Family in room during a resusitation?

veetach · Jun 1, 2004

personally, I dont have a problem with having the family in the room during a code, expecially a pediatric code. In my experience, most family members are silent and shocked and want to stay out of the way.

I am an advocate of letting the family be with their loved ones as much as they can, before, during and after the rescuscitation attempt.

In our hospital, the house supervisor is always with the family to answer whatever questions they may have. I have also observed that most families (except those of pediatric patients) do not want to be at the bedside...

pgrsctrn2be · Jun 1, 2004

I work in EMS parttime as well as being a nurse. One code that family was present for they excepted the situation well. I was on the ambulance dispatched for difficulty breathing, got on scene to find CPR in progress, with only myself and the driver we had to act quickly and start transport. There was a rather large group of by standers that had started CPR so I picked one and asked him to board the ambulance with us. After we called dispatch for additional help and met them in route to the ED, I found out the gentleman was the patient's brother. I felt really bad for asking him to come on the truck until after the code was called and he came looking for me to tell me thanks and how much easier it was to accept what had happened after seeing how hard we worked to save his brother. Now this same man is running with a local vol. rescue squad. I have also seen the family react in the ED during a code that made it very difficult for the ED staff to perform, you know the screaming and pulling at the staff type of thing. I think each code should be a case by case decision as to if family can be in the room.

RNMedic1977 · Jun 2, 2004

I guess I used to be against this idea, and then I heard the last words of a 17 year old patient....then he went downhill, coded, and the family was kept out during the whole time (although with frequent updates). I changed my thinking after that patient...why was I the one to hear their child's last words? :crying2: His parents could have been there to hear him, but he was dumping quick and we kept the parents out, like most ER's do in these cases .

I then did a Lit search on this subject and found that times are changing. Just like we used to keep everyone out when babies are born, we keep out people when a child/parent/spouse is dying. That practice is changing. I think the choice should be given to the family (& what the space will allow in the ER too), to stay with their loved one as their life comes to an end. During the Lit Search, I read about one hospital in Michigan that allows family presence, and they have had great success with the program. The #1 worry was "Lawsuits", and this hospital stated that NO LAWSUITS have been filed by any of the family presence families. The biggest hurdle was getting the ER Staff & Docs to accept the change.

This is another change in health care that is becoming more and more accepted, ask yourself....if it was YOUR family member, would you not want a choice to be at their side and possibly hear your loved one's last words? :confused:

Think about it.....

Brownms46 · Jun 2, 2004

I guess I used to be against this idea, and then I heard the last words of a 17 year old patient....then he went downhill, coded, and the family was kept out during the whole time (although with frequent updates). I changed my thinking after that patient...why was I the one to hear their child's last words? His parents could have been there to hear him, but he was dumping quick and we kept the parents out, like most ER's do in these cases .
I then did a Lit search on this subject and found that times are changing. Just like we used to keep everyone out when babies are born, we keep out people when a child/parent/spouse is dying. That practice is changing. I think the choice should be given to the family (& what the space will allow in the ER too), to stay with their loved one as their life comes to an end. During the Lit Search, I read about one hospital in Michigan that allows family presence, and they have had great success with the program. The #1 worry was "Lawsuits", and this hospital stated that NO LAWSUITS have been filed by any of the family presence families. The biggest hurdle was getting the ER Staff & Docs to accept the change.
This is another change in health care that is becoming more and more accepted, ask yourself....if it was YOUR family member, would you not want a choice to be at their side and possibly hear your loved one's last words?
Think about it.....

NO! I would NOT want to remember my father or mother that way!

KaroSnowQueen, RN · Jun 2, 2004

Yes, I would give anything if I had been able to be at my mother's side and hear her last words.

SmilingBluEyes · Jun 2, 2004

I am mixed, but if they want to be there, I think it is their RIGHT>!

