families watching codes

[donedeal]

How do you feel about families watching you run a code on their loved one? This seems to be a common occurence in south florida hospitals. Family members are brought into the ER to watch to give a sense that we are working as hard as we can to save the person, perhaps give some closure. If the code is run efficiently it can be a positive thing, but if something goes wrong (cant get the tube, cant get a line, cant find something!) it can look really bad and shows disorganization on our part. Not to mention the added pressure and cluster of having the family right there in your face. Thoughts?

[Ridryder 911]

I have done extensive research, thesis and lecture presentations on this topic. From all the research that I have encountered there is very little reason on not allowing the family to view. With that said, each case has to be evaluated carefully with having appropriate staff such as Chaplain, Social Worker, response to family psyche at the time, etc. Pre protocol and procedures should be well thought out prior to initiation of such programs. There are several well thought and studied programs that ED's can obtain through Emergency Nurses Association, American Association of Acute Care Nurses, Hospital Chaplaincy program, etc.

One may think that increasing litigation could occur, in which actually quite the opposite has been proven. Families appear to see the efforts and trials that the staff has undertaken. The old saying "the unknown" is worse than the knowing. Studies have also demonstrated that they were able "to handle " the emotional effort as well, more than most rescuers presumed. Very few cases were documented were family became overwhelming distraught.

The disadvantages was not having enough staff. Wounds or injuries that might be seen as grotesque, or injuries that may appear "bad" not to allow immediate family to view. Although, studies have also demonstrated that with recent television, movies, etc. most real wounds are far less dramatic than those many have seen in dramatization.

The advantage is allowing some closure for the family and possibly the patient. There was an increased in proper procedures in medical care, as well as more increased professionally, and more awareness of staff participation. Very little negative results were found in perspective to those of the positive nature.

I personally believe it is a case by case basis. Most families will request to stop the code faster, and I do believe accept the death faster. Also in my experience, they have appeared to appreciate the efforts make forth in treating their loved one. The only down fall is some staff feels insecure, and awkward.. which is more their problem, than the situation.

Just a few References:

Nurse Management; Springhouse 2004; 35(6) 20:Is Family Presence Practical During Resuscitation; Blair, P. et al.

Emergency Medicine Australia 2004 15, 294-305: Family Presence During Resuscitation in the Emergency Department; An Australian Perspective: Redley, R., Bott, I, et.al

Emergency Nurses Association; Family Viewing Resuscitation Measures; Program Guidelines and Procedures, 2005 ENA

R/r 911

[itku2er]

I agree it should be a case to case basis depending on the emotional needs of the family.

You can tell when you arrive on scene who needs to be in the room and who does not.

Kids are the worse to work codes on due to the emotional state of the family.

Terr

[KE5EHI]

Kids are the worse to work codes on due to the emotional state of the family.

I remember a call a few months ago. It was a 6YOF auto-ped with family around. We were the first on scene by minutes (which seemed a lot longer) and had to control the father from killing the driver at the same time we were trying to help this kiddo. Fire arrived and we got the kid to the nearest pedi trauma center alive (but she was beyond savable). The family told the hospital later that because they saw everything being done and was able to say goodbye to their daughter, it made things easier on them than not knowing what all happened. Mom rode up front with us to the hospital and stayed by her side until the end.

I do agree it is a case-by-case decision, but more often than not, it helps the family with closure.

[VentMedic]

Many hospitals made it their policy to allow families to stay during a code, especially in pediatrics, about 15 years ago. The first few times it bothered me because we did do more invasive procedures, including open chest in the cardiac PICU, than in the prehospital situations. It also unnerved me to be video taped during L&D codes both maternal and infant. The family members were "allowed" or just not asked to turned the cameras off during an unexpected resuscitation. Sometimes the video recorder was allowed on during an expected L&D resuscitation but the family member was "only" supposed to record the birth. However, the recording usually continued afterwards. I've actually had a video camera rest unexpectedly on my shoulder while intubating a baby until a nurse politely asked the family member to give me some room. Luckily most NICU teams are experienced enough to resuscitate quickly and quietly. I'm sure the hospital attorneys dealt with the legal issues with the family in a gentle way later.

I do believe it is important for the families to see that everything has been done. Many families also don't want to let go of their elders. These families need to have a role in letting their elderly loved on go in order to finalize that they took care of them until the end. This is especially true in some cultures where the children actually vow their lifelong service to care for their elders.

[Yummymedic05]

I fully agree with letting families watch, and will give them room to do so. The only code I didn't let anyone in on, without saying too much, I knew would be a coroners case.

I also have learned that if the family doesn't want to watch you work it, but would like to see their loved one afterwards, it's best not to clean up the room. On our part we feel we are doing good in picking up papers, and whatnots off the floor, covering up the patient, etc. But I have learned when the room is clean families think you did a whole lot of nothing-yet if it looks like a tornado hit the room (which lots seem to do) they thank you for all you've done.

[aussiephil]

I think the differentiation here needs to be for pre hospital & in hospital cardiac arrests.

I read rid's post with interests, but it appeared all in hospital. Pre hospital presents its own problems.

I am in a small community & we have, if we are lucky, 4 people to assist with an arrest and in most cases 2 are off duty so the family will watch us because we have no one spare to talk to them (1 person on drug therapy & defib, 1 on airway managment & ventilation, one doing CPR & one getting stretchers & running for equipment as needed).

In hospital, there will usually be at least 1 or 2 spare bodies to be with the family & keep an eye on them. I think we need to respect the families wishes, but we also need to have a medical professional to explain what is happening & observe the family. They can also be prepared to call for chaplains as necesarry.

They are also in the position to explain to the family the reality that the majority of people who arrest will not survive & prepare them for that.

[Just Plain Ruff]

Prehospital you many times have no choice in letting family watch.

Just designate one person to explain what is being done so the family has a chance to ask questions.

[Ridryder 911]

Yes, all the studies was conducted in a hospital setting. I agree, in the field setting one has to use commons sense, and like even in the hospital setting; it should be case by case scenario.

I have even use family members in participation in the code. I have seen + results as well, that they were able to "do" something. I believe that it adds closure.

R/r 911

[Just Plain Ruff]

I agree Rid, I have used a couple of family members in a code situation to hold the bag of fluid, or to hold granny's hand.

It's on a case by case basis and only I make that decision to allow them to participate.