[GilaRN]

If you look at how much of this information was gathered, I would bet that this concept was performed in a highly controlled environment. I do not think we are suggesting letting a single nurse deal with the code and the family.

A very detailed process must be in place prior to allowing family into the "code room."

Edit: Ukstudent: we are asking the same questions. I am not sure what process needs to be in place. These are the questions that must be answered. When we allow family to obseve, we have incorperated them into the code.

I remember a process that was used by an ER doc that worked very well. We coded the patient, established an airway, established IV lines, and gave our electrical and chemical therapy. After several minutes without any response, the doc would have us run the code per ACLS guidelines and leave the room. He would talk to the family and tell them what was going on. He would explain the situation, answer questions, and spend some time getting a feel for the family. Then, he would allow only one person back and stay with that person. He would explain everything and answer any questions. Then, he would usually call the code. Security was also in the ER at this time as well. We never had a problem with this method. Will it work for every hospital, no; however, it worked well for us.

[RN1989]

Originally Posted by GilaRN

If you look at how much of this information was gathered, I would bet that this concept was performed in a highly controlled environment. I do not think we are suggesting letting a single nurse deal with the code and the family.

A very detailed process must be in place prior to allowing family into the "code room."

Again - this is great in theory. But when we struggle on a day to day basis to have enough staffing to do a minimally competent job of keeping people alive; when we have new grads orienting new grads and the orientation lasts 3 days; when the hospital doesn't do any education except making sure that someone can do CPR checkoffs; when the staff turnover rate is high because everyone is about to fall out themselves from overwork and stress - why would we wast time, money, and energy on planning, educating, and implementing a program for this? Having family prepared for a code and then having them in on it is not going to keep other people alive or to raise the overall satisfaction survey numbers. It is not going to help the public at large understand what goes on in the hospital so that they can help the nurses fight the corporations for better healthcare.

These programs are a waste of time and resources. They are simply designed to give some graduate student a reason to get a grant to study something while they are working on their DNSc. They do not have practical application in the real world. GilaRN is right that this is going to require a very detailed process. I can tell you that this concept has not or is ever likely to even make it to the bottom of my priority list, much less be something that I am going to waste my energy working on unless there are drastic changes in healthcare that allow me the time and money to work on getting more families involved in a code. Sorry, but right now I'm too busy keeping people alive to worry about whether or not their family feels good about the code and has a better time letting go if their loved one doesn't come out of the code all smiles and without any problems like they always do on TV.

[GilaRN]

Hey, do not kill the messanger. As I stated, my opinion does not count. Personally, I am happy never to deal with family or friends. This is not on my to do list. However, if facilities start doing this, then you will have to deal with it or go elsewhere.

Who knows if it will ever come to pass.

[gaylordfocker2002]

wow, those are some great stories. they are the complete opposite of the most of the research i have gathered.

how have these experiences affected your profession?

[canoehead]

Research is gathered usually in ideal conditions, or at least in better conditions than half past the butt crack of midnight, with no support staff.

[Christie RN2006]

We do not have a particular policy that I know of at my hospital concerning family in the room. Sometimes we let families in, sometimes we don't. It all depends on how the family is reacting, etc. I know with our teenagers and young adults that code, we generally let the parents or spouses stay in the room. I went down to the ED to help with a trauma victim that was only in his teens. They let the parents stay in the room and even brought them chairs to sit in. Another time, I had to care for a young trauma victim that was dying and we allowed the mother into the room so that she could see that we were trying everything we could to save him. After working on him for over 2 hours, when he was coding for the 3rd time, the doctor asked the mom if it was ok if we stopped and by that point she had seen that he was not coming back and she gave us permission to stop.

Sadly in both of those cases, the patients died, but at least the parents had the opportunity to be with their child in their last few minutes here. Emotionally it is extremely hard to be there seeing your loved one die, but I am yet to hear a parent/spouse say that they wish that they hadn't been there. The majority of the comments I hear is "I wish I could have been here sooner" etc. I was in the room when my grandpa died and it was one of the hardest things I have had to witness, but I'm glad I was there.

A lot of times when we have a patient begin coding the family members drop everything and run out of the room. If we have a family that is getting too rowdy or getting in the way, we ask them to step back and occasionally we have to remove them from the room by telling them we need to ask them some questions. I personally have never seen them have to forcibly remove a family member, and I hope we never have to do that!!

[ukstudent]

[quote=GilaRN;2487334 I remember a process that was used by an ER doc that worked very well. We coded the patient, established an airway, established IV lines, and gave our electrical and chemical therapy. After several minutes without any response, the doc would have us run the code per ACLS guidelines and leave the room. He would talk to the family and tell them what was going on. He would explain the situation, answer questions, and spend some time getting a feel for the family. Then, he would allow only one person back and stay with that person. He would explain everything and answer any questions. Then, he would usually call the code. Security was also in the ER at this time as well. We never had a problem with this method. Will it work for every hospital, no; however, it worked well for us.[/quote]

I am not trying to shoot the messenger. But what you are talking about above is family involvement post code, just prior to calling it. What the OP is talking about is family being in the room as you do cpr, shock, intubate etc. From a nursing point of few, in the codes that I have been part of with family in the room, as it is going on, has not gone well and all have had to be removed to out side the room in order to complete the code. The rooms are too small to have a family member, someone to watch the family member and possibly security in case they get totally out of control standing around inside it.

[GilaRN]

No, post code would be having the family enter after the code is called.

[Emmanuel Goldstein]

Originally Posted by ukstudent

Possibly if the code team included a social worker/pastor that's function is to look after the family during this time, but in all the codes I have been part of, it has ended up as the nurse looking after them.

In one of the links above, they describe how this is done.

According to Dr. Guzzetta, all of the organizations recommend that a designated family facilitator—a nurse, chaplain, social worker, or child life specialist who is familiar with family presence guidelines and trained in crisis management—be involved to assist the family throughout the event. The family facilitator assesses the family to rule out possible combative behavior, emotional instability, or behaviors consistent with an altered mental state. If family members are judged as suitable candidates for family presence, and if a supervising physician or nurse agrees, the family is offered the option to be present during the emergency procedure. If the family accepts, they are escorted into the room by the family facilitator, who then finds a place for them to stand or sit, encourages them to support the patient, and stays with the family.

[WarEagle4Life]

OK, so I'll jump in. I work in Pediatric ICU, and yes, families may be present during codes. Quite frequently, it isn't a matter of "allowing" as it is that the child coded while family was present.

When family is present, the chaplain, family representatives and Child Life are all paged. One RN is "tagged" to support the family and explain what is happening. If our NM is at work, she is frequently this person.

Some codes are successful, some are not. Family presence has become a very accepted part of our philosphy. Sometimes, being present helps parents decide when enough is enough, occasionally not, though. Some decide to keep on until our MDs have done all things possible with no results. For some parents, just that last touch of the fingertips is a tremendous comfort and have expressed to us their appreciation at that last little gift.

With family presence, there are no hard & fast rules.

Again, my experience is only pediatrics. Our facility is implementing family centered care throughout. I know that the adult ICUs are making the progression to family presence and are reporting that while uncomfortable, the feedback from families is positive.