Family members at the bedside during a code blue?

allnurses Guide · Jun 22, 2003

Funny, I picked up the June 2003 American Journal of Nursing and on page 17 there is an article about this issue. It states that most nurses favor family presence during CPR and invasive procedures. Evidently there are more articles in the Feb 2000 and May 2001 isssues. The main issue in the article is that 75% of nurses supported family presence but only 5% worked on units that had written policies allowing (or disallowing) family presence. That was pretty interesting.

I don't think we have a policy either.

Check out AJN . .. I'm sure there are lots of footnoted info for you.

steph

pickledpepperRN · Jun 22, 2003

Originally posted by NurseLili
Inevitably most of us will be in that situation, and it wil all depend on the culture of the family.
I agree it's pretty ugly to witness all the rib-cracking, skin-fizzling shocks and nasty intubations that occur during a code, but if I can give a little advice, it's essential that SOMEONE stays with the family, at least initially to explain what's going on and to give a little of support in this awful moment. There's nothing like knowing your loved one is in peril and you don't know what's being done...
I remember an incident when everyone ran to the room and no one stayed with the family. The pt's daughter walked in at the end of a 20 min. code & her mother had expired, spread on the bed like a sacrificed animal...
It was an awful scene... The daughter let out a scream and passed out on the floor.:stone

Absolutely agree. No family member should be alone. I completely agree that immediate family should be able to be with their loved one. In the last century i brought the mother into the room when her daughter was being coded. The doctor running the code said to get her out. I just brought the moter to the side with less activity and told her, "You can hold her hand."

This doctor rose to the sistation and explained what was being done without his usual insults and humor.

The mother thanked him and the team for trying so hard to save her daughter. She said, "I was with her when she was born. Thank you for letting me be with her when she died."

I_Love_Donuts · Jun 22, 2003

Well...I think it depends on the family and the code. I work in onco/hemato. ped and I have participated in many blue code (except it's pink in ped.) with the parents in the room. Usually they let us do what we have to do... they watch us from the corner, crying and praying, but they are pretty calm. I think it's different in onco/hem because they are chronic patients and we get to know the family pretty well...so we kind of know how they would react. But every situation is different...

dosamigos76, RN · Jun 22, 2003

Spacenurse-how brutally awesome! Thanks for sharing that.

nrw350 · Jun 23, 2003

Originally posted by spacenurse
The mother thanked him and the team for trying so hard to save her daughter. She said, "I was with her when she was born. Thank you for letting me be with her when she died."

That sent shivers up and down my spine reading that! Very sad, I could not have handled it.

powmol · Jun 23, 2003

I think that you deserve a gold star here! how beautiful!! I can not imagine if it were one of my children there, but I could only wish that I had a warm hearted nurse like yourself guiding me!! Bless you!!!!!!!

**canoehead, BSN, RN** · Jun 23, 2003

I have no problem with families being right there for any procedure or problem, but ther is a sticking point. A code is an unplanned emergency and everyone needs to be focused on the patient. Myself-I can't explain or give good emotional support when I'm trying to stay one step ahead of what the pt might do or what the doc might need. Families have a right to know what's going on and to ask questions, but I can't answer them coherently, and sometimes no one knows the answers. I can see that a designated support person for the family would help in this case but at my hospital we don't have that extra person.

Families really don't know what they are getting into witnessing a code. If they think it's going to be one shock and over (ha), but we may end up cutting open a chest, breaking ribs, etc. I've seen the pt concious while chest compressions were being done, and lots of emesis and incontinence of course. I can't imagine having a family seeing their loved one semiconcious and responsive during the compressions, and then the code is called and they die. (Massive MI) What a horrible memory to be left with.

Last thing- I think that we need to recognize that everyone on the health care team is human too. Maybe they need a minute to gather themselves after a death, or even a code before tending to the needs of someone else. I know we are all there for the pt and family, but in some codes, for some people, emotions are intense. How can we take that moment and check in with each other as coworkers- should we consider caring for ourselves in that instance to be a priority? I'm talking about 1-2 minutes to say "Is everyone ready?" not a full debriefing- just a deep breath.

If someone knows how to take that moment, and include the family, I'd like to hear it.

pickledpepperRN · Jun 23, 2003

Originally posted by canoehead
I can see that a designated support person for the family would help in this case but at my hospital we don't have that extra person.

Last thing- I think that we need to recognize that everyone on the health care team is human too. Maybe they need a minute to gather themselves after a death, or even a code before tending to the needs of someone else. I know we are all there for the pt and family, but in some codes, for some people, emotions are intense. How can we take that moment and check in with each other as coworkers- should we consider caring for ourselves in that instance to be a priority? I'm talking about 1-2 minutes to say "Is everyone ready?" not a full debriefing- just a deep breath.

If someone knows how to take that moment, and include the family, I'd like to hear it.

pickledpepperRN · Jun 23, 2003

What a great idea! We need to plan ahead starting with discussions at staff meetings.

*meant to go with quote from canoehead*

LauraF, RN, ASN, CNA, LPN, RN · Jun 23, 2003

I watched my infant be coded twice. I am thankful that they let me stay. I just stepped back and allowed everyone to do their work but I felt I needed to be there for her. Although all the nurses and doctors loved and enjoyed taking care of her, know one will ever love her like her mom. Thankfully she survived, but watching how fast her nurses responded and others jumping in calling RT, MD's and getting supplies made me know she was in the right place.

pickledpepperRN · Jun 23, 2003

Posted by NRSKarenRN on another thread:

https://allnurses.com/forums/showthread.php?s=&threadid=38836

mattsmom81 · Jun 24, 2003

Ya'll probably don't want to get me started on this...LOL! Pet issue of mine......

This is the wave of the future...open visiting. Trouble is we in my unit are not STAFFED sufficiently to deal with the demands of todays family, and too often they detract from the important care we must give in critical care, IME.

My manager wants unrestricted open visiting. We do the best we can. It's just another unrealistic expectation from management in our understaffed unit, IMO. With nurses' needs the low priority on the totem pole. We must do more and more with less and less.

My idea of a perfect ICU setting (and it used to be this way for good reason) is with set times for visiting, so we can organize our day around our patient needs, and be prepared to give family the best possible visiting experience. It benefits everyone, IMHO. Plus it's MUCH easier to relax a rule (like set visiting rules) on an individual basis than to try and gain some semblance of control over my chaotic unit of today...it's not uncommon to have 30 plus visitors in my ICU nonstop with 12 patients. The commotion alone is not conducive to critical care.

Our docs snarl at us to 'get that family out of here" so nurses are not the only ones who notice the trend and dislike it. One doc tells our supervisor daily "This is not reality TV, it's a critical care unit". I agree, but our management doesn't listen...even to the docs.

With an increasingly demanding public and management committed to 'customer service', I doubt things will go back to the good old days.