just sharing about my good night

[anon456, BSN, RN]

I work in a busy PICU. I know that oftentimes it gets very hectic and families stay with the kiddos and it can get crowded and messy and that can't always be helped. Last night I had a kiddo who was so sick he has never been home and won't probably ever go home. Major desats and frequent bagging but parents want to save him for as long as possible. They visit daily but not for long.

I think because of the sadness of the case, and the frequent interventions this kid requires, some of the staff get depressed and do minimal care. He gets all his meds and other ordered things but his room was a mess and people did not go in except to intervene or provide scheduled care.

My goal is to make each child's day as good as it can be. This child is pretty miserable all the time and I think the futility and suffering is hard on the staff. This kid desats and has to be bagged if you do anything-- diaper change, temp, and once he passed gas and desatted on me. I asked the doctor to change his assessments to Q4H so as not to disturb him so much. I recorded monitor vitals and looked at his access device hourly and asked people who were doing rounds to also not touch him and they respected that. I did not even change his diaper unless it was poopy, except Q4H because it was not worth it to his happiness. He was not a kid who was at risk of getting worse and not a post op or something like that. This was his normal and many of the staff are sad about the fact that he won't ever get better, so there was no reason to bug him so much just to chart down the full assessment.

Near morning I got another nurse and together we did the whole bathing, changing, full assessment, scale, linen change, trach tie change and surprisingly he did not desat at all. Everyone was amazed. I mean, this kid had to be bagged too many times to count usually and this was just his normal. He also responded to being swaddled, and before I had found him in an unswaddled sideways position after being bagged previous shift. People just saved him and left. His feet were cold so I put a heat pack near his feet and he seemed to really like that too.

I also at that time cleaned his room which was a mess. His supply cart was all unorganized with random meds including some old ones throwin in. I found a vial of Ativan in there that was unopened from who knows when! I organized his supplies, took all the intervention garbage such as wrappers and old stuff off the foot of the crib, stacked some diapers and wipes, hung his suction at the head of the bed instead of on top of his bed on the sheet, rerouted his wires and all that. The room looked like it belonged to a kid who was actually loved, not one who was a hopeless case.

And, all night long, after I put that no touch intervention in place, he did not desat for hours at a time, actually was able to sleep, and everyone came by amazed at how normal his vitals were and how stable he was. I only had to give him one PRN all night right before the bath more as a preventative.

I guess I just wanted to share because I have to talk about it somewhere. This is only my 2nd or 3rd week (however you count it) of PICU nursing, and maybe I'm just too new to be burned out. Or maybe becasue it was a quiet night. I just felt really good about how I was able to make a difference in this kid's very difficult and short life.

[NotReady4PrimeTime, RN]

You proveded exemplary care - and carING to this baby. It really doesn't take a lot to be sensitive to someone else's needs, something every patient, no matter how unlikely their survival, deserves. Thank you.

[NeoPediRN]

My previous job was pretty much 50% babies exactly how you described. Hopeless cases and massive suffering with a ridiculous amount of stimulation and intervention involved. Our nurses for the most part always made sure the babies were calm, clean, and well cared for. They would always be tucked in with clean, stocked, rooms, and fresh outfits/trach dressings. It was really refreshing to know that no matter how hopeless their cases were, there would always be people to make sure their time here on earth was as loved as possible.

[anon456, BSN, RN]

double post

[anon456, BSN, RN]

The unit has a high standard of care and because of their amazingness he was still alive for his mom to enjoy a bit longer. The room was a mess because of all the life saving that had been goingon. But it does get to you, and one nurse said she felt guilty and helpless with him and his suffering. I just wanted to find ways we could still help this kiddo and I really never expected that he would do so much better with just a hands off approach. He just needed to be allowed to rest and be made to feel secure and maybe some of my loving was felt by him too. Who knows? I hope mom felt happy when she saw all the beanie babies around him! He almost looked normal.