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?

[ZASHAGALKA, RN]

And for the family that doesn't want to be in there, they usually excuse themselves.

See that's just it. Alot of grieving is perception. I'm supposed to be crying. I'm supposed to wear black. We're supposed to have a funeral.

Funerals are almost universal, even if cremated, because there is a strong societal pressure/need for closure.

If you allow the opportunity to witness, a large percentage of the population will preceive it as a requirement, else they aren't grieving like they should.

We've let our TV facination with the macabre dominate our lives, and now we are passing it off as advocacy. I said in my previous post that it might be family advocacy but not patient advocacy. I change my mind. It's not even family advocacy.

codes are ugly nasty business. It's cruel to let (require) a family member to witness.

Funerals are where closure happens. It's a time tested, time honored process. Save the macabre for those who are trained to deal with it.

Families in codes is bad medicine, all the way around.

Fortunately, in my area, the doctors aren't far-sighted enough to adopt such lunacy. But I'll say this, most policies that address such issues have a 'in the nurse's opinion/assessment of its appropriateness clause'. I would NEVER find it appropriate and would always invoke the policy to object to the family's presence.

Why? Because I'm an advocate.

~faith,

Timothy.

[William_SRNA]

Tim, you bring up some excellent points

See that's just it. Alot of grieving is perception. I'm supposed to be crying. I'm supposed to wear black. We're supposed to have a funeral.

Funerals are almost universal, even if cremated, because there is a strong societal pressure/need for closure.

If you allow the opportunity to witness, a large percentage of the population will preceive it as a requirement, else they aren't grieving like they should.

We've let our TV facination with the macabre dominate our lives, and now we are passing it off as advocacy. I said in my previous post that it might be family advocacy but not patient advocacy. I change my mind. It's not even family advocacy.

codes are ugly nasty business. It's cruel to let (require) a family member to witness.

Funerals are where closure happens. It's a time tested, time honored process. Save the macabre for those who are trained to deal with it.

Families in codes is bad medicine, all the way around.

Fortunately, in my area, the doctors aren't far-sighted enough to adopt such lunacy. But I'll say this, most policies that address such issues have a 'in the nurse's opinion/assessment of its appropriateness clause'. I would NEVER find it appropriate and would always invoke the policy to object to the family's presence.

Why? Because I'm an advocate.

~faith,

Timothy.

[traumaRUs, MSN, APRN]

I am an adamant supporter of this and the literature/research bears this out. I did my master's thesis on family presence during resuscitation and invasive line placement and in one study (considered the gold standard because it followed every patient/family for nine years) had a 92% rate of "yes, I would want to witness resuscitation." This is not touchy-feely by any means, it is common sense. I work in a large level one trauma center and frequently facilitate this. The most important idea to take away from this discussion is that it is NOT the nurses or care providers who are the support system - it is a specially trained RN who knows the ropes, knows what to expect and has the patient's best interest at heart. It can be done and should be done.

As to my personal experience with family members - both of parents were DNR so there was no CPR. However, my son has been in the hospital several times and I never stepped out of the room, nor was I asked to.

[ZASHAGALKA, RN]

I am an adamant supporter of this

And I'm an equally adament opposer of this idea. But that's not to say there can't be a debate on it. And I can almost bet that this thread will get over a hundred posts before it's done.

There are just too many aspects of a code that cannot be interpreted through a lay person's eyes. And 'dumbing' down a code so as not to offend that lay person is NOT true advocacy of any kind.

You are an exception because you are not a lay person. I might suggest you leave, but I wouldn't force you out.

But to the lay person, "oops, I think I cracked a rib' is not what I want them to take away from their loved one's death. Codes aren't pretty, nor are they for the weak. But we want to put it out there that this should be part of the grieving process and the result will be to 'force' participation in an often gruesome event.

This will not last. Codes are, by nature, messy. Even if only 1 in a hundred family members wonders 'was that a mistake, why did the doctor yell about that' and even if only 1 in a hundred of them seek a lawyer, the malpractice angle of this practice will end it.

TO YOU, this would be closure. To a lay person, I believe this practice to be very close to negligence: we should know better and be better advocates.

And we haven't even discussed the Heisenberg Uncertainty Principle: The simple act of observing an event changes the system of the event.

~faith,

Timothy.

[PedsERRN]

We often allow families in the room for codes. We are a level one trauma center and have a social worker who stays in the back of the room with the parent and explains procedures. We will advise the SW if things are going to get bad, i.e. cracking a chest, and they will discuss with the family if they still want to stay. I've had parents thank me for letting them be there.

I've always worked peds, so it's not that much of a transition-we always have families at the bedside for everything else!

[ZASHAGALKA, RN]

IThe family members deserve to see their loved one in this situation.

I cannot disagree more. Reality TV has rid us 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.

[sirI, MSN, APRN, NP]

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.

Again, respectfully disagree. Yes, the family deserves to be able to view this process. Their loved one is not considered undignified to them. It is their child, father, mother..........

[DusktilDawn]

One thing that's comes to mind (thinking of the "man dies holding wife for epidural" thread) is how many lawsuits result from letting family watch a code.

Or a family member trying to run the code.

[Marie_LPN, RN, LPN, RN]

I agree with a CHOICE to watch it.

I don't think it's right to rule out anyone watching, to automatically assume what would be best.

[medicrnohio, RN]

I am unsure if I would want to watch a code on my family or friends. But I do support family being present during a code situation if there is someone present who can be there with the family member during the code. Unfortunately the hospital I work at now has a policy that no family members may be present during a code situation.

[ZASHAGALKA, RN]

I also am trying to respectfully disagree. I know your opinion has many supporters and some evidence, even if I believe that such 'evidence' can never be unbiased because it is almost always researched by those looking to support their already reached conclusions.

Let me elaborate some on my strong feelings about this.

The very first code I particpated in was my father's death. He died of, more than likely, a blown graft 10 yrs after his bypass surgery. I did CPR on him for 45 minutes, counting downtime at home and assistance in the ambulance.

Because my brother worked at the ER where we went, they coded him for another 40 minutes, out of respect. We (the ambulance crew and I) delivered him to the ER still in V-fib. As soon as the ER crew took over, I walked away.

I'd done all I could, and that was enough. (No need to offer condolences as this was 12 yrs ago and I've long ago come to terms w/ this.)

My father considered himself to be a powerful man. I grew up thinking about him in just that vein. My children know when to joke around and when the only right answer to me is, "Yes, sir!". That is my father's legacy. He would not have wanted the last living image he presented to his family to be, well, so powerless.

I think we've lost all sense of what is appropriate and what isn't. And not just here, but in society overall.

Forget about the trauma we can induce on the lay person for a minute. Forget about the Heisenburg Uncertainty Principle. To me, this is a matter of simple decency and respect to keep private what should be kept private.

I can see significant others attending births as a positive change over the past. It's important to be or feel like you are being a participant in life's joyous events. But this, this is different.

I agree that there needs to be closure. But, we already have societal mechanisms in place to obtain that closure. A code is not the right time or place for 'spectators'.

If we can't find better ways to come to terms with death than to be a gawking participant, then we have truly lost something as a society. The crux of ethics in many aspects of healthcare, to me, is the line between what we can do, and what we should do.

We should not do this.

~faith,

Timothy.

[Marie_LPN, RN, LPN, RN]

With all due respect, i do not feel that one person's experience should dominate what is best for other people.

And "appropriate" has a technical definition in the dictionary, but it has a different meaning to each person, for each or any situation. As well as "decency".