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Withdrawl of Life Support in the PICU

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by JudithRN24 JudithRN24 (New) New

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!

johnnyDoGood

Specializes in babysitting.

gotta do what you gotta do. can't be timid about the situation. you might face this again many times. death is a natural process, very natural. you can't fight death. yes you feel sorry for the family, but it was not your fault that life support had to be stopped. why grow gray hairs worrying about this? what's done is done.

I am just starting my clinicals in my first year of nursing school and was asking my clinical instructor the same questions the other day. Her response was that is ok to feel emotion, it is ok to shed some tears with the pts. family in these situations, we just have to be there to support them and not fall apart. Just asking this question seems to me like you are a very kind person and will do great supporting the family. There really isnt much in the way of total support you can give really. I think just being kind and compassionate to their situation will be what you need to do. The thought scares the hell out of me. You will be fine though. If you need to have a tearfest at home after this situation. We are just human and things hurt us as well.

johnnyDOGOod the death of an infant is not a natural process. It is a sad situation and to feel compassion and and have emotion about it is the natural process (or about any death). As a new grad it would be something that I would be worried about also. I believe compassion and empathy are very strong traits for a nurse to have.

OP you will deal with it in a perfect way. Dont ever lose your compassion. Good luck with this situation you will face. May it make you a stronger nurse....

johnnyDoGood

Specializes in babysitting.

I am just starting my clinicals in my first year of nursing school and was asking my clinical instructor the same questions the other day. Her response was that is ok to feel emotion, it is ok to shed some tears with the pts. family in these situations, we just have to be there to support them and not fall apart. Just asking this question seems to me like you are a very kind person and will do great supporting the family. There really isnt much in the way of total support you can give really. I think just being kind and compassionate to their situation will be what you need to do. The thought scares the hell out of me. You will be fine though. If you need to have a tearfest at home after this situation. We are just human and things hurt us as well.

johnnyDOGOod the death of an infant is not a natural process. It is a sad situation and to feel compassion and and have emotion about it is the natural process (or about any death). As a new grad it would be something that I would be worried about also. I believe compassion and empathy are very strong traits for a nurse to have.

OP you will deal with it in a perfect way. Dont ever lose your compassion. Good luck with this situation you will face. May it make you a stronger nurse....

it depends on how you look at it with infants. do they still consider SIDS a natural death, for instance. like i stated, it's traumatic for the family, but it happens. if the OP frets about this on every case, then they are putting themselves at emotional health risk.

it depends on how you look at it with infants. do they still consider SIDS a natural death, for instance. like i stated, it's traumatic for the family, but it happens. if the OP frets about this on every case, then they are putting themselves at emotional health risk.

I understand what you are saying to a point, but who isnt a little freaked out at thinking about their first death as a nurse. I know I sure as hell am. I dont care if someone is 100 or 1 day it still freaks me out to think about dealing with it yet I know I will have to at some point and I will do jsut fine. I believe its the families reaction that will get to me. Im emotional. i cant help it. (my life is an emotional health risk!! hahaha) I dont believe emotions make people less than in the nursing aspect. (i know you did not ever say that just sayin) I believe having compassion and feelings are great things for nurses to have. Anyway Im kind of babbling because its so late. With all due respect to you johnnyBeGood! :)

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 45 years experience.

The death of an infant is not a "natural process" but a long, harrowing and emotional process for these parents, who have come to the conclusion that continued life here on earth is something they would like to have more than anything, but know their little one is better to be released to a different level, and what that is will depend on their spiritual beliefs.

I hope some more of the PICU nurses will contribute, but just in case they don't, I would see that the family have enough comfortable chairs and blankets, talk softly and try to minimize any noises and interruptions that may occur. You won't need bright lights and monitors anymore, the only thing that counts is a meaningful farewell to the baby. Find out what the preferences are for picture taking and momentos such as locks of hair, etc -they may want you to take some pictures, and depending on your unit's policies it would be a kind gesture. Other families may not want pictures.

