Family present during code of patient

erteamplayer · Apr 2, 2000

Originally posted by sharonhayes:
Would like some feedback on how other ER nurses feel about having family at bedside during a code. Our ER is getting ready to adopt a policy that permits family presence during a code if the staff feels patient and family will benefit from the experience. Some of our staff have very strong feelings about this. How do you feel and why do you feel this way? Do you have an "legal" backup for your answer? thanks

Our er has been doing this for about 2 yrs and it works fairly well. We choose the time for the family member to come in... usually it's when we know that we are going to be unsuccessful in reviving the pt and we want them to see that we did everything possible for their loved one. But in every situation we give the family member the option of going in at one time or another, explaining to them that what they see may be upsetting and graphic. We also have a special room for the family of a code pt called the "family room" which is positioned right next to the trauma room. We have several comfortable chairs, a phone and coffee for them. This all seems to help with our code situations.

Trauma Columnist · Apr 19, 2000

Our large (70,000 visits/yr) ER allows family members in during codes. Our criteria is that there is a social worker or RN available just for them to explain everything. We allow them to touch the patient and encourage them to talk to them also. I have had very positive experiences with this, especially with children whom we couldn't save. It also gives us insight into who the pt was and how hthey will be missed. I have always encouraged this. I will say, that I use restraint if there are disfiguring injuries. If I can't drape the injury adequately then I discourage it. Lets face it, you wouldn't want to remember what a gunshot wound to the face can do to your family member. Overall, though I certainly endorse it.

mommatrauma, RN · Mar 6, 2005

According to the American Heart Association 2000 Guidelines.....

"For in-hospital resuscitation efforts, especially for infants and children, family presence during resuscitation attempts has positive psychological value, provided that a designated staff member is able to remain with the family during the resuscitation."

We will allow one family member at the bedside if they request it...Usually we do it only at the very end maybe last round of drugs...We don't offer it outwardly...it usually happens when the family requests it...If they are present they must stand back and a staff member, usually chaplain or social service remains with them at all times...We have mixed reviews on it...Alot of times if it is a child or infant the last thing the parents want to see if someone pounding on the childs chest...other times, it seems it was very healing to the family to know that we REALLY did everything we could to help their loved one...I think every situation is unique and should be assessed as such...If you have family that wants to be present, but becomes disruptive and isn't allowing you to do your job...then its a good idea to have security standing by to handle any issues that may arise...

Okami_CCRN, BSN, RN · Nov 29, 2007

I dont think family should be present during a code. It creates too many complications and makes the staff really nervous especially when the said family member(s) cannot be controlled. The other day we had a lady who coded while the family members were in the room and they started yelling and cursing at us and would get in the way of the code team. So I would have to say no.

meandragonbrett · Nov 30, 2007

Read the current literature on the topic.

sjt9721, BSN, RN · Dec 3, 2007

I dont think family should be present during a code. It creates too many complications and makes the staff really nervous especially when the said family member(s) cannot be controlled. The other day we had a lady who coded while the family members were in the room and they started yelling and cursing at us and would get in the way of the code team. So I would have to say no.

I'm sorry you've had this experience. Family presence is meant to be a case-by-case situation, with the proper support in place for the family and not just a carte blanche to remain in the room no matter what.

Imagine this for me..

Your child/parent/spouse/sibling collapses while having dinner at your house. 911 is called and you begin CPR. EMS arrives and assumes care of your loved one. You watch them...compressions, defibrillation, intubation. It's time to transport and they offer you to front passenger seat in the ambulance. Resuscitation continues and you can hear their efforts from the back. You arrive at the ED and follow the stretcher in through the automatic sliding doors. Into Room 2 goes EMS & your loved one...then someone blocks your path, points to the wating room, and closes the door in your face...

While this is just one of my family presence experiences, it's the one that sticks out in my memory. How dare we keep someone out...were we protecting them from the horrors of resuscitation? Hell, they'd already seen (and participated in) it in their own dining room.

This particular family member, an adult son, followed the stretcher into the room. He stood at the foot of the gurnery, holding onto his father's feet, fulfilling the hasty promise to his mom about "staying with Dad" because she couldn't bear to be in the room.

We heard him quietly say "C'mon Dad" a couple times, then his words turned to "It's okay Dad. Mom's okay". Our doctor moved to the foot of the bed, explaining everything that was being done and how his dad wasn't responding to any of the efforts. It was almost a collaborative decision to call the code.

