About Hui-wen Sato, MSN, MPH, RN, CCRN

Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN, is a pediatric intensive care nurse in Southern California and blogs at http://heartofnursing.blog.

Honoring the Personhood of Brain-Dead Patients: A Delicate Approach

A dandelion alone in a field suggests the fragility of life. Photo by RIDVAN AYRIK/ Pexels

In the past month, we had a couple of patients in our pediatric ICU who had suffered tragic neurological injuries and were declared medically brain-dead. In the state of California as in most states, a pronouncement of brain death is equal to a legal pronouncement of death, and the medical team then possesses legal permission to remove mechanical support from the physical body that has remained under intensive care.

In both of these cases in our ICU, the parents struggled to accept the terminal implications of brain death and pushed back to varying degrees for more time to see if their children might still somehow find a way to recover. In these types of cases, the actual moment-by-moment practice of bedside nursing care becomes complicated. How do we honor the personhood of the patient as we provide intensive care for the body prior to removing mechanical support, and at the same time gently help the parents accept that their child has medically died?

The potential for misunderstanding nursing care

The interactions nurses have with family members as we care for their brain-dead child present many opportunities […]

2023-06-21T13:06:54-04:00June 21st, 2023|end of life, Ethics, family experience, Nursing|1 Comment
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Primary Nursing of Medically Complex Children in the ICU Increases Parental Trust

Differing views about quality of life.

Photo by Pat Smith/Pexels

As medical care has become increasingly advanced in its ability to prolong life in the face of serious, chronic illness, it has also presented complicated challenges for both the caregivers and care-receivers alike. This holds especially true when we venture into the thorny, subjective realm of “quality of life.”

Sam was a patient with serious chronic illness and severe developmental disability who had been in and out of our pediatric ICU for many years. His most recent nine-month hospitalization had been the most frightening and uncertain thus far, and the gap between the perspectives of the medical team and Sam’s mom had became more apparent. The medical team speculated whether Sam was approaching the end of his life, while his mom asked us to continue doing all we could to maximize Sam’s physical longevity.

Unspoken questions also involved our struggle to measure what exactly comprises “enough” quality of life to justify the continued offering of health care resources. It’s an inevitable struggle with scarce resources and the monetization of quality of life, particularly with a chronically ill, severely disabled child who can feel so “other” to those of us living “normal” lives.

Parents come to our unit seeking care […]

2022-09-14T10:01:23-04:00September 14th, 2022|family experience, nursing roles, pediatrics|1 Comment
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Loss from Nurse Attrition Goes Deeper than Numbers

On watching familiar colleagues leave your unit. 

Photo by Javier Allegue/ Unsplash

It feels as though every week, I hear of yet another one to two colleagues who are leaving our pediatric ICU (PICU).

Reasons colleagues leave.

They’ve been at all kinds of experience levels. Some have only been in our unit for a couple of years, and some have been with us for anywhere from eight to 15 years. Some leave because they realize as young nurses that they don’t want to be around so much pediatric death and dying in the long-term, so they move on to other positions where they can care for healthier populations. Some leave because they’ve already been around so much pediatric death and dying for so long by now that it’s time to practice in different kinds of spaces for their own mental and emotional well-being. Some leave for the significantly higher pay offered by travel nurse positions, and some leave to be closer to family in other states. A smaller percentage leave quietly without ever really disclosing the reasons why.

Every departure hurts on a numbers level.

In a time when nurse staffing seems to be at critically low levels everywhere, raising our workload and stress levels to new all-time highs, every departure hurts on a sheer […]

2022-06-29T10:48:07-04:00June 29th, 2022|Nursing|2 Comments
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How to Support the Nurse in Your Life, May 2022

Photo by Dương Nhân from Pexels

A few years ago, I wrote a blog post directed towards friends and family members of nurses, entitled “How to Support the Nurse in Your Life.” While the ideas in that post still hold up today, so much in nursing has changed, the COVID pandemic being the obvious main factor. With nurses in more need of support than ever, I find it important to revisit this idea of helping friends and families supporting the nurses in their lives at this unique point in time.

1. Listen to what the nurse is actually distressed about in the moment, and stay with them there.

In normal, non-pandemic times, nurses already have many people, situations, and issues to tend to in addition to the actual patient. There are so many unique aspects of the nurse role that challenge us, all of them rolled into a tangled ball in the course of a 12-hour shift. If we are distressed about one particular aspect, please stay with us in your focus on the actual issue at hand so we have time and space to unpack it without all the other competing stressors vying for all our attention.

For example, we might be upset one […]

2022-05-02T09:19:45-04:00May 2nd, 2022|Nursing|2 Comments
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Finding Effective Means of Rest as a Nurse and Mother

When I had my first of two children almost nine years ago, I switched from full time (three 12-hour shifts per week) to part time (two 12-hour shifts per week). With my husband working four 10-hour days per week, this arrangement has allowed our family the incredible privilege of not needing childcare outside of the family.

That said, the arrangement also means that I as a nurse and mother have very little opportunity to rest. When I’m at work, all cylinders are operating on high alert in every way—mental, physical, social, emotional, and spiritual. When I’m home, I am keeping tabs on everyone’s physical, social, emotional and spiritual needs. I’m managing the housework, trying to keep track of groceries, struggling with creative and healthy meal prep, and caring for a complicated dog and two less complicated tortoises. My husband and I are deeply involved in our church community and trying to faithfully maintain friendships. I have various speaking engagements to prepare for. Life is incredibly full.

In the midst of life’s ongoing demands, I’ve had to become smarter about approaches to downtime and venues of rest that are actually restorative.

Beware of default mode.

As much as I find cleanliness and organization in my home to be refreshing and calming in their […]

2022-04-13T13:02:18-04:00April 13th, 2022|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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