With her preceptor, Annabeth was assigned to care for a 12 month old with leukemia who had undergone a bone marrow transplant. Unfortunately, his bone marrow recovered with blasts forcing the family to make the tough decision to shift the goals of care from aggressive treatment to ensuring his comfort at the end of life. Annabeth continued to care for him following the end of her orientation because of the intimate relationship she had developed with his family. She effectively managed the increased acuity level of this assignment quite well with the assistance of the charge and resource nurses despite her inexperience.
When the family decided to stop all aggressive measures, Annabeth smoothly transitioned to attending to the child's comfort and supporting the family. The mother expressed her heartache that he would not experience so many milestones. Annabeth recognized that the loss would really be the mother's in that she would not share those experiences with him. She led the mother to describe what activities would create those memories while in the hospital in the time he had left.
Annabeth brought in a floor mat so he could play like any other toddler and took lots of pictures to capture the moment. When the end was near, Annabeth encouraged the parents to lie in the bed and hold him. The oncology attending noted "the patient died a very peaceful death. His mother commented on Annabeth's role asking the right questions" to help her and her family feel at peace.
Shortly after this patient's death, Annabeth was assigned to care for a patient well known to PICU. The child was born prematurely, was severely developmentally delayed, technology dependent, and was frequently admitted over the past year with sepsis and respiratory failure. During this admission, the mother discussed her feeling that the child had suffered enough and had a poor quality of life with the health care team and expressed her desire to allow him to die peacefully without aggressive treatment. The team supported the mother's decision.
During her shift, Annabeth recognized that even though the mother was confident she had made the right decision, she was still very anxious. Annabeth asked her to describe her experiences with the child over the past two years, focusing on what he enjoyed. The mother told Annabeth that his favorite activity was watching "The Wiggles". Annabeth combed the unit's collection and found a Wiggles DVD. She played the DVD to make him more comfortable and to ease the mother's distress. He passed away peacefully during Annabeth's shift.
Annabeth's sensitivity and compassion will certainly help to comfort these families as they travel the journey of grief and the difficult road ahead. What makes these situations extraordinary is that Annabeth has just recently completed her first six months of employment as a nurse. The maturity, insight, communication skills, and creativity she demonstrated are assets usually cultivated by years of experience!