Family presence during resuscitation is a hot topic. We are all faced with a better-informed public then ever before. allnurses recently discussed this topic with the expert: Dr Cathie Guzzetta.
Cathie Guzzetta, PhD, RN, FAAN, is a nursing mentor, consultant and award-winning researcher who is focused on the importance of holistic care. She has served on the clinical faculty at George Washington University School of Nursing, Washington since 2007.
Dr. Guzzetta received the AACN Pioneering Spirit Award on May 16, 2016, at NTI 2016 as the preeminent nurse expert on family presence - and as the consummate mentor of pediatric patient care research by nurses at the bedside.
allnurses.com was fortunate to have the privilege of interviewing Dr. Guzzettaon the same day that she received her prestigious award. "I've worked on adult and pediatric family presence during resuscitation since 1994, " she stated to Mary, allnurses Community Manager during the interview. Nurses at that time questioned why families were not present during resuscitation. She related a story from earlier in her nursing career where family presence during resuscitation of a fourteen year old boy was honored, but the nurse was admonished and almost lost her job for doing so. She went on to reiterate the importance of family integrity during these very stressful situations.
Holistic Nursing
Holistic nursing is the framework for family presence and spans birth to death and emphasizes family involvement in every patient care unit. ICU is frequently the location where end of life decisions are made. Nurses that staff these units want to be the best of the best. So, utilizing family presence fits this goal of being at the top of their game.
Some holistic nursing techniques include
Visualization
Guided imagery
Distraction
Partnering with the patient to meet the outcome that the patient wants is also extremely important. This is relevant to both adult and pediatric patients and families. Nowadays patients and families demand family presence and shared decision making. With the advent of information readily available on the Internet, patients and families are better informed than ever before.
Family Presence During Resuscitation
Dr. Guzzetta relates that in pediatric resuscitation research shows that 97-99% of parents want to be present. In adult resuscitation the numbers are approximately 87%. However, in all instances the families' wishes must be honored and respected. Families often feel the need to be present but also experience some ambivalence during the event. Research has also proven that despite the fact that families wish they didn't have to make the decision about family presence, they are universally positive that they made the decision to be present. Sometimes this is the last act they can give their family members.
The Emergency Nurses Association has well established practice guidelines for family presence. AACN has also recently updated their guidelines as to family presence. These are all based on the latest research and provide much information for nurses.
We want to publicly thank Dr. Guzzetta for her time. Her research and authorship of many books on the subject of family presence have elevated nursing professionalism and brought this topic to the forefront of many discussions in the medical community.
What has been your experience with family presence?
Does your facility promote family presence and shared decision-making?
We let families come in. Our rooms get crowded, too, but there's usually some space against a wall somewhere that family members can stand.
Most are very well behaved during a code, and don't get in the way. We've only had to get one family out of the room because they were being disruptively loud, at least during the ones I've been to. We had one wife who stood at the edge of the bed and held her husband's feet the whole time once, but she was still (and a small person) so even she didn't interfere with what we were doing in any way.
It gives families closure, and really shows them we are doing everything we can. Another benefit is the families that watch more often than not end up telling us to stop at some point, so family presence is helpful in that we don't spend forever coding someone who is a futile case but a full code.
calivianya, you bring up such a valid point. The families, when they see what a REAL code looks like and sounds like, very rarely do they ask to continue indefinitely!
Family presence helps with closure both for the family and for us - we did our duty to the pt and the family and respected everyone's wishes.
I can't help but to chime in on this discussion. My question is: Is this what the PATIENT wants? If I were in the situation, as a patient,...I would NOT want my family present.
It may be great for the staff and onlookers...but what about the patient?
I can't help but to chime in on this discussion. My question is: Is this what the PATIENT wants? If I were in the situation, as a patient,...I would NOT want my family present.
It may be great for the staff and onlookers...but what about the patient?
In my experience, when the patient is sick enough to code, the patient hasn't had his/her wishes followed for a long time anyway. I can't tell you how many DNR/DNI patients I've seen intubated and coded the second they pass out because the POA wants what the POA wants, and rarely does that match what the patient wants. Patients have no rights once they lose consciousness if they've designated a power of attorney.
I personally plan on hiring a lawyer to be my POA, preferably someone I don't even know. Family members have a really tough time looking past their own wants to honor what the patient wants, and I don't want to be coded against my will.
99% of the time, family members are allowed in our resuscitation room; mainly because it's a PediED.
We have social work, child life and even the chaplain available, sometimes in the room during the effort.
I can recall one time that a parent ended up feeling faint during the event, and one parent didn't want to go in at all; but most of the time the parents want to be there.
I think it's a good idea to offer the choice to families. I think they need to know what it is we're doing, whenever possible.
Most of the codes I've been in have occurred in the OR. We do not allow families "back" with us. Typically the only exceptions are some pediatric patients where Mom/Dad/familiar person comes back for anesthesia induction. Then it's hard too because everyone wants to be there but nobody is every really prepared to see anesthesia induction on their kiddo.
People do not want to see what codes in the OR look like. If I could avoid it I would. The ones I've been in have been bad. The few I've been in where resuscitation was unsuccessful - probably look roughly the same as a crime scene. Even some cases where we don't run codes look like that...
1. Many times a pt's wishes are disregarded way before a code situation occurs - this is the time to bring in SW, palliative care, etc., to discuss plan of care, how far treatment should go and "what happens if?"
2. Agree that most pedi-codes most parents want to be with their children. That is what Dr Guzzetta's research has borne out also.
3. I think I speak for all nurses when I say we want to be mindful of our pts wishes in all cases.
Our local EMS protocols changed several years back and now (unless there is a safety issue or extenuating circumstances) we typically work the patient on scene. Often family members are present. We try to have someone designated to provide support/ explanation to the family.
When we first implemented this, I was very concerned but my view has changed. From feedback from families, most of the time they appreciate the effort placed into resuscitating their family member and some that I've encountered later have expressed how it helped them during their grief process.
I say let them be there, if they wish, as long as they don't get in the way.
However, from my personal experience, I would NOT want to be present to see a family member of mine being resuscitated and can't understand who would want to. Unfortunately, a little over a year ago, I had to leave work and go to the ER (in the same hospital) because I was told that my Mom was sent there. I was scared; I didn't know what was going on. When I found her and saw her unconscious, my world came crashing down. When the Rapid Response nurse identified who I was and told me she had coded upon arrival, I broke down. Even though I wasn't there, since I have seen how CPR goes and knowing that my dear Mom went through that tore me up. They got her back, but she was only with us 6 more days until I lost her. I can barely handle a code now, even when they aren't mine. I nearly had an anxiety attack last week after just seeing the Code Team; I didn't even see the patient. It brings back sad memories. I thought I had healed some, but apparently not.
calivianya, BSN, RN
2,418 Posts
We let families come in. Our rooms get crowded, too, but there's usually some space against a wall somewhere that family members can stand.
Most are very well behaved during a code, and don't get in the way. We've only had to get one family out of the room because they were being disruptively loud, at least during the ones I've been to. We had one wife who stood at the edge of the bed and held her husband's feet the whole time once, but she was still (and a small person) so even she didn't interfere with what we were doing in any way.
It gives families closure, and really shows them we are doing everything we can. Another benefit is the families that watch more often than not end up telling us to stop at some point, so family presence is helpful in that we don't spend forever coding someone who is a futile case but a full code.