Family Witnessing Code Activities

tencat · Sep 9, 2005

I have to admit, I haven't read all the replies to this one, so maybe someone else has said this. I'm only a student, but I have performed CPR on a 65 year old man who died. I've never been at a code, but I've seen enough on TV (Trauma, Life in the ER) to know that it ain't pretty. It is very traumatic, and I imagine that those who perform it can also be traumatized. It's already a sad, stressful situation for those treating the code. Adding heartbroken family members into the mix makes it way more stressful and sad. So my point is that yes, we need to be patient advocates and I care a lot about patients, but we also need to take care of ourselves as caregivers or we risk burnout. I personally think that it would be a lot harder for me to "decompress" and process the event if I was haunted by the wailing of a heartbroken family member. I know that as an EMT in a rural community I witnessed a 15 year old girl's parents come to the scene of an accident and kneel beside her dead, broken body, wailing. I knew the girl very well, and I knew the parents. It was a horrible thing to see, and I was traumatized by it for several years. So to take care of myself, I'd have to say that family should probably not be there. I think if we let them in right after the code has been called, and their loved one has been cleaned up a bit is much better for everyone left behind.

JMHO as a student not yet in the trenches.

DhornRN · Sep 9, 2005

No way! I think family members watching their loved one in the midst of a code is a very bad idea for the following reasons:

1. They don't know what you're doing so they can get the wrong ideas. We don't have the time to teach them until the code is over.

2. Watching the code gives the ones who want to sue more ammo. It looks and sounds bad when ribs break.

3. The nurse doesn't need to wonder about the above things when trying to save a life.

4. Who knows what emotional trauma the family member(s) may experience from watching the code?

I think family should be informed in a waiting area thoughout the course of the code.

Deidre Shiobhan · Sep 9, 2005

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?

No! not for me. I'll not want to be there when my family member is being resuscitated, it's too painful to watch. I'll rather wait outside and pray besides codes are normally messy, confusing and stressful. Having a family member around may cause more inconvenience than beneficial.

I believe this will not be allowed in the hospital that I practice. :uhoh3:

DusktilDawn · Sep 10, 2005

How about a poll asking how many of us would want our families to witness OUR code?

Sorry, but I wouldn't want my family present if I was coded.

grannynurse FNP student · Sep 10, 2005

How about a poll asking how many of us would want our families to witness OUR code?
Sorry, but I wouldn't want my family present if I was coded.

Which is your right. What some of us object to, is the barring of a family member who does wish to be with a loved one. And the failure of some insitutions to establish reasonable guidelines to permit it.

Grannynurse

anney1981 · Sep 10, 2005

I agree with everyone when it comes to the craziness involved in a code. There are so many things going on during a code that having to worry about a family member watching, not only adds to the stress, but also is one more body in the way. That doesn't even include the trauma that it may cause the family member. If the patient does happen to survive, that family member will have to remember that situation for the rest of the patient's life. I cannot imagine watching someone perform CPR on my wonderful husband, him surviving and me have to think about someone pumping on his chest. I honestly believe that I would have nightmares are constantly worry that he would again have to go through the same situation. I hope that all of this makes since, but the situation definitely gets under my skin....

DusktilDawn · Sep 10, 2005

Which is your right. What some of us object to, is the barring of a family member who does wish to be with a loved one. And the failure of some insitutions to establish reasonable guidelines to permit it.
Grannynurse

Again it is being made an issue of what the family member wishes and not what the patient may actually wish.

I don't have an issue with family members being present if it is in accordance with the patient's wishes, but I do agree there has to be reasonable guidelines to permit it.

Several years ago, I watched a program that addressed this very topic. The standard, for one famiy member to be present, was clearly presented to the family. And the person was accompanied by a staff person. Research showed that rarely did the family person freak out and have to be removed. Nor was there any increase in lawsuits. Research demonstrated that it was beneficial to both the family member and the patient, even when the patient die. I believe that it is the fear of the staff, that they will be second guessed that interfers with their judgement.
My daughter was present when I coded, in the ER, following multiple trauma. She and I later discussed her feelings. She told me, if I had die, she would have been able to cope better, knowing the staff had done their best. Both she and I agreed my mother would never have been able to tolerate it. It is a personal decision, that a person should be given the opportunity to decide. And should the person decide yes, they should understand the guidelines and should have a staff member present.
Grannynurse

I can understand that as a patient, you would want your daughter present in this situation again if it should happen.

This is also an issue that needs to be addressed prior to a patient being in a position where they may code by both the patient and the family. What I may want as a patient may be completely opposed to what my family feels are their rights in the situation.

grannynurse FNP student · Sep 10, 2005

Again it is being made an issue of what the family member wishes and not what the patient may actually wish.
I don't have an issue with family members being present if it is in accordance with the patient's wishes, but I do agree there has to be reasonable guidelines to permit it.
I can understand that as a patient, you would want your daughter present in this situation again if it should happen.
This is also an issue that needs to be addressed prior to a patient being in a position where they may code by both the patient and the family. What I may want as a patient may be completely opposed to what my family feels are their rights in the situation.

Then, as a patient you should make you wishes known, thru a living will and a health care poxy. Funny thing, the programs I have watched and the research I have read, no patient has ever complained afterwards.

Grannynurse :balloons:

ZASHAGALKA, RN · Sep 10, 2005

Then, as a patient you should make you wishes known, thru a living will and a health care poxy. Funny thing, the programs I have watched and the research I have read, no patient has ever complained afterwards.
Grannynurse :balloons:

Considering that upwards of 85% don't survive, and there is a probably a distinct difference in watching somebody survive vs. watching them die, the real question is, how many of the DEAD patients would complain?

If the answer is 1, then you've just violated that person's rights.

~faith,

Timothy.

rsh3rn · Sep 10, 2005

maybe I'm crazy here, but how about what would the patient want. Not what the family wants, not what JCAHO wants, not what Billy Bo Bob Bush wants. What does the patient want, shouldn't this sort of thing be addressed at the time we look at advanced directives, not when compressions are started.

Tweety, BSN, RN · Sep 10, 2005

maybe I'm crazy here, but how about what would the patient want. Not what the family wants, not what JCAHO wants, not what Billy Bo Bob Bush wants. What does the patient want, shouldn't this sort of thing be addressed at the time we look at advanced directives, not when compressions are started.

I agree, maybe it's time to start including this kind of thing in advanced directive, even though most advanced directives I've ever see state the patient as being a no-code, the question should be answered "do you want the family present at the time of your death". So we should advance toward this.

Tweety, BSN, RN · Sep 10, 2005

Considering that upwards of 85% don't survive, and there is a probably a distinct difference in watching somebody survive vs. watching them die, the real question is, how many of the DEAD patients would complain?
If the answer is 1, then you've just violated that person's rights.
~faith,
Timothy.

Again, since we're mainly talking about unexpected traumatic events I think it's a good idea to go with the current accepted law/standard that when a person can't speak for themselves consent/medical treatment/decisions are made by the next of kin.

Unfortunately, as I'm sure you see in your critical care environment family members quite often don't make good decisions, and quite often make selfish decisions that you know the patient would not want.

But you're right, we shouldn't assume that we all want to have our loved ones with us when we die, especially if its during an expected code.

Family Witnessing Code Activities

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