Survey: Should family be present for a code?

RNKitty · Nov 16, 2001

Not only is it compassionate to allow the family to be with their loved one until the end, they also can see how hard you work to save them and how much the doctors and nurses truly care about their patients. I work OB and have participated in neonatal codes at birth, one that was unsuccessful. The father was able to touch his baby's feet and pray, which mattered very much to this family. Unless they are disrupting the work that needs to be done, by all means include the family.

hoolahan, ASN, RN · Nov 16, 2001

Sorry Brian, for me it isn't as black and white as yes and no.

I am fine with a family being at a code, for the reasons RNKitty has mentioned, but only

If the family wants to be there, and

If there is an available staff member, preferably a nurse, who can describe what is happening. I've had a few people practically faint when I drew blood from a family member.

But, for the record, I have had family members present in codes and it has never been a problem.

deespoohbear · Nov 16, 2001

I agree with the poster who said it just isn't yes or no. There would be a several determining factors on whether I would be comfortable in letting a family in on a code. First of all, does the family want to be there? Can a nurse who is not involved in the code stay with the family provide the information and support the family would need? Is the family going to stay out of the way? I know this may sound cold-hearted to some, but the family must not interfere in any way with the resusciatation effort. The thing I would be afraid of would be that hysteria would develop, and then control of the situation would be down the tubes. I wish more people had a chance to view a code being run on someone so they could more wisely make decisions regarding code status. I believe that most people who have no medical training are clueless in what happens in a code situation. I think they believe it is like it is on ER, where most of the patients survive without any longterm consequences. I truly believe that educating families about code status is where area where we are truly lacking, at least at our facility.

betts · Nov 16, 2001

Findings:

Ninety-seven percent of the families believed they had a right to be present with their loved one during IP/CPR and 95% reported that it helped them to realize the seriousness of the patient's condition and know that everything possible was done. Families reported that the visitation was an overwhelmingly positive experience that provided the opportunity for comforting, bonding and connectedness, a reminder of personhood, closure, and meaning. Although 76% of healthcare providers said they supported FP during CPR, a higher proportion of nurses and attending physicians supported it than did interns/residents (P=.001). Thirty-eight percent were concerned that families might become disruptive although no such incidents occurred in any of the visitation cases. Some were concerned about the psychologic effects of the visitation on family members and that the family might misinterpret the activities of the team. Eight-eight percent thought the FP program should be continued at our institution.

Conclusions: The tolerance of family members to being present with their loved ones during IP/CPR challenges current thinking of physicians and nurses. Most families, physicians, and nurses found the experience embodied more benefits than problems. Healthcare workers should explore ways to implement this program nationwide to best meet family needs.

P_RN, ADN, RN · Nov 16, 2001

I agree with Hoolahan, it isn't a yes or no proposition. I recall one arrest that the LPN and I had on our team. The dietary aide was doing CPR.

I started the monitor, IV, O2 etc, with the aide doing compressions, and the LPN doing the Ambu. In a matter of seconds the team arrived and we were relieved. The aide stood aside, the room being so crowded she could hardly have made the door if she had tried.

The patient did not make it though. When the doctor was calling it, we then, and only then learned that the patient was the mother of the aide's fiance. What dignity she showed. She was sad of course, but she was also glad she could see what was done for her future mother in law.

She was present with her "family member" when the son could not be, because he was in the military in Germany.

Slowone · Nov 16, 2001

I would like to share the one experience I've had with family in the room during a code. 70 ish yo male, s/p MI, was very stable and was goign to be discharged that day.

PT came to do a discharge evaluation and had the guy do a couple flights of 5 steps. He went up and down twice at his own request and tolerated it fine from what we could see and his tele showed NSR as well, family was there cheering him on.

He was being walked back to his room which was about 100 feet away and he collapsed in the hallway and the code began, we lifted him up and took him to his room which was only a couple yards away and the code team showed up. The code only ran for about a minute or so until the primary care RN informed of the DNR status.

The family refused to step out of the aleady crowded room and was yelling out the door at the Physical Therapists "you killed him, what do you think you were doing? You killed our father!" They yelled at one of the RT's for dropping his denture by accident stating that he will pay for those if they were cracked!

When the code was aborted they flew off the handle and demanded it continue or they will sue the hospital. The gentleman was very lucid and has his own POA, his wishes were respected and he died.

it is a siuation where you can never tell how a family will react, but saving the patient is the primary focus and if family is in the way, out they should go, social services should be there to pick up.

It should be based on a case by case situation. Imagine if your child or parent were dying and you were not allowed to be there! Scary!

nurs4kids · Nov 16, 2001

Absolutely not!! That is, unless it's me present with MY family member

lennim · Nov 16, 2001

I work in a small, community hospital & we have been doing family-witnessed resuscitation for the past eight years or so....... we have never experienced a problem with family members being present. We offer the family member the OPTION of being present & remain non-judgemental of their decision. The families have voiced positive thoughts about their experience & are truly appreciative of being with a loved one during a crisis/or their final moments. It truly is a blessing to allow an elderly couple to be together during a final breath or to allow parents of a toddler, who has drowned, to stay together during futile resuscitative efforts.

The one hurdle is Physician acceptance. It is NOT their choice. It is the family's choice.

Give it a try......

**canoehead, BSN, RN** · Nov 16, 2001

Some family members insist on being right beside the bed, or ask continuous questions, or get angry or hysterically sad. Any of these situations will interfere with patient care and at our small hospital there is literally not an extra person anywhere to stay with family 1-1.

If a family member is already at bedside when the code is called and stands back, and is able to hang in there until someone can address their needs I will not tell them to leave. If someone goes down the tubes we don't go and get family, and actually will actively request that they wait until we get the patient "settled" if they interfere with interventions or concentration. It may be unfair but at times the health care team has needs too, and I think the family's right is to get a full explanation, and sometimes an apology, after the crisis, not during.

housoj · Nov 16, 2001

I agree it would be a holistic measure to include the family in a resusitation situation, but in the area of the country in which I work it would be impossible. The Rio Grande Valley of Texas has the highest rate of law suits against medical professionals in the nation. Unfortunately, when we have tried to include family members it has been met with as much as multiple faintings and hysterical yelling and throwing of themselves on the floor in front of the code team. I was even involved in a situation where a family held a dead body hostage for over four hours because they refused to believe she was dead (Even after 2 seperate physicians pronounced her in front of the family). I have to say that both cultural as well as legal aspects need to be considered prior to allowing them in the room.

debbyed · Nov 16, 2001

If there is someone there to explain simply what is happening and to answer their questions.

Since many codes are unsuccessful this is the last time a family member will see this person "alive". It gives thwm a chance to say "I Love you" and in many cases this is important to the surviving family member. Sometimes we leave our loved one and forget to say I love you or maybe there has been an agrument and the last words were wounding ones. We'd all want a chance to say that last I Love You.

This also gives a family member a chance to see that everything possible was done which assures not only them but the rest of the family.

All that said......I think it should be allowed when requested. When a family member asks "May I stay" or arrives during the code and says "May I see him". I don't think it should be offered to a family member who has not asked. I wouldn't want to make a person feel that they should be there when they don't want to be.

I'm a firm believer that family should be involved in all aspects of a patients care as long as the patient either agrees or is unable to agree (ie: unresponsive). From personal experience I can tell you that there is nothing worse than sitting in a tiny room, knowing that there is something seriously wrong, but not knowing what is happening. When left alone many pictures form, none of them pretty. By allowing family they understand that everything possible is being done that can be done.

Well I'm rambling.........but you get the idea.