Family in room during a resusitation?

NYCRN16 · Aug 3, 2004

As an ER nurse, I don't have a problem with family being present at codes, usually we have a chaplin, RN, or patient rep that talks to the family during the code. I have always been pro family in the room.
Then a few weeks ago my dad with no heart history went into vtach in a small community ER, the doc said "you have to leave now". I said " i am not going anywhere". nothing else was said. i stood outside of the room, curtain open, and watched.
The other times ( several) that my father coded in OSU med center ........the docs and nurses allowed my sister and I in the room. As a family member/daughter, i felt reassured that everything possible was being done. sure, it was painful especially for my little sister(24), but it helped me to see that everyone was working so hard, and doing the right things to help my dad.
I agree with the ENA, as an ER nurse I agree, and as a family member who has experienced it i also agree that family presence during resusicitation is extremely important.
thanks, jen

I am happy that this experience was a good one for you, but being that you work in healthcare and understand what is going on, you are able to remain calm and not interfere. If you placed a family in the same situation who knew nothing about how a code is run, the reaction may be very different.

NYCRN16 · Aug 3, 2004

Just some food for thought..

This situation occured in Peds, but could also easily be applied to adults.

One of my co-workers was working in Peds ED a few years ago when a parent carried in a lifeless child. (I dont know what the cause of the arrest was). Child placed on monitor, in asystole. PALS protocol followed, and the father became irate, started screaming "you need to shock him, I watch ER, I know that they shock them when they are trying to save the patient". Father almost assaulted MD participating in the code.

Point being: The families may expect the code itself or the patient outcome to be like it is on TV. Ex: shock everything, frequent recoveries, ect.

"If they saw it on ER, it must be the way it really is!" :angryfire

Trauma Columnist · Aug 3, 2004

I am still a strong advocate for family presence IF:

they want to be present

they have been briefed beforehand about everything that is occurring

there is a knowledgeable and qualified RN at their side

we limit it to two family members at a time

we tell them there is no right or wrong - whatever they want to do is fine with us and they are free to come and go as they please

With these caveats - we have had great success. Not everyone wants to be in the code with the family member and that is okay too. We provide frequent RN-directed updates.

As to the poster who was concerned about the mess - I work in a very busy trauma center and even when we intubate, put in chest tubes or even crack a chest - there is no reason that the mess can't be kept to the minimum. After all, we usually have another trauma coming in within the next 10-15 minutes. It is a very individual thing though and staffing has to be able to support a dedicated-RN to the code.

nursemike, ASN, RN · Aug 3, 2004

I am still a strong advocate for family presence IF:
they want to be present
they have been briefed beforehand about everything that is occurring
there is a knowledgeable and qualified RN at their side
we limit it to two family members at a time
we tell them there is no right or wrong - whatever they want to do is fine with us and they are free to come and go as they please
With these caveats - we have had great success. Not everyone wants to be in the code with the family member and that is okay too. We provide frequent RN-directed updates.
As to the poster who was concerned about the mess - I work in a very busy trauma center and even when we intubate, put in chest tubes or even crack a chest - there is no reason that the mess can't be kept to the minimum. After all, we usually have another trauma coming in within the next 10-15 minutes. It is a very individual thing though and staffing has to be able to support a dedicated-RN to the code.

It seems to me that a big part of the solution would be to improve nurses' education regarding managing family members. I do think many would appreciate seeing that all that could be done was being done.

In my experience, every code I've seen had about twice as many staff members present as were necessary--you can't physically fit 20 people in our rooms. It is good, of course, if new folks can watch before they have to do, but surely 1 can be spared for the family.

I strongly agree about the mess! Mess=Danger! I once got "caught" in a code (it was between me and the door) and I noticed the sharps box was a long way from the action, so rather than stand there and look stupid, I had a friend toss me an empty one and I collected sharps. Later got several pats on back and learned that pt was HIV+.

I think we need to do more practice codes. I volunteer to role play the hysterical family member.

MarcusKspn · Aug 3, 2004

I had one Code in long term care where the wife was present. The patient was coming back to the home walking from his car to the door when he collapsed outside. We called the code (Not ACLS, just BSL until the ambulance arrived, just a couple LPN's with CNA's present, no doc to run the code). Everything was real quiet, I was very pround of my aides, there was no screaming, no yelling, everybody did what they needed to do, everybody ran to their assigned stations and got the necesary supplies (O2, airways, backboard, AED) I had never seen all my staff work together like this. One of the LPN's was standing with the wife, calming her, letting her know what was happening. The ambulance came and picked up the husband, and the nurse that was talking to the wife drove with her to the ER to calm her. I think seeing that we were doing all we can to save her husband made her feel at peace.

