Family Witnessing Code Activities

[BabyRN2Be]

With the new changes in allowing family members to witness code activities, would you want to watch your family member go through a code? I've heard this is done so that the family knows that the staff did all they could do, and to take the mystery out of codes. But would you want to watch a family member go through the pain of a code and all that it entails? What do you think?

[Tweety, BSN, RN]

About 10 yrs ago I watched them do a code on my sister, (inadvertently) and can honestly say that I would never want to witness that again on a family member. I had nightmares from that experience and some of the last images that I had of my sister for a long, long time was of that. No thanks for me.

Perhaps if it wasn't inadvertant. Perhaps if you were given the choice, perhaps if you had counseling during and after, someone to hold your hand and talk you through it, rather than be an inadvertant witness. Perhaps if you had the choice and you said "no" you would have been escorted to a quiet place where your wishes were respected and you wouldn't have been traumatized.

My sincere condolences at your loss.

[nursemomruns]

Last time I renewed my CPR the medic who did it severly lectured me on the fact that nurses do not support the new trend. That is allowing the family to witness CPR. I did not appreciate being talked down to like that and told him I was aware of the new thinking on the subject. I also told him that this new policy had to be instituted by the individual health care facilities. I could not just go in to work and start a new policy. I did not tell him that I have mixed feelings about the subject and do not know if I approve or not. I therefore voted UNSURE AT THIS TIME.

The ENA supports family presence in these situations nad has for quite a few years now. You can let your smug medic friend know that.

[Spidey's mom, ADN, BSN, RN]

You say you're not sure they could keep you away from your child. Wouldn't it be nice if you had the choice so the "scene" of you demanding to be with your child could be avoided?

The original topic was would we like to witness a loved one's code. However, (off topic) when deciding a policy for your unit/hospital our personal choices should not necessarily come into play. It's not fair to put our personal choices on everyone. Offer the choice and leave it at that, and support them one way or another. It's perfectly understandable and reasonable to not want to witness a code, and the movement towards FP doesn't demand witnessing a code, just offering the choice.

Whether or not I want to see my loved one coded shouldn't come into consideration when offering it to others.

In regards to Kat's comments, the code team should be in charge of the code and the family doesn't run the code. The family is with a support person, out of the way. Following ACLS protocol, not family wishes is when the code should end. Letting family in, shouldn't change a thing that you do during a code.

Again, just a humble opinion.

I do think we should have a choice - I think I stated that but in looking back I can see that when I said "I'm not sure you could keep me out" I didn't mean that there would be a policy against it and I would fight it . . . it was just a way to say that I would want to be there, to explain the intensity of me wanting to be there. I guess it sounds confusing.

One of the things that can happen though and did happen to me is that even though, as you say, the code team is the one who makes the decision when to stop, you may have a family member like the one I dealt with who had a very strong reaction to stopping and truly believed that prayer was going to bring this person back to life. And our doc supported them. We are a very small rural facility and this was in the middle of the night - no real support staff to hold someone's hand as we were all tied up in the code.

steph

[ktwlpn, LPN]

I cannot disagree more. Reality TV has rid of of the old fashion notion that what people deserve is dignity and the respect of NOT being seen in such a 'compromised' situation.

family members most certainly do not DESERVE to witness such an ungraceful 'assault' on their loved ones. It wasn't that long ago when we would have rightly said that patients DESERVE not to have such a situation witnessed by those they care about. True advocacy would be protecting that dignity.

But this, It's unseemly.

~faith,

Timothy.

People need to be educated regarding the dying process both in a DNR situation and in a code.Maybe if we talk about death without euphemisms we won't be so afraid of it.If you call a code an "ungraceful assault" what do you consider dying? It usually is NOT pretty ....Maybe if family members understand what a code really is they won't be so eager to choose that route for their terminally ill loved one....Bottom line-it should be up to the patient and their loved ones-specify in your advance directives if you wish to allow your loved ones to witness your dying process...If you don't want a vigil at your bedside then absolve your family of the guilt they may feel for letting you die alone....Tell them now if you don't want them with you.... Preserving ones dignity means to carry out their wishes and that of their loved ones IMHO. Calling the process "unseemly" seems a bit Victorian,I think...They used to think it was "unseemly" for a lady to show her ankles....

[Tweety, BSN, RN]

I do think we should have a choice - I think I stated that but in looking back I can see that when I said "I'm not sure you could keep me out" I didn't mean that there would be a policy against it and I would fight it . . . it was just a way to say that I would want to be there, to explain the intensity of me wanting to be there. I guess it sounds confusing.

