resuscitation and family presence

GilaRRT · Nov 9, 2007

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 · Nov 9, 2007

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, BSN, RN** · Nov 9, 2007

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 · Nov 9, 2007

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 · Nov 9, 2007

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.

GilaRRT · Nov 10, 2007

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

EmmaG, RN · Nov 10, 2007

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.

AlabamaBelle · Nov 10, 2007

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.

hellerd2003, RN · Nov 10, 2007

I think it depends on who you invite to the code team. Usually, if family is present, our nursing supervisor (who responds to all codes) stands with the family outside of the room (our rooms have glass windows/ doors) and explains what is happening. This gives us the freedom to do our job during a code. I prefer to have families present, because if it were MY relative, I'd want to be there during a code. Grey areas are eliminated.

TRAMA1RN · Nov 10, 2007

I have worked several ER's from small community, lots of elderly dying in ER, to inner city lots of gunshots and violent and drug induced deaths to a level 1 trauma center. All facilities have allowed family, and I feel this is best for all involved, nurses and MD's, the key to making this successful is having a patient advocate with the family the entire time explaining what is happening and why. All the families have appreciated this. The hardest have been the pediatric cases but even these that have had death as an outcome have been well recieved by all families. The patient advocate has been trained to know the basics of a code and has been trained to answer questions with minimal medical information. After codes the final key needs to be the physician apeaking directly with family and answering any final questions the families may have. Nurses do benefit from codes run this way since the families can see how caring the medical staff are, it also keeps medical staff from creating more drama than is necessary, which is the tendency with young staff in codes. Hope this helps!

ZASHAGALKA, RN · Nov 10, 2007

A very lengthy thread on this very topic:

https://allnurses.com/forums/f8/family-witnessing-code-activities-117691.html

I think it gives much insight into the concerns involved.

~faith,

Timothy.

doe9181 · Nov 10, 2007

I know I would possibly want to be in the room with my loved one but only with the staff's permission and as long as I'm not in anybody's way or to big of a distraction. I know I would be one of the first to get out of the way if anything goes wrong. I would hate to be the one that caused a negative outcome for my loved one because I did not get out of the way in time.