Code blue: family at bedside????

[ljcraigrn]

Hi everyone!! I am trying to find some research and resources for a paper. My topic is "Code Blue: family members at bedside." I was wanting both sides of the issue. Nursing and family. Any help I could get would be greatly appreciated.

Thank you

ljcraigrn:nurse::typing

[Lorie P.]

i strongly believe family should not be present at the bedside during a code. i believe that there should be a designated md to periodically go outside and inform the family members of what is happening and what the medical and nursing team is doing.

i have seen family members get in the way of a code and not let us do what we have to do properly. some begin to shake the person as we do cpr, some push us away and begin crying.

all in all every code is a different and calls for different measures. but for the majority of situations i strongly belive family members should be asked to move to the patient lounge or outside the room, to let the health professionals work on their loved one

:yeahthat::yeahthat: some one that knows how crazy a code can get!!

[StrwbryblndRN]

I do not run codes but I am looking at it from a family perspective.

I also do not think family should be present. There are probably many family who could remain calm and stay at the bedside. HOwever this is unknown to the staff and can't be risked. Like I read on other posters you have someone pass out, throw themselves on the pt, and possibly argue with the code team. It is not worth the risk and there should be a hard fast policy on this.

I won't even tell certain family members that I am taking one of my children to the ER due to their lack of sanity regarding this. They show up and cause a rucus. And I know these people! During a code you do not want to have to figure out the sane family vs the insane. It is not worth it.

[CHATSDALE]

the rooms in the hospitals are really small and the amount of people who respond to a code can really preclude family from being there

in these times of tv where a code can result in a patient being awake and alert after conversion family sometimes don't understand why patient is being run off to icu

[traumaRUs, MSN, APRN]

But, research shows that families are NOT a problem, if you have a support person there solely for the purpose of family support. Believe me, I worked in an inner city level one trauma center where we had a large knife and gun club (lots of traumatic, emegent codes) and in 10 years, never had a family member be inappropriate. Here are some references:

American College of Emergency Physicians. (2005). Family presence. Retrieved

April 29, 2005 from http://www.acep.org/webportal/PatientsConsumers/CriticalIssuesInEmergencyMedicine/FamilyPresence

American Nurses Association. (2005). Code of Ethics. Retrieved May 14, 2005 from

http://www.nursingworld.org/ethics/ecode.htm

Change Solutions. (2003). Approach to change. Retrieved May 3, 2005 from

http://www.changesolutionsgroup.com/approach.htm

Emergency Nurses Association. (2004). Family presence at the bedside during invasive procedures and resuscitation. Retrieved May 14, 2005

from http://www.ena.org/about/position/familypresence.asp

Fallot, M. (2004). Ethical and legal considerations in pediatric surgery. Retrieved

May 1, 2005 from http://www.emedicine.com/ped/topic2951.htm

Gold, K. Bratton, S., Gorenflo, D., (2004, September). Family presence during pediatric resuscitation: a national survey of prevalence and attitudes among healthcare providers. Pediatric Critical Care Medicine. 5:510-512. Retrieved May 21, 2005 from http://80-gateway.ut.ovid.com.ezproxy.apollolibrary.com/gw1/ovidweb.cgi

McLean, S., Guzzetta, C., White, C., et. al. (2003, May). Family presence during

cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses - Family Issues In Critical Care. American Journal of Critical Care Nursing. Retrieved May 3, 2005 from http://www.findarticles.com/p/articles/mi_m0NUB/is_3_12/ai_101414608/pg_1

King, C. (2001, May). Family Presence During Invasive Procedures And Resuscitation –

positives dominate survey results. American Operating Room Nurses

Journal. Retrieved May 14, 2005 from http://www.findarticles.com/p/articles/mi_m0FSL/is_5_73/ai_74571589

Mclenathan, B, Torrington, K, Uyehara, C. (2000). Family member presence during

cardiopulmonary resuscitation: a survey of US and international critical care professionals. Chest. 12:00. Retrieved May 2, 2005 from

http://www.findarticles.com/p/articles/mi_m0984/is_6_122/ai_96306101

Meyers, T., Eichhorn D., Guzzetta C. (1998). Family presence during invasive

procedures and resuscitation. Journal of Emergency Nursing. 24:5, 400-405. Retrieved November 12, 2002 from

http://www3.utsouthwestern.edu/parkland/pr/98/erstudy.html

Medstar. (2001). Family presence in the emergency room. Retrieved April 29, 2005 from

http://www.medstar.com

Midwest Values. (No date). Midwest values. Retrieved May 1, 2005 from

http://www.midwest-values.com/M_BnC.htm

O’Brien, M., Creamer, K., Mill, E., Welham, J. (2002, December). Tolerance of family

presence during pediatric cardiopulmonary resuscitation: a snapshot of military

and civilian pediatricians, nurses, and residents. Pediatric Emergency Care.