Ironically we had some consultants that the company had hired in the building that day, trying to explain to us the concept of teamwork. They were sitting in the conference room looking out the window that faces the entrance and were watching us run the smoothest Code I have ever seen that didn't involve ACLS. After the code (which was done outside, in the sun, in very humid 100+ degree weather) I walked into the building covered in sweat, out of breath, and proud of the good job everybody did and walked up to the consultant who had a terrified look on his face (I don't think he had ever seen anybody code) and calmly asked him: "How was that for teamwork?" :rotfl:

critcarenurse16 · Aug 4, 2004

I would not have a problem having family present during a code. But I feel there should be a member of the staff present to explain what is happening and to keep family from interfering with the code team. I have always felt bad that family members have lost their final opportunity to say goodbye simply because we feel they can't handle witnessing a code or because the staff has reservations about 'performing'for a crowd. We 'perform' for a crowd already--our peers. During a code your focus is on the patient; you may have times during the code where you don't realize the family is even there because of the intenseness of the situation. This is where a family mediator (for lack of official title) would be beneficial. Let them stay and say goodbye.

Just my $0.02

hospicemom · Aug 4, 2004

What has been your experience with this? Our hospital has started encouraging the pts family to be in the room during a code. They say that they are more accepting of the outcome if they are present. Perhaps its that they can see that everything was done. I'm not really comfortable about this. Has anyone here had a pts family in the room during a code?

Boy, I dont know how comfortable I would be either with the family in the room as I am doing compressions on their(lets say) 80 yr old grandmother....I think that would cause more heartache for the family in the long run.

sjt9721, BSN, RN · Aug 7, 2004

Actually, the research on family presence during resuscitation was begun by a staff nurse that bucked the system & allowed a mother to hold her 14 year old's hand while the staff worked to save his life. The mom is still thankful for being able to be with her son when he died.

I understand your discomfort!!
And who is going to hold back the frantic family member who is trying to pull a staff member off the pt who is getting chest compressions? Good grief, just what the staff needs is to worry about someone interfering with their jobs of saving the pts life!
Wait, maybe the administration who comes up with these assinine ideas should be present to hold off the family!

marylandnurse76 · Aug 7, 2004

As I was sitting here thinking about how I would feel if I were to have a family member that I loved dearly in the Hospital; ER, ICU, CCU, etc. and they were to "code" I would want to be with them especially if this were to be there last breath so at least I could be there to see them take there last breath ... I would certainly not want to be in anyones' way; I would want my family member to receive the best medical care possible especially when it comes to a "Life or Death" situation ... so I guess if there were a way to stand back so the Code Team would be able to get to the bedside and the family stand back so they could perform but if the family members become hysterical then they would be asked to leave the room ... you know this is one of those no win solutions ...

sjt9721, BSN, RN · Aug 7, 2004

The last family member I brought into the room was an adult son. Dad had collapsed at home & the family had witnessed all the efforts by EMS on scene. Who am I to bar them just because we were now "in the hospital"? The wife was too distraught & asked the son to "go be with him". The son was shaken but calm & felt he could handle seeing the resuscitation. I moved him to the foot of the bed, he occasionally would touch Dad's feet & say "Come on Dad" or "I love you Dad".

When it came time to tell the rest of the family that Dad had died, the son was a valuable link between us & the survivors. I think the widow was comforted by the fact that her husband didn't die alone & that their son was watching after him.

As I was sitting here thinking about how I would feel if I were to have a family member that I loved dearly in the Hospital; ER, ICU, CCU, etc. and they were to "code" I would want to be with them especially if this were to be there last breath so at least I could be there to see them take there last breath ... I would certainly not want to be in anyones' way; I would want my family member to receive the best medical care possible especially when it comes to a "Life or Death" situation ... so I guess if there were a way to stand back so the Code Team would be able to get to the bedside and the family stand back so they could perform but if the family members become hysterical then they would be asked to leave the room ... you know this is one of those no win solutions ...

hospicemom · Aug 7, 2004

I think we are all assuming these codes are "controlled" as the family members are watching. I have been to a fair share of codes which were absolutly uncontrolled....everything from the nurse shouting a code,nurses running for the crash cart....adrenaline pumping as we work the pts chest,feeling for pulses and yelling that we have nothing.....it is not a pretty site and I dont feel the family needs to share in this. Everything doesnt always run smoothly as we all know. and uncontrolled codes should never happen but they do.....and yes, even during these times we are always sure that a nurse stays with the family explaining what is happening....however they still see everything and sometimes it looks like a mess. I had a pt who needed a central line put in stat during a code....do we really want the family to be present for that? and at which point do we ask they not be present. this is a tough situation and I do feel even though I dont believe it is the place for ALL familis there are exceptions. I would take into consideration that emotional status of the family at that time before permitting them to watch.

sjt9721, BSN, RN · Aug 7, 2004

I doubt that anyone in favor of family presence would endorse it in every situation. We all (should) realize that there are exceptions & extreme circumstances for every situation. Nearly all of us have a story that begins "...I remember this one patient..."

Many say that the ED is no place for family presence for various reasons. Remember though, that much of the initial research on the topic was done at a Level I Trauma Center that consistently ranks in the top 5 busiest EDs in the nation.

I just don't want to see the option of family presence being ignored. It can be a successful undertaking in the right situation.