Code blue: family at bedside????

Nurses General Nursing

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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::banghead::typing

Specializes in Advanced Practice, surgery.

Now I have been at resuscitations with family members present,

I worked for some time in Peads ICU and the parents were present when the child arrested, they were adamant they wanted to stay and we had sufficient staff to support them during the resuscitation attempt, they were distressed but recognised we were doing everything we could to help thier child. The child did not survive but those parents spent the last moments where they wanted to be at his bedside in the knowledge that everything possible had been done.

I understand the concerns about how the staff will feel, and how the family cope. THe resusciation has to be well run and calm - an ICU is a good place for this to happen as should be a EU resus room. THere has to be a dedicated member of staff to support that family and all members of the team need to be aware and happy that the resus is witnessed. I think each case needs to be assessed individually as we should be doing with all aspects of our patient care.

On a personal note if it were my family member or child then I would want to be there

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Specializes in Critical Care.
Now I have been at resuscitations with family members present,

I worked for some time in Peads ICU and the parents were present when the child arrested, they were adamant they wanted to stay and we had sufficient staff to support them during the resuscitation attempt, they were distressed but recognised we were doing everything we could to help thier child. The child did not survive but those parents spent the last moments where they wanted to be at his bedside in the knowledge that everything possible had been done.

I understand the concerns about how the staff will feel, and how the family cope. THe resusciation has to be well run and calm - an ICU is a good place for this to happen as should be a EU resus room. THere has to be a dedicated member of staff to support that family and all members of the team need to be aware and happy that the resus is witnessed. I think each case needs to be assessed individually as we should be doing with all aspects of our patient care.

On a personal note if it were my family member or child then I would want to be there

Pediatrics is different, for a variety of reasons. That was discussed in the above-mentioned thread.

Basically, a parent has the decision making power over a minor. When it comes to adults, our golden rule, surrogate decision making, undergoes an unacceptable conflict of interest in the case of family presence. WHOSE interests are being supported by family presence, the patient or that family member?

Privacy isn't trivial. Neither is dignity. We used to respect those things. Now, a dramatic death is just a freak show. Pass the popcorn and DVDs will be on sale in the lobby after tonight's performance.

I have not stopped family the few times they demanded entry to a code. THAT is not the same thing as an open invitation.

There are more time-honored methods for closure.

~faith,

Timothy.

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Specializes in ICU/Critical Care.

I don't think I would mind as long as the family stayed out of the way and let the RNs and docs do what we need to do. I would just prefer that one family member stay not the whole family. Most of the time, if the family is quite anxious, then yes, they can stay outside. I think once they see what we are doing they will realize the reality of it. Alot of people think that all those meds that we give during CPR are like instant cures and "bring the patient back to life". Hopefully once they see what we are doing for the patient and how traumatic it is to the patient, especially one in which CPR is going to be completely futile, they will want their loved one to pass away in peace. It would be good to have a doctor stand with the family member explaining everything that we are doing. I know this seems a little far fetched.

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Specializes in Critical Care.

http://64.233.169.104/search?q=cache:EmMXxpNnLzcJ:www.ethics.va.gov/ETHICS/docs/net/NET_Topic_20010814_Family_Presence_During_Resuscitation.doc+VA+-+Ethics+Hotline+Call,+%22August+14,+2001%22&hl=en&ct=clnk&cd=10&gl=us

"Dr. Gary Abrams, San Francisco VAMC:

I have a question. Where do we draw the line on this. What if a family wants to videotape the resuscitation? Where does the local judgment of the professional community come into this particular argument?

Dr. Berkowitz:

I will take a stab at this one. I think allowing the onlookers that that premise is predicated on the fact that it is justifiable because it will do some good, either for the family or for the patient, by providing support and a presence. I am not sure that you could say the same about making a videotape. So to me that is over the line. That's my personal opinion."

~faith,

Timothy.

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Specializes in ICU/Critical Care.

Ok, so do they think that if they videotape the code, they could possibly use it in court against the docs and nurses if the patient didn't survive? Um, CPR does not always have a guaranteed outcome. People are just insane nowadays.

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Specializes in Nephrology, Cardiology, ER, ICU.

In the ER where I worked, codes were well run and extremely efficient. I have been unfortuantely to some goat rodeos! Come on folks, you don't need a bazillion folks in the room - one attending, one resident, two RNs, two techs and perhaps a RRT. That's it (Pastoral Care and/or SW) should come and go. NO ONE SHOULD BE STANDING AROUND GAWKING!!!!!!!!!!!! That is ridiculous! However, it is not ridiculous to allow one or two family members in to the room!

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Specializes in CICU.
NO ONE SHOULD BE STANDING AROUND GAWKING!!!!!!!!!!!! That is ridiculous! However, it is not ridiculous to allow one or two family members in to the room!

As a nursing student, I've observed one code and participated in another during my senior practicum in a cardiac ICU. I didn't consider myself a "gawker" because I was following my preceptor, who was on the code team. I was learning from watching an actual code taking place. However, there were many others in the room who did appear to be gawking, but I figured they were backup or were also learning about codes.

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Specializes in Nephrology, Cardiology, ER, ICU.

Having one extra person in the room during a code (you) is fine. However, you yourself note that others were in the room too without a stated purpose. Why??? Were family present? Was it offered to them? Maybe some of the gawkers need to leave so that family who desire to be there with their loved one can be. That's all I'm saying.

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Specializes in ICU/Critical Care.

