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

[nicurn001]

I agree with what ZASHAGALKA said " The POINT is how many of those that DIE would have wanted this to be the last thing their family saw of them". Or how many family members would prefer their last memory of there loved one , is the code , rather than some pleasanter moment they had experienced together .

[ZASHAGALKA, RN]

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

Of course not, for several reasons.

First, surviving a code would, I would think, lead to satisfaction of the outcome in general and so, taint the opinion of family being there under the lens of that satisfaction. NOT surviving a code, if you could survey those that DIED, would, I would think, lead to much LESS satisfaction regarding the outcome.

2nd, surviving a code, by definition, means that this wasn't the VERY LAST thing those family members saw of that patient. That is a different criteria to measure, altogether.

3rd, the issue of dying and death is a different order of dignity than of surviving.

It's a measure of apples and oranges.

~faith,

Timothy.

[ZASHAGALKA, RN]

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?

I would be much less resistant to the idea, but still opposed. And no, I would not want my family to see me like that. There are better and more time-tested means to achieve closure.

~faith,

Timothy.

[ZASHAGALKA, RN]

I agree with what ZASHAGALKA said " The POINT is how many of those that DIE would have wanted this to be the last thing their family saw of them". Or how many family members would prefer their last memory of there loved one , is the code , rather than some pleasanter moment they had experienced together .

Which goes back to the fact that this CANNOT be an optional experience. This is the most fundamentally vulnerable moment of a person's life: "Your spouse is currently being resusitated." AT THAT MOMENT, we are going to give them this option and expect that someone, anyone, could make a rational decision?

That isn't how things work. We highly ritualize such moments PRECISELY to pre-meditatively deal with circumstances in socially acceptable ways during times when we simply aren't rational enough to make decisions on our own. We do that for a reason. This concept stands that on its head.

NO. It's not ethical or advocacy to place someone in that position, at the most vulnerable moment of their lives.

The vulnerability of that particular moment, by definition, will take away the option of a rational choice from most. As a result, the choices made, by both them and us, become capricious. Inserting that kind of unpredictability into the most vulnerable moment of a person's life just isn't advocacy.

There is a reason why funeral customs are so ritualistic and THAT is to remove such unpredictability. Instead, we foster it and call it advocacy. I disagree.

~faith,

Timothy.

[casi, ASN, RN]

So Timothy, as a young reckless person lets say I do the worst and wrap my car around a tree. I land my butt in the neuro ICU comatose with tubes coming out of places most people didn't know tubes could come out of. Would you as my critical care nurse allow my family in? Here I am vulnerable and unconcious. How do you know I would give my family permission to see me in such a condition?

Say things got even worse and my parents, would who be respecting my decision, decided to d/c the feeding tube. Would you let them sit at the bedside watching me waste away? How dare they say goodbye while I'm still alive, vulnerable, and in a state most people wouldn't want to be seen in when they can wait for the funeral and wake?

Just because YOU wouldn't want your family watching you being coded doesn't mean that your patients would want the same thing. We advocate for the patient's beliefs, we don't advocate assuming the patient has that same beliefs that we do.

If a family member says that their loved one would want them there, chances are they probably do. Famlies tend to share with eachother their ideas and beliefs about death. I've only heard a few stories about families being in codes, two of them I've heard of being really posistive because the wives were the ones who said, "Let him go."

[nicurn001]

So casi , I guess if we try to pull this together :-

We cannot exclude family members from observing a code ( particularly if there is a record of their desire to be there at this time) , nor should we be encouraging them to attend the code .

If the family attends the code and staff is available , a staff member can describe what is being done and why . If family interferes in the code they should be excluded observing the code .

A code is chaotic enough , without adding a family to the mix . So the default option ,should be to shield the family from the emotional trauma , of an unexpected code . If as noted , they have recorded there desire to attend a code , or are adamant at the time of the code to attend ,let them do so at their own risk .

I do tend to agree with Zashagalka , wondering for whose benefit , the family attendance is and the effects it has upon the code

[ZASHAGALKA, RN]

Just because YOU wouldn't want your family watching you being coded doesn't mean that your patients would want the same thing. We advocate for the patient's beliefs, we don't advocate assuming the patient has that same beliefs that we do.