Pediatric Critical Care Columnist · Jun 2, 2004

One of our intensivists did a formal survey of staff in our PICU about two months ago. Based on conversation in the break room during the survey period, his results will be as mixed as those I see here. The catalyst for his interest in our opinions was a situation we were faced with last fall. A teenager, previously "healthy" came into our ED one evening after fainting at home. Earlier in the day the child had also fainted at school and had been taken to a walk-in clinic, examined, determined to be dehydrated and sent home with instructions for oral rehydration. On arrival at the ED, the child was found to be severely hypotensive and had an enlarged cardiac silhouette on CXR, and so was sent to us. After admission, an echo was done revealing an extremely dilated heart with an ejection fraction of less than 10%. Aggressive treatment was started and shortly after midnight, the child arrested. The extended family, including grandparents, aunts, uncles, cousins and pets ( :rolleyes: well, maybe not pets...) had camped in our waiting room, and at the time of the arrest, several of them were in the room. The mother lost it and began screaming for us not to let the child die. She could not, would not be removed from the room and continued to scream at the staff to do everything possible to save her child. She was physically ejected when the OR staff arrived at 0230 to cannulate for ECLS. The child went on to receive a heart transplant the following night. There have been numerous complications, many none of us have ever seen before and the child is now permanently paralysed from the clavicles down, has surgical short gut with colostomy and no left leg, tracheostomy and now I hear, rejection. The child has been in hospital now 236 days, with no discharge date in sight. And the mother has asked all of us and herself if she did the right thing, and maybe all of them would be better off had the child not lived. :crying2: The child too has wondered, and asked the mother, "Why didn't you let me die?" :sniff:

I still believe that family members should be given the option of staying without pressure brought to bear to decide one way or the other. It's my personal bias, having been in the situation of having my own child arrest and being sent away to wait in the hall. I was out there for hours, no one came out to update me on what was happening and I had no idea if he was alive or dead. I feel that I should have been there, come what may.

My $.02...

CHATSDALE · Jun 2, 2004

There are things which should be decided on a case by case basis. If they know before hand that a code is possible and if a dnr is being considered then you can prepare a family. My son-in-law arrested in er after having some chest pain, first occurance, the only family member in with him at the time was my teenage grand-dtr....she nearly freaked out----he came through w/o complications but this was a little too much for her to handle

susswood · Jun 2, 2004

In the ER, I find it absolutely appropriate for family to attend during resucitation. The best codes I have ever been in have involved family members.

camay1221_RN · Jun 2, 2004

After reading the many different perspectives, I don't find it as easy to say, "Keep them out!" I guess, I would have to agree with what some have said about being dependent upon the circumstances.

I dare the person try to keep me out of the room of one of my children! See, when I put myself in the position of the family member, I can't imagine having someone tell me to stay out!

Just another one of those, no right answers and no wrong answers. Like with our pts, we have to treat everyone individually.

camay1221_RN · Jun 2, 2004

What a little darling your baby is!!!:)

In the ER, I find it absolutely appropriate for family to attend during resucitation. The best codes I have ever been in have involved family members.

Gompers, BSN, RN · Jun 2, 2004

In the NICU, the family is almost always present during codes. Ours is a big, open unit, so there is plenty of room for everybody and plenty of staff around to support the family and explain things to them during the code. We rarely have a problem with families getting in the way - they usually are in shock and stand back, letting us work. I think it helps them to understand the severity of the situation and that we really are doing everything humanly possible for their child. Like others have said, the familes that refuse DNRs often change their minds when they see how traumatic codes can be. The few times I do remember a family member getting in the way will always stay with me...a father physically having to pull the doctor's hands off his baby's chest to stop the compressions, telling him the baby had gone through enough already...the grandmother fighting her way to the head of the crib to give her grandson a heartbreaking pep talk...the mother who understood that her child was gone trying to embrace the baby, only to have a doc with a God complex push her away as he kept torturing the baby - then WE were the ones that pushed HIM out of the way.

The biggest problem we face is getting OTHER familes out of the unit - some parents get downright angry when we ask them to leave, ranting about how we're impeding on THEIR visit with THEIR child. And yes, that's true, but it's a small sacrifice to make, if it means giving this poor family some privacy, isn't it? I can't imagine why a family with a baby in the NICU would even WANT to be anywhere near another child's code!