Survey: Should family be present for a code? - page 3

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   NurseNancy
    As a ER Rn i have been faced with this issue for many years. I find physcians are the ones who are the most uncomfortable with family members being present during codes. They have voiced their concerns that the family members might think we did something wrong.. WRONG... I have found that family members are not at all interested in what we are doing, they are more concerned with being there so their love one is not alone.
    On a personal note i had to go to another ER after i got a call saying my father had suffered a cardiac arrest. I wanted to be in the room while they worked on him.. And believe me i could not tell you anything they were doing or not doing. My biggest concern was being there so my father won't die alone. Although there was a negative outcome i am grateful i was there with my father in his last minutes of life.. So YES i am a big supporter of having family memebers present..
  2. by   CATHYW
    Having done codes in most areas of the hospital (including the CT scanner), I agree with those that say that there never seems to be enough room for the code team, crash cart, 02, respirator, etc. If there was a way to allow people to view the proceedings from a quiet room with a window, that would probably be the best solution, with a nurse in attendance to the family to explain the goings-on, answer questions, and provide medical care for them, if needed.

    I would not, ever, want family in a room during a code. There is no time for calming overwrought folks, and it is difficult to think or communicate with other members of the team if they are shreiking or crying. When the nurse from the Rio Grande Valley spoke of remembering culture, it reminded me of the evening a person coded in our ER. I was fairly new to the ER. After I prepared the person to be viewed, I escorted the family (quite a large number of family, with one VERY large woman at the front) into the room. I had already explained the presence of the ET tube (law required that it not be removed). The large lady walked up to the stretcher, grabbed hold of the rail, began wailing and swooning, and nearly turned the stretcher over! Family members assisted her to the floor, where she continued to writhe. I was aghast-nothing had ever prepared me for that.
    The lesson learned: I never took another family into a post-code room without having at least one chair handy to push under an "overcome" person.

    As for me and my family, I am with the others who said that they didn't think they could bear to watch the code. HOWEVER, if one of you would be kind enough to step outside every few minutes and tell me what is going on, I sure would appreciate it!
  3. by   canoehead
    Cathy, think of it as a cultural thing, sometimes all the moaning, wailing and gnashing of teeth is the way they show their love and respect for the person who has passed. Not to get really upset for them would be disrespectful, so maybe you didn't have to do anything.

    Anyway I think we have all known some families who were happier to be able to talk about how so and so was so upset she passed out on the floor . In that case shoving a chair under her would have actually been counterproductive to the greiving process.

    Rmember, if they are screaming they are breathing, and OK.
    When they are quiet you rush over and check for a pulse.

    I am getting jaded in my old age.
  4. by   CATHYW
    Yep, Canoehead, you are. Working ER and getting older tend to bring things into sharper perspective, don't you think?

