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 Geriatrics, med/surg, LTC surveyor.

I would not want to present if one of my family members was coding. I could not stand to watch it. I have always had the family leave the room gently.

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Specializes in Nephrology, Cardiology, ER, ICU.

My experiences in the ER have always been very positive for the families. 100% of them say thank you and realize that everything possible was done. (As we all know, so few survive). Because I worked in a tertiary peds hospital, we had many peds arrests too - I always tried to allow the parents in unless police said no. I always feel that I would never want a child to die alone without parents or loved ones present. However, sadly, it does happen.

We as nurses need to move from our comfort level of keeping a code a deep, dark secret and open it up to families so they can spend the last few minutes with their loved one.

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Specializes in Critical Care.
My experiences in the ER have always been very positive for the families. 100% of them say thank you and realize that everything possible was done. (As we all know, so few survive). Because I worked in a tertiary peds hospital, we had many peds arrests too - I always tried to allow the parents in unless police said no. I always feel that I would never want a child to die alone without parents or loved ones present. However, sadly, it does happen.

We as nurses need to move from our comfort level of keeping a code a deep, dark secret and open it up to families so they can spend the last few minutes with their loved one.

But, how many of their dead family members appreciated the utter lack of dignity in their final moments that allowed for this closure? Again, I'm not talking about children because parents have that right over minors - and should. With children, parents aren't 'surrogate decision makers'; they are actual decisions makers - and should be.

I'm talking about adults.

If even one would have objected (I would have), you have violated their privacy and YOUR prime directive as a nurse. It's not like you asked them permission. And, more importantly, it's not like that family member was a SURROGATE DECISION MAKER, making decisions their family member would have made. No. They made selfish decisions for themselves. That conflict of interest is inherent in offering a service to family members AT THE EXPENSE of patients. The decision to allow that kind of invasiveness (having YOUR code be viewed by loved ones) cannot be assumed and it simply cannot be surrogated - not ethically. It's a conflict of interests for family members. More important, it's a conflict of interests for US.

So, once we completely violate our ethics and make surrogate decision making a joke, then what? Advanced directives don't mean a thing if family object? That could never happen. Right? Move 20 yrs down the road and Momma can't be DNR because I'd miss my chance at the closure of seeing her coded!

You guys are presenting this as an OPTION, but that isn't how things work. Fathers in L&D rooms are no longer optional. The father that wouldn't - HE would be the biggest CAD on the planet, with upturned noses by the in-laws and nurses alike. Go down this road and the same will be true of family presence. ESPECIALLY since death rituals are necessarily ritualistic. Whether I want to or not, I HAVE to go to Momma's code. It's what I'm supposed to do.

Why do we wear black when a loved-one dies? We're supposed to. Why do we have a public funeral? We're supposed to. Why do we have a wake? We're supposed to. Why did I just go to Momma's code? I was supposed to.

Save the rubber-necking for prime-time TV and interstate accidents. Death should be more dignified. WE used to be more dignified.

~faith,

Timothy.

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How common is it to have such a support person available?

It should just be a part of your code team; it is in ours. One of the nurses who is a part of the code team is dedicated to family if family is present. The operator who calls the code also pages the chaplin who comes to be additional support for family if it is needed.

Security also sends a team member to each code. We've never had to eject someone with security that I know of, but they are there in the event that we *do* need to.

Each code that I have been in on that has had a family member, the family member has later commented how much it helped them. Each time they just gushed other family members how great everyone was, how coordinated and smoothly it went, how we did everything possible (I've seen this three times-once the person made it, the other two they didn't). However, it is my experience that most family members don't WANT to stay. As I said, we've only have three that I've been at. Every other one, the family member chose to stay outside the room, with the dedicated person still at their side, explaining what was going on, and occasionally going into the room briefly for updates.

If we have more than one family member, we have the option of making them (the family members) choose one person to be in the room. Since I work nights, I've never had to do this as usually there is only one person staying the night with their family member.

Finally, I know that if my husband or child were coding, I would want to be there. If it were the last minutes I had with them, even if I were in the corner watching from afar, I would want to be there. It would kill me to have to leave the room.

