Family Presence During Resuscitation: Why It Matters & How To Make It Happen

It’s a question that has stirred controversy in hospitals for years: Should family members be allowed in the room during resuscitation of a loved one?

 Whether due to concerns about increased litigation or potential interference with the code, there are plenty of reasons why clinicians might be wary of giving family members a front-row seat to a high-stakes emergency. But the counterarguments are equally compelling. With family-centered care a major focus at many hospitals today, it can feel disjointed and inconsistent to deliberately exclude family members from a medical emergency that their loved one may not survive.

Here’s the good news: Despite understandable concerns about family presence during resuscitation, research shows that the effects are positive rather than negative. Keep reading to learn how including family members can have a positive impact, plus tips to make it a success at your hospital.

Family presence during resuscitation: myth vs. reality

Common fears and concerns

When it comes to allowing family members in the room during a code, clinicians often have several concerns. The most common include:

• Will the family get in the way of the clinicians responding to the event?
• Will family members be more likely to pursue litigation if resuscitation is unsuccessful?
• Will it traumatize them to see their loved one in such a vulnerable, life-or-death position?

These concerns are understandable. We live in a litigious society. Codes are stressful as it is: Do clinicians really need the added pressure of family members looking on — and potentially looking to point fingers? Lastly, Code Blues are complex, fast-paced events that require laser focus and advanced levels of team coordination. Whether due to overcrowding in the room or the potential for disruption, concerns about interference are valid too.

Reality

Fortunately, research done on this topic in the past 50 years should put many of these fears to rest. While every individual scenario will be different, research has shown that:

• Family members focus on their loved ones during a Code Blue rather than on the clinicians, and they do not interfere with the event.¹
• There are no negative impacts on clinicians or family members present during the event.¹

In fact, allowing family members in the room often has a positive impact. Crucially, it gives family members peace of mind. They don’t have to wonder if every possible step was taken to try and save their loved one’s life because they saw it for themselves. This is an important form of closure that family members sitting in a waiting room — excluded from the event itself and waiting anxiously to hear a secondhand account of what happened — are unlikely to receive. As a result, rather than being critical of clinicians and their efforts, family members who witness the code are often supportive.

Tips for allowing family presence during resuscitation

Of course, policies and preparation will make all the difference in determining whether family presence has a positive or negative impact at your hospital. Keep these key tips in mind:

Have a designated support person in the room

What this means:

If family members are in the room, there needs to be a designated support person there as well. This person often has a background in social work or spiritual/pastoral care, and their job is to focus solely on the family. For instance, they can help²:

• Guide family through the event
• Answer basic questions they may have
• Leave the room if they desire

Just as there would be for any other team member (e.g., scribe, team leader, etc.), make sure there are guidelines and protocols in place to outline this person’s role. And if there is no family at the event, have a plan in place for the support person to either leave or absorb an alternate role, depending on the team’s needs.

Why it matters:

Having a support person will help alleviate clinicians’ concerns about distraction or disruption to the code. When family members have a dedicated point person to turn to, the likelihood of interference in the code itself is minimal. And for family members, it can also help them process and understand the events that are taking place — or give them an easy way to opt out if it proves to be too emotionally challenging to witness.

Use training and simulations to prepare clinicians

What this means:

Incorporate family presence in mock codes, simulations, and other training scenarios. Use every training opportunity to practice a variety of situations that clinicians might encounter in real life: for example, the family member might be crying/loud, silent, or requesting to leave.

Why it matters:

If family presence is normalized in training, clinicians will be less likely to feel increased pressure or anxiety during an actual event.

Like anything else, having to navigate family presence during the code while also performing clinical responsibilities will take some getting used to. This kind of multidisciplinary training — providing both the clinical skills needed during the code and the ability to navigate family presence — is essential to success.³ And the best place to do it is in a low-stakes simulation environment, like a mock code. While training is most important for novice responders, all clinicians will benefit from the opportunity to practice and prepare beforehand.

The bottom line

Studies show that the overall impact of allowing family presence during resuscitation is positive. Rather than leading to more litigation, it can often give family members peace of mind and closure that is so important for accepting and processing the event. But in order to reap these benefits, hospitals need to ensure they have well-outlined protocols, a dedicated support person, and the right training and preparation in place for clinicians.