Dealing with emotion during patient care.

Specialties PICU

Published

I am a nursing student and have an assignment to post a discussion on a listserv about a topic that interest me so far in my nursing adventure. I have a year left for a BSN degree and have realized that through your course of education they do not teach you how to deal with the emotion's you are feeling during the care of a patient. An example would be How do you as a nurse in a PICU deal with ending life support on a little infant? I have been on the side of the mother losing that child and relized that the nurse showed no emotion(no tears, no sadness). I have taken care of a child during my peds clinical that had nobody because he had so many medical problems that his parents didn't even want him. During my clinical stay that day I never left his side. During this same visit at this hospital 2 children were hurt and the parents were being investigated. I found it very hard not to say something to these parents for the hurt that these children are going through, but I managed. The same could go for adult patient's being neglected by their caretakers.

Any advice for the future nurses?

I find that very intersting when my daughter was dying the nurses showed no compassion. Though they did the normal things like you we received in the mail the hand and foot prints, the clipping of her hair, the clothing that she was in when we got to hold her for the first time. We received no sorry for your loss. She was 15 days old and lost her battle with her medical problems. Had it not been for my sister who was a RN I would have been lost when it came to making decisions about her care down to what kind of autopsy we wanted done. Glad to hear that other parents receive better breavement care than I did. I only hope that I can be the nurse that I was looking for that day in the NICU.

I am very sorry for your loss, and that it had to be that way. This is one reason I am part of my units bereavement committee and am committed to doing what we can for parents in these terrible situations. Some people want to skirt around this issue but in an ICU environment I think it is very important for staff to be able to do whatever they can to make a terrible situation a little bit better

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Specializes in Emergency, Pediatrics.
I find that very intersting when my daughter was dying the nurses showed no compassion. Though they did the normal things like you we received in the mail the hand and foot prints, the clipping of her hair, the clothing that she was in when we got to hold her for the first time. We received no sorry for your loss. She was 15 days old and lost her battle with her medical problems. Had it not been for my sister who was a RN I would have been lost when it came to making decisions about her care down to what kind of autopsy we wanted done. Glad to hear that other parents receive better breavement care than I did. I only hope that I can be the nurse that I was looking for that day in the NICU.

I'm sorry for your loss. In the NICU where I work, most of the nurses are kind and compassionate. But, I have witnessed some who just seemed like it was just another day. I, personally, take cues from the parents. I always offer my condolences, but from there I let them take the lead and I either talk, give a hug, shed a tear... or I remain quiet along side them for as long as they are. Hugs to you.

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Specializes in NICU, PICU, PCVICU and peds oncology.

I'm very sorry that you feel the nurses involved in your daughter's care were unfeeling. However, I've been doing this a long time - 17 years of peds critical care - and I am sure there was more to the situation than meets the eye. Have you ever heard of moral distress? Moral residue? Compassion fatigue? While the situation with your own child may not have encompassed any components of those, there will have been many before you whose situations did. Moral distress is an emotional response experienced when we are required to perform interventions that are not in the patient's best interests, which may increase or prolong suffering and which are not going to change the ultimate outcome. Moral residue is the accumulation of many months or years of morally distressing activities wherein we have compromised our own ethics or have allowed our ethics to be compromised in instances where we have no authority to act otherwise. And compassion fatigue results when these emotional upheavals are unrelieved and unaddressed. People who work in caring or helping professions often reach a point where, to protect themselves from further hurt, they close off their emotions and find it difficult to express emotions of any kind in their workplaces. Burn out is a huge issue for nurses working in ICUs, especially those caring for children. Why let oneself get close to a child or a family when experience tells one that the outcome will be the death of the child? I haven't reached that point yet, but feel it might be drawing nigh. Too many sad, sad, suffering families over the years have broken my heart over and over. Will today be the day that I can't do it any more? I hope not.

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Specializes in Pediatric ICU.

Wow Janfrn. Great post.

I too work in a pediatric ICU. We see far too many deaths for my taste. I wonder how long I can continue to work in this environment. We have a great support staff for the patient's families as well as the staff. It is extremely difficult, as you said, to see "everything done" for a child that is trying to die. Who's to say they won't get better, however, sometimes I feel we certainly cross the line of "too much". We have an ethics committee as well as several resources for when things get sticky.

It still doesn't make it any easier when a family has to say goodbye to their child. It truly takes it toll on the staff. A lot of times the kids that pass are the ones that we've been caring for months on end and most every nurse has had a hand in their care. It touches everyone.

Difficult? Definitely. Worth working in this specialty? Absolutely.

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Mary Hicks,

I am so sorry for your loss. Your post brought tears to my eyes.

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Specializes in pediatric critical care.

Also...as a Nurse I have never "ended a life". I have been present and part of support being withdrawn but its life support, ventilators, pressors, sedation, heart/lung bypass, dialysis...yes without those things the patient wouldn't have a heartbeat but in withdrawing support we are allowing nature to take its course, I don't look at it as "killing" or ending that life...and there are times despite all the maximal support we can give, patients declare themselves, hearts will stop despite all the drugs you can give to restart it and by that point nature is taking its course

Well said. I have been the assigned nurse to many a child crossing the bridge into heaven. I have also been the mother who had to allow her child to cross that bridge. I look at it like this: when it gets to the point where no treatment can make a difference, when a child is suffering like that, it is better for that poor child to be at peace. Yes, it is a horribly sad situation. Yes, it can tear up your heart. But sometimes, the alternative is so, so much worse. And there are so many things you CAN do at the bedside to ease the situation, medicating the child to keep them comfortable, allowing the parent to cuddle a child they may never have been able to hold before, making handprints with ink or plaster, cutting a lock of hair to be saved. Just being there for that family, so they don't feel alone, can make all the difference in the world. It's not something everyone is comfortable with. Just remember, the smallest gestures can make the biggest impact on a family.

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What an excellent post and interesting to read all the responses. We have a social worker where I work in the PICU that when asked "How do you know when they (the child) are done?" She simply replies "I think when you ask that question" "It comes when we find ourselves doing things TO them and not FOR them anymore" I was recently faced with a very difficult passing of a child with whom I had bonded with as well as his family. His parents were split - one wanted to continue, one was done. As staff we knew we were doing things TO him. I found myself tearing up with every assessment. Hugging parents, and letting them know that we are behind them in whatever decision they make. I think that once you disconnect yourself from the patients so far that you cannot involve yourself emotionally to grieve for a passing soul it is time to find a new unit.

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Specializes in Critical Care; Cardiac; Professional Development.

To the OP, I am so sorry for the loss of your precious baby. I lost my 13 year old son in PICU to pneumonia after bone marrow transplant for relapsed AML. The nurses in PICU were what made me decide to become a nurse after he died and remain friends of mine to this day. They were there the day the world stopped turning. I hate it that you didn't have that and am impressed that you too are letting your loss spur you into a career that lets you take what you learned in that tragedy and do some good in the world with it. I wish you all the luck in the world in your new career.

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