[TJRN]

Just last week a late 40's male was brought in by EMS in asystole. After about 20 minutes of full blown effort, one of the docs called out 'Where's the family?' It seems that he arrested at home, with family and EMS present.

While the code continued, I brought the family in. His adult son performed some form of prayer ritual using, what I think, was holy water. His wife was encouraged by one of the docs to hold his hand and talk to him; and, I encouraged his sister not to run out since this might be the last time she may have a chance to talk to him. Yes, it was heartwretching and we had to spend an enormous amount of time dealing with members of the family during and afterwards. Yes, most of us cried along with the family. But, the family eventually was at peace knowing that everything that was possible was done for their loved one and accepted that his death was meant to be. Without seeing the code, this family may not have been able to do the things important in their religion; nor, would have been as readily accepting of his fate-denial certainly slows down the grieving process and generally turns very quickly into an anger/blame phase of grief (where I think most malpractice suits get their spark). In addition, the interaction we had during all of this allowed the family to realize that the man who died had a strong family history of male related coronary problems-the son now knows to look out for this and we may have had some input into possibly extended his life.

I applaud the doctor who wanted this family in against the wishes of the charge nurse. Is it not our role as nurses to attend holistically to our patients and their families? I do feel that in situations like this is where we get the most chance to attend to the mind, body and spirit of our patients (which include the family); and, get away from our task-oriented rut.

[RockinRobynRN]

I have found that the comfort level of the nurse is often what determines family presence during a code. I work in the ER and ICU and I always present it as an option for families. If they are hysterical or getting in the way of procedures, then absolutely they should be escorted out. However, this is often not the case. This being said, there should always be a staff person (nurse, chaplain, etc.) who can attend to that person and help decide when or if they need to remain in the room. Think of your own loved one. Would you, as a nurse, be comfortable with someone telling you that you could not see your friend/family member during their final moments? We all know our own limitations & some of us may opt to stay out. I, however, do not want anyone telling me that I am forbidden because of "policy." As someone else has mentioned, it often gives families a great sense of peace knowing that everything possible was done. In fact, I think codes are usually not as long when family is present. It's easier to say "Do everything" when you are in a family room, as opposed to watching the team pound on your mother's chest & shock her repeatedly. I know that others may disagree, but I have never had a negative response to letting family stay.

[TJRN]

Originally Posted by RockinRobynRN

I have found that the comfort level of the nurse is often what determines family presence during a code. I work in the ER and ICU and I always present it as an option for families. If they are hysterical or getting in the way of procedures, then absolutely they should be escorted out. However, this is often not the case. This being said, there should always be a staff person (nurse, chaplain, etc.) who can attend to that person and help decide when or if they need to remain in the room. Think of your own loved one. Would you, as a nurse, be comfortable with someone telling you that you could not see your friend/family member during their final moments? We all know our own limitations & some of us may opt to stay out. I, however, do not want anyone telling me that I am forbidden because of "policy." As someone else has mentioned, it often gives families a great sense of peace knowing that everything possible was done. In fact, I think codes are usually not as long when family is present. It's easier to say "Do everything" when you are in a family room, as opposed to watching the team pound on your mother's chest & shock her repeatedly. I know that others may disagree, but I have never had a negative response to letting family stay.

Very well said! I agree with you 100%

[txnexus]

I've instituted a practice of allowing families who wish to view resusitation efforts that privilege. I've had nothing but very positive feedback from the few families who chose to watch their loved one go thru this process. Most articulated that there would have been doubt that everything possible was done to save their loved one. After watching, most knew in their hearts that they made the right decision. I'll never forget one young mother whos cardiomyopathy plagued husband crashed one night..he was awake during CPR and we let her come so they could say their last goodbyes. After that, we stopped compressions and allowed him to pass. Based on that one incident, I would say if they want to watch...let them.

[Neversettle71]

It is refreshing to see that so many of us agree. The trend to pull back the curtain and let the family "see the wizard" has always been a positive experience for me. Heartwrenching, sure. Stressful, absolutely. Fufilling, take it to the bank. Behind "closed doors" an element of doubt will always remain for the skeptical family member not ready to lose their loved one, in full view it is hard to deny all of the effort. Of course I agree with the many guidelines expressed here: choice, a supportive presence and explanation. I hope to continue to read many more well thought out opinions.

[Jabel]

I agree that letting the family stay is good. However, emotionally I couldn't really handle it yet. I am still really new at this and just get so nervous whenever there's family inside the room. I do hope I get over this soon because I know my nerves sometimes show and doesn't help anyone at all.

[Jessgurl723]

I think that it should be a case by case situation. So regarding a "policy", I dont think there should be one. But if the family is clearly in extreme distress, I think they should be escorted out. Also if there are multiple family members (ie. more than one) I dont think they should be in there, simply because there is no room! Or atleast not at the hospital I work in.

[RNview]

In our hospital, we usually send the family out of the room with the chaplain or social worker. If they insist to stay in the room, it's fine with us. Some doctors allow it. They think it's better that way especially if the patient has a poor prognosis, then most of the time, the family (who's watching )calls the code off. If the family starts freaking out in the room, we stay with them and guide them out of the room. We have a waiting area where we send the family with chaplain.