    I have been out of the ER for 3 years now, and the things you mentioned (pulse, etc.) I also found helpful for people who were faking seizures. I never did it, but a nurse I was working with one night was trying to "determine" LOC on a freq flyer. She was a young woman who was faking a seizure. I tried sternal rub, pinching the clavicle, etc. This nurse came in, pulled down the woman's gown, took hold of her left nipple and twisted it like she was opening a door. With my own teeth on edge, I watched this woman quit "seizing" abruptly, open her eyes, and scream at the other nurse, "what the hell do you think you are doing?" Lessons learned in the ER are invaluable!
  5. by   pamela5rn2
    Hi again, I think there have been alot of point of views for this particular subject. My question would probably be; if polled which nurses work in ICU, or the ED, vs the floors, or other areas. That is not a derogatory statement by any means, as I work on a floor prn. I truly feel, that there there should not be family involved in a code. I think when the team feels that the decison to stop, is close, that the family should be brought in at that point. As horrible as it may sound, at that point, you should be doing what is important for the family, as the pt is not the priority any longer. There truly isn't the room, the pace is frantic, and it would scare me to death, if I was not in the health profession. Watching your husband, or father, or brother, being slammed back down onto the bed, after an intubation, and an, at least immediate resucitation, is not something that is pleasant for us that are not a family member. My hospital's policy is to call in the family immediately, if an attempt is not successful. But not before. The pt is the top priority up until that point. That are the ACLS Guidelines for 2001, and I believe they have been researched, and have a valid point. I feel like until the time the code is called, the pt is my #1 concern. I know we all have a lot of opinions on this subject, but, I think people that deal with this on a day to day basis truly see the overall effect.
  6. by   bmatous
    I would be happy to share that I have both ICU and ED experience. I have also worked Med-Surg, but that was long enough ago that I am not sure I can any longer lay claim to working in that environment. I also work in pediatrics now which makes a huge difference, I think. I coordinate the resuscitation program and am involved in education of nurses, support staff, residents, and professional staff and we teach the staff to consider many things during that time. This includes whether the family should/can be present. Most of the time, the answer is that they can/should be present. We also, as stated earlier, are very lucky to have appropriate support so a social worker and/or chaplain can perform that role. We do not have to tie up nursing resources. We also offer the family a way to "opt out" of being at the bedside. Most of the time, when children are involved, the family "opts out" - their preference is to leave. We then have someone go out on a regular basis and keep the family updated on the progress of the situation.

    Your fact that the ACLS/PALS guidelines were moving toward family presence. All the most recent literature supports offering the family the option of staying. Another person stated earlier that the physicians were the ones that were most resistant. I would agree with that statement, but if something goes wrong, they are the one with the most to lose. I honestly believe however, that even if something does "go wrong" that families understand that we are doing the best we can with the circumstances presented. The literature also supports the fact that there are far fewer suits brought by families who were at the bedside at the time. (Can this be statistically correlated?? Who knows?) I really do believe, however, that this is becoming more and more the standard of care and that hospitals wil shortly no longer have the option. Consumers who chose to be there will demand it. When this starts to occur, you are much more likely to get sued not letting them see what is going on!
  7. by   canoehead
    Sounds painful, hurts just reading about it, but I will try it.

    Unfortunately some of our guests would find it erotic...(and some of the BB members )
  8. by   Jay Levan
    Of course as usual, someone branches out on any particular subject. As in this case, no one had discussed "The Fellow Professional" present at a Code of their Significant Other. On this subject, I feel this way, I believe that we should all extend "Professional Courtesy" to our sisters and brothers in Nursing, as long as A. They respect their fellow professional's expertise in these situations, and B. Stay out of the way until there is time to allow them to communicate with their Loved One, and C. they are actively working in the field. I believe that what we were discussing was "Lay Family members at Codes" If there is to be a discussion on Professional Courtesy, then lets do that.
    For Nurse Nancy; I believe you said that Family Members Do Not Care about what or How we perform our duties, and that MD's were the ones behind not allowing family members at these "Codes" I am from the North(New York) but am currently living in the South(Georgia) and I Guarantee you that people here
    (Family members here fight with great Zeal, over material things left behind by any particular family member), and LOOK for any way they can to sweeten the pot Where Docs are concerned
    I have advised in particular situations that family not be present only to be Ignored and overruled. Great discussion and I don't see anyone attacking others for their point of view, maybe there is hope for our profession
  9. by   pamela5rn2
    Originally posted by bmatous
    I would be happy to share that I have both ICU and ED experience. I have also worked Med-Surg, but that was long enough ago that I am not sure I can any longer lay claim to working in that environment. I also work in pediatrics now which makes a huge difference, I think. I coordinate the resuscitation program and am involved in education of nurses, support staff, residents, and professional staff and we teach the staff to consider many things during that time. This includes whether the family should/can be present. Most of the time, the answer is that they can/should be present. We also, as stated earlier, are very lucky to have appropriate support so a social worker and/or chaplain can perform that role. We do not have to tie up nursing resources. We also offer the family a way to "opt out" of being at the bedside. Most of the time, when children are involved, the family "opts out" - their preference is to leave. We then have someone go out on a regular basis and keep the family updated on the progress of the situation.

