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]

I personally have a hard time with this new "POLICY" also. I have seen families allowed in the room during a Code situation, and the problem is that the family is not emotionally stable to understand everything that is going on. The nurse is trying to save the patient, but it also takes another hand to take care of the family and keep them from interrupting the "CODE". I personally do not think that it is a good idea!!

Valid concerns. You're not alone with having a hard time with it. No need to rehash what has already been said in this thread.

However, you shouldn't presume the family to be not be emotionally stable. It's an emotional situation for sure, and not for everyone.

Yes, it does take another hand to take care of the family, otherwise the process doesn't work.

[Tweety, BSN, RN]

As a former ER nurse, I vote NO to family members present during codes. There are never enough nurses, or the chaplain is still 1hr away, to tend to both the family and the patient. I cringed when I read a post that said families "deserve" to be present during a loved ones rescucitation efforts. NO ONE deserves any such thing. This is not a spectator sport. When my beloved mother was dying in the hospital (unbeknownst to us), she knew it and send us all home (demanded we go home to rest)....saying she would be alright. That night she passed away and to this day I know that by sending us home she was sparing us undue heartache at what was about to happen. She kept her pride and dignity as she always had. To have watched anyone pounding on her chest would have been an awful memory to deal with.

That's your choice, your family dynamics, and your wishes. Why project them onto everyone else. Many of us want to be around when loved ones die. I can't imagine leaving my loved ones to die alone. If they asked though I would respect their wishes and leave. When I die, I want my spouse there (parent too if they are alive), I don't want to be alone.

But during an emergency, if I am there, then I'm staying. I've already asked this of my spouse, and typical male "I'm dead what do I care if you watch them pound on my chest".

If you're in a hosptial that doesn't have enough staff to safely run a code, then that's one thing. But most hospitals have a multitude of people helping out during a code, standing around watching, waiting to be of assistance.

I agree it's not a spectator sport. I disagree and say families deserve to be with their loved ones during resuscitation.

[Marie_LPN, RN, LPN, RN]

That's your choice, your family dynamics, and your wishes. Why project them onto everyone else.

Thank you.

[traumaRUs, MSN, APRN]

I too am passionate about families being provided a choice. I am sensitive though that in some of the smaller hospitals with limited staff, this may not be possible. But...if it is at all possible or the family clearly states that they want to be present, then their wishes should be followed.

[BabyRN2Be]

Maybe we should address this with patients at the same time we discuss advance directives and the like so the patient can decide if they would like to allow family to observe or not. Then family could decide if they wish to observe.

This is an excellent idea. I know that it would take several years to implement, but I like the idea of adding this to advanced directive statements. It would bring up a time to discuss whether or not a family member wants someone to watch code activities.

I think we underestimate the understanding that many families have. I don't feel it is our place to decide such personal things for family members. For myself, I feel less confident in a person who does not want me around than I do in one who doesn't mind. The one who is comfortable and self-confident enough to have me around as a family member is the one I trust enough to leave alone with my loved one.

I highly agree with this statement, too. Who are we to decide for the family what they want or not want to have done? If a family member is educated at what happens at a code, then why exclude them from being with that person at what may be their final moments?

[lwlpn2]

Maybe we should address this with patients at the same time we discuss advance directives and the like so the patient can decide if they would like to allow family to observe or not. Then family could decide if they wish to observe.

I think we underestimate the understanding that many families have. I don't feel it is our place to decide such personal things for family members. For myself, I feel less confident in a person who does not want me around than I do in one who doesn't mind. The one who is comfortable and self-confident enough to have me around as a family member is the one I trust enough to leave alone with my loved one.[/quote

This is not a confidence issue! I am not saying that we should make up the "minds of the family", but it is just considerate of them, the patient and coworkers to question if this situation is suitable for family to see. I think no matter what age the dying pt is, it is never easy, but I feel a big difference in an older adult vs a small child. I feel that you should take into consideration that if it were my child what would I do. As far as letting the family know that every possible effort was made to save their loved one, leave the ETT in, and dont clean up the room where the mess was made. In NCLEX world there would be that extra set of hands to help deal with families and their emotions, in real life it never happens that easy!!!

[ZASHAGALKA, RN]

edited out by poster.

~faith,

Timothy.

[Jennifer, RN]

If I were to go into cardiac arrest in an emergency dept., I would not want my family to witness. I would want my family to remember me in the most positive light, and I agree that our society has many rituals in place to deal with the concept of closure. We have wakes, viewings, funerals for that. My husband is not a nurse or in the medical profession. He would probably have a very difficult time watching the event take place. I completely understand, being a nurse and knowing how very gruesome a code can be. Pt's are naked, exposed, lifeless. Vomit, urine, blood and stool may be abundant. In our ed, our codes can be very calm or very chaotic, depending on the staff and physician running the code. We are a level 2 trauma center, so we do see "good" traumas, and are accostomed to running codes. I think families should be allowed to watch from the outside of the room. Some one needs to be there to comfort the family. Time seems to stand still in the first moments of a code, there is usually someone that can stand with the family member and explain the situation and offer comfort and support.

Wow, I am exhausted, time to go to bed and dream of this wonderful world and life of mine!

[Jennifer, RN]

However, I would definitely be a my child's side if they were to ever code. I would also encourage my husband. I could not sit in another room while my child was being coded. Never.

[Altra, BSN, RN]

This is an older thread, but I never voted until today. Now, with almost a year in the ER under my belt, I feel like I can now form an informed opinion.

As a medical professional, I understand exactly what is going to happen during a code, and I am not horrified by it. I would not be offended by the emotional detachment, and possibly even warped jokes, of the medical staff present. However, I would probably decline the opportunity to watch, even with my child. It's not a matter of being uncomfortable with "watching them go through that pain" because I don't view it that way. I just do not need to know how many epis were given, etc. to be assured that everything possible was done. My presence might very well infringe on the detachment and concentration of the people coding my loved one, and there's no need for that - it's not going to change the outcome. I also have confidence that I will be given how ever much private time I need after all possibilities have been exhausted.

For me personally, part of this is probably my own spiritual beliefs too. An individual's belief system regarding death and dying and regarding emotional connection between loved ones profoundly impacts decisions about, and perceptions of, end-of-life care.

[bluesky, BSN, RN]

This is an older thread, but I never voted until today. Now, with almost a year in the ER under my belt, I feel like I can now form an informed opinion.

As a medical professional, I understand exactly what is going to happen during a code, and I am not horrified by it. I would not be offended by the emotional detachment, and possibly even warped jokes, of the medical staff present. However, I would probably decline the opportunity to watch, even with my child. It's not a matter of being uncomfortable with "watching them go through that pain" because I don't view it that way. I just do not need to know how many epis were given, etc. to be assured that everything possible was done. My presence might very well infringe on the detachment and concentration of the people coding my loved one, and there's no need for that - it's not going to change the outcome. I also have confidence that I will be given how ever much private time I need after all possibilities have been exhausted.

For me personally, part of this is probably my own spiritual beliefs too. An individual's belief system regarding death and dying and regarding emotional connection between loved ones profoundly impacts decisions about, and perceptions of, end-of-life care.

I definitely agree with this. I would not want to watch a loved one coded. I really really really DON'T want to know if they mess up the code because the outcome is final anyway. Additionally, I have never personally encountered a family that wanted to stay in an overcrowded small ICU room full of flipped out medical professionals while their loved one is being aggressively resuscitated.

All that said, I still believe that they should have the right to choose. I am pretty certain that only a minority will actually do it.