[Marie_LPN, RN]

One thing that's comes to mind (thinking of the "man dies holding wife for epidural" thread) is how many lawsuits result from letting family watch a code.

[sirI]

Originally Posted by ZASHAGALKA

Sorry,

This is a touchy-feely trend that will go back out of style when the lawsuits mount.

But more important, while it might be family advocacy, it's not patient advocacy and the patient is my PRIMARY objective, with families taking a backseat.

During a code, I need every ounce of my energy, focus, skill, and experience on that patient. Familes require, if nothing else, keeping an eye on what is said and how - and that extra eye, that off my patient eye, is not advocacy.

And everybody in the business knows that codes are clustered messes at times. When the doc asks for a spinal needle, or you choose the esoteric device here, and it takes 72 seconds for it to arrive, how is that gonna impact perceptions of outcomes.

The other thing is, how much longer are codes going to last, when they are clearly futile, because the family needs more than 10, 20, 30 minutes to believe in the closure.

This is bad medicine. But eventually, common sense will win out over touchy feely.

And that's just my opinion, even if it's a strong one, so let the debate begin.

~faith,
Timothy.

I respectfully disagree.

The family members deserve to see their loved one in this situation. Yes, many things happen that are bizarre to say the least. The family can observe events and treatments and see that their loved one is fighting for life because the healthcare providers are trying so hard.

No......it is not going away. In this day of heightened litigation, this is the best way for families to see first hand that their loved one was not "left to die". It has been proven that the family member that did not see that all was being done, is the very one that will seek litigation.

As for the code lasting longer, that surely depends on the physician and her/his management of the situation. As for when the family should come into the code........you would not bring them in with the first "shock", you would bring them in when there is a realiazation that this becoming futile, but, before all "hope" is lost.

This is a part of the closure process and it is here to stay.

[ZASHAGALKA]

Originally Posted by super_rn

And for the family that doesn't want to be in there, they usually excuse themselves.

See that's just it. Alot of grieving is perception. I'm supposed to be crying. I'm supposed to wear black. We're supposed to have a funeral.

Funerals are almost universal, even if cremated, because there is a strong societal pressure/need for closure.

If you allow the opportunity to witness, a large percentage of the population will preceive it as a requirement, else they aren't grieving like they should.

We've let our TV facination with the macabre dominate our lives, and now we are passing it off as advocacy. I said in my previous post that it might be family advocacy but not patient advocacy. I change my mind. It's not even family advocacy.

codes are ugly nasty business. It's cruel to let (require) a family member to witness.

Funerals are where closure happens. It's a time tested, time honored process. Save the macabre for those who are trained to deal with it.

Families in codes is bad medicine, all the way around.

Fortunately, in my area, the doctors aren't far-sighted enough to adopt such lunacy. But I'll say this, most policies that address such issues have a 'in the nurse's opinion/assessment of its appropriateness clause'. I would NEVER find it appropriate and would always invoke the policy to object to the family's presence.

Why? Because I'm an advocate.

~faith,
Timothy.

[William_SRNA]

Tim, you bring up some excellent points

Originally Posted by ZASHAGALKA

See that's just it. Alot of grieving is perception. I'm supposed to be crying. I'm supposed to wear black. We're supposed to have a funeral.

Funerals are almost universal, even if cremated, because there is a strong societal pressure/need for closure.

If you allow the opportunity to witness, a large percentage of the population will preceive it as a requirement, else they aren't grieving like they should.

We've let our TV facination with the macabre dominate our lives, and now we are passing it off as advocacy. I said in my previous post that it might be family advocacy but not patient advocacy. I change my mind. It's not even family advocacy.

codes are ugly nasty business. It's cruel to let (require) a family member to witness.

Funerals are where closure happens. It's a time tested, time honored process. Save the macabre for those who are trained to deal with it.

Families in codes is bad medicine, all the way around.

