Families are the basic unit of our society. One of the most stressful events in a family occurs when a member has a health crisis and comes to the emergency department. Family presence is often the only comfort these families can provide to their loved one who is seriously ill or critically injured.
Families should be allowed to remain with their family members during resuscitation or invasive line placement, with appropriate support mechanisms in place. “Family members are frequently not given the opportunity to remain with the patient during invasive procedures, including resuscitation efforts” (Emergency Nurses Association (ENA), 2004). Many factors influence this decision including healthcare providers’ perception that it will be too stressful on family members. The American Heart Association recommends giving family members the choice to remain with their loved ones during resuscitation efforts (Shelton, 2000). The American Nurses Association (ANA) Code of Ethics “has been acknowledged by other health care professions as one of the most complete. It is sometimes used as the benchmark against which other codes of ethics are measured” (ANA, 2005). The first part of this code states that nurses must provide services with respect for human dignity. The most undignified act all mankind experience is death. To give dignity to patients during the resuscitation process is to follow the ANA Code of Ethics (ANA, 2005). This is why family presence during resuscitation or invasive line placement is an important policy to have in place.
References:
American Nurses Association. (2005). Code of Ethics.
I work in a busy ER that gets most of the patients from the south side and housing projects, as well as the Salvation Army homeless shelter. We are the main receiving point next to the LSU Charity hospital, so we get a lot of all the usual traumas daily. We do have some really wonderful staff, from MDs, nurses, and ER techs, and everyone is always ready to lend a hand in a crisis.
If EMS is en route with a code and we have been made aware, our secretary activates the code pager system to include resp, xray, the other usual staff and also the priest. It is a Catholic facility, so during the week on days, we usually have at least 2 clergy in house, also case mgrs and social workers. Our clergy, I feel, are just wonderful, and I have seen them arrive even before resp therapy arrives. We have a room that is kind of out of the way so to speak, from the usual ER hustle and bustle. It is nice, and can handle quite a large family. Dimly lit, and has a few couches, chairs. The clergy first talk to the family and are in and out of the code room if they can get in so they csn assess the situation, and also brief the family. Then they, or we if on nights, feels the family out as far as who would like to be in, their physical health and anxiety level at that time. They usually just take 1 at a time, and we actually don't have too many that want to go in. We keep a w/c just outside the door to the patients room, but out of the way of the staff. He will kind of explain in laymans terms what is going on and why it is being done.
One patient I remember in particular, coded and his wife was at the bedside. She refused to go in, which if they feel that way, I am more than happy to just let them stay in the family room, and get updates. This wife was just hysterical, and sobbing when I got her in the w/c. I would go in and see the status and return to the wife. and quietly talk to her "They have the tube in to help him breathe...his heart is just in a bad rhythym and the doc is foing _____ to fix it...Were giving this medicine to _____. This little lady, I felt so bad for her, she was just grief stricken and had no family at all. She looked up at me from her w/c and said, "Why are you telling me this? Is it because he is dead?!" I said, "Oh, no maam, The doctor is there and ... " And I told her, "I am coming out to let you know what they have going (what she could understand or tolerate) because that is your husband. If my husband was in there and coded, I would like to be able to know what is going on so you know how he is doing right now." She looked up at me again, eyes full of tears, and said, "You are the first person to ever do that for me. It is just so scary to just have to sit here by myself and not even know if he was alive or dead."
I kept my composure at the time, but when we were done, I had to go to the ladies room to catch a few tears that I knew were coming.
I have only had 1 patient where the family members were in the room, and we had to crack the chest. I was escorting them out and one ran up to the bedside and actually tried to put her hands inside the chest cavity while the MD was getting ready to defib with the internal paddles. Needless to say she got escorted out pretty dang fast!
Ilovemypuppies - sounds like you are a very compassionate nurse. It does take a toll on us as caregivers to see so much death and destruction. Like dogs, it helps so much to have EAP counselers readily available. Also, critical incident stress debriefing is helpful for an especially traumatic event.
Ilovemypuppies - sounds like you are a very compassionate nurse. It does take a toll on us as caregivers to see so much death and destruction. Like dogs, it helps so much to have EAP counselers readily available. Also, critical incident stress debriefing is helpful for an especially traumatic event.
You are right, it does take its toll - some of our nurses that just can not handle helping the family members during this time. For some reason, I have always been able to help explain to the family members what is happening, and I try my best if staffing permits. I am a trauma nurse by nature and enjoy being right up in it, so to speak.
I am usually the nurse that gets voluntereed to be the family advocate if the clergy and/or social workers are not readily available. When I was in college, my minor was in Sociology and I was able to take quite a few classes pertaining to death and dying. These classes were very useful and I was able to take quite a bit of knowledge that I feel has helped me assist these family members while going through the trauma.
Like most of us ER nurses, I am an adrenaline junky, and enjoy the traumas. For the most part, I have been able to keep my emotions in check until afterwards and we can have a little debriefing.
