Peer-reviewed article
Legacy at the Bedside: A Nurse-Led Evidence-Based Framework for Memory-Making in the Pediatric Intensive Care Unit.
Torrez K, Ursua K, Phillips H, Lilitwat W ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This article presents a framework for memory-making practices in pediatric intensive care units when children are dying. It synthesizes evidence from palliative care and bereavement literature to guide nurses and interdisciplinary teams in helping families create keepsakes and preserve connections. The framework emphasizes listening to families' needs, explaining options gently, and respecting cultural and spiritual practices. The article focuses on the emotional and practical support of bereaved families rather than on child well-being outcomes or interventions to improve children's health or development.
Key points
- Memory-making practices can help families preserve connection and create tangible or digital keepsakes during end-of-life care
- The LEGACY-PICU framework includes listening, explaining, guiding, acknowledging culture and faith, creating keepsakes, and yielding space for privacy
- Implementation requires coordination with child life specialists, palliative care, chaplaincy, and social work
- Staff need clarity on roles and debriefing to avoid adding distress to families
- A structured but flexible approach is recommended to offer memory-making as a compassionate invitation
Limitations
This is a framework synthesis article, not an evaluation of an intervention's effectiveness. It does not provide empirical data on whether memory-making practices improve family outcomes, reduce grief, or affect child well-being during their final care.
Abstract
Children who die in the pediatric intensive care unit (PICU) and their families often face sudden deterioration, limited time, invasive technology, and emotionally overwhelming decisions. Memory-making can help families preserve connection, support parenting and sibling participation, and create tangible or digital keepsakes, yet bedside teams may feel uncertain about when and how to offer these practices without adding distress. This evidence-based practice article synthesizes recent pediatric palliative care, bereavement, and critical care literature and translates it into a nurse-led bedside framework for the PICU. The proposed LEGACY-PICU framework moves from listening to what matters most, through explaining options gently, guiding participation in a choice-centered way, acknowledging culture and faith, and creating keepsakes safely, to yielding space for privacy and ritual. PICU-specific actions include preparing supplies; integrating child life, palliative care, chaplaincy, and social work; coordinating timing around withdrawal of life-sustaining therapies or organ donation; and unburdening staff through role clarity and debriefing. A structured but flexible approach may help nurses and interdisciplinary teams offer memory-making as a compassionate invitation rather than a task.