Families at the bedside during codes?

Specialties Emergency

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Hi everyone! I am finishing up my ADN program and we just had to read our chapter on emergency medicine. I am especially interested in the ER, have always been, and I have an offer to work in the ER of a local hospital after graduation. :D

Most of the info we were responsible for self teaching out of the book because the instructor who was to teach the material became ill.

There was a small paragraph in my book advocating for family at the bedside during a code, as long as there was a nurse available to explain what was being done. The author felt that it helps the family to accept the situation, and facilitates the grieving process if the patient dies.

I was just wondering if this is done anywhere, and what your opinions are. And for those who do agree with it and/or have seen it done, how likely is it that there is a nurse available to explain procedures to the family member?

Thanks for your opinions!

Each family is different. Some absolutely do not want to be there. Some would like to hold their hand the entire time. We do not routinely have family members stay unless they ask to. We simply explain that lifesaving measures can be a confusing situation for the bystander because there are alot of things going on, some which appear to be very scary and rough. We tell them that if something were to happen that we would need them to step out of the room, that they would have to. We have never had a problem with family members stepping out for a code.

When the code starts to get to the point that nothing can be done, someone will go out to the family, tell them what has been done, but that their loved ones heart still is not beating. Some families will opt to come back in and watch the last minute of CPR. When they come in and see how many people have been working, and we explain that 30minutes to an hour have gone by and their loved one still doesn't have a heart beat.... most, not all but most will say ok... we can stop.

I can understand bringing them in at the end, if they want. But I personally do not understand allowing them to remain the entire time. Things could be misinterpreted, there is lots of yelling, and certainly no extra room. It defiintely seems like we would be opening ourselves up for a lawsuit.

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Each family is different. Some absolutely do not want to be there. Some would like to hold their hand the entire time. We do not routinely have family members stay unless they ask to. We simply explain that lifesaving measures can be a confusing situation for the bystander because there are alot of things going on, some which appear to be very scary and rough. We tell them that if something were to happen that we would need them to step out of the room, that they would have to. We have never had a problem with family members stepping out for a code.

When the code starts to get to the point that nothing can be done, someone will go out to the family, tell them what has been done, but that their loved ones heart still is not beating. Some families will opt to come back in and watch the last minute of CPR. When they come in and see how many people have been working, and we explain that 30minutes to an hour have gone by and their loved one still doesn't have a heart beat.... most, not all but most will say ok... we can stop.

I can understand bringing them in at the end, if they want. But I personally do not understand allowing them to remain the entire time. Things could be misinterpreted, there is lots of yelling, and certainly no extra room. It defiintely seems like we would be opening ourselves up for a lawsuit.

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The last couple of codes I worked on the ambulance, the family was present when we began the code and at the hospital were present at the end of the code. Both families came to me and told me that they were glad they were there, that they knew that everything possible had been done. At the hospital we have a nurse with the family at all times, and if at any time a family member becomes a hindrance, they are taken from the room.

I think that if it were my husband or one of my kids, I would want to be there.

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We bring the families in a lot after we have done everything and have decided that there isn't any hope. The MD goes out to talk to the family and bring them back so they can see us doing CPR. The room is usually a wreck, crash cart busted open so they can see we have done everything that we could. I have had parents in the room during peds codes. They usually sit quietly in the corner and watch..as long as they can handle it. That only happens with certain pediatricians who can calmly run a code and explain to the family what is going on at the same time.

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We allow families to be present for many of the codes in our CVICU. Exceptions are when we do an open sternotomy or when space is too crowded. In the latter case, the family is kept out temporarily until space opens up.

Often times a code is the last time a family can be with their loved one before death -- a very valuable experience for all parties.

I did my student research on this specific topic. I read one occasion when a man was coded and stated afterwords that during the code he was very much aware of his wife's presence and it was that feeling that made him want to continue to live. My feeling is that if this is truly the case for even a few patients, then families at the bedside are as important as defibrillation or epinephrine.

It also occurs to me that we do far too many codes on patients that are not good candidates for quality of life or survival. I have found that many times a family at the bedside during a code is a good way to have them stop a code that probably shouldn't have been started in the first place.

I should also make clear that we always have a nurse (usually the supervisor or manager) with the family to explain the process. Many of the sights and sounds can be very frightening.

