Family Centered Care in the PICU at Tampa General Hospital

"Above and Beyond" Family Centered Care in the Pediatric Intensive Care Unit Team

Family Centered Care in the PICU at Tampa General Hospital

Pediatric ICU and Surgical Trauma ICU
Tampa General Hospital
Tampa, Florida
United States
Danielle Del Buono, RN (Team Lead); Meredith Regal, RN; Julia Mulford, RN; Christine Pifer, RN; Hannah Robey, RN; Michael Davitt, RN; Kelley Cwiok, RN; Jerry McCubbin, RN; Juana Hernandez, RN; Alexa Joseph, RN; Dr. Riggs; Dr. Weibley; Dr.Paidas

One evening, a multi-vehicle trauma resulted in life-threatening injuries to an 18-month old female child, her mother, and her father.  The child was admitted to the PICU at TGH with devastating neurological complications.  The mother and father were admitted to Bayfront with extensive injuries.  The child was declared brain dead within hours of arrival to TGH. Dr. Riggs, Dr. Weibley, and Dr. Paidas were the Attending Physicians leading the case. Driven by the mission of TGH to provide compassion and advocacy to the practice of healthcare, incredible measures were taken by the PICU nursing staff to coordinate the transfer of the child’s parents to TGH.  In response to this tragic event, Danielle Del Buono, RN (PICU-night shift) organized with the TGH Surgical Trauma team to accept the mom and have her admitted to the adjoining adult surgical trauma ICU.

Julie Mulford (PICU-day shift) continued Danielle’s efforts taking multiple phone calls to coordinate the mother’s transport while caring for the critically ill child and supporting the family. At this time the father was medically unstable for transfer and remained at Bayfront. Once the mom arrived at TGH and was stable, the PICU nurses collaborated with the Surgical Trauma RNs to reunite mother and daughter.  Danielle Del Buono, RN led the efforts to collaborate with Michael Davitt, RN and Jerry McCubbin, RN (from Surgical/Trauma ICU) to safely transport Mom into the PICU.  Extraordinary measures were taken by Danielle to provide the mother time with her daughter. Mom could not get out of bed, so her hospital bed was rolled into her daughter’s room.  A combined effort by Danielle, Jerry, and Michael, along with all the PICU nurses on staff that night, allowed mother and daughter to be placed side by side (in their beds); enabling the mother to touch and embrace her child.  The PICU RNs prepared ahead of time by providing a calm, compassionate environment anticipating an intense emotional response. The mom naturally became overwhelmed and hysterical with grief, bringing tears to everyone’s eyes. Each and every PICU and Trauma RN on that night supported not only the family but each other during this tragic event.

Throughout this time, there was an enormous amount of family presence at TGH.  Most family members were Spanish speaking only. The family was led by one particular “Aunt” who was instrumental in advocating for and educating the grieving family. At this point, numerous measures were taken to support the influx of such a large family, who cared tremendously for this little girl.  Each shift the PICU nurses went above and beyond to provide quality care for the patient while helping the family understand the physician’s diagnosis of “brain death”. For most, this is a hard concept to accept; the incongruity of brain death when the physical heart still beats.  The PICU nurses paid special attention to the small details of the family’s culture by placing personal items at the bedside while allowing quiet time for prayer.

By this time, Life Link was involved for possible organ donation; however, with the sensitive nature of the family’s medical needs, additional support was provided by Social Work, Neuropsychology, Pastoral Care and the entire PICU team to support the child’s extended family with the Life Link coordinators.  When the family agreed to donation, the PICU RNs once again recognized the importance of reuniting the entire family; especially the father. Christine Pifer, RN (PICU) contacted colleagues at Bayfront to arrange for transport of the father to TGH.  The father had extensive injuries (paralyzed T4 down) and would also need ICU level of care. Dad arrived safely at TGH.  PICU RNs Hannah Robey and Alexa Joseph along with the Kelley Cwiok from the Surgical/Trauma ICU, once again advocated for the patient needs, making all efforts to get Dad to the bedside of his daughter.  Kelley Cwiok coordinated the transport of Dad and his hospital bed was rolled into his daughter’s room. The nurses placed the child into his bed for their final goodbyes.  This was a tremendously emotional moment.

These efforts exemplify extraordinary collaborations that model the values of integrity, advocacy, compassion, and excellence.  The RNs displayed amazing teamwork that made a true difference in all the lives of this little girl, making family-centered care their priority. Making this type of difference may all be in a day’s work in the PICU, however, these nurses deserve recognition for doing what they do best!  They provided the mother and father special time with their beloved daughter. PICU nurses not only care for the most critically ill and medically complex patients, but they give with all their hearts to achieve the best possible outcomes, even if the outcomes are less than desired. PICU nurses make the most of difficult situations by caring for each patient individually and treating them as family. Additionally, the members of the Bed- File/Transfer center should be commended for their extraordinary efforts on the coordinated transfers.

In closing, this tragic event led to the miraculous gift of organ donation.  An 8-month-old little girl from Florida received the heart.  The liver recipient was a 7-year-old little boy from Connecticut and a 58-year-old woman received both kidneys.