So the other day I had to go to class to learn about ACLS. Over the course of two days, we learned the drugs and their dosages that we would use in the instance of a code. Thankfully, I did this because according to the nurses on my floor, we have a lot of them! Taking this class really made me comfortable with the idea of a cardiac arrest type situation ( well, as comfortable as one can be).
But, it really got me thinking about something though: Should family be present in a code? I think this is a great topic, and I know where I stand on it, but I would really love to hear other people’s point of views.
Let’s get a discussion going!!
November 11th, 2008 at 8:18 am
Since I have been a nurse for 35 years, I have seen many codes in that time. There has not been one of them that a family member should have seen. Some much is happening at once that no one has time to explain what is happening to the family. It could very traumatizing to anyone who does not have a medical background.
November 12th, 2008 at 6:38 pm
Although I am a new nurse, I had a code the other day and I was SO thankful that there were no family members present. Codes are extremely fast paced, loud, hectic, and scary. Even though I had a sense of what was going on, I found it very, very stressful. I feel that family members should not be present during a code because it is such a hectic situation. There is no time to explain to the family what is going on, and some of the procedures being done to the patient may be upsetting for the family to watch. I think it is best for the family to not be present, and inform them what is going on after things have calmed down.
November 17th, 2008 at 4:16 pm
I completely disagree with the other comments that have been posted thus far. I am an ER/Trauma nurse. I started bringing family members in to resuscitations approximately 15 years ago, +/-, and I think the code is handled much better when the family is able to be there, given that there is a staff member who is able to support the family member. The staff member doesn’t need to be part of the health care team; the unit secretary, someone for Pastoral Care, or patient representative do well in this role. Cardiac arrests are run more calmly when the family is there, because the staff members stay focused, and they remain appropriate. Most family members appreciate the ability to watch what is happening to their family member, and they get a sense of participating in what may be the last moments of the patients life. If nothing else, they know that everything possible was done for their loved one, and they get to touch them while the patient is still warm, rather than room temperature. I think they also realize more quickly what their family member would and wouldn’t want done to and for them in the event of a cardiac/resp. arrest. Too many people don’t have discussions about DNR/living wills, and the family members frequently feel guilty about “not doing something” and they make choices for the family member based on inaccurate interpretations of the possibilities. We have discussions w/ patients and families that go something like this, “if your mom should stop breathing, would you want us to put her on a machine that would breathe for her?” “if you dad’s heart should stop, would he want us to give him medications to start it again?” The lay persons interpretation of these questions is that we are going to give them a pill or hang an IV and they will be all better. We then further re-inforce those poor and inaccurate choices by bringing them into a room after a code, when we have cleaned up and ’sterilized’ the area. What does that say to the family member? It says, “they did nothing”.
November 17th, 2008 at 4:19 pm
I have been a registered nurse for 39 years with many years in ICU. I have been in situation where the family was present when the patient actually coded. It was difficult to do what was needed and deal with a family member that was hysterical because they realized that the family member was dying before their eyes. It has been my eperience that the sooner you can get the family member out; the better. I even recall a case where the family member obstructed the actual code process by throwing themself over the patient.
November 17th, 2008 at 7:07 pm
After 40+ years of nursing, most of which was in CCU, I can say yes and no. There are times it would have helped the family deal with the death. Other times no, the family would not have benefited from the experience. It depends on the indivudual and the situation. Also it is imparative that there be adequate staff for someone to stand by their side and explain things and give support to them, make sure they do not interfere and escort them from the area if needed.
I don’t know if it would have helped to be there when they were coding my father. I do know as a nurse in uniform coming on to my shift the physician not knowing this was my father stood with his back to me and told my mother he was dead. I will never forget the feeling. I know they did everything they could but would I have told them to stop sooner? I don’t know. But it has haunted me for a lot of years. It was sudden but I would not have wanted them to do anything extensive.
November 18th, 2008 at 10:53 am
I am so glad to see that everyone has such great opinions on this topic. I think I agree with Judy. In certain circumstances it isn’t a great idea but what about if the family needs to address Code status. If a family member doesn’t want to be resuscitated but the family wants it- maybe witnessing what exactly goes into a code would help them realize what is best for their situation. As long as someone is with the family during this then I think its a good way to educate. Also, there are some people that could handle the situation better than others so we as nurses have to be prepared to judge when a family member is capable of witnessing something so intense.
