Responses to family presence during codes

Responses to Family at Codes: A Beneficial Practice

Our hospital policy for code blues does not dictate a particular preference on whether the family should stay or leave the area. However, it has often been the practice to escort the family away from the immediate area. The primary reason has been to provide room for the code responders so that they can be unimpeded in their work.

I have attended many codes over the years and I have seen the pros and cons of both scenarios. I agree with Brent Peery that it may be beneficial for "select" family members to be present during a code. The key lies in knowing which family member will help or hinder the process.

My experience has been that not all family members can withstand the emotional stress and chaotic ambience of a code. Some have become very emotional, tearful, angry, frustrated, and bewildered by the situation to the point of yelling negative comments at the responders over the apparent lack of success. At times, they have refused to move away from the bed or only moved a few feet after being physically forced to move.

The chaplain's task is to evaluate as quickly as possible which family members can deal with observing the code. That evaluation will determine if the chaplain will advocate for the continued presence of the family in the room or choose an alternative. On many occasions, it has been better to remove the family from the very stressful environment of the code.

However, I have also seen the benefits of family members being present during a code. The sharp reality of their loved one’s struggle to survive has helped some family members to accept the inevitable. Being an eyewitness to the trauma and the tremendous effort required to try to keep a loved one alive can be very helpful for some in accepting a poor prognosis. Sometimes the family member who was an eyewitness to the code can relate their experience, their feelings and their thoughts to other family members who may be struggling with letting go. Again, the chaplain needs to use good judgment in deciding if a family member should stay in the room.

Lastly, cultural factors and language barriers must be considered in any decision being made about family presence. A family's behavior during life and death scenarios is often guided not by rational thinking but by cultural norms and expectations. When one adds the element of language barriers to the already confusing and chaotic rush of staff and the yelling of orders by the attending medical staff, a very volatile situation can occur.

Therefore, chaplains need to hone their skills and include all aspects of the family’s dynamics when considering who they should or should not advocate for when a code is called.

Grimaldo H. Enriquez, Chaplain Supervisor
Chaplain Services, Community Medical Centers
Fresno, CA

 

I want to thank Brent not only for this well written article, but also for its timeliness. Here at our hospital we are just beginning to talk about this situation and my director has asked me to locate an accessible and well written one page article to give out to the rest of the staff in our department, and Brent's article is perfect. It is not uncommon for us to have family present at codes in our ER, but extremely rare on the floors. We had one recently, however, because I, as the chaplain, assessed it would be appropriate, as well as helpful. Some of the staff were not sure about it and so I spent some time debriefing them and asking them what worked and what didn't. It became clear that we needed some clear guidelines, so we are beginning to look at it seriously.

Mark LaRocca-Pitts, PhD, BCC
Staff Chaplain
Athens Regional Medical Center
Athens, GA

 

Thank you for this article. I agree that it is often beneficial to have families present. I also agree that the chaplain should be present with a family during these codes. However, I would add that the chaplain and/or a medical staff person should explain what is happening and ask if the person wishes to be present. Preparation helps the family members in this type of experience. It also helps when the decision to stop is the result.

Recently, on two occasions at the hospital where I work, the nurse educator came out and hurriedly rushed in family members with no preparation. In both cases it was detrimental. In the second case, the code was already over and the patient’s face was covered with a cloth. The room was in disarray and the medical staff was about to leave. The daughters were shocked and collapsed onto the floor. The medical staff felt that the memory of this would forever affect them in a negative way. I feel that things would have gone well if I had prepared them for the ordeal and gently supported them. I was with them in the waiting room prior to the incident. However, the chaplain is NOT consulted in these cases. We do respond to codes, but are not considered a part of the team. This is frustrating for me as I have worked where the chaplain is an essential team member.

Anonymous

 

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