These days with reality TV like "Trauma: Life in the ER" and even dramas like "ER", we have to realize that most people are familiar with the process of resucitation -- even if a bit naive about outcomes.

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One of my instructors said that at her hospital, they encourage the family to be at the bedside during a code because it shows them that everything was done to help save their loved one and decreases the amount of suits filed against the hospital.

Keely

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Specializes in CCU (Coronary Care); Clinical Research.

Since I work nights, families are often not there for our codes...The one time that the patients wife was in the room, things went okay...the patient was post op valve replacement and aortic dissection...he had been extubated for a few days but when we came on shift, he just didn't look that good. His wife was always in the room, we could see that his respiratory stats was quickly declining...called the er doc up stat...we ended up reintubating the patient all the while his wife was there holding his hand. I think that it went okay with her in the room...although it was not a "surprise code" where we were defibrillating and working for a long long time or anything...i think that it definately depends on the family...for some families i think that it can work, for other families (and staff) i think that it is not such a good idea...

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Thanks for the replies! I wasn't sure what is common practice since we didn't get to have lecture for the Emergency care unit. It helps to hear the pros and cons, although I probably won't be able to form my own opinion until I have first hand experience.

It's great to read about others experiences to get a sort of grasp on what to expect. Feel free to add more! Thanks again!

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Our rescue service recently did a code in the middle of the night in a patient's home (when else?). Most of the squad was out on a HUGE fire, so our rescouces were very limited...ended up being, 1 medic (me) and 1 EMT working the code and 1 EMT assisting the wife of the patient because she had an asthma attack and chest pain. The patient's 16 year old son ended up coming in and helping us...he relieved the EMT on compressions, suctioned, and I don't remember what else. The patient ended up surviving and his son said that he was glad we let him in the room and he was honored that we let (MADE) him help. Propbably not the most appropriate thing to let happen, but this kid made a HUGE difference in saving his dad's life...

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My father died young and his death was unexptected. I got to the hospital room just as they were performing CPR. They asked me to wait outside. I asked the doctor "Please let me stay-this is the last time I will see my father alive." Somehow I just knew.

He let me stay. It was the last time I saw my father still alive. 10 minutes after they declared him dead his skin already turned blue. I was grateful they let me stay because even for the short time they were performing CPR he still looked like my dad. As I said before 10 minutes later he looked totally different-not like my dad at all. Plus I was able to SEE that they did everything that they could to save him.

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I think family presence during a code is very appropriated under some circumstances. Many nurses I work with are uncomfortable with the family being in the room and we have had many heated discussions regarding the situation. But a ED educator (who is one of the smartest people I know) told me something when I graduated and began working in the ED as a staff nurse that has always stuck with me. #1 - That person coding does not belong to you. They belong to that family member and you have no right to keep them away if they want to be present. AND if you are uncomfortable with the family being present, you are either unsure of your skills or unsure of how you feel about death. And these are two issues you have to deal with if you're going to make it in this profession.

I realize that it sounds harsh. But it is really the truth.

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I have been a nurse in various types of ER's (rural, urban, and pediatric) for 17 years. Although I think it is important for all arrests, I think it has special importance when there is an "unexpected" death, such as in the case of trauma, etc. Anecdotally, these parents/children/other family members/friends, have a tendency to deal better with the loss. There is so much discussion about it in the literature, that I think it will really become the norm, not the exception. It is done very well at my facility with the support of Social Work, Chaplaincy Services, Child Life, the medical staff, and Nursing. There are a couple of editions of the Critical Care Nursing Journal that are dedicated to family presence at the bedside. It has been added for consideration in much of the CE type courses nurses often take - Advanced Cardiac Life Support, Advanced Pediatric Life Support, Advanced Trauma Life Support, Trauma Nursing Core Course, and Emergency Pediatric Nursing Course. It is also directly endorsed by the Embergency Nurses Association. There is a position statement posted on their website for your perusal. The only thing in the literature that does not support family presence are anecdoatl experiences that are way out of the normal.

I will admit that it took a lot of getting used to, particularly with physicians. It often makes the healthcare providers uncomfortable, but that is not a reason to keep the family out. There is some fear of lawsuits in cases of errors, too. The literature however supports that there are many more lawsuits of those families kept out of the resuscitation room regardless of the errors being made. If you think about it, we are all more leary of those things we cannot see and understand. It only makes sense that more lawsuits would result with the unknown.

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