Survey: Should family be present for a code? - page 2

Here are the results of last months survey question Should family be present for a code? : Please feel free to read and post any comments that you have right here in this discussion thread... Read More

  1. by   essarge
    After I discussed this with my family, they said that it would depend on the situation.

    I personally would like to stay, but my background allows me to understand what is going on.

    I was reading on another thread about social workers working in the ER to help family members deal with the situation and I found that to be interesting. I think it is a personal decision and one that would absolutely need an informed party to be present should the family decide to stay for a code.
  2. by   hoolahan
    Here is a horror story memory to consider as well. Once had a pt on IABP, and the balloon ruptured. Pt went down the tubes rapidly while being prepped for reinsertion. Mean while, this was the third balloon rupture in a week, and we had gotten new balloons, but not all docs knew the little differences about inserting. So, here is our best anesthesiologist at the bedside with the package insert, reading instructions to the surgical fellow. Yes, they got it in fine, hey, I give 'em credit for reading the instructions! But, can you imagine how that would have looked to as family member?? Would they have pulled out that instruction sheet in front of them, or excused themselves for a precious few minutes to review the paper in private?? Knowing these two great docs, they probably would have done nothing different, just spent time explaining to the family why it was done.

    Thank goodness it was night shift, no family was there.

    Also, once had a surgeon who asked pt's to rescind adv dir before open heart surg. So, when one pt coded during visiting hours, and they were allowed to stay, they actually defib'd the pt "36 times" according to what the son told me later when I came on for pm's. He told me the docs would not allow him to be made a DNR, but he wanted me to call him first if anything went wrong. I did,and he and his sisters came up and joined hands in a circle around the bed and REFUSED CPR to be done! These can be the after effects of witnessing a code, and in my opinion, in this particular case, it was theright thing to do!!

    In fact, after that, I encouraged the supervisor to bring in families who were approached about DNR, but did not think they could do it, after seeing a code, they had no problem with making their loved one a DNR.

    I think, knowing what I know, I seriously would haveto be heavily sedated if I had to witness a code of my loved one, if it was unexpected especially.
  3. by   nur20
    I don't feel that they should be there. A Code can be very ugly and some things family just do not understand. I suppose if they insist,they have the right,but i feel they can add to an already tense situation, particularly if it's a small area, crowded and they are accusing you of doing something wrong or just don't understand what's going on.
  4. by   bmatous
    This topic is at best a double edged sword, and I have been both on the side of the family and as a nurse. In addition, I have attended some resuscitations that I would have been proud as a healthcare provider for the family to be in attendance and then there are those that I did not even want to participate in.

    As a family member, I wanted to know that my family member was appropriately taken care of. Without seeing those procedures occur, I think there is always some wondering involved as to what was going on behind those doors.

    As healthcare consumers are getting more and more saavy, I am not sure the decision will be up to the healthcare providers much longer. I think the families will begin to stay and from a customer service stand point, we may find ourselves in a situation that we cannot refuse.

    There are several things to keep in mind when making this decision. The first is that the family must have the appropriate support there. We often use social workers and chaplains in this situation. They have made themselves available and can answer questions the families may have at the family level, not the healthcare provider level. I work at a free-standing children's hospital where the support network is fantastic. We have those systems in place to allow families to stay. Secondly, I think we should not assume that all families want to stay. We have found that many families will leave when given the opportunity to do so, and that is how we approach it. We have a social worker or chaplain who lets them know that there is a place they can go to (along with the social worker or chaplain) and then there is a designated resident who goes and updates the family periodically as things change. Thirdly, if it is a resuscitation that is not going well, there needs to be a way to communicate that to the social worker or chaplain so they can encourage the family to leave the bedside with the understanding that frequent updates will be given. We have to remember that families don't know what the "right" things are to do, so they don't know the "wrong" things to do either. Lastly, it is the helathcare providers that are uncomfortable with this concept, not the families.