Fortunately, in my area, the doctors aren't far-sighted enough to adopt such lunacy. But I'll say this, most policies that address such issues have a 'in the nurse's opinion/assessment of its appropriateness clause'. I would NEVER find it appropriate and would always invoke the policy to object to the family's presence.

Why? Because I'm an advocate.

~faith,
Timothy.

[traumaRUs]

I am an adamant supporter of this and the literature/research bears this out. I did my master's thesis on family presence during resuscitation and invasive line placement and in one study (considered the gold standard because it followed every patient/family for nine years) had a 92% rate of "yes, I would want to witness resuscitation." This is not touchy-feely by any means, it is common sense. I work in a large level one trauma center and frequently facilitate this. The most important idea to take away from this discussion is that it is NOT the nurses or care providers who are the support system - it is a specially trained RN who knows the ropes, knows what to expect and has the patient's best interest at heart. It can be done and should be done.

As to my personal experience with family members - both of parents were DNR so there was no CPR. However, my son has been in the hospital several times and I never stepped out of the room, nor was I asked to.

[ZASHAGALKA]

Originally Posted by traumaRUs

I am an adamant supporter of this

And I'm an equally adament opposer of this idea. But that's not to say there can't be a debate on it. And I can almost bet that this thread will get over a hundred posts before it's done.

There are just too many aspects of a code that cannot be interpreted through a lay person's eyes. And 'dumbing' down a code so as not to offend that lay person is NOT true advocacy of any kind.

You are an exception because you are not a lay person. I might suggest you leave, but I wouldn't force you out.

But to the lay person, "oops, I think I cracked a rib' is not what I want them to take away from their loved one's death. Codes aren't pretty, nor are they for the weak. But we want to put it out there that this should be part of the grieving process and the result will be to 'force' participation in an often gruesome event.

This will not last. Codes are, by nature, messy. Even if only 1 in a hundred family members wonders 'was that a mistake, why did the doctor yell about that' and even if only 1 in a hundred of them seek a lawyer, the malpractice angle of this practice will end it.

TO YOU, this would be closure. To a lay person, I believe this practice to be very close to negligence: we should know better and be better advocates.

And we haven't even discussed the Heisenberg Uncertainty Principle: The simple act of observing an event changes the system of the event.

~faith,
Timothy.

[PedsERRN]

We often allow families in the room for codes. We are a level one trauma center and have a social worker who stays in the back of the room with the parent and explains procedures. We will advise the SW if things are going to get bad, i.e. cracking a chest, and they will discuss with the family if they still want to stay. I've had parents thank me for letting them be there.
I've always worked peds, so it's not that much of a transition-we always have families at the bedside for everything else!

[ZASHAGALKA]

Originally Posted by siri

IThe family members deserve to see their loved one in this situation.

I cannot disagree more. Reality TV has rid us of the old fashion notion that what people deserve is dignity and the respect of NOT being seen in such a 'compromised' situation.

family members most certainly do not DESERVE to witness such an ungraceful 'assault' on their loved ones. It wasn't that long ago when we would have rightly said that patients DESERVE not to have such a situation witnessed by those they care about. True advocacy would be protecting that dignity.

But this, It's unseemly.

~faith,
Timothy.

[sirI]

Originally Posted by ZASHAGALKA

I cannot disagree more. Reality TV has rid of of the old fashion notion that what people deserve is dignity and the respect of NOT being seen in such a 'compromised' situation.

family members most certainly do not DESERVE to witness such an ungraceful 'assault' on their loved ones. It wasn't that long ago when we would have rightly said that patients DESERVE not to have such a situation witnessed by those they care about. True advocacy would be protecting that dignity.

But this, It's unseemly.

~faith,
Timothy.

Again, respectfully disagree. Yes, the family deserves to be able to view this process. Their loved one is not considered undignified to them. It is their child, father, mother..........

[DusktilDawn]

Originally Posted by Marie_LPN

One thing that's comes to mind (thinking of the "man dies holding wife for epidural" thread) is how many lawsuits result from letting family watch a code.

Or a family member trying to run the code.