Theresa Strine is an exceptional staff nurse in the Pediatric Intensive Care Unit (PICU} who consistently exemplifies the spirit of the DAISY Award. Theresa has a special gift that allows her to deeply connect with her patients and their families and these connections lead her to not only provide outstanding clinical care, but her unique skills and abilities have helped many patients and families navigate unfathomable decisions during their most difficult days. This nomination seeks to recognize Theresa specifically for the support, compassion and guidance that she recently provided to two families in the PICU.

In late October, a 2-month-old patient, M.H., was upgraded to the PICU during a rapid response due to her deteriorating clinical condition. This patient was known to the PICU as she had recently spent approximately two weeks on the unit after she was diagnosed with Hemophagocytic Lymphohistiocytosis (HLH) which is a life-threatening inflammatory condition that results in multi­ system organ failure and can lead to death. When M.H. was transferred to the PICU on that day, she was deteriorating quickly and required a multitude of procedures and rapid interventions over several hours in an effort to save her life.

During this shift, Theresa was assigned to be the unit resource nurse for PICU. In light of M.H.'s condition, Theresa spent a great deal of her shift supporting the clinical care needed for this very unstable patient. As the hours progressed, M.H.'s condition continued to worsen and she was requiring escalation of vasoactive support along with resuscitation via a multitude of medications. The options for M.H.'s care were dwindling and the last option to save her life would be to place her on Extracorporeal Life Support (ECLS). Several hours had passed since the M.H.'s family was able to see her as she had spent a great deal of time undergoing several sterile bedside procedures and enduring ongoing resuscitation efforts. When the attending physician went to the lobby to update the family on M. H's condition and offer ECLS as the last possible intervention that could save her life, they asked if they could come back to see their daughter. When M.H.'s family entered the room, they immediately recognized Theresa as she had cared for their daughter during her initial stay in the PICU. Theresa had such a positive impact on M.H.'s family during that time that she had already developed a trusting relationship with them. This existing rapport immediately made M.H.'s family feel more comfortable and they quickly began to look to Theresa for her support and guidance.

As several other nurses and I continued to support M.H.'s clinical care, Theresa was able to help the patient's family navigate their difficult conversation with the attending physician. She was able to help them understand their options and the implications of each of those options. She supported them through many difficult conversations with the utmost compassion, empathy and respect. Once the attending physician left the room to allow the family time to weigh their options and make their decision, Theresa remained at their side. After some time had passed, M.H.'s grandmother pulled Theresa aside and asked her to speak with M.H.'s parents. Her grandmother said that M.H.'s parents would be most comfortable sharing their wishes with Theresa, and they ultimately expressed to Theresa that they wished to stop the resuscitation efforts and withdraw support for their daughter.

Theresa was able to speak with them about what to expect and then gave them options for how and when the withdraw of care would happen. Theresa then brought the attending physician back to the room and it was discussed that resuscitative efforts would be stopped and the family would wait until additional extended family members arrived prior to withdrawing support.

Once this decision was made, Theresa immediately began to make arrangements for the family to spend some peaceful time with their daughter before withdrawing care. She was able to help place the patient in a large ICU bed and helped her mother navigate all of the tubes, lines and other equipment in the room so she could lay with her daughter during her final hours. Theresa was able to help M.H.'s mother bathe her and she placed a special blanket from home over M.H. to comfort her. Once her mother was laying with her, Theresa was able to begin making legacy items for M.H.'s family so they would have hand prints and other items to remember her by. Throughout her final hours, Theresa gave M.H.'s family space but was always close by to lend a listening ear or a hug to her family when it was needed. Despite the chaos and intensity of the resuscitative efforts that occurred during that shift, Theresa was able to create a quiet and calm environment for M.H. and her family so they could have peace during the final hours of M.H.'s life. M.H. ultimately passed away later that morning in the comfort of her mother's arms.

Just a short two weeks later, Theresa admitted a 23-month-old patient, J.K., who had suffered a peri-intubation cardiac arrest at an outside facility. The patient had received approximately 15 minutes of compressions and code medications before an airway could be established and return of spontaneous circulation was achieved. We knew that the prolonged downtime for this precious young patient meant that his prognosis was poor. Upon arrival his arrival to the PICU, Theresa and the rest of our team worked diligently to stabilize him and implement post-cardiac arrest measures in an effort to save his life. Once J.K.'s parents arrived, Theresa immediately made a connection with his family. She seamlessly navigated, explaining to the family all of the patient's lines, tubes, and medications. She provided unparalleled support and compassion to his family by remaining present at J.K.'s bedside and narrating each step of her care. Over the course of the next week, Theresa was assigned to care for J.K. for several shifts and she continued to build a rapport and deep connection with his family. Unfortunately, approximately a week after his arrival, J.K. suffered from a brain herniation that resulted in a non­ recoverable injury. This news devastated J.K.'s family. As they explored their end-of-life options for J.K., his family decided that they would like to proceed with organ donation.

On the night that J.K. was scheduled to go to the OR for organ donation, Theresa was again assigned to care for J.K. As soon as she walked into his room that night, his family breathed an audible sigh of relief and said that they just knew that everything would be okay because Theresa was their nurse. That night, Theresa was able to help prepare J.K. for the OR while emotionally supporting his family and letting them know what they could expect each step of the way. One nurse even overheard J.K.'s mom say, "I told you Theresa would make sure I was taken care of," when Theresa ensured that both parents were able to eat prior to taking J.K. to the OR. An honor walk was organized with team members from throughout the Children's Hospital, and staff lined the hallways from the PICU to the OR to show support for the patient's family and recognize the gift that J.K. would be giving by donating his organs. The patient's family sang a song to J.K. throughout the walk through their tears and Theresa supported them every step of the way. Once in the OR, Theresa remained at the family's side and was able to place J.K. in his mother's arms before the donation procedure began. Once his heart stopped and the procedure started, Theresa remained at his parents' side as she helped them navigate the difficult walk without their child out of the hospital. Through hugs and tears, J.K.'s family expressed their sincere gratitude for the exceptional support and care that they received from Theresa.
 
A few weeks later, Theresa attended J.K.'s funeral service to show support for his family. His family was overwhelmed with emotion and his parents immediately ran to Theresa when they saw her arrive. Theresa even brought a Spiderman statue as a gift for the family. Spiderman was one of J.K's favorite action heroes and Theresa always wanted his family to remember the connection they shared and the special little boy that they lost.

These are just two examples of the incredible connections that Theresa makes with her patients and their families. Theresa always goes the extra mile and takes time to really learn about and understand the patients and families that she cares for. She displays incredible compassion, creates trusting and supportive relationships, works seamlessly with other members of the interdisciplinary team, and is exceedingly effective in helping patients and families to navigate difficult decisions.

Although M.H. and J.K. did not have the outcomes we had all hoped for, Theresa made a significant impact on both families as they had to navigate the unexpected and traumatic experience of losing a child. Theresa is a DAISY Nurse for not only the impact that she had in these two cases, but for the exceptional care that she provides to her patients and their families each and every day.