    I would also encourage you to look at the literature regarding litigation. I think one of the things that concerns us is if the family sees us doing the "wrong" thing or that something doesn't go perfectly that we will get sued. If you look at the supporting literature, suits occur when patients/families don't get what they want. If they were there and saw that you worked for 45 minutes on Aunt Susie, they are going to be much less likely to sue. They saw that Aunt Susie did not resond to the 43 therapies that were tried. They don't look for that 44th therapy that was not tried.

    As you can tell, this is a topic that I am passionate about. Nothing more than my two cents worth!
  5. by   thisnurse
    i dont know if i would want to be there if it were someone in my family. codes are ugly most of the time and it would be difficult for me to watch my family member be defribillated.
    some pts seize which isnt too pretty either.
    i dont know that id want to remember my loved one like that.
    the last code i was at was run by a very young, attractive doc. he was VERY good at what he did. one of the techs flirted with him the entire code. it was sickening. and then she said...i was hoping something like this happened. i was having trouble staying awake.
    i wanted to kick her. i remember thinking i was glad no family was in there at that time.
    it would be hard to say goodbye or i love you during a code. its hard to even get near the patient.
    for some people tho i think its important. like said before, i would not go and get them but if they were in the room i would ask them what they wanted to do.
    of course if they wanted to id let them stay so long as they didnt interfere.
  6. by   semstr
    No family at codes for me. Wouldn't want my family watching my own code!
    I am a very holistic thinking and working nurse, but there are frontiers, where I think we as nurses have to protect innocent people, who don't know what is happening to a loved one.

    It is aof course different, when medical personal is among the family, but even there................. my mother in law is a nurse and she arrived at the hospital just at the moment the doctors stopped CPR on my father in law (she didn't know he arrested, she just felt so "strange" all of a sudden and went to the hospital, mind you this was 11pm).
    He was 78 years old, a physician and recovered from a pneumonia on his way home the next day.
    My ma in law went nuts (I was told later) and screamed at the team to go on, the teamleader said they'd resusitated my pa in law 45 minutes already and there was no reaction what so ever, and he called it to end.
    Well there was a very nasty situation, where my ma had to be restrained, becuase she tried to start the CPR on her own.
    As I arrived at the hospital, she had been given Valium and was calmer, but still very pushed. I tried talking to her, and said that we discussed all this a lot of times with pa, he knew he didn't want to end up as a grown-up-baby-in-diapers (his own words) and to let him go, when time came.
    Well, in the end she was better, I took care of my father in law, she asked me to do this, so I washed him and the whole tango.
    That was sad, but now I know it was important to me.
    I loved that old man dearly and took care of him until, no over, the end. What more can you do for the people you love!

    Take care, Renee
  7. by   Li'l abner
    I agree that the family could be present at a code only if there is enough staff to deal with the family. I have been on the cardiac team at 5 different hospitals in my 26 year career and it has been my experiance that there is never enough staff or room for extras in the room during a code. The family has been allowed to watch from the door and ask questions after the code has been stopped but there was no time during the code. I spent a lot of time with the family after the code explaining what happened and greaving with them. I now work in the high arctic and as the only ACLS provider here I have to be nurse, councellor, provider, and friend.
    A code is a very invasive and stressful time and hard for families to understand what you are doing to their loved one, but I am a strong advocate for pt and family rights.
    These are just my opinions Humble as they may be.
    RAH
  8. by   kaycee
    I would have to say no, at least in my facility. We do not have the staff to handle family during an arrest. We have had hysterical family members break in to the room which was awful.
    I am not totally against it, depending on the situation and the family. I am always up for going against the grain if it is helpful to a pt. or family at the time.

