Myth or reality: Families can’t cope with codes
Fear of unknown often worse
The emergency department at Columbia Clearwater (FL) Community Hospital considers case-by-case requests of families who wish to be present during codes. There is no formal policy addressing family presence during life-saving procedures, but it is not prohibited.
"I can’t think of a time when it hasn’t been beneficial to have the family present," says Teri Fahrney, RN, director of emergency services for the hospital. "There is some comfort, I think, in seeing that everything possible is being done, and the first-hand experience eliminates the unknown."
Including family members during even the most critical patient care events can work to the benefit of the nursing staff and the family, Connie Jastremski, RN, a critical care nurse consultant and long-time critical care nurse, tells Medical Ethics Advisor.
The debate about liberal visitation policies continues, she contends, yet, "there is no validation for these concerns; this is just how nurses feel."
One common myth among staff is that it is too hard to know what families need in the ICU. Families have three important needs when a loved one is in critical care, Jastremski says. These needs must be met by the staff:
• Information.
Families need to know and understand what is happening to their loved one during treatments and procedures, such as suctioning.
• Hope.
"Families really need to have hope; if they can, that the outcome will be good. When a positive outcome is not expected, the family needs to know that their loved one is being well cared for," Jastremski says.
• Trust.
The best way to develop trust is to have the family with the patient when care is being delivered.
A second myth is that families do not need to be involved in the acute phase of illness and that family visits upset the patient. Staff, however, particularly those in a teaching hospital, interrupt the patient’s care more often than family members, contends one study.1
"Staff/patient interactions may be more stressful than family/patient interactions," say the study’s authors. In addition, "families can play an important role in recovery that translates to improved patient outcomes. In the case of a confused or highly anxious patient, having a family member close at hand can be of great help to both the patient and the nurse," it concludes.
Reference
1. Dracup K, Bryan-Brown W. An open door policy in ICU. Am J Crit Care 1992; 1:16-18.
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