[gaylordfocker2002]

i have done much research on this topic, and i have discovered the advantages and disadvantages to the patient, the family, and the staff. i do have a question that i feel some of you more experienced members may be able to help me out with.

what makes this topic important to nursing as a profession?? how has the nursing profession been effected?? and what is the impact of this subject as it relates to health care in the US??

ladies and gents...i have been searching this topic for weeks. there is no journal articles that discuss the impact of this topic on nursing as a profession. this is something that i know many of you have experienced in your profession as a nurse. i graduate in 2 months....and if i can get any opinion on this....i will be forever gratefull.

thanks everyone.

[GilaRN]

http://www.ena.org/about/position/PD...F5BCF87F7C.PDF

[Emmanuel Goldstein]

One of our anesthesiologists was pushing for a policy to allow family presence during a code. (I left the hospital before it became policy) I think families should have the option to be present if they so choose.

Good articles on the subject (with some excellent references at the end): http://ajcc.aacnjournals.org/cgi/content/full/12/3/190

http://www.pulmonaryreviews.com/mar06/family.html

[gaylordfocker2002]

Originally Posted by Emmanuel Goldstein

One of our anesthesiologists was pushing for a policy to allow family presence during a code. (I left the hospital before it became policy) I think families should have the option to be present if they so choose.

Good articles on the subject (with some excellent references at the end): http://ajcc.aacnjournals.org/cgi/content/full/12/3/190

http://www.pulmonaryreviews.com/mar06/family.html

thanks you guys for the articles. everything i read seems to contain the same material. i am specifically looking for its impact on the profession of nursing. i appreciate your help.

anyone have any personal opinions???

thanks

[gaylordfocker2002]

i have been researching for weeks, this one small topic is the only thing holding me back. i graduate real soon...if i can complete this dang paper. someone please help me!!!

i am getting so nervous. time is running out.

[ukstudent]

Are you asking, does having family present during codes help nurses? Then I think the answer is no (however it does help the family at times). Families have a strange idea about codes from watching too many tv shows, where when someone codes they do cpr for 2 minutes, shock once and the pt comes back and is sitting up and talking in the next 5 minutes. Reality is very different. During a code the nurse needs to concentrate on the pt, having to divide that focus to also include the pt's family (in case of hysterics, fainting etc) does not help the pt. 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.

[RN1989]

I have been present at codes with families. Each one was a nightmare. Family literally laying on top of the pt screaming - doing that whole movie death scene bit. Couldn't get to the pt. Big surprise - pt died.

Had another one where the wife stood on a chair in the room and was screaming at all the staff. We couldn't hear each other talk and it caused difficulty with orders and interventions. Had to have security tackle the woman and remove her kicking and screaming from the room.

Had one elderly lady crying so hard that the staff kept getting distracted by her instead of concentrating on the pt. By some miracle the guy came back after a couple of shocks.

Don't want to forget the entire family gathered around the bed who were so freaked out by the arrest that we couldn't get them to get out of our way so we could get the cart in the room.

All those lovely studies they have done are great but thus far I have yet to see them be practical. If the family has been prepared, then you can deal with them in the room. But how many people are going to be prepared for a sudden cardiac arrest? If they want to watch a code - tell them to turn to NBC on Thursday nights and get out of my way. I don't have time to babysit you while I am breaking your loved ones ribs and trying to get a good IV in - unless of course you don't care that your loved one dies because you were in my way.

[GilaRN]

My opinion makes little difference as most of the information indcates family involvemnt is generally good practice. Now, the question is how to implement this concept. We cannot arbitralily allow family in the room during a code. A screening process is needed to help identify families that would benefit from this concept. In addition, I would suspect a specially educated staffmember/s would be needed to deal with the family one on one during the code. Once we can effectively ID people who would benefit from this and have a process in place to effectively incorperate their presence into the code, I think we should be able to eliminate most of the meladramatics.

[canoehead]

The experiences I have had with family present at emergencies have been good, but I STILL think that should not be the default position. We need to get some kind of control over the situation for the health of the patient, and to support the health care team in a very stressful situation. Only then can we support the family- and I don't mean the crowds that show up in OB for a delivery, just those that would normally see the patient naked and ill (ie the spouse or partner, or intimate caregiver).

I also worry about specifically asking the family about coming back to see. They may feel obligated to come, and find it disturbing. We have the spouse/partner in the ER available to answer questions about health history. They either come to the door for more information, or they choose to wait in another room where we've directed the other family members. If they come to the door we (the recorder, or the doc) asks if they would like to come in, and gives explanations or support. We are a tiny ER, sometimes just one RN, secretary, and a doc, so in a code there is NO extra person. The custodian(!) directs family to a private room, and decides if incoming triages need immediate attention, or they can wait til after the code. I'm not kidding.

When life or death situations occur we have to take care of each other. That means limiting stress, including visitors until we've got some control over the situation.

If I was at a huge teaching hospital I might feel differently. If I'm the ONLY nurse, I just can't do it, no matter how important it is. My priority is the patient, the team (if we collapse we can't help anyone else), the other patients with life threatening issues, and then any family of patients. I'm sorry if anyone gets hurt by the way I do things, but we can't spread ourselves that thin and still be effective.

[ukstudent]

Originally Posted by GilaRN

My opinion makes little difference as most of the information indcates family involvemnt is generally good practice. Now, the question is how to implement this concept. We cannot arbitralily allow family in the room during a code. A screening process is needed to help identify families that would benefit from this concept. In addition, I would suspect a specially educated staffmember/s would be needed to deal with the family one on one during the code. Once we can effectively ID people who would benefit from this and have a process in place to effectively incorperate their presence into the code, I think we should be able to eliminate most of the meladramatics.

How would you have a screening process? When would you do it? How would you be able to tell pre-code which family member is going to turn into a raving lunatic (seen that) and which one will stand still and quiet in a corner so that you can code the pt. I am also not sure what you mean by "incorporate them into the code", as what?