Most children with life-limiting conditions in Australia die in hospital. Bedside nurses are doing the hard work, carrying the burden of wanting to ‘get it right’ for children at the end of life and their families. These nurses play an integral role in the provision of care for families, and are uniquely placed to bridge the gap between patients and their families, and the wider medical team.  

We have observed that bedside nurses often miss opportunities to participate in both family and professional meetings. They express feeling uncertain in what the child and family understand of their situation, how decisions have been made, and what to do in the event of deterioration or unstable symptoms. Such uncertainty around the provision of end-of-life disempowers nurses in their pursuit of great care, and has been found to contribute to moral distress and burnout.  

The VPPCP introduced an ad hoc intervention we termed a “prebrief”. Contrary to the traditional debrief model, in which bedside nurses are provided an opportunity to reflect on care provided after the event, the prebrief offers an opportunity to share and reflect on an anticipated end-of-life scenario. This enables moral distress and uncertainty to be addressed in real-time, and proactive strategies to support the child, family and staff to be enacted. The aim is to provide a safe space for nurses to voice their questions or concerns, actively acknowledge the emotional impact of their work, and if applicable, to be informed on the conversations that have taken place and the rationale for decisions that have been made.  

This intervention has not been described in the literature. In this discussion we will share our process for formalising the prebrief intervention and describe the outcomes we have observed as they apply to sustainable practice.