There are several possibilities here: 

• Some nurses believe that this procedure should be undertaken by nurses and that family members should not be involved. It is possible that Zoe was trying to protect the family from something she felt they should not see and therefore she asked them to leave the room.
• Another option is that Zoe is herself lacking in confidence in undertaking this procedure and therefore would have felt uncomfortable having the family present.
• Zoe might be worried that she would become upset in front of the family and possibly believes that this would be wrong. Many children’s nurses do cry in front of parents and this is often greatly appreciated by the families concerned.
• With regard to James, the protectionist approach identified above is the most likely reason why Zoe was so reluctant to involve him. There is a mis-conception that death is something that only adults should manage and that children should be excluded, but recent research suggest that doing this might be detrimental to a child, particularly those involved in their sibling’s care throughout their illness.

The most important reason for allowing Terri, Max and James to be involved in performing Last Offices is that it gave them the opportunity to continue in their role as his carers and undertake the final act of caring for Jake. They have all been actively involved in Jake’s care over the past 6 months and have undoubtedly discussed this moment on a number of occasions.

By enabling them to be involved they can genuinely say that they did everything they could for him. Their grieving process is likely to be full of mixed emotions – relief because Jake is no longer suffering alongside the sadness that only the death of a child can bring – and giving them these precious last minutes with Jake would bring tremendous relief.

Often, when your perform Last Offices for a patient you have been caring for, whilst it might make you sad that the patient has died, it provides you with time to reflect upon the good care that you have given to the patient, and to ensure that the patient is treated with the respect and dignity they deserve.  Performing last offices for the first time is usually something most nurses remember, and for Harriet, performing this procedure with another student, who understands how she is feeling, makes the process less daunting.  Once you are more experienced, like Ella, it is very positive to be able to support a less experienced colleague, and share with them how you coped with a similar situation.

Other students are excellent sources of support during placement.  Make sure that you take the time to ask them about their experiences and how they have coped with situations they found challenging.  If you see another student struggling when you are on placement, make sure that you offer them the support you would like if you were the one struggling.  As students you have a wealth of knowledge to offer each other, and can often understand exactly how each other are feeling.