18:6, 409-413. Retrieved May 21, 2005 from

http://80-gateway.ut.ovid.com.ezproxy.apollolibrary.com/gw1/ovidweb.cgi

OSF Saint Francis Medical Center. (2005). Website. Retrieved May 14, 2005 from

http://www.osfhealthcare.org

Press Ganey. (2005). Mission of the company. Retrieved May 4, 2005 from

http://www.pressganey.com/about_us/mission.php

Robinson, S., Mackenzie-Ross, S., Hewson, G., et al. (1998, August). Psychological

effects of witnessed resuscitation on bereaved relatives. Lancet. 352:614-617. Retrieved May 17, 2005 from http://www.thelancet.com/journals/lancet/article/PIIS0140673697121791/fulltext

Shelton, D. (2000). The American Heart Association tackles a social-ethical issue.

Retrieved April 29, 2005 from

http://www.ama-assn.org/amednews/2000/09/18/hll20918.htm

Six Sigma. (2005). What is Six Sigma? Retrieved May 3, 2005 from

http://www.isixsigma.com/library/content/six-sigma-newbie.asp

[EricJRN, MSN, RN]

Recently in our NICU we were repeatedly coding a desperately septic 30ish weeker in a situation where the family was requesting that we "do everything." Mom came down as CPR was in progress. At first, the physician wanted to have mom wait outside. It was only after he decided to let her in that she saw the reality of what was happening and requested that we stop, finally allowing the baby to pass peacefully.

Each situation is unique, I think. Especially in the ER or on critical care units, if you have a lot of teamwork and have security that can respond rapidly, I don't think there's a reason to establish a blanket "no family at the bedside during codes" rule. On a unit where you code people less often, I can understand not wanting the family there while someone is trying to remember how to hook up the Zoll.

[suanna]

AJN covered that topic fairly well several years ago. It would probably give you some good baseline info to do a lit search for those articles at your nursing library- sorry, I don't have access to these at my current computer or I would post a link.

[jjjoy, LPN]

But, research shows that families are NOT a problem, if you have a support person there solely for the purpose of family support.

How common is it to have such a support person available? I totally understand and can see the benefits of family's having the option to stay. However, unless there is such a support person, then it would be prudent to ask the family to leave the room. With that many people around, there just seems to be too much potential for someone getting in someone else's way. No matter how accomodating and unobtrusive family may be, the code team won't know that family from Adam and whether or not there may be potential for problems, and without time or resources to make sure that the family is out of the way and taken care of, it makes sense to decrease risk of problems by asking the family to step outside.

[pattycakeRN]

As long as it is understood by everyone in the room (hospital staff), that if a family member becomes disruptive, they are to be ejected. Hands down. I work nights, so I've never seen a family in a code.

Come to think of it, I've only seen like 2 codes. :stone

[sfn2008, RN]

During a Code all concern and attention is on reviving the patient. I think it makes a difference if the Code is called in the ED, the ICU or the Floor. In many of the hospitals that I have worked someone from the chaplain's office responded to the code specifically to address the NEEDS of the family. I agree with the abirobs post, too much going on for family to witness. I have sat with family members during a Code with the ability to support them in their time of HOPE for a successful recessitation. Families need someone to pay attention to their feelings during a crisis, and inside a room where a patient is being Coded, it is the patient that has the focus of the team. I agree that family should be taken somewhere where the focus can be on their grief, anxiety and hope.

[ZASHAGALKA, RN]

Here's a very extensive thread on the topic.

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

Here is one of my opinions from that thread:

Much 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.

[meandragonbrett]

Would we let family members into the OR during surgery, or in the room while placing a chest tube?

.

Chest tube? Yes I allow family all the time. Bronchs? Yes. Intubation? Yes. I always give the family members the option to step out if they would like. I've never had a problem. Those of you who would not allow family presence at a code or procedure....I hope you never take care of my loved one.

[aeauooo]

Those of you who would not allow family presence at a code or procedure....I hope you never take care of my loved one.

Excuse me?!

That's an extraordinarily judgmental thing to say about people whom you do not know who are expressing their opinions.

Like several other people who have posted on this thread, my opinion about families being in the room during a code is tempered by bad experiences.

I have NEVER seen a family member present during a chest tube placement or intubation. I've never seen a doc who didn't ask any family member present to leave before performing one of those procedures.