I think this is a wonderful research piece and when I go back to school for my Master’s I really hope to do some on this topic!
Keep it up! get your friends involved in this conversation!
November 18th, 2008 at 3:46 pm
I have been in nursing since 1976. I have worked in the critical care setting since 1992. Over the years I have witnessed all kinds of code situations. As far back as I can remember we have allowed family in the rooms during the codes…under two circumstances: one was that they wanted to be there and two was that someone stayed with them. We find our codes that are attended by family members to be shorter. Also that when you said you did everything you could, they really knew that you did. I whole heartedly support the concept. It is the philosophy throughout the whole hospital.
January 1st, 2009 at 1:23 pm
I totally agree with Martha. Families belong with their loved ones,if they want to be there.
I have never had difficulty with a family member who was present during a code. It should also be important for hospitals to develop clear policies in order to avoid confusion among staff.
January 14th, 2009 at 10:14 pm
I have been a nurse for several years with the majority of my experiences being in the critical care setting (ICU/ER). In my opinion, I believe that each situation is unique, and requires our respect and compassion for the family members who are experiencing the event. Many family members chose to be with their loved one during this event so in their mind the patient isn’t alone when and if they should pass away. From my experience in working as a neonatal intensive care nurse I think it is vital for the parents to be present at the bedside in order to see that all has been done to save one of their most precious gifts in life.
Thankfully, our hospital has a rapid response team that includes all types of healthcare and support team members for all codes within the hospital (minus the newborn ICU). It helps because we have the clinical team to perform the medical tasks, but their are always at least two chaplin/support team staff to be there for the family and any of their needs.
January 21st, 2009 at 5:16 pm
Its so very traumatizing to the family so my vote is NO onn family being present at the code.
January 28th, 2009 at 12:45 pm
When you are comfortable in the care you are providing you do not need “control” of the patient or the environment. I have been practicing since 1980 and have also had family at the bedside during resusitation with only good results. The family sees how hard the team workes and that is so much better than being ushered to a room with someone appearing with that face that predicts disastrous news. Aside from the following organizations making policy regarding family presence: Amer. Academy of Pediatrics, Amer. College of Emergency Physicians, Amer. Assoc Critical Care Nurses, Emergency Nurses Assoc and the Society of Critical Care Medicine. It has been shown that self confidence and nurses who hold advanced certification and membership in professional organizations mor strongly support family presence. You can see I am a strong advocate. Did my masters research thesis on nurses attitudes toward family visitation in Critical Care Units (more open visiting, more family/patient satisfaction). Nurses appear to need control of the patient and surroundings, rather than thinking of themselves of the vehicle of treatment, wellness and education. The family loves this person…we will forget them soon after contact.
February 13th, 2009 at 12:26 pm
I love the discussion on this topic. I have had medical ward and ICU experience. I have found that the very ill with the unlikelihood of survival, with family that is pursuing a full code status, it is best that they stay in the room if they wish to, as they understand exactly what happens to the body of their loved one when a code occurs, and as many have said, they know what all was done and the full extent of it. Every code I have participated in was expected sooner or later. Personally if it was an unexpected code, I would sure hope there would be someone there to explain what is going on to their loved one as the process continues. I’m glad to hear that there are many supportive people during code situations in other hospitals! I certainly know, where I currently work, when the code team arrives and takes over CPR, that person would be myself.
As for those that think its traumatic to watch… I think those who say that, it is coming from their own point of views, as it is a very one sided statement. Everyone has their own wishes, some more educate and understanding than others, but they are their wishes.
February 21st, 2009 at 11:56 pm
We are having a mock trial over this topic “families in codes” I am a firm belivier in case by case. Most people can handle being there at the bedside. I am an ICU nurse, have seen many codes and the familis have been present for most. All but one contested by the doc. A gang shooting hours of surgery and was being coded while being shipped to me. I got the mom and was letting her be present. The doc became very angry, did not want the family there. He wanted my job. I stood my ground. Another doc(our internist for the hospital) took over care and let the family stay. They were very thankful after seeing everything that was done for their loved one. Now at our hospital the debate is in full gear. Every hospital should have a written plan. I pray it is done case by case, everyone should have the chance to be there!!!
