Sometimes it hits you... - page 3

It was five minutes till seven at the end of a long but good shift. I was on my way to fill my water bottle before giving report to the oncoming nurse. A nurse called out to me, "hey aren't you a... Read More

  1. by   canoehead
    SCORE!!! WE WIN!
  2. by   SwansonRN
    Would you mind telling me more about family presence facilitators? I am working on a project on my unit about inviting families to be present during codes and this role sounds like a really good idea!
  3. by   umcRN
    Quote from sarakjp
    Would you mind telling me more about family presence facilitators? I am working on a project on my unit about inviting families to be present during codes and this role sounds like a really good idea!
    What would you like to know?
    We have a training program for RN's who are interested, I am not part of putting that on so I'm not sure where they get the videos/handouts. We got funding for this because over the long term we are doing a study and hoping to publish about it.
    Essentially when a code occurs (or any kind of sudden decompensation ie needing rapid intubation) the family presence facilitator goes to be with the family (the facilitators are identified during morning huddle so everyone on that shift knows if we have one and who that person is). The facilitator is the liason between the medical team and family, they are RN's so can explain procedures to parents (coding/meds/line placements etc). Families are told that they are allowed to stay in the room if they can be calm and not hysterical, if possible they are allowed to be close enough to touch a hand or foot if they want to. If the patient is going on to ecmo that is a surgical procedure so parents cannot be in the room. In that instance they are invited to sit in the hallway outside the room and continue to get updates from their facilitator who never leaves their side. In the example I gave in my post the mother was already outside the room, I was able to ask her if she wanted to see/touch her baby prior to her going on ecmo and she wanted to, I then asked the doctor if that would be ok and she said it was so mom and I approached the baby so she could kiss her.

    For the study we have paperwork to fill out after each time family presence is used, those papers are located on the code cart with the code sheets.

    So far we have had almost no occurrences of families being disruptive and all appreciated being able to be with their child and observe resuscitative measures, there have also been several instances where families were present and they requested that resuscitation be stopped, most of those cases were kiddos who were not going to survive but parents wanted everything done anyways...until they saw what "everything" meant and they then decided they wanted to stop their childs suffering.

    If you have any other questions just PM me, if I don't know the answers I can ask one of the other nurses who is more involved in the actual study.
  4. by   SuperRN7
    I had a very similar experience. It was Christmas day and we were half way through having a fairly decent day when we were told we were admitting a DKA. Okay, not a bad admission usually. Unfortunately, she basically came up the elevator arresting. Poor tracing on ECG, O2 sats not picking up and we weren't able to pick up a BP on the monitor. And all the while the ER nurse making excuses for why she was like this. Within minutes of her arriving we were compressing. Parents hadn't even made it into the unit. After an hour of CPR we were trying to put her on ECMO and someone spoke up and reminded us of the parents. Me being the only person without my hands in something I went out and got family. I will never forget the reaction when they saw me... they asked me if I was there to tell them she was all better. I could have collapsed. Instead I was leading them into a code situation. I stayed with the family throughout the rest of the arrest including helping to explain to newly arriving family what was happening, picking mom up off the floor in the elevator and then listening to them tell the doctor to stop.

    Then I left at the end of my day to celebrate Christmas with my family...
  5. by   Liddle Noodnik
    Quote from SuperRN7

    Then I left at the end of my day to celebrate Christmas with my family...
    Wow, something you will never forget I am sure ...
  6. by   NotReady4PrimeTime
    I had one of those moments recently. I admitted an infant from an outlying hospital who had been seen in the ED for decreased urine output. Further history revealed a several day history of being unwell, a slight cough, some vomiting. The baby was also diaphoretic, small for age, mottled and significantly tachypneic. A chest x-ray revealed massive cardiomegaly so the kiddie was sent to us for assessment and maybe some HFNC. On arrival there was much crying and squirming, as one would expect from someone in the second half of their first year. The cardiology resident was already on the unit waiting for the kid so the echo was started right after we'd moved from the transport stretcher to the crib. About 10 minutes before the eventual end of the echo, the baby fell asleep... and my spidey senses started really tingling. The nap lasted only a few minutes and then the crying started again, but much less vigorously. Then, in the time it took the resident to call his attending, the baby's heart rate dropped from 140 to 120... then 100... then 70 and I was calling for the crash cart. We did CPR on and off for more than an hour with the inevitable cannulation for ECMO. The kiddie's mother and grandmother were in the room for the first part of the resus, and I remember hearing the mom say, "Is my baby dead?" several times. We moved them into the next room and let them watch through the doorway while we carried on with what needed doing. Every so often one of us would go to them and update them on what was happening. Both of them had been up since early the previous morning and were exhausted, but they stayed put. By 4 am things had settled down and I was able to really explain what had happened and what would likely happen next.

    This baby had a witnessed arrest and got good CPR. It's nothing short of a miracle that the outcome was virtually a complete recovery. The underlying extremely rare cardiac defect was repaired and after a few days of ongoing support, decannulation and extubation followed with the kiddie back to baseline neurologically. Sometimes we win one!