One of the things that can happen though and did happen to me is that even though, as you say, the code team is the one who makes the decision when to stop, you may have a family member like the one I dealt with who had a very strong reaction to stopping and truly believed that prayer was going to bring this person back to life. And our doc supported them. We are a very small rural facility and this was in the middle of the night - no real support staff to hold someone's hand as we were all tied up in the code.

steph

Those kinds of situations are awkward, and staffing considerations is definately an issue. (Here there's usually a half a dozen staff hanging outside the door ready to help, it gets a bit too crowded with staff.)

If your doc supported the family, then was any real harm done in supporting the family. Allowing the family to see that indeed everything possible was done was probably important. Of course sucking up staff resources and exhausting the staff was not appropriate either.

Anyway, there are lots and lots of stories of family presence that didn't go well. We all have them. Still as nursing is an evidenced based practice using best practice, I say we should consider the option.

I guess I've said all I need to say. Thanks for an interesting thread.

[ZASHAGALKA, RN]

If your doc supported the family, then was any real harm done in supporting the family.

- (Ok tweety, as happens alot, I'm not directly rebutting you; you just have great quotes to respond to).

Yes, this has been my point all along. There are several things that can do REAL harm to this patient.

1. You have violated his/her privacy. As has been said, many people, even if they wanted to see a family member's code, WOULD NOT want them to see theirs. This is not the same as a DNR event. A code is very 'undignified'. I wouldn't want a loved one to see me like that, and I'm not alone. It's not about projecting my opinion on others; it's about understanding that this is probably not a statistically negligent opinion. A good percentage of people would probably feel this way. But without studying the right questions, we've blindly, BLINDLY decided that, at the initiation of a code, the patient no longer matters. There is a time to shift our focus from patient to family - when I'm charging to 360 isn't it. And even if only, say, 10% of patients would not want their family to see them like that - at what percentage is it appropriate to violate their rights? How high a minority do I have to be before my rights don't matter, anymore?

2. The Heisenburg Uncertainty Principle: observing an event changes the system of the event. All the supporters of this just dismiss the fact that a code with a family member present isn't the same as one without. The counter-argument is that a family member protects that patient's 'person-hood'. Ok, fine, but that is an admission that you have changed the code, placing requirements upon those performing the code that change their behaviors and actions. How can you expect that that couldn't also change the outcome?

3. It is 'unseemly'. There is a time and place for grieving and closure. We have carefully orchestrated this with our highly traditionalized funeral process. Subjecting grief to an uncertain process will yield uncertain outcomes. Some people will be highly traumatized by such an observation, and you cannot tell who they are in advance. To them, we have not been advocates. At what point does their grief become secondary? How high a minority do they have to be before we advocate for them?

4. FP is highly stressful to staff. This may not be true at a level 1 trauma center; but that is not where all codes take place. Talk about projecting your situation on others. This is disrespectful of the day to day heroes that actually manage to save a few codes. Oh I know, we just need more education to allay our fears. I'm sorry, no. My CONCERNS are valid, and my repulsion by this need to tap into our fascination w/ the macabre is justified.

Let people rubberneck at a wreck or watch ER. I'm a nurse, not someone that plays one on TV.

I understand that there are strong advocates of this practice. And I can even understand your POV, even if I disagree with it. It does get frustrating that those that support FP dismiss my POV as uneducated, fixable with the right 'education' to allay my 'fears'.

~faith,

Timothy.

[Tweety, BSN, RN]

1. You have violated his/her privacy. As has been said, many people, even if they wanted to see a family member's code, WOULD NOT want them to see theirs. This is not the same as a DNR event. A code is very 'undignified'. I wouldn't want a loved one to see me like that, and I'm not alone. It's not about projecting my opinion on others; it's about understanding that this is probably not a statistically negligent opinion. A good percentage of people would probably feel this way. But without studying the right questions, we've blindly, BLINDLY decided that, at the initiation of a code, the patient no longer matters. There is a time to shift our focus from patient to family - when I'm charging to 360 isn't it. And even if only, say, 10% of patients would not want their family to see them like that - at what percentage is it appropriate to violate their rights? How high a minority do I have to be before my rights don't matter, anymore?

It's always been the case that when a person can't speak for themselves, next of kin takes over. If next of kin chooses to believe the loved one would want them there, or wants to be there themselves, we shouldn't deprive them of this.

The Heisenburg Uncertainty Principle: observing an event changes the system of the event. All the supporters of this just dismiss the fact that a code with a family member present isn't the same as one without. The counter-argument is that a family member protects that patient's 'person-hood'. Ok, fine, but that is an admission that you have changed the code, placing requirements upon those performing the code that change their behaviors and actions. How can you expect that that couldn't also change the outcome?

I'm not following you here, but perhaps if I read more slowly and think about it I can comment.

