Wishing Well in a Pediatric Intensive Care Unit

This award was formally named “Coping with End of Life”. Our Excellence in Quality category names changed in 2020 to reflect the updates to our BC Health Quality Matrix. Visit our Categories and Criteria page to find out more.

Each year, the Pediatric Intensive Care Unit (PICU) team at BC Children’s Hospital provides end-of-life care to about 30 young patients and their families. When illness no longer responds to treatment, or when life support will likely result in outcomes that don’t line up with patient and family values, care providers focus on making sure patients die with dignity and compassion.

In December 2017, the PICU launched a Wishing Well program where critically ill patients and their families are invited to generate “wishes” that help bring peace to their final days together.

Through ongoing dialogue at the bedside, staff learn about the patient’s life, preferences and values, so they can co-design personalized wishes. Families report that these rituals help foster their grieving process and lend meaning to these tragic situations.

Here are just a few examples of wishes the PICU team has granted:

• One young patient, who became an organ donor, had a special affection for Christmas. Within 24 hours, in the middle of July, the PICU team turned his room into a magical Christmas wonderland.
• When a patient reached her 100^th-day birthday – a milestone celebrated in her family’s culture – the team transformed her room into a princess suite, complete with an oversized card signed by all the staff. She was dressed in a new, pink frilly dress to ensure that she sparkled for the important occasion.
• After their child sustained a life-threatening traumatic injury, a family was given packages of origami paper so they could fold cranes to decorate the room. In their culture, cranes signify hope. The family encouraged staff to participate and taught them how to make the cranes.
• A patient requested the presence of her beloved family pet. Her dog spent her last hours with her, on the bed.

The program allows staff to see the patient beyond their medical condition. Instead of just “a cardiac patient,” they see a little boy who loves firetrucks, Oreo cookies and screwdrivers.

PICU staff may feel a sense of helplessness when caring for patients at the end of their lives, and the creative process of granting wishes helps them take action that feels positive and meaningful. Staff report reduced burnout and high levels of engagement, teamwork and cohesion.

The PICU team credits the initiative’s success to the guidance of one of their social workers, Rhonda Kotick. Rhonda was instrumental in championing the program’s benefits, bringing people on board and ensuring its successful launch. The BC Children’s Hospital Foundation supports the funding of materials needed to realize patients’ wishes and local businesses, from photographers to aestheticians, have also donated their time and skills.

A community of engaged staff and volunteers has grown out of this initiative, making a meaningful difference in the lives of these patients and families at a time when they need the most support.