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?

[mhull]

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.

I am getting ready to write my Ethics in Nursing paper on this. Will you share with me your sources? I need a few more. Also if anyone else has any good literature about this, please post it, PM me or something.

[sirI, MSN, APRN, NP]

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".

I agree.

[suebird3]

I don't like the idea of family in on codes. Why? Several factors. If the patient makes it through, but has brain damage/the high rate of lawsuits. If the patient doesn't make it, "we didn't work hard enough."

Tim.....you have a good point, also. Thank you!

[ZASHAGALKA, 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".

I disagree with this statement. If appropriateness and decency are subject to EVERYBODY'S individual preferences and meanings, then NOTHING is appropriate or decent. Or EVERYTHING is.

Such standards are set by society, hence the phrase 'societal standards'. As the front line of healthcare, this standard WILL be set by us, either pro or against. OR rather, the standard was set long ago and is being challenged by the 'current' thinking.

It's not anymore 'wrong' for me to hold to the status quo than it is for somebody to advocate changing that status quo.

I agree that it's a decision, but it's not an individual decision, it is, in effect, OUR decision.

Before you change a standard, you do well to examine why the standard was implemented in the first place. This standard was set because 1. WE deemed it irrespectful to display loved ones in such a state. 2. When you subject grief to unpredictable processes, you get unpredictable results. This is why funerals are CAREFULLY ORCHESTRATED events. 3. The Heisenburg Uncertainty Principle (HUP) - the act of observation changes the event. In this case, it promotes restraint for sake of family. That restraint, by definition, prevents 'all out effort'; it restrains those efforts. 4. In an age of rampant 'defensive medicine' to avoid suits, why on earth would you purposely expose emergencies to such measures. Now, instead of ensuring that every possible HELPFUL measure was done, we are ensuring that every possible measure is done.

To say that everything and nothing can be decent or appropriate is to deny that we live in a world governed by STANDARDS. This is why it's so hard to regulate Media. What is Media? I know it when I see it.

What is appropriate and decent? I know it when I see it, and this isn't it.

~faith,

Timothy.

[grannynurse FNP student]

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 :balloons:

[canoehead, BSN, RN]

In all the chaos of a code I was recording on suddenly no one was doing compressions and I was able to shout it out, along with reminders that it had been so many minutes since the last drug and could we give another dose. Many times the docs will ask "does anyone have any ideas?" and we all problem solve out loud. Teaching happens during codes, especially when using pacers or defibrillators. Sometimes we have a doc that doesn't know the patient and we need to give a report on what led up to the code, sometimes the circumstances are not flattering for someone in the hospital. All those situations could be remembered by family and leave them with the feeling that something was done incorrectly or not soon enough. sometimes things ARE done incorrectly, and we need to state it bluntly in order to get to a solution and save a life.

I also think that ours is a profession where we give endlessly, and sometimes to the point of breaking. I think we MUST take 2-3 minutes after a code, and before speaking to family, to collect ourselves and offer support to each other. People that work the codes are human too, and we have gone above and beyond to put the patient first throughout the development of the profession.

As a rule we do not expose ourselves to blood and body fluids, we take the 30 seconds to put on gloves. We don't lift 250lb alone. Caring for both the patient and family during a code is like lifting 250lb. It may be good for the one patient at the time, but not as a long term standard of care. We lose too many good workers with injuries, and eventually the patient (or family) is going to be hurt as well.

Thank you Timothy for your well thought out points.

*************

I am a dogged family advocate in my practice, but this idea is a "300lb" one for me. I have to have that minute to breathe after a code, or my ability to function for the rest of my shift is gone.

[ICRN2008, BSN, RN]

I believe that it is not in the best interest of the patient for the family to be present during the code. At my hospital, the rooms are small as it is. During a code, there are a ton of people in the room, and at least a few of them are the excitable types that feel the need to shout and run. (We don't have many codes, I'm sure if there were more they'd learn to calm down.)

The patient's care could be compromised because the family member is asking questions, getting in the way, or getting worked up themselves (can you blame them?).

The primary objective during a code is to get the patient breathing/heart beating, is it not? There are many other opportunities for the family to be involved in the patient's care without additional stress to both them and the health care team.

[fergus51]

I used to argue that families have every right to be present for a code. Now, after having participated in more of them, I see the problems more clearly. I would not want my family present if I was ever coded. Hopefully my rights to dignity and privacy still outweighs anyone else's rights.

[SmilingBluEyes]

I think it should be their option. Some want to see EVERYthing is being humanly done.

[BabyRN2Be]

Thank you for all of your replies. I'm about half way through and the arguments for/against are very interesting. I'll definitely read more tomorrow when i'm a little more awake.

I wanted to say for now, one of the advocates for families watching a code is that it gives them the chance to say "goodbye" at the moment of death, not after death has been pronounced. My feeling is that at the moment of death, the person is probably not conscious enough to say anything meaningful. As codes are often a messy, gruesome spectacle, I think that it would be just as well for me to say "goodbye" after some cleanup has been done, so I could remember that person sort of as they were, and not being "railed upon" heroically trying to stop the inevitable.

I'm fine with families wanting to watch a code, but if they get in the way and start to run the code, or otherwise become disruptive, I can see how it can be disruptive.

[DusktilDawn]

I have had families outside the room when there has been a code. There were able to see that the staff were doing their best for their family member, however, they were not close enough to see all the "gruesome" details that occur during a code. They also didn't interfere during the code, nor were they asked to leave the area, escorting them elsewhere was not a priority at that time.

I believe most families would want to be near enough to see that something was being done but not be in the room to witness the gory details up close.

The present facility where I work, I cannot imagine family IN THE room during a code with the 10 or more staff +equipment, the rooms are too small at this place.

I would be curious to see some posts where family members have been present and disruptive during a code. This is a situation I can easily see happening, although I believe it would be the exception.

[Gompers, BSN, RN]

No, I wouldn't want to watch.

I wouldn't want my last memory of a loved one to be an image of them being coded.

JMHO.

ETA: This is just an answer to the original question - would I want to watch a code. I do feel like it's a personal opinion though, and that it should be allowed if the family wants and doesn't get in the way. I work in the NICU, and parents are encouraged to be at the bedside during a code.

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