It is 'unseemly'. There is a time and place for grieving and closure. We have carefully orchestrated this with our highly traditionalized funeral process. Subjecting grief to an uncertain process will yield uncertain outcomes. Some people will be highly traumatized by such an observation, and you cannot tell who they are in advance. To them, we have not been advocates. At what point does their grief become secondary? How high a minority do they have to be before we advocate for them?

Offering choice allows the families to be their own advocate. Again, I'm a bit lost on your point.

FP is highly stressful to staff. This may not be true at a level 1 trauma center; but that is not where all codes take place. Talk about projecting your situation on others. This is disrespectful of the day to day heroes that actually manage to save a few codes. Oh I know, we just need more education to allay our fears. I'm sorry, no. My CONCERNS are valid, and my repulsion by this need to tap into our fascination w/ the macabre is justified.

Let people rubberneck at a wreck or watch ER. I'm a nurse, not someone that plays one on TV.

I understand that there are strong advocates of this practice. And I can even understand your POV, even if I disagree with it. It does get frustrating that those that support FP dismiss my POV as uneducated, fixable with the right 'education' to allay my 'fears'.

~faith,

Timothy.

Codes are a very stressful time period, FP or no FP. I'm sorry if you feel your concerns are being negated. But this is the point of education and research into the issue. To take into consideration objections, concerns and fears that you express. Please don't be insulted or feel your concerns are invalid when what limited research there is disproves some of objectors concerns.

I'm getting a bit repetative. Didn't I say I've said enough already.

[Homesick Gypsy]

When my dad was diagnosed with congestive heart failure, we discussed a DNR with his cardiologist. Our preference was that if you're standing there and he drops, yes, revive him. We knew he was very ill, but wanted him around as long as possible.

The cardiologist's office was adjacent to the hospital. As it so happens, my brother and his two sons were going to pick my dad up from his appointment with the cardiologist. They parked and were crossing the street when they saw my dad standing on the sidewalk, talking to his doctor. Without warning, my dad dropped to the sidewalk. My brother and nephews stayed back, but watched the code. The doctor did CPR, the ambulance was there in less than a minute. They saw him shocked, they saw all kinds of things. My dad was revived and lived another couple of months, until he died in his sleep.

What my brother was able to convey to the rest of the family was a doctor and other professionals, going the extra mile to try and save my dad. Had he not witnessed him hit the sidewalk, and his arm bounce off the gurney as they were trying to get him quickly loaded, we might have been upset at his incidental injuries. But we knew what happened, and we appreciated that the professionals did everything they could to save our dad, which included some not-so-pleasant things.

What gets medical professionals in trouble - some times - is when it seems as though they have been secretive about procedures or is keeping something from the family. When a family witnesses a code, it's all hanging out there with no secrets to be had.

[BabyRN2Be]

I just wanted to add something right now. This last week I've been going through a CNA class (my first step towards getting my nursing degree!!! ) and I've been quite busy. I'll refine this a litte later, but have there been any hospitals that have family preparedness classes that may be required watching if the family come to the joint conclusion that one family member will witness the code? I'll type up my throughts when I'm a bit more coherent, but I'm just wanted to know for now if any of this is currently in place, and what it's success rate is.

Thanks!! I'll post more a little later about this issue!

[ljds]

I haven't even attempted to read all of the responses....sorry!

We allow all family members to watch a resuscitation of an infant, even if it goes beyond a little PPV. We even allow them to video tape it (as in, we don't ask them to turn off the camera if they have it set up and running), which I know is a legal no no (though, frankly, not if you are doing things right).

Every time I've had to do any sort of resuscitation on an infant, the family has been incredibly thankful that they were a part of that. And I think they SHOULD be a part of it. We have only lost one baby to my knowledge, almost two decades ago, and that mother still comes to us for her well-woman care. She told our doc that it meant so much to her, to see that everything was done that could have possibly been done. She said it also meant alot to her to see the expressions on everyone's face. When the nurse was sobbing as she was giving oxygen while the doc was doing chest compressions -- the mama said it made her feel better to know that someone who cared that deeply and passionately was trying to work on her child.

For me, I would want to see that everything was done. I would want to talk to my loved one through out, even if it was from across the room. The unknown, the imagination is always worse than reality, at least for me.

Lori

[ljds]

And I think Timothy has a valid point, though I disagree with most of what he is saying.

We should encourage people to not just talk about what their wishes are (DNR, which funeral home, what music, who is the guardian of the children, who gets the house, etc), but also if they wish their loved ones to be present or not, should that person be coded. I would want my family near by, if they wanted to be.

I would have to be physically restrained from being near my husband or child if they were being coded.

[bluesky, BSN, RN]

I would have to be physically restrained from being near my husband or child if they were being coded.

Me too!