The man accompanied the doc to the family room to break the news. She was reassured that all efforts had been exhausted, and both were thankful that someone was allowed to be with the man during that time. A comment was made that they couldn't bear the thought of him "dying alone".

I urge you to keep an open mind on this topic.

Diary/Dairy, RN · Dec 3, 2007

I witnessed a bad situation with this recently - the patient had been restless all night, his wife stayed with him and kept yelling at him to be quiet......she was a nurse too, I think. Well, he arrested, she was in there, distraught, weeping, so upset that the last night had been filled with her yelling at him.

My objections to family members being present is just that codes, CPR/Intubation/shocking are all violent actions - I think it would be horrible to watch someone do those things to my parents. I would be open to trying it in a more controlled environment...

MAISY, RN-ER, BSN, RN · Dec 3, 2007

Although I've read the reccomendations I think family at the bedside during CPR should only occur with calm, chaperoned family members.

Codes are loud and scary for new personnel, so imagine how a family member would feel without medical training seeing their loved ones shocked, pounded on, unclothed, and seemingly abused by staff as they are moved quickly to perform maneuvers necessary for resuscitation.

I know people just want to make sure that everything was done for their loved one, but will they understand when we stop? It is emotional for staff after an unsuccessful code....we ask ourselves if we did enough, quick enough.....where does the family fit in that equation?

I have had both...I'd prefer if they weren't there.

Maisy;)

rachelgp · Dec 3, 2007

I recently took both TNCC and ENPC. In both classes, they made the point that, as many have already stated, family presence is decided on a case-to-case basis. If you (the team) feel that there is a family member that will be able to handle it and remain non-disruptive. There is also supposed to be a staff member assigned to the family member that will be in the room to explain what is going on and to answer questions, rather than the whole team having to worry about this. Also, the family member should be briefed on what to expect (sights, sounds, smells, etc.) and determine for themselves if they think they can handle it (and be able to leave at any point). AHA advocates family presence based on the above.

scattycarrot, BSN, RN · Dec 5, 2007

I dont think family should be present during a code. It creates too many complications and makes the staff really nervous especially when the said family member(s) cannot be controlled. The other day we had a lady who coded while the family members were in the room and they started yelling and cursing at us and would get in the way of the code team. So I would have to say no.

Its not about us healthcareworkers though, is it? It shouldn't be about whats easier for us. It should be about whats right for the family members and as uncomfortable as that makes us during a code, they should be allowed to be there. Having said that, if your unit does not have a policy on this than that may be why problems emerge. There needs to as assigned nurse who talks to the family before they go into the resus room (and will stay with them through the whole CPR attempt)and is very blunt with them about what they will see. No time for beating about the bush here or being nice to save feelings. If they still want to go in then its no more than 2 people that stand away from the patient(unless its a child)and do not get invovled.

Obviously, this is said in as nice a manner as possible! If there is a problem, than they need to be asked to leave the room and by that, I don't mean the family member being emotional, I mean them shouting at staff members and/or getting in the way. The patient is the primary concern and while it is unpleasant to get security involved, if that is what you need to do than do it. This a coutesy being extended to the family not a right. But, in my exerience, not alot of family members want to come in after being told what to expect and if they do , they don't tend to stay for long. However, when a patient codes with family present, that is more of a tricky situation but again the patient is the primary concern and if the family members are being disruptive they should be asked to leave. I would say the vast majortiy of codes that I have been involved in that have family present have gone very smootly and were of great help to the family members. As some one else said, it allows them to see that everything that could have been done, was done.

Joe B1 · Dec 7, 2007

I've been in a few codes where family members where present. It has never been a blanket policy allowing family in codes in any place I've worked, but rather a case-by-case basis. The few that we've had family present went very well. The families were, needless to say, inconsolable. Some were quite vocal, but all were very grateful to us for what we had done and commented on the effort we put into trying to resuscitate their loved one. I remember the wife of an elderly gentleman who asked us to stop once she saw what her husband was going through and later told the social worker that she had had no idea what people went through during a resuscitation until then. I've heard of a few codes that went badly during family presence, one a pediatric code in which one of the parents kept throwing herself over the child and begging God and the team to save her child, but not staying out of the way so that they could. I'm glad I haven't had to deal with a situation like that.

I had my reservations about ever allowing a family to see what we did to trying to save their loved one, but I think it's mostly been a good experience for me and my co-workers. One must choose the family well, however.

Joe