title: Parental Physical Proximity in End-of-Life Care in the PICU.
abstract: Health professionals in PICUs support both child and parents when a child's death is imminent. Parents long to stay connected to their dying child but the high-tech environment and treatment implications make it difficult to stay physically close. This study explores in what sense physical aspects of end-of-life care in the PICU influence the parent-child relationship.
  
  
  
  Retrospective, qualitative interview study.
  
  
  
  Level 3 PICU in Erasmus Medical Center in the Netherlands.
  
  
  
  Thirty-six parents of 20 children who had died in this unit 5 years previously.
  
  
  
  Parents vividly remembered the damage done to the child's physical appearance, an inevitable consequence of medical treatment. They felt frustrated and hurt when they could not hold their child. Yet they felt comforted if facilitated to be physically close to the dying child, like lying with the child in one bed, holding the child in the hour of death, and washing the child after death.
  
  
  
  End-of-life treatment in the PICU presents both a barrier and an opportunity for parents to stay physically connected to their child. Parents' experiences suggest that aspects of physicality in medical settings deserve more attention. Better understanding of the significance of bodily aspects-other than pain and symptom management-improves end-of-life support and should be part of the humane approach to families.
authors.affiliation: 1Intensive Care Unit and Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 2Department of Practical Theology, VU University Amsterdam, Amsterdam, The Netherlands. 3Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia's Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Jeannette L
authors.initials: JL
authors.lastname: Falkenburg
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Ruard R
authors.initials: RR
authors.lastname: Ganzevoort
authors.forename: Saskia
authors.initials: S
authors.lastname: Gischler
authors.forename: Jacobus
authors.initials: J
authors.lastname: Hagoort
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
mesh_terms: D000293:Adolescent; D001293:Attitude to Death; D001294:Attitude to Health; D001601:Bereavement; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D036301:Qualitative Research; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*