    Your fact that the ACLS/PALS guidelines were moving toward family presence. All the most recent literature supports offering the family the option of staying. Another person stated earlier that the physicians were the ones that were most resistant. I would agree with that statement, but if something goes wrong, they are the one with the most to lose. I honestly believe however, that even if something does "go wrong" that families understand that we are doing the best we can with the circumstances presented. The literature also supports the fact that there are far fewer suits brought by families who were at the bedside at the time. (Can this be statistically correlated?? Who knows?) I really do believe, however, that this is becoming more and more the standard of care and that hospitals wil shortly no longer have the option. Consumers who chose to be there will demand it. When this starts to occur, you are much more likely to get sued not letting them see what is going on!
  10. by   brandishae0814
    I am actually doing a paper and debate right now about my thoughts on this topic. I work in ICU and have done several with families present. We try very hard to keep families updated on the severity of the family member's condition. I work with my husband and it's very hard to code someone with their spouse saying goodbye while I look at my hubby. IF the family understands what will go on and someone can explain to them, then they should have the option. During out last code, we TPA'd the guy during the code, but no one thought to explain to the wife what it did. When she leaned over to kiss him goodbye, my husband gave a compression and blood came out the ET tube. Those kinds of things make us wish families could NOT be present...
  11. by   ZASHAGALKA
    This is a five yr old thread. It's been discussed much more in-depth since then:

    http://allnurses.com/forums/f8/famil...es-117691.html

    What I said there:

    Alot of grieving is perception. I'm supposed to be crying. I'm supposed to wear black. We're supposed to have a funeral.

    Funerals are almost universal, even if cremated, because there is a strong societal pressure/need for closure.

    If you allow the opportunity to witness, a large percentage of the population will preceive it as a requirement, else they aren't grieving like they should.

    We've let our TV facination with the macabre dominate our lives, and now we are passing it off as advocacy. I said in my previous post that it might be family advocacy but not patient advocacy. I change my mind. It's not even family advocacy.

    codes are ugly nasty business. It's cruel to let (require) a family member to witness.

    Funerals are where closure happens. It's a time tested, time honored process. Save the macabre for those who are trained to deal with it.

    Families in codes is bad medicine, all the way around.

    Fortunately, in my area, the doctors aren't far-sighted enough to adopt such lunacy. But I'll say this, most policies that address such issues have a 'in the nurse's opinion/assessment of its appropriateness clause'. I would NEVER find it appropriate and would always invoke the policy to object to the family's presence.

    Why? Because I'm an advocate.

    ~faith,
    Timothy.
  12. by   PANurseRN1
    A lot of nasty stuff happens during a code. The only way I can see it working is if there is one staff member devoted to nothing but being with the family to support and explain. Given the crappy staffing we deal with most of the time, I don't see that happening.

    Maybe I'm just old and set in my ways, but I don't really see this as a positive. There are few people, in my exp., who can handle witnessing the code of a loved one. Heck, I was anxious just watching a close relative getting Adenocard for SVT, and I'm an ED nurse.
  13. by   CaseManager1947
    My one and only experience with this situation, was on a fairly young woman who coded with end stage COPD/respiratory failure. Husband was present, I took him outside at this request, and found him a chair, stayed with him. About 1/2 way thru the code, the resident came out, and offered for the assembled family to come into the room. That's when things began to go south. Code was going well, teamwork very good, but no response from the pt. after several drug pushes, attemps to defib, etc. Daughter got to the room, bringing her daughter and a friend (whom we all thought was another family member. By this time, the doc was gently telling family, that it didn't look very promising that they were going to be able to revive her,
    and several of these people became hysterical, screaming and crying. I had to escort them out and down the hall to a waiting area for families. Not every family will be able to handle this, especially those who are either not prepared or cannot let go or perhaps has issues with medical procedures as a general rule anyway. I think in some cases , it might be good, but not all.

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