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?

[Mommy TeleRN, RN]

Here's my question:

When someone codes and a staff goes to get the family..is there ever any arguing over WHICH members are going to go? Obviously you can't let a whole family go... what if it ends up in a lot of resentment because Sue was allowed to be there when Mom passed but her brother, Aunt, etc weren't.

[ZASHAGALKA, RN]

When someone codes and a staff goes to get the family..is there ever any arguing over WHICH members are going to go? Obviously you can't let a whole family go... what if it ends up in a lot of resentment because Sue was allowed to be there when Mom passed but her brother, Aunt, etc weren't.

This is why we need to sell DVDs - so everybody can watch.

A tad bit of sarcasm there, but I was doing some on-line 'research' on this and there was actually a debate in a VA teleconference on Ethics whether videotaping a code was 'over the line'. It was, barely. But it seems to be where we are heading.

I noticed, during my look, that the Docs are strongly against family presence (80%) and nurses are 57% against this practice - from a 2002 study from the journal 'Chest' as reported in the Wall Street Journal 10/12/04.

I also noticed that most of the so-called advanced nursing research on this issue was widely dismissed by the various DOC organizations because they couldn't find any studies that fielded more than 50 participants, and, in most cases, those studies included BOTH codes AND lessor invasive procedures. One of the so-called landmark studies involved only 19 resusitation events. 19!? And this is where we are hanging our hat for national standards?

I was also interested to discover that only 5% of hospitals have a family presence policy. By simple mathematics, I can deduce that 95% do not.

Finally, while I wasn't surprised to find that 'nursing research' stressed the need for more indoctrination (um, education) on the topic, I was fairly surprised that most organizations that addressed the topic emphasized that it was inappropriate in situations where staff members would be greatly distressed by its implementation.

I want to point out that I am not speaking of pediatric codes, and none of my comments thus far have been directed at pediatric events. Parents have the legal right to speak for their minors and to make decisions for them. While I have other concerns about family presence, my major concern is the unseemliness of trampling on somebody's right to privacy, a right that cannot be evaluated at that point. That's not the case in pediatric events. In addition, the death of a child mitigates my other concerns. It doesn't eliminate them, but it tips the balance to parental participation. But, the concept of full parental participation with a minor is not as new or greatly controversial a topic as the topic under discussion.

~faith,

Timothy.

[Spidey's mom, ADN, BSN, RN]

I was involved in a code when I first became a nurse. A young Native American man was being coded, his Native American wife was standing in the room with arms raised, praying and the rest of his family were around the bed. We coded him for over an hour because the wife was positive that she could pray hard enough for him to live. Our doc couldn't persuade her to stop. She got angry with anyone who tried to talk to her. We all took turns, had to call in extra staff to help from the ER, it was awful.

Finally the young man's brother took his sister-in-law's arm and pulled her from the room and talked to her firmly that her husband, his brother, was gone. She finally let us stop.

It was very difficult.

steph

[sirI, MSN, APRN, NP]

I noticed, during my look, that the Docs are strongly against family presence (80%) and nurses are 57% against this practice - from a 2002 study from the

I also noticed that most of the so-called advanced nursing research on this issue was widely dismissed by the various DOC organizations because they couldn't find any studies that fielded more than 50 participants, and, in most cases, those studies included BOTH codes AND lessor invasive procedures. One of the so-called landmark studies involved only 19 resusitation events. 19!? And this is where we are hanging our hat for national standards?

I was also interested to discover that only 5% of hospitals have a family presence policy. By simple mathematics, I can deduce that 95% do not.

Finally, while I wasn't surprised to find that 'nursing research' stressed the need for more indoctrination (um, education) on the topic, I was fairly surprised that most organizations that addressed the topic emphasized that it was inappropriate in situations where staff members would be greatly distressed by its implementation.

~faith,

Timothy.

Would relly like to see the "linked" source/article name/year, etc. Some of these comments/studies are more than 3 three years old

[sirI, MSN, APRN, NP]

.

I want to point out that I am not speaking of pediatric codes, and none of my comments thus far have been directed at pediatric events. Parents have the legal right to speak for their minors and to make decisions for them. While I have other concerns about family presence, my major concern is the unseemliness of trampling on somebody's right to privacy, a right that cannot be evaluated at that point. That's not the case in pediatric events.

~faith,

Timothy.

Why aren't adult deaths just as important? Just as hard on the family member?

[Spidey's mom, ADN, BSN, RN]

Why aren't adult deaths just as important? Just as hard on the family member?

I'd say I have to agree that the death of a child is a special circumstance that, for me, would be harder than any other. I just asked my husband "what do you think would be harder. The death of an adult or the death of a child?". He said "A child".

steph

[sirI, MSN, APRN, NP]

I was involved in a code when I first became a nurse. A young Native American man was being coded, his Native American wife was standing in the room with arms raised, praying and the rest of his family were around the bed. .........Finally the young man's brother took his sister-in-law's arm and pulled her from the room and talked to her firmly that her husband, his brother, was gone. She finally let us stop.

It was very difficult.

steph

Believe me, I can relate.

[Spidey's mom, ADN, BSN, RN]

Believe me, I can relate.

We have a large Native American community here. The women are very tough - strong - outspoken.

steph

[sirI, MSN, APRN, NP]

I'd say I have to agree that the death of a child is a special circumstance that, for me, would be harder than any other. I just asked my husband "what do you think would be harder. The death of an adult or the death of a child?". He said "A child".

steph

I agree....the death of a child is heartbreaking and probably the worse thing that could happen to me.....but,.....

The issue here is that the comment was pedi family members on a code are o.k. and not on adult codes. Double standard employed here.

[sirI, MSN, APRN, NP]

We have a large Native American community here. The women are very tough - strong - outspoken.

steph

Yes, we truly are...... :balloons:

[Spidey's mom, ADN, BSN, RN]

I agree....the death of a child is heartbreaking and probably the worse thing that could happen to me.....but,.....

The issue here is that the comment was pedi family members on a code are o.k. and not on adult codes. Double standard employed here.

I'll have to go back and read that . ...I didn't see it.

steph

[ZASHAGALKA, RN]

Why aren't adult deaths just as important? Just as hard on the family member?

I didn't say this, even though I WOULD take the position that the death of a child is more traumatic.

I SAID that a parent can make decisions for a minor. An adult is different. If you truly believe that we should go down this road, then consent to witness should become part of advanced directives.

Unless that patient gives expressed consent for witnesses, then it is a violation of right to privacy. We cannot boldly declare that patients have rights, unless of course WE decide they aren't worth merit. The inherent problem is that a crashing patient cannot consent to witnesses. And a potential witness cannot understand the ramifications of what is being offered to them.

This reminds me of the old days, where a patient's advance directives ended the moment a family member objected. It's basically what we are saying now: a patient's right to dignity is only as good as a family member's objection. Only, it's not the family members, per se, violating that right and dignity. It's US, for offering to undermine it.

I wouldn't call this advocacy. (and consent is only one of many concerns).

As far as citing my material, I was compiling it on Word and the program crashed. I'll have to go back over it again - but alot of the data comes from AAST (amer assoc of surgery for trauma), the ENA (emergency nurses assoc) and, I believe, the College of ER Physicians.

Siri, you said you did a thesis on this topic. Can you quote a study w/ a significant statistical population? If we want our colleagues to take nursing research seriously, then we must apply the same rigid standards that we expect of others.

I'll be back after I recompile some data.

~faith,

Timothy.