Code situation

ahorton75 · Mar 28, 2015

Absolutely not. Codes are ugly and traumatizing. The focus is on keeping the patient alive...not on gentle or kind. To a family member it would appear mean and chaotic and devoid of emotion. Intubation, multiple attempts at arterial lines, defibrillation. All are invasive and ugly. No place for family.

SquishyRN, BSN, RN · Mar 28, 2015

Everything that I've been taught recently supports to allow family at the bedside. This was encouraged at my last ACLS class, and it is encouraged at my facility now. Well, in the ER at least. I don't know about the rest of the hospital. Reason being the family can help narrow down the H's and T's if they are familiar with the patient's condition. Within reason of course. It's one thing to have a single adult representative, it's another to have the entire family arguing at the bedside if compressions should continue or not. I'm sure there have been studies done on the topic. OP, you should find these studies to include in your discussion for class.

ixchel · Mar 28, 2015

I'd hate to have them there because of already cited reasons and I think I'd feel nervous, whereas without them there, the coding person is .... Well, science. I can function more clearly when I'm not thinking about how important what I am doing is to the people watching.

But..... We had a patient not too long ago who I adored. Frequent flyer, sweet, sweet man. He coded shortly before change of shift and died. I was on the shift after, so I wasn't there for it. The family was still in the room when I got there, and I went to pay condolences. It gave the family such peace knowing first hand how much effort the staff had put into trying to save him.

So I really don't know which I prefer. For my sake, I like walking away without emotion. For the family's sake, I like that they can know that an enormous effort is put in to save their loved one. Closure is important.

us2uk4u · Mar 28, 2015

I see both sides to this.

As previously mentioned, codes are not pretty. Intubations (and let me tell you most times the first attempt is not successful), central lines, shocks, and even chest compressions are not something I want a family member to see.

However, when we've had family members be at bedside during a code and see what we are doing to the patient, they often finally agree to a DNR/DNI status.

dah doh, BSN, RN · Mar 28, 2015

I see both sides to this.
As previously mentioned, codes are not pretty. Intubations (and let me tell you most times the first attempt is not successful), central lines, shocks, and even chest compressions are not something I want a family member to see.
However, when we've had family members be at bedside during a code and see what we are doing to the patient, they often finally agree to a DNR/DNI status.

Agreed! Codes aren't pretty! They do not look like TV!

Sometimes families are reassured we've done everything we could because they witnessed it! It gives them comfort & some sense of closure. Other families see us breaking their loved ones ribs and tell us to stop because they didn't realize what it truly meant!

We let the immediate family stay in the room or just outside the room usually with a social worker or chaplain to offer support & offer explanation as needed. Disruptive families are removed from the room & allowed to return when they can watch without interference.

The only time we don't allow family presence is when we do emergency surgery in the room such as sternotomy & tracheostomy because we kick out all nonessential people & staff during these procedures.

Family presence during a code situation is such a common occurrence now that it doesn't bother me anymore.

chare · Mar 29, 2015

I fully support family presence during resuscitation, and have for years. However, this is hardly a new concept. When I worked at Columbus Children's (now Nationwide) Hospital in early 2000 this was the expectation. In all areas, other than when a sterile environment was required.

Several practice organizations endorse and support family practice as well. The current Emergency Nurses Association (ENA) Clinical Practice Guideline: Family Presence During Invasive Procedures and Resuscitation was developed in 2009. And the ENA was supportive of family presence long before then. Likewise, the current American Association of Critical Care Nurses (AACN) Practice Alert: Family Presence During Resuscitation and Invasive Procedures was revised in April 2010. Some of the cited references date from 1991.

â€¦To a family member it would appear mean and chaotic and devoid of emotionâ€¦

On what do you base this opinion? As noted above, at least two professional organizations support family presence. In my experience as a nurse, I have never heard a family member utter anything vaguely resembling this. I have seen, however, family members decide to discontinue the resuscitation based upon being there and knowing that everything that could be done, was.

â€¦It's one thing to have a single adult representative, it's another to have the entire family arguing at the bedside if compressions should continue or notâ€¦

I agree with this. If family members are allowed at the bedside, their conduct cannot interfere with any resuscitative efforts.

â€¦I'm sure there have been studies done on the topic. OP, you should find these studies to include in your discussion for class.

Absolutely! There has been a considerable amount of research published on this.

I'd hate to have them there because of already cited reasons and I think I'd feel nervous, whereas without them there, the coding person is .... Well, scienceâ€¦

This is sad, and I think where a lot of misgivings about family presence come from. Allowing the family to remain at the bedside helps maintaining the human aspect of the resuscitation, at least in my opinion, at a time when we should be most mindful of the family.

But..... We had a patient not too long ago who I adored. Frequent flyer, sweet, sweet man. He coded shortly before change of shift and died. I was on the shift after, so I wasn't there for it. The family was still in the room when I got there, and I went to pay condolences. It gave the family such peace knowing first hand how much effort the staff had put into trying to save him.

Had they been allowed to remain at the bedside, all of this would have been readily apparent.

As previously mentioned, codes are not pretty. Intubations (and let me tell you most times the first attempt is not successful), central lines, shocks, and even chest compressions are not something I want a family member to see.

It's not going to matter to the family how uglyâ€ the resuscitation attempt was. What is going to matter is that they were allowed to be there, and spend these last few minutes with their loved one.

We let the immediate family stay in the room or just outside the room usually with a social worker or chaplain to offer support & offer explanation as neededâ€¦

This. If you let them stay, someone absolutely has to be with them. It doesn't have to be a nurse, but it should be someone with an understanding of the resuscitation process. At my facility, this is typically the house supervisor or one of our pastoral care staff.

Those of you that are against this need to ask yourself one question. If this was your family member, where would you want to be?

DisneyNurseGal, BSN, RN · Mar 29, 2015

On my unit, we ask the family to step out during the code because there is just not enough room. Our rooms are on the smaller side and by the time we get the code cart, 2-3 respiratory therapists, MD, several nurses and what not.. people are bumping into each other. Usually, the nurse who is handwriting the charting stands on the couch to get out of the way.

That being said, one RN usually stands outside the room with the family, ask them if they want to sit down, and that nurse stays with them the whole time.

nurseprnRN, BSN, RN · Mar 30, 2015

Totally not a new thing at all. Research indicates that most people are grateful to have been there, even if the patient dies, because they have seen that the team did their best to save the loved one.

I'll tell you, if that's my kid or my grandchild, I will tear you and the rest of anybody else limb from limb if you try to keep me out of the room.

la_chica_suerte85, BSN, RN · Mar 30, 2015

It's tricky because, yes, it seems like :nailbiting: to have family there. However, I think, especially when it comes to kids, having the presence of a social worker or someone who can basically illustrate everything that is happening and, if possible, maybe allow the parents physical contact, is a good idea. I guess it can still be helpful if those things are not in place but with the help of someone who can calmly explain things as they happen I think it could be very beneficial. From everyone's point of view, here, though, it seems like it is more difficult for the medical staff to work as they feel necessary than it is difficult emotionally for the family.

GrannyRRT · Mar 30, 2015

For the past 20+ years we have allowed parents to be present when their child codes. But, we will have at least one professional with them to explain everything and remove them if necessary.

TransportJockey, EMT-P · Mar 30, 2015

I tend to not like family present. I usually have them wait outside in care of SO or PD... In hospital, however, it seems that they are following AHA recomendations and assigning a nurse or tech (if available) to one family member in the room (only 1 allowed) and explains things to them. If something like a chest tube or pericardiocentesis is performed they are asked to leave though.