Preparing for the loss of a pediatric patient

[Heart_<3_RN]

Today I was given the news that a pediatric patient I cared for is potentially not going to make it. I had run into the parents in the hall and they let me know they had decided not to have CPR preformed if needed (I wanted to scream noooo please, aren't there other options can she/he be transferred to a hospital with a new set of eyes and possibly higher level of care, I am aware that the parents decision is a valid option that I am sure the parents have throughly thought out and hopefully been completely educated on) I have been crying my eyes out and so sad I am actually hurting. This is my first time experiencing this as a nurse, I have had patients die before but all with severe diagnosis, much older and with co-morbidities. I am sure some of you Pedi nurses go through this more often, how do you deal? i am trying to do what we nurses do and separate my feelings but I can't.

[Sour Lemon]

Today I was given the news that a pediatric patient I cared for is potentially not going to make it. I had run into the parents in the hall and they let me know they had decided not to have CPR preformed if needed (I wanted to scream noooo please aren't there other options can she/he be transferred to a hospital with a new set of eyes and possibly higher level of care, I am aware that the parents decision is a valid option that I am sure the parents have throughly thought out and hopefully been completely educated on) I have been crying my eyes out and so sad I am actually hurting. This is my first time experiencing this as a nurse, I have had patients die before but all with severe diagnosis, much older and with co-morbidities. I am sure some of you Pedi nurses go through this more often, how do you deal? i am trying to do what we nurses do and separate my feelings but I can't.[/quote']

I'm sorry f this sounds "mean", but perhaps you need to remember that it's not all about you. What about the child's feelings? What about the parents', grandparents' and other family members feelings? As nurses, we are small and relatively insignificant parts of out patients' lives. I would encourage you to focus on supporting the patient/family (if requested) and not thinking so much about yourself.

[Heart_<3_RN]

I was expecting a comment like that i almost wrote a reference to it, and i would feel the same way.. which is why these emotions are surprising me.. thank you for your post

[xoemmylouox, ASN, RN]

It can be tough when you are their nurse. I have attended the funeral for more than one of my pedi patients that have died. I don't make it a habit to go to all of them though. You will be upset, but just remember no matter what, you aren't the one losing the child/sibling/loved one. It isn't about you. It is about the family. It doesn't make you wrong for getting upset though, so don't beat yourself up about it.

[Heart_<3_RN]

thank you for your words, this one is just really getting to me. I know it is not about me and I maintain a very professional therapeutic approach with the family but at home I am a mess. I am an OR nurse not a PICU nurse. So this is a new feeling for me.

[Coffee Nurse, BSN, RN]

9237274[/url]]thank you for your words this one is just really getting to me. I know it is not about me and I maintain a very professional therapeutic approach with the family but at home I am a mess. I am an OR nurse not a PICU nurse. So this is a new feeling for me.[/quote']

I don't entirely agree with the PPs that "it's not about you." Certainly it would have been inappropriate for you to question the parents' decision and interject yourself into their situation that way, but you didn't and it sounds like you've conducted yourself in a professional manner. Well done, that's your duty towards them discharged. Now remember that you also have to take care of yourself. Compartmentalization helps, but there will always be that patient/family/situation that just gets under your skin unexpectedly, and it doesn't do you any favors to try to just ignore it, especially if it's affecting your personal life to the point that you're a mess at home. If you feel you need to talk about it, find an appropriate resource, whether it's a therapist, a counsellor provided through your employer, a coworker, etc.

[traumaRUs, MSN, APRN]

Its very hard to face the death of a child. My youngest grandchild had a life-threatening event two years ago and then had complications and it got to the point where they asked the family about code status as they were not sure of neurological outcome.

As an APRN I knew the discussion was coming but it still hurt tremendously (I'm tearing up writing about it now). However, the doctors and nurses gave us the facts and we made the decision to continue with all life support and full code status.

This is a devastating decision for any family to make so please understand these parents have had to come to terms with possibly losing their child and the hopes and dreams they had for their family and their future. They just need affirmation - not that their decision is right but that they made a decision at all.

[RNNPICU, BSN, RN]

I am sorry you are going through this, as nurses sometimes things affect us in ways we don't even realize just because we deal with life/death on a daily basis.

We see this frequently in the PICU. The parents that have chosen this route, not to do CPR, are some of the strongest parents I know. Sometimes choosing the option to proceed with all interventions can have far worse long term effects than anything else. I have seen both sides were families do not want heroic interventions done and the child passes. Other times, the family proceeds with a trach and GT surgery, child needs a vent support to live, doesn't move on their own, is feed via Gtube, no longer communicates, smiles interacts, and then passes 1-2 years later. Sometimes heroic interventions can cause more pain when the end is still the same.

As nurses, I think we are accustomed to dealing with all kinds of things and something catches us of guard and hits us emotionally.

Please take care

[Nurse SMS, MSN, RN]

As a parent who had to make the decision to discontinue treatment for my child who was dying, please excuse yourself from caring for this child should the opportunity present prior to the child passing and avoid his or her parents if you gracefully can. This is a hard enough decision without a caretaker having an emotional reaction that is so intense. It is appreciated that you care for the child and hoped for a better outcome. It is not appreciated that you would second guess the parents' agonizing decision. Chances are they are too wrapped up in their own suffering to notice yours to be honest, but just in case they can sense it, do all you can to stay away if you feel you may get overly emotional.

[HouTx, BSN, MSN, EdD]

We all have our "no go" areas - for one reason or another. Mine is the little ones. I have never been able to maintain a sufficient level of compartmentalism to care for pedi patients, even in ED situations. NICU was emotionally devastating for me. I realized my limitations - and stuck with adults. BTW, I also discovered that I couldn't cope well with caring for severely burned patients of any age.

I believe that is is also injurious to choose to expose yourself to ongoing emotional trauma when we know the potentially harmful consequences to our own wellbeing. We're not invulnerable and that's OK. But we do have a responsibility not to burden patients/families with our frailties. They have enough to cope with.

[Heart_<3_RN]

i think my message was miss understood i did not question the parents, i understood why they choose that. i only added that part to explain my interpersonal thoughts. I have never and would never say anything like this to a family member. I was being selfish not wanting to see this little girl go. she passed away at the beginning of last week. I didn't stay away from them i was there for anything the mother needed. I cried with the mother but was able to keep myself together and be a therapeutic supportive nurse. thank you for your comment