    Lynne
  9. by   pamela5rn2
    Hi, in response to many of the posting's, I feel like this is a very difficult call, but I feel like thier is truly not enough room in a hospital room for all the staff that are thier to assist in the code, and I think although they should be close by, this is truly a very traumatic thing to watch a family member go through. And honestly, thier have been some really screwed up codes I have assisted with, not that I know the pt outcome would have been any different, but would have indeed been detrimental to the hospital I work for, and the health profession in general. I believe in what we do, I believe in keeping the family as involved as possible, but I don't think family members at the bedside during a code is a good idea. Many family members in the unit I work in, stay outside the door, do not want to get in the way, or move to far away. I truly believe that is probably the best scenario. They are there, they see staff running in and out of the room, they are able to observe the coordinated effort of many staff members fighting for thier family member's life, yet they are not in the middle of the fray, or in the way, or possibly hysterical and uncontrollable at the worst possible place, at the worst possible time. Have a good nite
  10. by   KARRN3
    YES. I HAD A YOUNG MAN, IN HIS FIFTIES COLLAPSE IN CARDIAC ARREST WHILE I WAS WALKING HIM IN THE HALL, POST OP CABG.WE CODED HIM RIGHT THERE ON THE FLOOR AND HIS WIFE AND SON CAME ON THE UNIT DURING THE UNSUCESSFUL RESUSCITATION ATTEMPT. I BROUGHT HER IN SO SHE COULD HOLD HER HUSBAND'S HAND AND TELL HIM SHE LOVED HIM ONE LAST TIME. AFTER THE CODE WAS OVER, SHE ASKED ME IF I THOUGHT SHE HEARD HIM,WE HAD GOTTEN A PULSE A FEW TIMES
    DURING THE CODE AND I FELT LIKE AT LEAST I COULD TELL HER THAT IT WAS POSSIBLE THAT HE HAD HEARD HER AND THAT IF HE HAD THAT IT HAD GIVEN HIM COMFORT TO HEAR HER VOICE. I'M GLAD TO SEE THAT THE NEW ACLS GUIDELINES ACKNOWLEDGE THE IMPORTANCE OF FAMILY IN THIS SITUATION.
  11. by   KatWright
    I agree that it all depends....
    I live outside of Wash, DC and in my county we have 100 different languages (!!!) so therefore we have alot of issues.
    Quite often the sick family member is brought to the US and comes to us right off the plane because they think that we can save them. (I work on an oncology unit)
    Needless to say, they are more often than not, too far gone. The family is upset that we can't do more, even though they can see that their family member is half of their normal weight, can't eat, doesn't recognize anyone and is scared because all of these people are doing painful things to them and they can't communicate with them.
    We recently had a death of gentlemen that was a DNR, but when he died the family did the whole ritual that was expected of them out of respect of the man that died. Every time another family member arrived, the wailing and throwing of objects started allover again. It was WILD>
    If this had been a code situation, I shudder to think of the pandemonium.
    But there are times when someone is trying so hard to die and the family won't let them, and as hard as this sounds I think that this kind of family needs to see a code, because as hard as we try, they just don't get it. (Of course we do because this is what we do.)
    I once had a family member that asked that we "shock" their dad, "you know like on Rescue 911". I gently told her that this was not a 911 type of situation and Rescue 911 is TV.
    This is a rough question because there is no right or wrong answer, there are hundreds of situations that need to be assessed individually. And it's too bad that more people don't have this discussion with theri ENTIRE family before they come into our hospitals in an emergcy.

    Kat
  12. by   egmorgan
    If the family wish to attend, and they understand what they are seeing, then I guess that is ok.. If the code is appearing to be unsuccessful then the family can use that time at the code to be with the family member up until the end. It is a part of the grieving and dying process. There obviously should be someone with them explaining the process.
  13. by   Jay Levan
    Whew you really hit a "Hot One Here" If you mean the "Entire
    Family" I say resoundingly, NO I believe therein lies the
    problem. Is the trauma of losing a Loved One, compounded by what we have to do, during this time of crisis for all,(Staff&
    Family)? Will the family member(s) interfere in the performance
    of our duties,at this critical time? Will one or more family members
    faint because of what they are witnessing? I have personally
    witnessed all of these reactions and the range of emotional
    distress this causes and have come to the conclusion that only One "Significant Other" be allowed in the room, with a staff person at there side, to make sure of their safety as well as
    prevent "Physical Interference" On a personal level, I have a signed and Noted DNAR, my reasons are many and we won't go into them here. One more question, if almost 70% of us feel that
    Family Members should not be present, how did the ENA come down on the other side of this Important Issue??

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