Letting very young children see a dying patient

[Cuddleswithpuddles]

Hello all,

I wanted to get some input on letting young children into your critical care units to see their dying moms or dads, especially if the children are at an age when they would normally not be allowed in the unit.

I recently had a very sick patient who was unlikely to survive. Our ICU requires children to be 12 and older in order to visit but I got permission from the house supervisor to let this patient's young kids come in with an adult to say goodbye. The younger ones (around the age of 5) looked confused or numb with shock, the older ones understood and were very, very stricken with grief. Needless to say, it was very emotional.

My coworkers were very conflicted. One person said it was very selfish of the adults to expect their kids to see their parent all gray, jaundiced, bleeding and terribly swollen. I, on the other hand, feel it was my duty to respect the family's wish to have the kids say goodbye.

Maybe the kids will be traumatized, maybe they will not. It is not my place to determine what their kids can and should handle. Then again, I am not a mom.

What do you think? I look forward to hearing your input and experiences!

[JeanOfAllTraits]

Our child life isn't avalible to help with the families of adult pts, but the first thing they will say if we call for some advice is to let the kids do whatever they want to do and nothing more, nothing less. If they want to see, then let them, if they don't, thrm don't force them. Above all, never lie to them.

[pfongk]

I was 6 when my grandfather died, mum took us kids down when he was sick so she could help my grandmother look after him as he wanted to die at home. I remember just sitting with him on his bed reading the comics from the paper to him, applying moisturiser to his arms when they were dry and even getting to help with his ng feed (under the supervision of an adult of course). I'm still grateful that I got to spend that time with granddad, even if we flew back before he died and I missed out on the funeral.

[SubSippi]

The situation may be traumatic for the child, yes, but the alternative is to not allow someone to say goodbye to their mom or dad. I dated a guy whose dad died when he was young, and he was not allowed to be in the unit when his dad died. This has plagued him his entire life. However distressing such an encounter may be for children, I feel that closure is extremely important, when going through the grief process.

I don't think it is a nurse's (or doctor's) decision to make. That decision should be left up to whoever is in charge of the child. They have a better idea of what the child needs and can handle.

[whofan, ADN, BSN, RN]

We do if they other parent requests or if the dying patient requests. We also get the chaplain and child life involved. Alot of times they make handprint casts and things of the dying patient. It gives the children some way to say good-bye and can be helpful for them having good mental health in the future. But ultimately it is a case-by-case decision and we usually defer to the other parent/grandparent or custodian of the child.

[LoveMyBugs, BSN, CNA, RN]

We let them, we get child life involved to help prepare them for what they are going to see.

As someone else said, let them see if they want and if they don't, do not force them. Don't lie or sugar coat things.

One thing our child life does is let them see and touch the equipment that they may see in the room as a way to prepare them. To let them ask questions before they see their loved one.

A lot of times the medical stuff is overwhelming and if they have had a chance to see/touch/ask before they see it on their family member they handle it a little better.

Always go at their pace and comfort level.

I have had siblings of patients who after seeing the equipment first decided that they did not want to see their sibling that way and others who were initially scared had no problem going into the room

[traumaRUs, MSN, APRN]

This is so timely for me as as I went to a full arrest yesterday of an elderly man who died from a massive GIB. He was deceased when we arrived to the home and it was obviously a horrific scene with much blood all over the bed, floor, etc.

The wife called the daughter to bring the young grandchildren to say goodbye to grandpa!

Uh....it was traumatic for our young firefighters let alone these poor grandchildren.

This bring back up the fact that as nurses we must always consider the circumstances prior to allowing children in.

I can remember oh so many situations in the ER and pre-hospital where we used very careful draping to at least leave a hand or foot open so that family could hold, hug or kiss and say goodbye.

[MunoRN, RN]

I've actually always found that children consistently deal with death far better than many adults do. I think the poor coping skills regarding death many adults have are learned and therefore aren't as common in children. The 'blank slate' children have is actually more effective at dealing with death.

You'd think that as we mature our ability to cope with the reality of death would also mature, but the opposite seems to be case for many.

[Shawn417]

Children may not be able to fully understand what was going on with their father but in my personal opinion they have every right to see him regardless of his bleeding from every orifice and moaning in pain. As one of the other posters said more than likely they will not remember specifics about how he was all they will be able to remember when they are older is that they got to say goodbye.

[AnthonyD]

If the family makes the decision that they would like the child to be there, then by all means I will do my best to make it happen. It isn't my place to judge what is appropriate for someone else's child to see or not see, and I would not want to be the one to deny them that request. Some things I would try to do however - make the patient and the room as presentable as possible, talk to the kid first to try to make sure they understand what they are going to see, and show them what the equipment in the room is. Kids seem most afraid of all of the various pumps/machines etc, but it doesn't take long to explain in simple terms what each thing is doing for their mom or dad or grandparent.

[spacemonkey15]

I've encouraged families who've been sat on the fence to bring in their kids before after talking with them, I've agreed with others that it wouldn't be the best idea. The way I feel about it is, that there's no one size fits all rule to the situation, some situations may be so horrific that adults find it distressing to see, even people working in healthcare, however parents know their kids best, they're the best ones to talk to about this. Units may have set policies on what age kids can visit patients, but if someone is at the end of their life then that's one time I feel we can get away with bending the rules. Children can have a maturity years ahead of their actual ages, they're often more than aware of what they're seeing in hospital and to deny them of spending one last moment with someone they love should be very carefully considered.

[Red Kryptonite]

I think seeing a loved one hooked up to tubes and machines and all that is much of the traumatic part. Families and health care professionals need to be encouraged to admit the truth sooner and transfer to hospice care, so the last moments can be spent more peacefully and without all the scary-looking and sounding apparatus.

[hppygr8ful, ASN, RN, EMT-I]

My own dad died in 2007. I took my son to see him several times before and after he was ravaged his body. These visits started when the man cub was 7. Towards the end he understood that grandpa was very sick and would soon go to heaven. One day which was a good one for dad my son asked him to take care of his dog who recently died. After his death I became very ill and in 2012 nearly died from a peritoneal abcess - My son asked me if I was ok and I told him I was sick and going to the hospital. He was very calm as he walked out of the room but then turn around and with just a bit of fear on his face he asked "Are you sick like grandpa?" We cuddled on the couch and talked and laughed and It all turned out ok. Kids are far more resiliant than we give them credit for.