Steps

Rationale/Points of Emphasis

1a After the physician has pronounced the child’s time of death, provide psychosocial support to the family. If family is not present, confirm with physician that he or she will notify them.

The loss of a child is a devastating experience for families; the nurse can help the family find needed privacy and can help facilitate communication among family members and members of the healthcare team.

1b Provide privacy (e.g., pull curtains, close doors).

Allows family and significant others to begin the grieving process and to have some special time with the deceased child.

2 Ask the family members if they would like to assist with cleaning and changing of the child.

Gives the family a sense of control in being part of the care of the deceased child. Respects and acknowledges cultural and religious beliefs.

3 Perform hand hygiene.

Reduces transmission of microorganisms.

4 Gather the necessary supplies and basin of warm water.

Promotes efficient time management and provides an organized approach to the procedure during postmortem care.

5 Don gloves. If the deceased child had been in isolation for any reason, the same isolation practices need to be followed after death; label the body accordingly.

Standard precaution to reduce transmission of microorganisms.

6 Cleanse the body.

Conveys respect and prepares the body for family’s viewing, if not already present. Many coroners and pathologists no longer require that lines and tubes be left in for autopsy cases.

If child has a pacemaker, place tape across chest with the word “pacemaker” written across to alert the mortician.

7 Prepare the child and the room for the family’s visit, if not already present:

• Provide clean bed linens as needed.

• Dress the child in clothes brought from home or provided by the hospital.

• Position the child in a pose of comfort; close child’s eyes, if open.

• Turn off and push equipment to side.

• Deodorize room, if needed.

Familiar clothing reinforces the unique and special characteristics of this child to the family. Comfortable appearance of child and calm room may comfort the family.

caREminder

It may be beneficial to leave much of the resuscitation equipment in the room to reinforce the fact that efforts were taken to save the child.

8 Explore family’s desire to have specific momentous and perform/facilitate memory making opportunities. Use “keepsake kit” to take photos of the child alone and/or child and family in an aesthetically pleasing manner. Make hand and/or footprints. Collect a lock of the child’s hair and place in a plastic bag. Collect the clothes the child was wearing, if appropriate, and place in a sealable plastic bag. Offer these mementos to the family, or place them with the medical record to be given to the family at a later date.

Mementos give the family reminders of the child. Sealing the plastic bag may help preserve the child’s scent on the clothes. The family may not be ready for the photos and other mementos at this time in their grieving process; however, many families often change their minds and want these items at later dates.

9a If family members have not been present for any end of life interventions (as previously discussed) for the child, accompany them to the bedside and allow for privacy with the deceased child. If the family has been assisting, allow them time with the deceased child alone.

Many families experience a sense of comfort when allowed private time with a deceased child.

9b Without forcing, encourage the family members to spend as much time as they wish with the child.

The length of the final visit should be determined by the needs of the individual family.

9c Support the family as necessary. Offer the family the opportunity to hold the child, and assist as needed. If siblings of a deceased child are present, discuss with the family allowing siblings to see the child. Use child-life specialists, if available, to assist in preparing the siblings to see the child.

Viewing or holding the deceased child reinforces the reality of death and may help in saying farewell to child.

KidKare Inform siblings of what happened and give them an opportunity to express their questions and fears and to see their brother or sister if requested.

9d Provide support for the completion of any requested religious practices, such as baptizing or blessing the child.

Demonstrates respect for cultural and spiritual needs and practices associated with the child’s death.

10 Inventory the child’s personal belongings and give them to the family. If family is not present, turn personal belongings over to security. Have the parents sign the appropriate documents (e.g., donor papers, autopsy).

Ensures that the family obtains the child’s belongings, which can help the family in the grieving process.

11 Before the family has departed, ensure that the child has on the correct armband. If armband is not in place, apply one.

The family provides positive identification of the child.

12 After the family leaves, fill out the labels of the shroud pack with the appropriate information.

Ensures correct identification of child among medical team, mortician, and organ procurement agency or coroner, if involved.

13 With assistance if needed, roll deceased child onto plastic sheet in shroud kit.

Keeps body fluids that may be released because of relaxed sphincters from contaminating any surface that the body may be moved to.

14a Attach one of the labels to either the great toe or ankle. Follow institutional policies.

Ensures proper identification of the child.

14b Loosely tape wrists or ankles to maintain alignment of body if necessary; do not use cording or other ties.

The ties may cause damage to the skin and tissues of the deceased child.

15 Fold plastic sheet around the body, securing ends and closing with tape.

Maintains body fluids in that space.

16 Remove gloves and perform hand hygiene.

Reduces transmission of microorganisms.

17 Attach second label securely with tape to top portion of covered body.

Ensures proper identification of the child.

18 Obtain stretcher for transporting deceased child to morgue, and place deceased child onto the stretcher.

Provides easier transportation than moving the entire bed.

19 Notify security or other personnel as required by institution for escorting the deceased child to the morgue.

Facilitates transport into the morgue.

20a Escort the deceased child to morgue with second person.

Provides emotional support for unit personnel after a death and safe and discreet physical transport.

20b Verify identity of the child and accuracy of accompanying records upon arrival at morgue. Complete documentation and dispense the medical record per institution policy.

Reduces chance of identity errors. Provides permanent record of care.

21 Enter the necessary information into the morgue log book, and fill out other unit documents as appropriate.

Ensures proper identification of deceased child for anyone working with body.

22 Upon return to the child’s room, don gloves.

Reduces transmission of microorganisms.

23 Clean room of linen and equipment; dispose of equipment and waste in appropriate receptacle.

Prepares room for terminal cleaning. Standard precautions.

24 Remove gloves and perform hand hygiene.

Reduces transmission of microorganisms.