February 23rd, 2009 at 3:16 pm
Several years ago, I was present when a 3 yr old boy was brought in, had fallen into the family pool. The doctor hoped that the water had been cold enough that we could resuscitate the child. His dad stayed in the room, with me at this side for over 3 hours. He witnessed the nurses from other units that came to bring equipment with tears in their eyes. He saw the people who brought microwaves into the room to warm blankets. When the child coded for the final time, he was there and could honestly tell his wife that everything that could be done, had been done. I gets lots of grief about wanting family in the room, but I have seen what a difference it makes for the family. By the way, the child’s family donated a blanket warmer to the ER in memory of their son, to help save others.
May 1st, 2009 at 4:11 pm
Hi,
Although I am not a nurse, I was an ER Admitting Rep at a small community hospital. I think at the beginning and during a code it can be very traumatic for the patient’s family; however, I think toward the end of the code, when it’s obvious that the patient is not going to make it, letting the family in is necessary. It gives them closure, they have a chance to say goodbye, and as the previous poster said, it allows them to see how hard the hospital staff worked to save their loved one.
May 19th, 2009 at 12:30 pm
I think the families should *absolutely* be present during a code. They need to know we did everything we could do to help their loved one.
We are fortunate to have a social worker during our codes who explains to the family what we are doing and why. I can understand how hysterical family members can be a distraction, however, as long as you’re comfortable with your role during the code it should not be a problem.
May 30th, 2009 at 12:35 pm
Personally, I think it’s too traumatic for families to be there during Codes. I was there when my father died I can say being a nurse helped me a lot because I understand totally what the medical professionals where doing as they try to revived my father but my family was not. Now I understand fully how it feels to have a dying patient. Medical professionals like us, should understand that being hysterical is quite normal for family members as they don’t know what’s going on there.
June 15th, 2009 at 6:42 am
I am a new nurse and I believe that it depends on the family itself and how they function. It also depends on if that family has been with the patient night and day and has been there through everything that we have done. I think that if they are prepared (explain what happens) they should be allowed to be there if they want to as I think that it is cruel to have them leave during their loved ones time of need. They may need this as closure. I read a research article that stated that families that were prepared (explanations of what happens and how the body goes through changes is the dying stage) by the actions that are taken during a code. This helps to prepare the family for the what may be inevitable. So my vote is yes for those that are able to handle it. If they seem to be losing it, you can always give them something to do to help them and make it appear that they are helping with their family member (distract them so to speak). It would be great to have a member of the code team that is trained to handle the family during this time.
June 22nd, 2009 at 7:12 am
I also feel that this should be determined on a case-by-case basis. I was present throughout my mom’s code and, although a nurse for 25+ years with 13 as an ED nurse, I felt somewhat ‘traumatized’, but mostly reassured that everything was done. My dad has no medical backgroung whatsoever and as I saw her brady down and get that first atropine, I told him they would soon be starting CPR and asked if he wanted to stay. He did and stayed for the first few minutes after which it was too much for him. When the outcome was clear, I went and got him so he could say good bye while they were doing CPR and she was still alive in his eyes. Fortunately I was able to explain that we needed to tell them to stop because nothing more could be done and I think that was a huge help to him. Although I remember ever single minute, he now has no memory yet seems to understand that every effort was given. I have always felt the family should be given the choice, and after my personal experience I am sure.
June 26th, 2009 at 7:58 am
I have been in nursing for a long time and have worked many different rolls. I have seen many codes those with family and without. I would say that how the team functions has nothing to do with the family and everything to do with the team members skill and confidence. Just like everything else we do for our patients and their families, we need to individualize this to the patient, family and situation. But remember what the families see can not be unseen. If the code ends and the patient has died that will be the lasting memory. This is from personal experience. I would give anything to not remember my mother at the end of her code. My older sister feels the same way, she is not in healthcare.I was not a nurse when this happened, but it does color my view on families being present for the code.
July 31st, 2009 at 1:48 pm
No, I don’t think family should be present during a code. Reason being is that 15 years ago when my dad died, I was given a clipboard to record the code (mind you I did not work at that facility). It was the worst experience I have ever been through, because I was wearing a uniform the doctor and nurses assumed that I worked there (I was a nurses aide in a maternity unit).
I watched in horror as my dad’s chest was cracked, he was intubated and given units of blood. My dad still died, and I was yelled at because I was not quick enough with the clipboard. When it was discovered that I was not an employ there and the daughter of the patient in bed 6 all that was said was…..nothing.