I agree with Trauma, all too often there are like thirty people in the room. I always have to stand up on a chair because i'm short and yell "if you aren't doing anything, then you need to get out and make room for the rest of us that are." And I also hate when docs just randomly shout orders, thats why we have a captain. So the captain can give orders.

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Specializes in ICU, nutrition.

I've only had family in the room during two codes in my nursing career (and having worked in ICU I've been to probably a hundred). Both times it was not a problem, they stood over in the corner and were shell-shocked. The last time was in the unit, we had just finished shift change, the family had called to see if they could come in quickly to see their son, a MVC who had only been out of surgery for an hour or two and was very unstable. Before you knew it, he was coding and his parents were still in the room. We were too busy working on the patient to try to help the parents. I will never forget catching them out of the corner of my eye as I was hanging two more units of blood and how terrified they looked. I was thankful a chaplain showed up and saw them in the corner (I'm sure it wasn't that long but it seemed like forever). The mother told her son's nurse after it was over "I know you did all you could." When the nurse told me what she said I almost cried. At least they knew how hard we were working to save their son.

I guess, IMHO, if they're already there and they want to stay, that's fine, but I wouldn't be running to the waiting room to drag them in to watch. I honestly don't know what I would want. I couldn't watch the GI do a ERCP on my husband, so I probably couldn't watch the code team do CPR on him either. If it was my kid, though...I just don't know. I pray I never have to make that decision.

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Specializes in Advanced Practice, surgery.
Pediatrics is different, for a variety of reasons. That was discussed in the above-mentioned thread.

Basically, a parent has the decision making power over a minor. When it comes to adults, our golden rule, surrogate decision making, undergoes an unacceptable conflict of interest in the case of family presence. WHOSE interests are being supported by family presence, the patient or that family member?

Completely agree on the paediatric issue, yes it is different and this was just one example of many witnessed arrests that I have participated in

Privacy isn't trivial. Neither is dignity. We used to respect those things. Now, a dramatic death is just a freak show. Pass the popcorn and DVDs will be on sale in the lobby after tonight's performance.

I have not stopped family the few times they demanded entry to a code. THAT is not the same thing as an open invitation.

There are more time-honored methods for closure.

~faith,

Timothy.

I'm afraid I am going to have to respectfully disagree with you here, I don't think that allowing family to remain in the room where their loved one is being resuscitated is a "freak show", as I mentioned in my previous post not all resuscitations are appropriate, I have been to some resus attempts within ward areas where it was chaotic, in these situations it is not appropriate as the stress levels are high and the added pressure would be inappropriate.

I have also worked with well established resus teams within EU and ICU's where the resus attempt is calm and well structured, as it should be. If the family is present when thier loved one arrests and there are sufficient staff to provide the support, and they wish to stay then they should be allowed to. If it becomes too distressing for them then the person providing the support can escort them from the room.

I have never encountered a family member interfere with or get in the way of any resus attempt, in my expereince they recognise that you are trying to help almost all of the time.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

We have had discussions on this in the past and I went around and around with ZASHAGALKA/Timothy back then and I won't again. (Although you know that's one of my favorite Allnurses activities. LOL)

I'm for family prescence during codes, if the staff is trained properly and there is a designated person in support of the family such as chaplain or a nurse. I'll leave it at that.

I did a review of literature for a classs I took a couple of years ago. Since you really weren't asking for an opinion, I'll offer my references. (not all the links will work because they are from my college's library)

References

Bassler, P. (1999). The impact of education on nurses' beliefs regarding family presence in a resuscitation room. Journal for Nurses in Staff Development, 15(3), 126-131. Retrieved July 22, 2005, from http://gateway.ut.ovid.com/gw2/ovidweb.cgi.

Ellison, S. (2003). Nurses' attitudes toward family presence during resuscitative efforts and invasive procedures. Journal of Emergency Nursing, 29(6), 515-521. Retrieved July 22, 2005, from http://gateway.ut.ovid.com/gw2/ovidweb.cgi.

Emergency Nurses Association (ENA). (n.d.). Emergency Nurses Association position statement: family presence at the beside during invasive procedures and resuscitation. Retrieved July 17, 2005, from http://www.ena.org/special/ps-no1226-meisje/familypresence.doc.

MacLean, S., Guzzetta, C., White, C., Fontaine, D., Eichhorn, D., Meyers, T., Desy, P. (2003). Family presence during cardiopulmonary resuscitation and invasive procedures: Practices of critical care and emergency nurses. Journal of Emergency Nursing, 29(3), 208-221. Retrieved July 8, 2005, from http://gateway.ut.ovid.com/gw2/ovidweb.cgi.

Mason, D. (2003). Family Presence: Evidence Versus Tradition. American Journal of Critical Care, 12, 190-192. Retrieved July 17, 2005, from http://ajcc.aacnjournals.org/cgi/content/full/12/3/190#R8.

Meyers, T., Eichhorn, D., Guzzetta, C., Clark, A., Klein, J., Taliaferro, E., Calyin, A.. (2000). Family presence during invasive procedures and resuscitation: the experience of family members, nurses, and physicians. American Journal of Nursing, 100(2), 32-43. Retrieved July 8, 2005, from http://gateway.ut.ovid.com/gw2/ovidweb.cgi#toc.

Sanford, M., Pugh, D., & Warren, N. (2002). Family presence during CPR: New decisions in the twenty-first century. Critical Care Nursing Quarterly, 25(2), 61-66. Retrieved July 22, 2005, from http://web14.epnet.com/search..

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