August 21, 2017



This unique study describes how Paediatric ICU nurses in Australia empower the families of the dying children in two hospitals. (1). Previous studies have investigated the families’ perspective (2, 3), but this is the first to explore the nurses’ viewpoint.
The authors utilise their extensive experience in this field and make rigorous use of qualitative methods to investigate a subject not suitable for quantitative analysis. Convenience sampling produced nurses from 2 Neonate ICU’s and 2 Paediatric ICU’s in 2 Australian hospitals. Six focus groups and four individual interviews were conducted using a semi-structured conversational approach. These were audiotaped and transcribed verbatim for analysis. Inductive content analysis was used to limit subjective interpretation by researchers.
Four themes emerged:

1) Respecting the child as a person

2) Creating opportunities for family involvement and connection

3) Collecting mementoes

4) Planning for death

The study notes several initiatives undertaken by individual nurses, such as working to make the PICU welcoming and comfortable – with the goal of making memories for the family, or even arranging for the death to happen outside of the unit. There were several points not noted in the paper related to these initiatives, which might be interesting for readers:
  • Are these nurses part of a unit culture with written guidelines?
  • Are nurses supported emotionally after these events?
  • In this article, nurses share what they do; it would be interesting to also hear how that makes them feel.

This paper is part of a larger study; so perhaps the nurses’ experience and feelings will be explored a follow up article. Additionally, the sampling is taken from nurses that volunteered to take part. Investigation of nurses with more ambivalent attitudes towards engaging with dying patients and their families might prove worthwhile. It would also be interesting to know how the hospital management views and/or supports these initiatives. Are nurses given time and legitimacy from both unit and institution management?

Caring for dying children may be the greatest challenge to ICU nurses. This article makes a moving contribution to the literature on how nurses care for dying patients and bereaved families. Dissemination of initiatives undertaken by these Australian nurses provide ICU teams everywhere with insight and inspiration into how nurses can honour the dying of all ages.
Article review prepared and submitted by Maureen Ben-Nun, member of the N&AHP section and the ESICM Journal Review Club.  


(1) Bloomer MJ, Endacott R, Copnell B, O’Connor M. Something normal in a very, very abnormal environment. Nursing work to honour the life of dying infants and children in neonatal and paediatric intensive care in Australia. Intensive Crit Care Nurs, 2016 Apr; 33:5-11. doi: 10.1016/j.iccn.2015.09.001.
(2) Butler AE, Hall H, Willetts G, Copnell B. Family Experience and PICU Death: A Meta-Synthesis.  Pediatrics. 2015 Oct;136(4):e961-73. doi: 10.1542/peds.2015-1068. Epub 2015 Sep 14. Review. PMID: 26371203.
(3) Falkenburg JL, Tibboel D, Ganzevoort RR, Gischler S, Hagoort J, van Dijk M. Parental Physical Proximity in End-of-Life Care in the PICU.  Pediatr Crit Care Med. 2016 May;17(5):e212-7. doi: 10.1097/PCC.0000000000000682.

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