What has been your experience with family presence during codes?

fergus51 · Feb 6, 2005

I've only had parents in once during a code and it was a beneficial experience for them. Too often staff complains that we are being cruel in coding infants, but since the parents don't know what it entails they always want their infants to be coded. The family that actually saw it was willing to make their infant a DNR and said that it gave them faith that the staff did everything they could.

gwenith, BSN, RN · Feb 6, 2005

I know at least ONE paeds ED that encourages the parents to be present during resuscitation of a SIDS in particular. They said that they don't care if the baby is in Rigor they will do a full resus just so the parents can leave knowing that everything human that could be done was done.

imnmk_rn · Feb 7, 2005

I touched on this on a post on family visitation... (I guess I'm being wordy tonight)

I have had three experiences with families present during codes - two bad, one very good. Honestly, though, those two families probably would have acted almost the same if they had shown up after the code. Screaming, yelling, falling down on the floor, running up and down the hall just happened to be their way of dealing with it all. I can't say they wouldn't have done that if they hadn't seen the code. I don't know if it helped them accept the death or that everything was done.

A few questions I have for you - who are you planning to have accompany the family into the code to explain? A designated person (and if that person is not available, will someone automatically step in)? And are you addressing this with families the minute the patient hits the unit so you know what they want? I just read an article in Critical Care Nurse on this topic and it advocates knowing what patient and family desires are ahead of time... how realistic is this? How are you planning to deal with "crowd control" issues? (We have enough of a problem with all the clinicians that gather without families in the room too - some rooms just are not large enough.) I only ask these questions because I'm curious how you have dealt with it or how you plan to deal with it - I think in theory, it's great to allow families but I would like to have a plan in place for the realities of patient/family situations.

As far as the great experience I had with a family member present at a code - it was one of those times when in the very short time I cared for the patient (all of two hours) that were entirely involved in crashing and not making any headway, I had one of those days where I really felt good about my job, both the physical care for the patient and the care of the family. It helped that I got a lot of positive feedback from many people, as the patient was a radiologist at our hospital. I was working with two of our absolute best intensivists and an awesome pulmonologist who were essentially at the bedside the entire time, and I had the backup of top-notch nurses a few feet away even when they were not at the bedside with me. The patient's wife stood at the end of the bed, with one of the MDs and I kind of taking turns explaining things as we were able, and just having an ongoing conversation about where this was going, and the moment we had the crash cart there and were ready to code the guy, she said no, to just let him go. Then I had the (unique, at least on my unit) chance to spend the next few hours with my patient's family and doing all the postmortem stuff before I had to take another patient. I was able to meet other family members, and was able to be with the patient's wife as she brought her 5 oldest kids (ages 5-17) in to see their Dad after he had died. It was like nursing in the ideal world with ideal docs and ideal families.

LatinaRN · Feb 7, 2005

i touched on this on a post on family visitation... (i guess i'm being wordy tonight)
i have had three experiences with families present during codes - two bad, one very good. honestly, though, those two families probably would have acted almost the same if they had shown up after the code. screaming, yelling, falling down on the floor, running up and down the hall just happened to be their way of dealing with it all. i can't say they wouldn't have done that if they hadn't seen the code. i don't know if it helped them accept the death or that everything was done.
a few questions i have for you - who are you planning to have accompany the family into the code to explain? a designated person (and if that person is not available, will someone automatically step in)? and are you addressing this with families the minute the patient hits the unit so you know what they want? i just read an article in critical care nurse on this topic and it advocates knowing what patient and family desires are ahead of time... how realistic is this? how are you planning to deal with "crowd control" issues? (we have enough of a problem with all the clinicians that gather without families in the room too - some rooms just are not large enough.) i only ask these questions because i'm curious how you have dealt with it or how you plan to deal with it - i think in theory, it's great to allow families but i would like to have a plan in place for the realities of patient/family situations.
as far as the great experience i had with a family member present at a code - it was one of those times when in the very short time i cared for the patient (all of two hours) that were entirely involved in crashing and not making any headway, i had one of those days where i really felt good about my job, both the physical care for the patient and the care of the family. it helped that i got a lot of positive feedback from many people, as the patient was a radiologist at our hospital. i was working with two of our absolute best intensivists and an awesome pulmonologist who were essentially at the bedside the entire time, and i had the backup of top-notch nurses a few feet away even when they were not at the bedside with me. the patient's wife stood at the end of the bed, with one of the mds and i kind of taking turns explaining things as we were able, and just having an ongoing conversation about where this was going, and the moment we had the crash cart there and were ready to code the guy, she said no, to just let him go. then i had the (unique, at least on my unit) chance to spend the next few hours with my patient's family and doing all the postmortem stuff before i had to take another patient. i was able to meet other family members, and was able to be with the patient's wife as she brought her 5 oldest kids (ages 5-17) in to see their dad after he had died. it was like nursing in the ideal world with ideal docs and ideal families.

:rolleyes:

thank you for your questions. they are important ones and one i will bring up to my nurse manager.....when are we to address this with the families? sometimes codes are unpredictable and unexpected.

the person designated to explain the code is the nursing supervisor. their way of "crowd control" is to allow two family members during the code. this was never done at our hospital and it will be interesting to see how it actually plays out when it happens.

proudmommielpn · Feb 7, 2005

I myself think families being present during codes would be good as long as they had someone right with them explaining everything. They would have to be strong as possible because lets all face it, codes are not pretty they are cruel. That is why I have told my hubby when it's my time just let me go. It kills me to see families put their loved ones through a code and them being like 70+ and with numerous illnesses I mean why make them suffer? Some people think that all you do is shock them and then they wake up or someone gets up on the side of the bed and pushes on their chest a couple of times and kabam everythings ok but we all know that you don't just push you really put force behind it even breaking ribs. I just think families would benefit from seeing the code and that way maybe next time they would just say "Let them go". That's my 2 cents worth. LOL

Celia M, ASN, RN · Feb 9, 2005

We have a policy to allow family to be present during a code and we do that quite often, in fact we just recently used it. The designated person for family support is the nsg sup. The number is limited to 2 and they must stay out of the way and not interfere with the code. In general the outcome is positive and it helps the family realize what is being done to save their loved one and recognise when it becomes futile.