I would love to work with you Anne! Bet it would be too fun! You sound a lot like me - I always love the adrenline rush too. However, (also like you) I'm the usual one nominated to talk with family.
I would love to work with you Anne! Bet it would be too fun! You sound a lot like me - I always love the adrenline rush too. However, (also like you) I'm the usual one nominated to talk with family.
Trauma - Likewise! I had thought for quite a while that you and I feel a lot alike from reading our posts. I guess the classes I took for my Sociology minor really helped and for that reason, get nominated for the advocate pretty often.
I wish we did work in the same ER, it would be great!
only 2 at a time please. and then stay out of the way.
I'm with you on two at a time. I've found that you have to keep monitoring the amount of familiy that try to sneek past the triage area to get to that pt's room. Don't get me wrong please. I'm a believer of letting the familiy at bedside for a code, but if they are in the way or overcrowding to the point where time is of the essence, they have got to go. Roller.
Roller - totally agree with you. And something that I had considered but hadn't stated: much depends on the size of your ER. When I worked in a level one facility, the ER rooms and resus bays were large enough and private enough that you could have a visitor or two in the room during a code and there wasn't a problem. Now, I work in a community hospital and the rooms are tiny! Would hate to run a code in one of them even without visitors.
Yes, indeed....this is the reason that there must be a dedicated, knowledgeable staff member who is there just for the family.
Right. So many times we as trauma nurses have to concentrate so hard on the trauma or code that has rolled in, that at times the family member doesn't really have someone that can work as an advocate for them and also the patient. They can't just be on "autopilot", for lack of a better word, and be exposed to the things being done for their family member.
I was in a trauma one afternoon and we were in the middle of a recuss, one of the staff brought in the member. She just opened the door and sasid, "Here you go. Just try to stay out of the way, or you'll make the MD mad and he throws things."
TraumaRU - you are right that we need a staff member that has the knowledge of how to relate to them what is going on, what is being done for the patient and why. I do try to gauge the responses they have, and I try to get them back out if needed depending on how the code is going. We've all been in those codes where Murphy's law takes over and things are dropped, lost, damaged, not pkged right from central supply after sterilized - or at least I know I've been in them.
We need a staff member that knows how or has experience relating to the family member at this critical time in their lives, and that can explain not just what we're doing, but WHY we are doing that for the patient. A little TLC and compassion can go a long way in making the family know we are doing so much for their family.
In this kind of thing, ignorance is definetly not bliss.
sissiesmama, ASN, RN
1,899 Posts
Hey Trauma -
I work in a busy ER that gets most of the patients from the south side and housing projects, as well as the Salvation Army homeless shelter. We are the main receiving point next to the LSU Charity hospital, so we get a lot of all the usual traumas daily. We do have some really wonderful staff, from MDs, nurses, and ER techs, and everyone is always ready to lend a hand in a crisis.
If EMS is en route with a code and we have been made aware, our secretary activates the code pager system to include resp, xray, the other usual staff and also the priest. It is a Catholic facility, so during the week on days, we usually have at least 2 clergy in house, also case mgrs and social workers. Our clergy, I feel, are just wonderful, and I have seen them arrive even before resp therapy arrives. We have a room that is kind of out of the way so to speak, from the usual ER hustle and bustle. It is nice, and can handle quite a large family. Dimly lit, and has a few couches, chairs. The clergy first talk to the family and are in and out of the code room if they can get in so they csn assess the situation, and also brief the family. Then they, or we if on nights, feels the family out as far as who would like to be in, their physical health and anxiety level at that time. They usually just take 1 at a time, and we actually don't have too many that want to go in. We keep a w/c just outside the door to the patients room, but out of the way of the staff. He will kind of explain in laymans terms what is going on and why it is being done.
One patient I remember in particular, coded and his wife was at the bedside. She refused to go in, which if they feel that way, I am more than happy to just let them stay in the family room, and get updates. This wife was just hysterical, and sobbing when I got her in the w/c. I would go in and see the status and return to the wife. and quietly talk to her "They have the tube in to help him breathe...his heart is just in a bad rhythym and the doc is foing _____ to fix it...Were giving this medicine to _____. This little lady, I felt so bad for her, she was just grief stricken and had no family at all. She looked up at me from her w/c and said, "Why are you telling me this? Is it because he is dead?!" I said, "Oh, no maam, The doctor is there and ... " And I told her, "I am coming out to let you know what they have going (what she could understand or tolerate) because that is your husband. If my husband was in there and coded, I would like to be able to know what is going on so you know how he is doing right now." She looked up at me again, eyes full of tears, and said, "You are the first person to ever do that for me. It is just so scary to just have to sit here by myself and not even know if he was alive or dead."
I kept my composure at the time, but when we were done, I had to go to the ladies room to catch a few tears that I knew were coming.
I have only had 1 patient where the family members were in the room, and we had to crack the chest. I was escorting them out and one ran up to the bedside and actually tried to put her hands inside the chest cavity while the MD was getting ready to defib with the internal paddles. Needless to say she got escorted out pretty dang fast!
Anne, RNC