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?

[ClaireMacl]

From a personal point of view, I wouldn't like my last memory of my loved one being someone pumping on their chest.

I've been in the situation a few times where a patient has crashed while relatives are with them, it poses a few problems I feel. In the situations I've seen, the family will, understandably, become hysterical. Now, while this is a normal reaction, it can impede upon our efforts to begin CPR, I've seen a relative throw themselves over a relative and refuse to move - out of grief, so we have no way of accessing the patient.

Distraught members of families also mean that one of the team who should be assisting in CPR will inevitably be separated from the patient to calm the family and explain what is happening when their skills would be better used assisting.

Provided the family was not prohibiting me doing my best to save their relative, I would let them stay if that was their choice, but to be honest, its not something I would advocate. The situation does change, however, if it is a child. I don't think anyone has brought this up so far, but I think I would actively encourage parents to be present during CPR, provided they wished to and it did not impede upon treatment.

It's such a difficult topic to decide on. I don't think it should be ever encouraged as part of the grieving process, but should be guaged on individual cases.

[Tweety, BSN, RN]

From a personal point of view, I wouldn't like my last memory of my loved one being someone pumping on their chest.

I've been in the situation a few times where a patient has crashed while relatives are with them, it poses a few problems I feel. In the situations I've seen, the family will, understandably, become hysterical. Now, while this is a normal reaction, it can impede upon our efforts to begin CPR, I've seen a relative throw themselves over a relative and refuse to move - out of grief, so we have no way of accessing the patient.

Distraught members of families also mean that one of the team who should be assisting in CPR will inevitably be separated from the patient to calm the family and explain what is happening when their skills would be better used assisting.

Provided the family was not prohibiting me doing my best to save their relative, I would let them stay if that was their choice, but to be honest, its not something I would advocate. The situation does change, however, if it is a child. I don't think anyone has brought this up so far, but I think I would actively encourage parents to be present during CPR, provided they wished to and it did not impede upon treatment.

It's such a difficult topic to decide on. I don't think it should be ever encouraged as part of the grieving process, but should be guaged on individual cases.

This is why I think first it's important to have some sort of training and education, and the family members should have someone there supporting them.

My hospital asks family members to leave the room, and someone usually stays with them outside the room or walks them to a waiting room.

Fortunately I haven't witnessed any hysterics. Most family members cry and even sob outside the room, wondering what's going on, some trying to peek into the room. It's very important to have someone supporting this person, talking to them, explaining things to them, keeping them calm.

Again, we all have our stories and there are plenty of stories of family presence that didn't go well. There are also plenty of positive stories, even though it's a horribly tramaumatic experience for sure.

[casper1]

One thing I feel in absolutely essential if a family member is witnessing a code, is a dedicated staff member who stands by the family explaining code procedures and what medications are being given who provides support to the family during a trying time for everyone involved patient, staff and family.

[VickyRN, MSN, DNP, RN]

One thing I feel in absolutely essential if a family member is witnessing a code, is a dedicated staff member who stands by the family explaining code procedures and what medications are being given who provides support to the family during a trying time for everyone involved patient, staff and family.

ITA. If such a policy is enacted, then the facility must ensure that proper supportive staff are available. Otherwise, this will put inordinate stress on nursing and other interdisciplinary healthcare members, as well as exposing them to an increased risk of lawsuit.

[Ruby Vee, BSN]

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

anyone had this happen?

.

had a wife (somewhat dramatic under the best of conditions anyway) fling herself, shrieking at my nm. i suspect she was trying to fling herself into the nm's arms to be held, but nm wasn't prepared for the onslaught and went down on a floor already slippery with blood and body fluids, hysterical wife on top of her. that put a halt to family witnessing codes in that unit for awhile!

another wife became overwrought and jumped on one of the residents, screaming and whacking away at him with her oversized purse. chaplain that was supposed to be with the wife just stood there with mouth gaping open . . . not a pretty sight.

while i would want to be there for my family (and hubby wouldn't mind) i wouldn't want anyone witnessing my code. and in general, i'm against the whole idea. there's nothing wrong with a little staff comfort, either.

ruby

[ZASHAGALKA, RN]

EMERGENCY NURSES ASSOCIATION POSITION STATEMENT

Actually, this was the first place I looked when I was researching it.

In another thread (the now famous 'can you be a nurse without Jean Watson' thread), to you, I suggested that the politics of academia limits what the ivory tower gang can say that is relevant to the bedside. Those politics limit their research to what is 'academically' accepted by their peers.

Nursing academia is entrenched on this idea. They have drawn a line. Do you think an academic in nursing can now publish ANYTHING negative of FP? I don't. So, because it's now a political sin (or rather a CLM - career limiting move) for any nursing organization or academic to go against FP, everything nursing has to say on the topic going forward is biased.

Why? Because anything NEGATIVE about FP will not be published, plain an simple. Not in nursing, not by TPTB. If you only publish the results that support your opinion and conveniently neglect what doesn't, that is bias. I went looking into FP yesterday. Read the quotes I found on it. Do you think it's possible that I also found positive aspects of FP, aspects I conveniently failed to post. I admit it, I'm biased and opinionated on this issue. But. I'm not passing my input off as unbiased 'research'.

