family presence during CPR

dbsn00 · Mar 5, 2005

I can assure you that I would NOT want them to be there :uhoh21: To be in a situation where you have to do CPR is already a stressful mind-blowing experience - a distraught & terrified family presence would only add to the chaos, not to mention be in the way of medical staff & equiptment. Only medical personnel should be present, IMO.

pmchap · Mar 5, 2005

Simply put - get them outta the room, into a quiet area where they can have a coffee, talk to a nurse/doc/ whoever is available and trained to let them know what is going on. Last thing you want is family spinning out watching you do cpr - let alone the failure rates meaning that the likelihood of patient survival is remote. I would ask - if family is there then the lkelihood of CPR would be minimised - surely they would be screaming out for a nurse before the patient has gone totaly flat...

Cheers

peter

happthearts · Mar 5, 2005

I have a legal/ ethical paper I am writing on this subject. From a nursing standpoint what do you think? Should family be able to stay in the room if a family member is in need of CPR?

NO! for the reasons already listed!

2ndCareerRN · Mar 5, 2005

Could you clarify your question a little bit?

Is this a patient that has been brought to the ER by EMS, or family. Or is it a pt who is an inpatient? And should there be a difference?

bob

Nurse2B2005 · Mar 5, 2005

I have a legal/ ethical paper I am writing on this subject. From a nursing standpoint what do you think? Should family be able to stay in the room if a family member is in need of CPR?

Hi there!

I am a nursing student in my last semester. After doing the BLS class that was required to get into nursing school, I had no idea what 'real-life' CPR was going to be like. I also work as a CNA, and while I haven't seen a code during clinicals, I saw one happen at work. The RN advised me to go into the room and watch from a corner since I was a student - she thought it would be a great learning experience for me. Quite honestly, it was very traumatic to watch - and I didn't even know this patient. The whole time, I felt like I was going to well up in tears because of what I was watching. It even makes me question what I want for myself when I am old. I mean, if I am 90 years old and have a debilitating disease, do I really want to be a full code, or have my loved ones like that, be full codes? It really made me think about the saying "when it's your time, it's your time." I think that it is easy for a family member to say that they want to be present in case of a code, you can explain to them what goes on during a code, but when you actually see it happen, I think it's a different thing.

I heard one of the students at another clinical location that is in my class tell me that she saw a code in ICU. The family was there and security had to be called because one of the family members was so distraught that she tried to attack the RN while she was doing chest compressions because she thought that she was breaking her father's ribs. The family actually wanted the pt to be a full code and was advised about what CPR entails, but I guess when they saw it in real life, it was different than they thought it would be. I have a great article from a nursing journal about family prescence during codes. PM me if you want a copy of it.

Gompers, BSN, RN · Mar 5, 2005

I've heard differing opinions on the subject. For most cases, it seems like it's not a good idea for the family to watch the code because it IS so traumatic. Who wants to have THAT image in their head when they remember their loved one???

However, in pediatric and neonatal codes, it's very common for the family to be present. About half of the codes I've seen in NICU have been with parents at the bedside. Most of the time the parents are grateful because they can see that we did everything we possibly could, and because they get to be present for the last moments of their child's life. We always ask if they want to go sit someplace private or if they want to stay. We also always call the chaplain to sit with them, and have a nurse explaining everything as well. I've never seen them get in the way of us working, but I have seen them decide enough is enough and tell us to stop.

ERnursie172 · Mar 5, 2005

when i was a new nurse in the er i was very uncomfortable with the concept of "family presence" during codes. mainly this was due to my own insecurities and fears of looking like i didn't know what i was doing or even worse not knowing what i was doing!!

now that i have been an er nurse for many years, i feel that having family presence (in certain situations) actually helps. this is especially true during pediatric codes, research has proven this and the emergency nurses assoc. supports this concept also. family say that being able to actually see this experience helped them with the grieving process. they also say that it shows them that everything was being done and that people were working very hard to help their loved one.

