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 Nephrology, Cardiology, ER, ICU.

But again, it should be a choice! It is up to family whether to witness or not, not up to the healthcare team!

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You may want to look at "family presence" this has been studied quite a bit with pediatric codes. Family at bedside.

Otessa

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Specializes in Travel Nursing, ICU, tele, etc.

Yes it is ALL about choice, but I will add here, choice with support. There MUST be someone to explain what is going on and to support their decision to be there or not ongoingly. Also, the family's physical and emotional safety must be monitored. At my facility, the house supervisor takes over that role, along with others who show up depending on the house sup's direction. It works very well and given that most codes are successful, the family is amazed at how well the team works together and what can be accomplished. Many family members have expressed that they will never look at nurses and doctors the same way again, it was awe inspiring to them. That is a common outcome where I work. Even when the outcome was not so good, the family are almost always thankful for all that we did for their loved ones. I know there may be bad outcomes to having family around, but this nurse has not seen one. Even when I do, the good outweighs the bad, in my experience.

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Specializes in MICU, SICU, CICU.

You know one of the most difficult codes I have ever been part of was due to family presence. The patient was a young pregnant woman with a massive PE, and her mother was allowed to be present. We coded her for 50 minutes without response listening to the mother's frantic cries and screams to save her baby. And when the code was unsuccessful she tearfully begged us not to stop and let her baby die.

There were staff members with her the whole time explaining. But for me it was already a difficult situation with the age and pregnancy, but her mom's pleas made it all the worse for the staff present. I left that room feeling like an utter failure even though I know that all appropriate treatment had been provided.

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Specializes in Travel Nursing, ICU, tele, etc.
You know one of the most difficult codes I have ever been part of was due to family presence. The patient was a young pregnant woman with a massive PE, and her mother was allowed to be present. We coded her for 50 minutes without response listening to the mother's frantic cries and screams to save her baby. And when the code was unsuccessful she tearfully begged us not to stop and let her baby die.

There were staff members with her the whole time explaining. But for me it was already a difficult situation with the age and pregnancy, but her mom's pleas made it all the worse for the staff present. I left that room feeling like an utter failure even though I know that all appropriate treatment had been provided.

Phew, that would definitely make me rethink the whole issue... I am sorry that happened to you and your whole team.

Even so, I have to believe on the balance, giving them the choice to be there is the best option. However, if their presence is interfering with the chance that the pt will recover, get them the heck out of there....

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Yes it is ALL about choice, but I will add here, choice with support. There MUST be someone to explain what is going on and to support their decision to be there or not ongoingly. Also, the family's physical and emotional safety must be monitored. At my facility, the house supervisor takes over that role, along with others who show up depending on the house sup's direction. It works very well and given that most codes are successful, the family is amazed at how well the team works together and what can be accomplished. Many family members have expressed that they will never look at nurses and doctors the same way again, it was awe inspiring to them. That is a common outcome where I work. Even when the outcome was not so good, the family are almost always thankful for all that we did for their loved ones. I know there may be bad outcomes to having family around, but this nurse has not seen one. Even when I do, the good outweighs the bad, in my experience.

100% agree that it must be a well-throught out program with support. This might not always be possible on off shifts or smaller facilities, but support is imperitive.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
You know one of the most difficult codes I have ever been part of was due to family presence. The patient was a young pregnant woman with a massive PE, and her mother was allowed to be present. We coded her for 50 minutes without response listening to the mother's frantic cries and screams to save her baby. And when the code was unsuccessful she tearfully begged us not to stop and let her baby die.

There were staff members with her the whole time explaining. But for me it was already a difficult situation with the age and pregnancy, but her mom's pleas made it all the worse for the staff present. I left that room feeling like an utter failure even though I know that all appropriate treatment had been provided.

Codes are rarely "good codes". Especially when it's someone young and unexpected, feelings of "failure" are common, whether or not there's a hysterical family member.

Obviously this was a poor thought out case. These types of people should not be present.

We need to use common sense and our inner voice when deciding wether or not to invite a family member to be present. If they do turn into someone hysterical it's counter productive and the family member should be removed. We have not qualms about escorting someone out at the beginning of a code, we should have no qualms escorting them out during the code if they are inappropriate, in the way, or hysterical.

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Specializes in Critical Care.
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!)

I was working, sorry. The answer to both questions is: I don't know. As far as the child, I've discussed why I think parents should be allowed at a pedi-code. I think I wouldn't want to be there. Really. I can't tell you how I would feel in a real situation, but I think no.

I couldn't help and I don't think I could watch such a thing.

Same for the Mrs, but that misses the point. The point isn't what I would want. It's what is best for the patient, in this case, her. I'm pretty sure I wouldn't want to be there. But even if I did, is it the right thing to do?

I say no. However, as I said, I would likely not stop someone determined to be there. That isn't the same thing as an invitation to someone not capable of evaluating the value of such an invitation.

I don't think it advocacy or ethical to push code-watching.

~faith,

Timothy.

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Specializes in Critical Care.
But again, it should be a choice! It is up to family whether to witness or not, not up to the healthcare team!

It's not up to the healthcare team to push people into codes! And besides, it should be up to the PATIENT, not the family!!!!

If you didn't ask, you can't know! Surrogate decision making is not appropriate when you are purposely introducing a conflict of interest.

It should NOT be a choice. Offering such a choice to someone incapable of making decisions is unethical.

~faith,

Timothy.

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Specializes in Critical Care.
However, if their presence is interfering with the chance that the pt will recover, get them the heck out of there....

BY DEFINITION. their presence is interfering with the chance of survival. ANY shift of focus from patient to family is unjustified. Codes are and should be for saving lives. Period.

There are better ways to achieve closure.

Dignity isn't optional. It should be a core belief for us. That core belief should preclude us from showcasing something so undignified and calling it advocacy.

I'm not an actor playing for a crowd. Codes are brutal. They shouldn't be a spectator sport.

~faith,

Timothy.

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Specializes in Critical Care.
We need to use common sense and our inner voice when deciding whether or not to invite a family member to be present.

Do you really, truly want ME to use MY inner voice to make that decision?

Can you imagine how that'd go?

~faith,

Timothy.

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Specializes in Advanced Practice, surgery.

I am not sure that anyone is advocating pushing code watching just assessing each situation individually. All the witnessed resuscitations I have been involved with the family member was present at the time of arrest, there was an experienced team and a person who could support the family they had been there during critical moments of that pateints care and because of the deterioration they had been called in.

I think this is what the majority of the posters are talking about, not offering every family member the "opportunity" to witness but using assessment and good judgment. The situation described a few posts up would not be appropriate due to the stress levels of the family member, good judgment would say this family needs to be supported and escorted from the area compassionately. Equally the stress levels of the staff are an important factor, if the resuscitation is particuarly difficult for what every reason the common sense should prevail.

My personal view, the majority of cardiac arrests are going to be unsuccessful, Timothy I think you quoted 85% I think in hospital cardiac arrests personal experience would say this is an optimistic figure, but looking at the ILCOR figures they state that less than 20% will survive to go home. But what we have here in the majority of cases is a dying pateint, yes we do what we can and must to prevent it but at the end of the day they are unlikely to survive the event. I would want my last few minutes to be spent with family present and I know that members of my family feel the same way. I don't want to die with strangers around me I want people who love me to be there.

That's my personal view and I can accept that it clouds my opinion on witnessed arrests, it is an emotive subject and it is one that you are not going to get agreement of everyone.

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