[Marie_LPN, RN]

I agree with a CHOICE to watch it.

I don't think it's right to rule out anyone watching, to automatically assume what would be best.

[medicrnohio]

I am unsure if I would want to watch a code on my family or friends. But I do support family being present during a code situation if there is someone present who can be there with the family member during the code. Unfortunately the hospital I work at now has a policy that no family members may be present during a code situation.

[ZASHAGALKA]

I also am trying to respectfully disagree. I know your opinion has many supporters and some evidence, even if I believe that such 'evidence' can never be unbiased because it is almost always researched by those looking to support their already reached conclusions.

Let me elaborate some on my strong feelings about this.

The very first code I particpated in was my father's death. He died of, more than likely, a blown graft 10 yrs after his bypass surgery. I did CPR on him for 45 minutes, counting downtime at home and assistance in the ambulance.

Because my brother worked at the ER where we went, they coded him for another 40 minutes, out of respect. We (the ambulance crew and I) delivered him to the ER still in V-fib. As soon as the ER crew took over, I walked away.

I'd done all I could, and that was enough. (No need to offer condolences as this was 12 yrs ago and I've long ago come to terms w/ this.)

My father considered himself to be a powerful man. I grew up thinking about him in just that vein. My children know when to joke around and when the only right answer to me is, "Yes, sir!". That is my father's legacy. He would not have wanted the last living image he presented to his family to be, well, so powerless.

I think we've lost all sense of what is appropriate and what isn't. And not just here, but in society overall.

Forget about the trauma we can induce on the lay person for a minute. Forget about the Heisenburg Uncertainty Principle. To me, this is a matter of simple decency and respect to keep private what should be kept private.

I can see significant others attending births as a positive change over the past. It's important to be or feel like you are being a participant in life's joyous events. But this, this is different.

I agree that there needs to be closure. But, we already have societal mechanisms in place to obtain that closure. A code is not the right time or place for 'spectators'.

If we can't find better ways to come to terms with death than to be a gawking participant, then we have truly lost something as a society. The crux of ethics in many aspects of healthcare, to me, is the line between what we can do, and what we should do.

We should not do this.

~faith,
Timothy.

[Marie_LPN, RN]

With all due respect, i do not feel that one person's experience should dominate what is best for other people.

And "appropriate" has a technical definition in the dictionary, but it has a different meaning to each person, for each or any situation. As well as "decency".

[mhull]

Originally Posted by 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.

I am getting ready to write my Ethics in Nursing paper on this. Will you share with me your sources? I need a few more. Also if anyone else has any good literature about this, please post it, PM me or something.

[sirI]

Originally Posted by Marie_LPN

With all due respect, i do not feel that one person's experience should dominate what is best for other people.

And "appropriate" has a technical definition in the dictionary, but it has a different meaning to each person, for each or any situation. As well as "decency".

I agree.

[suebird3]

I don't like the idea of family in on codes. Why? Several factors. If the patient makes it through, but has brain damage/the high rate of lawsuits. If the patient doesn't make it, "we didn't work hard enough."

Tim.....you have a good point, also. Thank you!

[ZASHAGALKA]

Originally Posted by Marie_LPN

With all due respect, i do not feel that one person's experience should dominate what is best for other people.

And "appropriate" has a technical definition in the dictionary, but it has a different meaning to each person, for each or any situation. As well as "decency".

I disagree with this statement. If appropriateness and decency are subject to EVERYBODY'S individual preferences and meanings, then NOTHING is appropriate or decent. Or EVERYTHING is.

Such standards are set by society, hence the phrase 'societal standards'. As the front line of healthcare, this standard WILL be set by us, either pro or against. OR rather, the standard was set long ago and is being challenged by the 'current' thinking.

It's not anymore 'wrong' for me to hold to the status quo than it is for somebody to advocate changing that status quo.

I agree that it's a decision, but it's not an individual decision, it is, in effect, OUR decision.

Before you change a standard, you do well to examine why the standard was implemented in the first place. This standard was set because 1. WE deemed it irrespectful to display loved ones in such a state. 2. When you subject grief to unpredictable processes, you get unpredictable results. This is why funerals are CAREFULLY ORCHESTRATED events. 3. The Heisenburg Uncertainty Principle (HUP) - the act of observation changes the event. In this case, it promotes restraint for sake of family. That restraint, by definition, prevents 'all out effort'; it restrains those efforts. 4. In an age of rampant 'defensive medicine' to avoid suits, why on earth would you purposely expose emergencies to such measures. Now, instead of ensuring that every possible HELPFUL measure was done, we are ensuring that every possible measure is done.

To say that everything and nothing can be decent or appropriate is to deny that we live in a world governed by STANDARDS. This is why it's so hard to regulate porn. What is porn? I know it when I see it.

What is appropriate and decent? I know it when I see it, and this isn't it.

~faith,
Timothy.

[grannynurse FNP student]

Several years ago, I watched a program that addressed this very topic. The standard, for one famiy member to be present, was clearly presented to the family. And the person was accompanied by a staff person. Research showed that rarely did the family person freak out and have to be removed. Nor was there any increase in lawsuits. Research demonstrated that it was beneficial to both the family member and the patient, even when the patient die. I believe that it is the fear of the staff, that they will be second guessed that interfers with their judgement.

My daughter was present when I coded, in the ER, following multiple trauma. She and I later discussed her feelings. She told me, if I had die, she would have been able to cope better, knowing the staff had done their best. Both she and I agreed my mother would never have been able to tolerate it. It is a personal decision, that a person should be given the opportunity to decide. And should the person decide yes, they should understand the guidelines and should have a staff member present.

Grannynurse

[canoehead]

In all the chaos of a code I was recording on suddenly no one was doing compressions and I was able to shout it out, along with reminders that it had been so many minutes since the last drug and could we give another dose. Many times the docs will ask "does anyone have any ideas?" and we all problem solve out loud. Teaching happens during codes, especially when using pacers or defibrillators. Sometimes we have a doc that doesn't know the patient and we need to give a report on what led up to the code, sometimes the circumstances are not flattering for someone in the hospital. All those situations could be remembered by family and leave them with the feeling that something was done incorrectly or not soon enough. sometimes things ARE done incorrectly, and we need to state it bluntly in order to get to a solution and save a life.

I also think that ours is a profession where we give endlessly, and sometimes to the point of breaking. I think we MUST take 2-3 minutes after a code, and before speaking to family, to collect ourselves and offer support to each other. People that work the codes are human too, and we have gone above and beyond to put the patient first throughout the development of the profession.

As a rule we do not expose ourselves to blood and body fluids, we take the 30 seconds to put on gloves. We don't lift 250lb alone. Caring for both the patient and family during a code is like lifting 250lb. It may be good for the one patient at the time, but not as a long term standard of care. We lose too many good workers with injuries, and eventually the patient (or family) is going to be hurt as well.

Thank you Timothy for your well thought out points.

*************
I am a dogged family advocate in my practice, but this idea is a "300lb" one for me. I have to have that minute to breathe after a code, or my ability to function for the rest of my shift is gone.