resuscitation and family presence

  1. 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.
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  2. 23 Comments

  3. by   GilaRRT
  4. by   EmmaG
    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
  5. by   gaylordfocker2002
    Quote from 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
  6. by   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.
  7. by   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.
  8. by   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.
  9. by   GilaRRT
    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.
  10. by   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.
  11. by   ukstudent
    Quote from 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?
  12. by   GilaRRT
    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.
    Last edit by GilaRRT on Nov 9, '07
  13. by   RN1989
    Quote from 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.
  14. by   GilaRRT
    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.

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