Once the baby is taken off the vent, someone will be holding the child possibly for the first time without all the tubes and wires they've experienced their baby in since birth. The best thing to do is be a supportive and available presence and let them set the agenda. If you shed some tears it isn't the worst thing at all - just remember to think support support support. Maybe there will be a member of the clergy or chaplain present.

Anyway, I just wanted to get you started as quite frankly trying to distance yourself because it's not the last time one of your patients will die is not the way it works in peds. You always feel. That's why you're there. There is a "place inside" where we feel and we function. Consider it an honor in a way -- best to you :redpinkhe

carolmaccas66, BSN, RN

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I think it's unfair of your charge nurse to put you in this situation. U need to tell her ASAP how you feel. Not every nurse can cope with such a harrowing situation as this. Just because you 'have a rapport with the family' does not mean you are expandable. Frankly, I would feel like I was being used, though I suppose some may see it as flattering. I am only looking at this from ur viewpoint.

Schedule a meeting with her and tell her how u feel. It doesn't matter who is going to be there when this infant dies, the parents will still be upset & it will be a terribly traumatic time. If u think u can't handle it, tell your charge nurse and NM ASAP. No point in u being traumatised as well.

Whoever is there is going to be traumatized. And it IS about who has best developed a rapport with the family. Apparently that's you.

Nurse156 gave good advice. Especially about getting the chaplain there. Make sure all the staff on the unit is aware what's going on, last thing you need is people walking by the room giggling and laughing because they don't realize what's happening. And make sure you have a few boxes of tissues, already opened, nearby and ready to go. (It really is just the "little things" at times like this that make a difference.) Just "be there" for them.

When all is said and done, and the family has left, make sure to take a few minutes to get completely off the unit, preferably some fresh air, and get yourself together before going back to your other work. This is one of those times when a protein bar while you chart should not be considered a break.

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

I disagree with you Carol. It is about the family and this is going to be a part of the job in PICU unfortunately. And you have to start somewhere.

We do assign people who have a rapport with the family because it is easier for the family to be with people they are familiar and comfortable with. They know that you care for their child, you have done a great job and they like you. As hard as it is, you will cry with them and they will be thankful that someone is there who cares.

Does your unit have a ritual they do? I know in our PICU they offer the mom and dad the opportunity to bath and dress the child, they will ask if they want a lock of hair, we have a photographer that will come in and take pictures of them with the child if they so desire, pre and postmortum. They may want clergy there, and other family.

No matter what, it is sad. But, be honored that you were able to take care of their child and be there for them at their absolute most vulnerable time. Take care and don't worrry, just do and say what feels right!

tryingtohaveitall

Specializes in PICU. Has 23 years experience.

It's not unfair of them to place her in this position, she works in a PICU. It is terribly sad and unnatural to lose a child, but it is part of the job that we have to do.

You did thankfully receive some good advice about supporting the family. I would talk to your charge nurse, ask what things your unit does to support families. We have an extensive bereavement program that includes hand & foot molds and framed prints, pictures, a prayer shawl, teddy bear, and lockets-one heart that stays with the child and the outer portion that is given to the parents.

We give the parents the option of holding the child while they are extubated or waiting until after it's done. We gently offer options that the parents may want. Sometimes in their grief, it's hard for parents to know what they want, however if this has been a long time coming, the parents may already have thought a great deal about what they do and don't want to do.

One of the last deaths I was involved with was very touching. The parents held the baby while the entire family and doctors, nurse (me) and chaplain all held hands in a circle surrounding them while a family member prayed for them.

Get an experienced, friendly coworker to help you. We never do post mortem care alone, not because we can't but because it's a time to support each other.

tralalaRN

Specializes in pediatrics. Has 21 years experience.

Judith - I want to talk to you from a mom's point of view rather than a nurse's point of view on this one. I had a 24ish week preemie who sustained a grade IV IVH. We placed a DNR on her when she was 2 days old because of this and other complications. .we held her for what we believed was the first and last time.

I agree with many of the viewpoints above, but want to elaborate a bit. . the parents might be feeling a little unsure of their decision - it's natural to want your baby to live. It's the most SELFLESS thing on the planet to make the decision they have made - to let nature take it's course rather than forcing their child to live on life support and/or in pain. Tell them that if they waiver.

