Some hospitals allow families to be present in almost all instances, including rounds and shift changes. Some encourage families, with patient permission, to sit in on discussions about charts and care plans. Family presence helps clinicians because relatives can answer questions, advise clinicians if a patient is allergic to something or is on a certain medication, or even help select food that the patient will eat, advocates of family-centered care say.

But many hospitals draw the line at allowing family presence during a code situation or resuscitation. The American Heart Association and the Emergency Nurses Association support family presence during resuscitation, but surveys show that many clinicians resist the practice, even some who believe strongly in family-centered care.

Code situations rarely occur at Barbara Ann Karmanos Cancer Institute in Detroit, said Dore Shepard, MS, RN, nurse manager at the institute, which has involved families in care since it opened 20 years ago. But when a code happens, family members are asked to wait outside with a chaplain or other support person, she said.

"There are so many people coming in to intubate and put in lines," she said. "It's kind of traumatic to witness."

Some clinicians worry that families might become hysterical or see what they think are mistakes. They also fear that families could get in the way of the clinical team.

But those who support the practice, including the families themselves, say anything they see cannot be worse that what they would imagine while waiting outside a patient's room. When they are in the room, they don't notice the maze of lines or the blood, said Beverely Johnson, RN, president and CEO of the Institute for Family-Centered Care in Bethesda, Md. "What they see is staff trying so hard to save someone's life and that's the memory they go away with."

Family members who observe a failed resuscitation reported less anxiety and depression after a death than relatives who weren't there, studies show. Hospitals with the policy have reported an increase in patient satisfaction and few or no problems when patients are present.

"We've had such heart-wrenching celebrations from it," said Kathy Harren, MHA, RN, senior vice president for patient care services at Little Company of Mary Hospital in Torrance, Calif., which has allowed the practice for 10 years. "We've had mothers who have been able to hold their sons prior to their deaths, families who have been able to hold their babies."

Families routinely write letters thanking the staff for letting them be present.

"It was hard for our staff originally when we made the change," Harren said. "All the dread and worries were there."

When the policy was implemented, physicians challenged it at first, she said, then changed their minds when they saw how much the families appreciated it.

The hospital always makes sure family members have a supporting person present, Harren said-a social worker, charge nurse or spiritual counselor. No one has ever had a problem finding someone to accompany the family, she said. "There are always supporting cast members that are there to take on that role."

Contact Cathryn Domrose at kaguilar@well.com