Withdrawl of Life Support in the PICU

[JudithRN24]

I am a new grad and work in the PICU. For the past few months I have been periodically assigned to care for a patient bumped from our NICU. The patient was born with a genetic disorder and after coding a few times and deteriorating the family has decided to remove the patient from the ventilator on Monday. Today, the charge nurse told me that she and the MD's felt I should care for the patient on Monday because of the rapport I have established with the family. I don't know what things I could do to provide comfort to the patient and family. I am also worried that I won't be able to control my emotions and be supportive. Please help!

[nursel56]

I should have known that. My message boarding skills are a bit rusty. Its been a long time since I have actively participated on a board. Used to be able to spot a troll from a mile away. Saw the name on a few more threads last night and kinda figured it out. Thanks for the heads up Esme12....

Then I should've known it too, but I didn't. I just thought he gave incredibly insensitive and uninformed advice.

[JudithRN24]

Thank you for all your feedback. Honestly, I feel privileged that the patient's parents included my name in the list of nurses they feel comfortable with, especially when the list was three names long. I want to take the assignment because it's part of being a nurse and it's part of my job. My main concern is making the patient comfortable and be supportive to the parents. Our PICU is an open unit; curtains serve as partitions. Chatter and laughter from the staff are prominent in the unit, so I hope everyone will be respectful and help maintain the unit quiet. Perhaps I will talk to the NM and ask her to speak to the staff so everyone is on board.

[tralalaRN]

One of the things high on the list for your unit, should be a room that offers privacy to the parents. When we held our daughter after placing the DNR, we had to do so in the middle of a huge room where everyone could watch. I realize that your unit has curtains, but it sure would be nice if there were a room for families to gather and have some privacy.

The parents obviously trust you to include you on the very "short" list. Going into this tomorrow, realize that you don't have all the answers, nor would the parents expect you to. They have been through hell up to this point, and have been through an immense amount of grieving already (there are worse things then death). .my good friend's daughter (a former preemie with a grade IV IVH) lived to be 12 years old, with horrendous disabilities - finally her shunt became infected over and over, so it was decided to stop treatment. She was completely at peace with this decision - in fact the first thing she said after her daughter died, was "it took 12 years to undo what neonatal did to her." So you may be surprised to find that the parents are not as much as a wreck you might expect them to be.

It is a beautiful thing that you've been selected by them. Obviously you've done many things right to have such a place of honor for them - and it is.

[NotReady4PrimeTime, RN]

Judith, you have indeed been offered a great compliment by these parents. Please don't agonize over getting everything "right" - your heart will tell you what's right. The best thing you can offer this family is your presence. They are never going to forget the day their baby died, which means that they are never going to forget you. They aren't going to remember the clinical care you provide as much as they will the tears, the gentle touch, the hug. I just know that you've been one of those nurses that talks to your patients as though they're listening and on the verge or replying, even when they're non-verbal or unconscious. I just know that you've been one of those nurses who touches her patients soothingly, whether they're aware of your touch or not. I just know you're one of those nurses who is professional and non-jugmental but still warm and comforting. I just know you're one of those nurses who doesn't shy away from what's difficult for everyone. I know all this because, as someone who has experienced this situation from both sided of the bed, you are who I would want to be by my side. I also know that you are just the kind of nurse PICU demands. This will never get easier - if it does that's a signal it's time to move on - but we do get better at it. God bless you.