCH OF RIBS.
    SHE LATER TOLD ME SHE APPRECIATED ME LETTING HER BE WITH HIM WHEN HE DIED. SHE LITERALLY SAT BETWEEN A DOC INTUBATING AND THE NURSE DOING CPR.

    ITS A GOOD THING...
  12. by   chimama
    Heving been both a family member in the room during a code (my sweet daddy who unexpectedly went from being perfectly healthy to dead) and having family members in a code (NICU and ICU) I have to say that being there and having them there is, in most cases, better for the patient and the family. Of course there are exceptions to every circumstance, and blanket policies must have flexibility...ie a hysterical or drunken family member.
  13. by   RNin92
    I am an advocate for families being in the code with their loved one.
    Let me just say, wild horses could not drag from the side of my child or husband...

    I think we all get so caught up in the life-saving part of it...we forget that it is someone's father/mother/child/sister/brother...we are jumping on...We don't want to admit that we may not be able to save them...and now there are witnesses to the fact that we CANNOT save them all...no matter how hard we try.

    We always have a staf member explaining as things are progressing...
    If the code is going to be called...we give the family an opportunity to come up to the head and say what they need to say to their loved one.

    When a previous poster was commenting on being the person to hear the 17 y/o's last words...I got chills...that should have been the mom.
    I am sure that moment would have been some solace in the horror of losing a child.

    No matter how crazy it gets in the code...if the family wants to be there...they should be there.

    Just my humble opinion.

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