Do not ever say that you "understand" what they are going through. You probably know that, but we did have people say that to us, and unless you've been exactly where we have been, no one understands what that is like.

Do try to keep the noise to a minimum as mentioned above. There is nothing more irritating than to be grieving and hearing staff nearby laughing about something else. It's completely disrespectful. Does the unit have a way of conveying to others what is transpiring in the room the baby is in without being obvious? For instance one of the hospital units I worked on put a leaf on the door of someone who was in the dying process so staff would know.

If you have had a good relationship with the family, by all means, you should be the one to do this. Death is a natural part of life. It is. Sometimes it comes at a week old, unfortunately. Some of the best nurses we had in the NICU were the newest nurses. Some of the older seasoned NICU nurses had seen/done it all - were hardened to what was happening to us. We treasured the ones who cried with us. Really, it's ok to do that with the family. They will remember you as a caring soul who was there for them at their worst hour.

carolmaccas66, BSN, RN

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

To some other posters:

The poster doesn't feel comfortable doing this. Is it fair to ask her to do something like this? Even if this is 'part of the job,' she still needs to let her NM or whoever is in charge know how she feels.

I've sat with a mother who's baby died after she gave birth & went through this with her, though I wasn't a RN then. But I don't think the poster is comfortable with being asked to do this. However I do agree that if she is going to be working on a unit like this, she does need to start somewhere. And just being there and being supportive is a great thing.

carolmaccas66, BSN, RN

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Meant to add also if she is very young, this could be too hard for her. It is different when u have a bit of life experience, and a comfortable philosophy for you that helps you thru life.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

gotta do what you gotta do. can't be timid about the situation. you might face this again many times. death is a natural process, very natural. you can't fight death. yes you feel sorry for the family, but it was not your fault that life support had to be stopped. why grow gray hairs worrying about this? what's done is done.

AH! the troll is out from under the bridge! HELLO TROLL!:devil:

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

I understand what you are saying to a point, but who isnt a little freaked out at thinking about their first death as a nurse. I know I sure as hell am. I dont care if someone is 100 or 1 day it still freaks me out to think about dealing with it yet I know I will have to at some point and I will do jsut fine. I believe its the families reaction that will get to me. Im emotional. i cant help it. (my life is an emotional health risk!! hahaha) I dont believe emotions make people less than in the nursing aspect. (i know you did not ever say that just sayin) I believe having compassion and feelings are great things for nurses to have. Anyway Im kind of babbling because its so late. With all due respect to you johnnyBeGood! :)

He's a troll!

BluegrassRN

Has 14 years experience.

If my baby were dying, I would want a nurse with whom I felt comfortable. It would comfort me all the more that the nurse cared enough to become emotional and cry with me.

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

Is anyone ever truly comfortable watching the parents endure this? No. Are any of us truly comfortable with this? No.

By all means, she should talk to a mentor about this, but to not assign her would be doing this family an injustice. Like we have said, this is part of PICU and you have to do it if you are going to survive working in there. And if the family sees her, and she does have a great rapport with them, they will be more saddened and upset that someone that they have trusted so much wouldn't be there. What does she say if they ask her to be there? sorry, ca't do it? No, you pull yourself up by your bootstraps, put on your big girl panties and get in there and help that family as much as you can.

Even after 24 years, I still don't like it. To lose a child is devastating. I wouldn't say I am hardened, but I have learned to keep myself together to be there for those poor families that have made the most selfless decision a family can ever make.

Carol, I have to disagree as well. I was a young nurse in the ICU and learning this is part of the process. Age has very little to do with it. One can be young and also possess maturity and empathy.

Not knowing what to do is also normal. It doesn't mean the OP shouldn't do it, it means she needs to seek support as she has here. It's all about knowing what to expect. There have been some excellent responses.

It's just not something they teach you in nursing school. IMHO, once you've done it once you feel more comfortable (as far as the mechanics, the procedure - NOT emotionally!) the second time around.

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