i once had a 2mo old that was brought in via rescue found not breathing and with no pulse, he arrived intubated, cpr in progress, asystole on the monitor. basically, we all knew this baby was already dead but we maintained resucitative measures until the mom arrived. at that point the focus turned towards the mother. she was prepared first and an rn assigned to just her, to be right by her side. she was taken to her sons side, she held his hand crying and we told her that there was nothing more we could do. she screamed, cried told him she loved him and said goodbye. we let her stay with him after for as long as she wanted. a few weeks later during a social worker follow-up with the mother she said that having that experience and being able to touch him and say goodbye helped her through this difficult time.

i suggest that you check out some articles on this subject and look into what your hospitals policy is on "family presence during resucitation". i hope this helps, let me know if i can assist ya any further...

good luck!!!

Trauma Columnist · Mar 5, 2005

ER nursie - thanks for the great post. I too fully support family presence. In fact as an ER case manager - one of my jobs is to facilitate this. Research (per the ENA), shows much greater satisfaction for the family. As ER RNs we are providing a service to the families. If this were my family member, you wouldn't get me out of the room. It is all in the presentation. I ensure that the staff in the code are fine with family presence, ensure that I fully explain to the family what they are going to see (I'm very straight-forward with the family about the tubes, the pts color, what type of machinery they will see as well as the noises and sometimes smells). I always give the family a chance to see their family member before we pronounce them if at all possible. Unanimously, the families are very appreciative they got a chance to say good-bye. One mother (of a crib-death baby), called me back several days later to tell me how much she appreciated that we let her in to be with the baby: after the baby was pronounced, we wrapped her in a warm blanket and let the mother hold and rock her.

LPNer · Mar 6, 2005

I have a legal/ ethical paper I am writing on this subject. From a nursing standpoint what do you think? Should family be able to stay in the room if a family member is in need of CPR?

If the familly wants to be there, let them stay! It sounds cruel but they will not remember their loved one in a traumatic situation of a code but will remember them as they were all their lives.

Seems to me, and I know this from personal experience, watching the code, and in my case calling a stop to the code, helped me know that this was the end.

As a society we try to protect others from harsh realities but protection only prolongs understanding and acceptance of reality.

I've been involved in several codes where family was present and even more deaths where there was no code called. Family do not get in the way (though there is always that possibility).

zambezi, BSN, RN · Mar 6, 2005

I think that it is appropriate to have the family there for some codes. It depends on the family and the situation...I have some some pretty nasty gi bleed codes that I would not ever wish for a family to see...still if the family wanted to be there and there was someone there to stand with the family and explain what was going on, I would let them stay unless they got in the way...If I think my patient might code and the family is in the room, I will let them know ahead of time "Your mom/dad whoever is unstable tonite (and I will discuss what I am seeing)...we are doing everything we can to fix the problem, but, if his heart should stop or go into cardiac rhythm not compatible with life (or respiratory arrest, etc) a whole team of us will come into the room all at once and do x, y, z...i don't mind if you stay but please step aside so we can do our job, someone will come and talk with you to let you know what is going on...if you don't want to be in the room, it is okay to step out into the hallway or waiting room and I will come and get you right away when I have minute"...Most families know when their family member is serious...I would rather have them know what might happen...it is always good when it doesn't, but if it does at least the family has been breifed...the few people that I have told this to and their family memeber actually did code did really well- and they could see all that we were doing for their family (which could be good or bad depending on what is going on...)

I certainly don't advocate for family at the bedside in all situations, but I do think that it can go okay...as I said initially, it just depends on the family, patient, and type of code...

flaerman · Mar 6, 2005

Yes, on occasion we have let families in during codes but it depends on the circumstances, peds etc. One thing having in during a code is that it lets them see you have done everything that you could to save their loved one.

Sometimes we bring in families esp in younger pt's being coded when we see where the outcome is going, first we do a quick pick of things(bloody etc) that would freak out the family, then bring them in. Just have to make eval of situation and any current dynamics(hyterical family members, etc) prior to inviting them in.

flaerman