I understand your point, but there is an order of magnitude difference between routine critical care modalities - no matter how intensive - and a full blown ACLS code. There is a difference. I agree that we can hold a presumption that someone critically ill would want their families to be there. That does not extend to include a presumption that they would want loved ones to watch their deaths, in a most undignified way. THAT would be one presumption too far.

The highlighted statement here, though, is directly related to my point. When you give a 'choice' to someone not in a position to MAKE a rational choice, you are, in fact, supplanting your belief system on this vulnerable family member.

I agree with you enough to say that I would not likely deter someone determined to be present. I haven't the few times that has been the case. THAT is NOT the same thing as positively advocating that presence. And, make no mistake, for somebody at the most vulnerable moment in their life, even suggesting it is tantamount to advocating it; it is, supplanting YOUR belief system over theirs. When you're paralyzed to make a decision, it is not uncommon to numbly follow the choices offered to you.

Add to that the whole norming array of funeral customs and what you end up with is an unavoidable mix of choice and obligation: Am I supposed to witness Momma's code in order to be perceived as grieving normally?

~faith,

Timothy.

[Tweety, BSN, RN]

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

There are many cases when it is not warranted to have a family member present. One has to take it on a case by case level, and have to have resources available. It's not a "every single code every single time we are allowing families present". But there are others when it doesn't violate our ethics or the dignity of the patient.......IF it's done properly with respect for all involved.

Nursing is a family centered job, like it or not. Most nurses ask family members to leave, not because they feel it's best for the patient and the family member, but because they personally are uncomfortable with it and don't want to deal with it. People should at least open their mind to possiblity, rather than snap shut their minds completely.

Codes can be ugly. The last one I was in was a bloody, poop filled mess that last two hours and I was thankful no family was present. If we had a policy to allow family present, this wouldn't have been appropriate. It would have been undignified. However, there are emergencies and procedures that having a loved one present isn't a bad idea.

Sigh...didn't I say I'd stay out of it. LOL

[Tweety, BSN, RN]

Am I supposed to witness Momma's code in order to be perceived as grieving normally?

~faith,

Timothy.

Depends on how the caregiver approaches you. Families have been allowed in codes for years, perhaps someone from they are allowed, can answer if their hospital culture has changed to the point it's considered "normal" to be present in an emergent code.

However, if you're with your wife in the hospital and she suddenly codes, the nurse/chaplain or someone should gentlly offer you the option, expressing that it's your choice and your choice alone whether you want to be there, with a gentle expression that you don't have to be and it's o.k. not to be there.

[deeDawntee, RN]

Which goes back to the fact that this CANNOT be an optional experience. This is the most fundamentally vulnerable moment of a person's life: "Your spouse is currently being resusitated." AT THAT MOMENT, we are going to give them this option and expect that someone, anyone, could make a rational decision?

I disagree. I would say that most people know if they can tolerate being in a room where a code is occurring or not. In my facility the family usually stands just outside the door and can leave as necessary. Also, there is always at least one or two staff attending to them and explaining what is going on. Often the Physician will also want to talk to the family if the resuscitation is not going well. The very best reason to have family around is so that they know that we did everything that we could to save their loved one and they don't have to wonder if we just didn't try hard enough. If people don't want to be there , they are escorted to a waiting room nearby and given updates. No one is every forced or encouraged to stay or wait, there is ALWAYS one or two who want to be there and many more who do not. This is not some kind of horrible, jarring confusing choice, it is very clear one way or the other in my experience observing families.

[traumaRUs, MSN, APRN]

Timothy- I'm hitting below the belt here but here goes: When your precious daughter was in the NICU would you have left if she had coded? Doubt it much. If, when your wife was giving birth, would you have left if she had coded? Doubt it much.

(Tweety - I should stay out this too but I'm such an idiot!)

[tobyboby]

I disagree with having family in during a code blue. Last month my sister was coded and my father, who is an ER RN, was in the room during the code. It was harder for him during the greiving process having witnessed on his daughter what he has seen so many times in the ER. I would strongly encourage family to stay out of the room because of this.