IN OUR UNIT HONOR WALK IN THE PEDIATRIC INTENSIVE CARE UNIT

Welling S, Gettis M, Jordon S, Henderson C. Crit Care Nurse August 2020;40(4)

In this case study, the authors sought to describe their pediatric institution's experience with their first honor walk for a family of a child who died of a traumatic accidental head injury. Prior to this patient's admission to the pediatric intensive care unit (PICU), the institution was engaged in discussion on pediatric end-of-life decisions on how to personalize this process for the families. Previously, the organization's staff raised an organ donation flag on the day that families decided to donate their child's organs. In addition, it was felt that an honor walk would offer a formal process that would provide additional end-of-life support for the family and allow staff the opportunity to process their emotions. The organization developed a protocol for their honor walk by having numerous interprofessional conversations including administration. Their protocol also included the ability of coverage for staff who wanted to be present for honor walk. The organization also established a "calling tree" so that other staff members could be quietly alerted when an honor walk was anticipated as to allow others to be present.

Signs and information on organ donation were present in the hospital on organ donation, and the family initiated a conversation on donating their child's organs not wanting their "child's death to be in vain." The family was offered the option of being present for the flag raising ceremony and the honor walk, which they both chose to participate in to honor their child. A hospital chaplain presided over the outdoor flag raising ceremony and offered words of comfort that were aligned with the family's faith. After the flag raising ceremony, the calling tree was initiated so that others could be present for the honor walk to the operating room. More than 80 hospital staff responded to be present for the honor walk.

When the honor walk was complete, the family was allowed to say goodbye to their child in the holding room privately. All staff who were in attendance were thanked by the PICU assistant nurse manager. Siblings were able to meet with a child life specialist. A staff debriefing was done after the family left, allowing for open discussion. The PICU leadership sent a survey to the nurses who participated (n = 28). Sixty-four percent (n = 18) responded to the 3 open-ended questions with positive comments. The staff also requested that honor walks be offered to all families of organ donors.