I think nursing academia could have brought this up short of making absolutes that alienate not only our other peers, but a good percentage of ourselves. This is a tough issue, with equally substantive opinions on both sides. But it's just like nursing academia to take a stand without regard to what ANYBODY in the real world, nursing included, think on the topic. (57% of nurses disagree with FP).

Nursing Academia is quick to point out that HOSPITALS must included bedside nurses from design to implementation on issues that affect the bedside nurse. But that are loath to follow their own advice.

~faith,

Timothy.

[canoehead, BSN, RN]

If a family member is witnessing a code I think all responsibility for their actions is removed (and they shouldn't have to feel guilty for that). But, I think that in a situation of life or death there should not be a person present who could possibly fling themselves on the bed and then claim it was the code team's responsibility to make sure they didn't interfere with the resuscitation. The code team already has a full and immediate obligation to the resuscitation. If they are in a situation where they are dividing their attention at all I think it is a breach of care to the patient on the bed.

Funny thing, I would absolutely, positively want to be there if my family member was coded, but I feel just as strongly that I would NOT want anyone witnessing my code. I can't put my finger on why, or how to resolve such an hypocritical personal opinion. Does someone else have the insight I lack?

[ZASHAGALKA, RN]

Funny thing, I would absolutely, positively want to be there if my family member was coded, but I feel just as strongly that I would NOT want anyone witnessing my code. I can't put my finger on why, or how to resolve such an hypocritical personal opinion. Does someone else have the insight I lack?

This is a common thought.

And it's EXACTLY why families cannot be surrogate decision makers for a patient in this situation. It is impossible to distinguish between your wishes as a family member and the potential wishes of the patient in this situation. And the gold standard for family members as surrogates isn't what they (the family) want, but their input into what the patient would want.

And the gold standard also isn't what nurses want the families to do, in order to create a standard.

Without a patient's actual consent, FP is a violation of privacy.

~faith,

Timothy.

[amnesia]

sorry but I just have to say NO!

With all critical responses/resusitative efforts being implemented in our familiar "organized chaos", during a code situation, I really feel that all energy needs to be directed to the PATIENT! What seems routine to us during a code is definately a horrific event for non-medical personel--especially loved ones. We really can not take on the additional load of providing family support and education during this crises. Sorry but NO!

[Katnip, RN]

If my son had been coded when he died, not in a million years would I have wanted to see his last moments like that. I'm already having nightmares, I don't need that added to it.

I think a lot of lay people think they want to watch, but the reality turns out to be a lot different than they expect.

Also, what happens when you get someone and you know it's going to be a 10-minute effort, but the family insists on making it longer just so see that the code team "did everything."

I know that anyone here who has been involved in a lot of codes has seen the patient who was futile from the get-go. But what do you do then? Continue with the code and tie up your resources for an hour just to make the family happy?

I just don't know. To be honest, I'm torn about the situation. I do agree about the privacy issue also. And in an emergency, who has time to look that up anyway?

[Tweety, BSN, RN]

Why? Because anything NEGATIVE about FP will not be published, plain an simple. Not in nursing, not by TPTB. If you only publish the results that support your opinion and conveniently neglect what doesn't, that is bias. I went looking into FP yesterday. Read the quotes I found on it. Do you think it's possible that I also found positive aspects of FP, aspects I conveniently failed to post. I admit it, I'm biased and opinionated on this issue. But. I'm not passing my input off as unbiased 'research'.

~faith,

Timothy.

Timothy, because you chose only to post opinions you found to validate your opinion is why I chose to post articles in favor of my opinion. Not to change your mind, but to offer information to other readers of this thread.

Also, when an organization like the ENA adopts a policy, they are going to put references to the research that supports their policy and leave the negative stuff out. The same as you and I just did. That doesn't necessarily mean bias, that's just backing up your opinion and your policy. One takes a stand, and one hopefully backs it up with facts.

I'm going to be naive enough to believe (as does the ANA and the American Heart Association), that the research so far supports family presence under certain controlled conditions. While it's very important to read with a critical eye, and take all research with a grain of salt and scrutinize it carefully for bias, I'm not going to believe that because someone in academia wants a certain policy, that there's a conspiricy to publish only positive studies. That is just too unethical for me to contemplate.

By the purist definition of "bias", most of the research is biased. Most of medical/nursing research is biased primarily based on the fact that the samples are small and localized, and usually voluntary, or samples of convenience.

[Tweety, BSN, RN]

One thing I feel in absolutely essential if a family member is witnessing a code, is a dedicated staff member who stands by the family explaining code procedures and what medications are being given who provides support to the family during a trying time for everyone involved patient, staff and family.

I completely agree. This person and the family member should be away from the "action". This person also should monitor this member and keep them from flinging themselves on anybody and if they get hysterical or can't handle it, to remove them.

There's usually plenty of people standing around during a code, or outside the room, that surely in addition to the other duties during a code, someone (preferably a chaplain) or a nurse who desires to do this, can be with the family member.

I certainly would not advocate a family presence policy without proper training of staff.