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Specializes in Nephrology, Cardiology, ER, ICU.

What we are discussing is the OPTION of having family present. It doesn't mean that its mandatory, just that it should be offered.

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Specializes in LTC.

What really bothers me about this thread is it seems like people turn death into this big scary thing that people should be sheilded from. It's not. We don't consider family members who crowd around the bed of a family member dying of cancer just there to watch the show.

Honestly, if it were my parent or loved one I would want to be there. It would kill me to be sitting in the waiting room while my loved one is going through one of the biggest events of their life. The idea of them dying in a room of strangers while I'm stuck in the next room really bothers me.

Maybe I'm a niave newby, but hospitals should provide a support person for the family on the code team. I also think that the minute a code blue is paged, a chaplain should be paged as well.

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Specializes in Critical Care.
What we are discussing is the OPTION of having family present. It doesn't mean that its mandatory, just that it should be offered.

That isn't how things work.

~faith,

Timothy.

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Specializes in Critical Care.
Honestly, if it were my parent or loved one I would want to be there.

Don't take this the wrong way, but IT REALLY DOESN'T MATTER WHAT YOU WANT! That isn't the purpose of surrogate decision making. It only matters what THEY would want.

And this is where we've strayed. THIS is why FP is unethical. Unless you have previous informed consent FROM THE PATIENT, family members shouldn't be allowed into a code.

This is simply a decision that cannot be surrogated, by your own admission. It's not what they would want; it's what YOU want.

I'm not picking on you. I'm just pointing out the inherent conflict of interest involved here. I'm a PATIENT ADVOCATE first and by priority.

~faith,

Timothy.

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Specializes in Critical Care.

We haven't even discussed the Heisenberg Uncertainty Principle: observing an event changes the system of the event.

Many point out that FP 'humanizes' a code. By frank admission, a code is being transformed from an all-out attempt to save a life to an observable closure-directed event.

You cannot do that without changing the focus, to the extent it shifts to the family, AWAY from the patient. I would want MY code (if I'm not DNR already) to focus ABSOLUTELY, COMPLETELY AND TOTALLY on saving ME.

I don't want the doctors and nurses wondering how a potential litigant is observing their actions. I want their complete attention.

Sorry if that seems selfish.

~faith,

Timothy.

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You've obviously thought and read about this a lot, Timothy. Have you or anyone else come across any studies that compare outcomes with FP codes, or litigation rates? My inclination would be that people would be less likely to sue. I've read about studies that show the more involved the pt and family is and the more information they receive, the less likely they are to sue; I wonder if this would translate into a decreased likelihood of litigation when the family is present during a code with a dedicated team member?

So, how do you feel about DMPOA being present? I understand your argument re: pt rights. If we know the family member who wants to be present is the DMPOA, then you wouldn't have a problem with that, is that correct? In the ER, I imagine you don't readily have that info very often. On the floor, that info is typically more readily accessible.

Is there any study that has addressed the pt's feelings, post code, of having their family present? How do hospital ethics committees and HIPAA compliance committees address FP at the bedside?

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Specializes in Critical Care.
You've obviously thought and read about this a lot, Timothy. Have you or anyone else come across any studies that compare outcomes with FP codes, or litigation rates?

There are so few studies on FP and the ones that exist are of such limited scope that it cannot be said that the issue has been studied, at all.

This is all emotion driven, on both sides.

There is one small study that favorably reported pt's wanting their family there. It's too small a study and misses the point.

85% and higher of codes don't make it. The POINT is how many of those that DIE would have wanted this to be the last thing their family saw of them. I suggest that is difficult to survey.

~faith,

Timothy.

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85% and higher of codes don't make it. The POINT is how many of those that DIE would have wanted this to be the last thing their family saw of them. I suggest that is difficult to survey.

Really? You don't think that the opinions of the 15% that survive would in any way be representative of those who die?

What about the DMPOAs? If someone has handed their decision making over to another, and that person wants to be there, shouldn't their desire to be present be treated as an extension of the pt's wishes?

I wonder, what would happen if this were a question on the advanced directive paperwork? Would most people choose to allow a family member to be present?

Obviously Timothy would not, as he previously stated. I would. How about anyone else?

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