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 just finished a research paper on this topic. It was a review of literature. The results of most research, that's been done primarily in the ER and ICU is that it's an overwhelming positive experience for family members, and most nurses fears are unfounded. But you're not asking for a debate.

So to answer your question: yes, through sickness and health I would be with my spouse through it all, including codes no matter how ugly. It would give me closure.

Hopefully, I'd see it coming on and make them a DNR. My parents are elderly and have living wills, so we won't have to be subjected to them being in a code.

[bluesky, BSN, 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.

~faith,

Timothy.

That statement is true about all research.

[DidiRN]

I was always thankful that I never got to see my dad coded when he passed away. Maybe it's okay for some, but I'm darn glad I didn't watch it.

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.

.

[traumaRUs, MSN, APRN]

Good debate. In the end, most families want a choice. I work in a large, level one trauma center (inner city with lots of knife and gun club action). Our codes are very calm, organized with the minimum number of people to get the job done: one attending MD, two residents, two-RN's and one tech. Whoever is going to be the support person for the family (Pastoral Care or case manager) assesses the family and their wants/needs. We offer the chance for up to two family members at a time to be presence during CPR. We tell them there is no right or wrong decision, just provide a choice. We escort the family into the room after first speaking with the code team. Then, we stay with the family (we have told them exactly what they will see and hear prior to this). We allow them to touch their loved one - even if only a leg or ankle. In nine years of doing this, I have never seen anyone hysterical or disruptive. When I did my research for family presence - I specifically looked at studies that didn't purport to push family presence and even those studies had no one being disruptive. It all goes back to fully preparing families.

[mitchsmom]

Yes, I would probably want to be there.

I definitely think it should be a choice.

[gr8rnpjt, RN]

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

Timothy, your views are intelligent and insightful.

This is not a situation that should be witnessed by family members.

What about the patients rights?

What if a family member who is visiting is not someone the patient wants to see them in this situation. Supposing he has a good outcome after the code.

He could get better, find out that his ex wife or his crazy cousin whom he hates saw him in this situation and the patient could turn around and sue, because his privacy rights were violated.

Just MHO, but there are a precious few people whom I would want to see me in this type of situation, and I would feel very violated. Just because the people are there at the time of the code, it does not give the staff a right to let my personal rights be violated in this situation.

[BabyRN2Be]

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.

I'm just curious if anyone has seen this happen, family members becoming disruptive during a code.

Anyone had this happen?

Also, gr8rn has some good thoughts. It would probably be wise to find out who should be present at a code. I wouldn't want my privacy rights violated because my MIL, for example, decided she wanted to watch me code. BTW, she lives for drama and I wouldn't want her entertainment to be at my expense.

[ZASHAGALKA, RN]

If those that support families in codes move this issue along, it WILL remove choice in the matter from family members.

Once upon a time, family members weren't allowed in the L&D room. Now they are. And now, years later, do you think I had a choice to be there or not? I might have been able to tell the nurses no, but I certainly couldn't have told my then wife!!!!!!!!!!!!!!! (And if I had told the nurses NO, you can bet more than one of them would have commented about how unsupportive I was being) Nurses made this the standard, whether the people actually being escorted in wanted it or not.

When you set a standard, you remove choice from the equation (for all but the extremely initiated). Especially at a time when most people are paralyzed to choose. They will just numbly nod their heads and be led along.

But in the end, NOBODY is in the L&D room if the woman doesn't want them. It's now a right, but it's HER right.

And, unless specifically granted bythe patient in advance, HIS/HER right to privacy should rein paramount. I would argue that any less is not only a HIPPA violation, it's a violations of trust. It's an abrogation of our duty to protect.

We have mechanisms in place for closure without intruding into very personal areas - intruding without the permission of those whos 'rights' we are treading upon.

And like was mentioned earlier - codes are very stressful for nurses. That's why many hospitals have a time set aside to review those codes. Unless you are in a level 1 trauma center where codes are, yawn, routine, a code is the most stressful part of a nurse's job. And now we are expected to perform for an audience? Not cool.

I just don't understand where and when we decided that nothing is personal, nothing is private, and everything is subject to invasion. What next, will we set up cameras and sell DVDs of the code in order to help continue the 'closure' process? You think that sounds unseemly? Not anymore than allowing codes to become 'spectator sports' in the first place.

~faith,

Timothy.

[elthia]

I'm just curious if anyone has seen this happen, family members becoming disruptive during a code.

Anyone had this happen?

.

Unfortunately yes. They family members were shoving and hitting the nurses and then the code team when the code team arrived. They were screaming and cursing. Security had to drag them out of the room.

The patient did not make it, (80 something year old man, renal failure, hyponatremia, Stg IV decub that was infected).

the family threatened to come back and kill all the staff on the floor.

They were escorted off the premises by security.

Basically, the patient had been at home, brought in the day before by family, had large pension that family was "taking care of" for him.

[elthia]

I think it would traumatize me to see my loved one coded. Something that I would have nightmares about later. I'd rather not have a memory like that bouncing around in my head when I remembered that loved one.

[Tweety, BSN, RN]

There are always going to incidences of family problems during resuscitation, particularly if staff isn't trained well in it, and there isn't someone specifically with the family member for support. There may even be a lawsuit or two.

To me that doesn't justify taking away the choice of family members.

Yes, a long time ago for some of the same reasons men weren't allowed with their wives during delivery. Yeah a few men have fainted, been disruptive and sued. Still no reason to go backwards and take away the right of men. That is has now become a societal expectation that men be there,

and men feel they have no choice is true. But family precense in recusication have been occurring over a decade and I don't see any societal pressure yet to be present. The option should be offered but not pressured.

Codes are indeed a tramatic experience. This is why mock codes, ACLS and other education is important to help the nurses through. Educating on the American Heart Association and the Emergency Room Nurse's association's recommendations for offering family precense should be an educational priority as well. There's too many fears and myths associated with this when the reality has proven different. Yes, of course there are going to instances of disruption, nurse discomfort, lawsuits, etc. My opinion is give it a chance. Train the staff, have support available, and offer to appropriately coping people.

Thanks for listening.

[BabyRN2Be]

I think it would traumatize me to see my loved one coded. Something that I would have nightmares about later. I'd rather not have a memory like that bouncing around in my head when I remembered that loved one.

This is exactly what I think will happen to me. I will have nightmares about seeing my loved one coded and that's not how I would want to remember them. Also, I believe that my loved ones would not want me to have nightmares about their last moments here on earth.

As a pre-student nurse, codes scare me. I'll have to overcome that, yes. The thought of witnessing a code on a stranger scares me, and I think it would be worse for me if I witnessed the code on a loved one, such as my husband, dad, mom, or brother.