Contributor: Adriana Figueira Oliveira

 I have been working in a pediatric intensive care unit for three years, an area that came into my life unexpectedly but has provided me with excellent professional fulfillment. This challenging environment, both theoretically and practically, as well as emotionally, demands a human and holistic approach, especially in situations of significant vulnerability and risk, such as those experienced by critically ill children. The reflection I propose arises from a specific problem related to palliative extubation in a child with an incurable illness. This procedure confronted me with profound ethical and emotional dilemmas, allowing me to reflect on suffering and dignity at the end of life. 

We had a six-month-old child admitted to the intensive care unit following surgery to remove a tumor. Initially, the baby was on invasive ventilation and was later extubated. At that time, the child was still responsive, maintaining eye contact, smiling, and reacting to external stimuli. Over time, the child’s general condition began to deteriorate, and it became necessary to resort to mechanical ventilation once again. When the results of the tests on the tumor arrived, the prognosis was very unfavorable, with a very slim chance of survival. The parents, tireless in their efforts, sought second and even third opinions, but unfortunately, all confirmed the initial diagnosis. Faced with this reality, our team decided to place the parents and their child in a private room, aiming to provide as much comfort as possible to everyone, within the constraints of an intensive care unit. 

We sought the support of a palliative care team, who guided both the parents and our team throughout this process, presenting the options available. At a certain point, we collectively realized that there was nothing more we could do medically. We then turned to the parents with sincerity and asked, “What can we do for you?”. Their only request was simple yet profoundly moving: “We want a bed so we can lie down with our child.” Something so simple, yet so heartfelt. 

Inevitably, and because we are human, we form deep emotional bonds with the family and the child. Even though we can distinguish our roles as nurses from our personal selves, these roles often intersect, stirring emotions of profound sadness, empathy, compassion, and even frustration. These emotions, despite the difficulty they bring, I believe, ultimately enhance our ability to provide more compassionate and meaningful care. 

This situation can be understood in light of Jean Watson’s Theory of Human Caring, which, by focusing on holistic care, proved essential in understanding that the goal is not only physical healing but also the emotional and spiritual well-being of the child and their family. Watson describes the practice of caring as a “caring-healing” process, where the aim is to help the person find meaning and peace while respecting their uniqueness and values. The “carative factors” proposed by Watson are fundamental to understanding how care should be practiced, highlighting the importance of sensitivity, hope, and trust, among others. This human-centered paradigm contrasts with the biomedical view, offering a more empathetic and comprehensive approach to care. 

Moreover, reflection on nursing practice requires critical analysis, as described by Chinn and Kramer, who emphasize the need to go beyond technical knowledge and consider the social and cultural context influencing health. Professional practice should be grounded in a multifaceted understanding, encompassing empirical, aesthetic, ethical, and personal knowledge, as highlighted by Carper (1978). In this sense, the nurse is not merely a task executor but a transformative agent of care. 

The situation of palliative extubation demanded a profound reflection on the ethical, personal, and professional aspects of caring for a child at the end of life. The dilemma between prolonging life and promoting comfort during a moment of inevitable suffering led me to rethink the nurse’s role, which goes beyond performing procedures. 

Jean Watson’s theory of Human Caring, with its focus on holistic care, proved essential in understanding that the goal is not merely physical healing but the emotional and spiritual well-being of the child and family. 

Based on this learning experience, I realized that the nurse must be a facilitator of dignity and comfort, providing care that considers the person as a whole. Reflecting on this practice, I understand that the humanization of care, particularly in situations like palliative extubation, must be centered on respect, the relief of suffering, and family support, allowing them to experience the process of dying with dignity and peace.

About Adriana Figueira Oliveira

I’m Adriana, 25 years old, born in Fátima but currently living in Lisbon,
where I moved at 18 to pursue my studies. I’ve been working as a nurse for
three and a half years, specializing in pediatric critical care in an
intensive care unit—a field I’m truly passionate about.

I was a scout for 13 years, and that experience played a big role in
shaping who I am today. It helped me develop essential soft skills that I
use every day in my profession. In my free time, I love solving puzzles and
traveling, always looking for new experiences and challenges