Legacy at the Bedside: A Nurse-Led Evidence-Based Framework for Memory-Making in the Pediatric Intensive Care Unit

Children who die in the pediatric intensive care unit (PICU) and their families often face sudden deterioration, limited time, invasive technology, and emotionally overwhelming decisions. Memory-making can help families preserve connection, support parenting and sibling participation, and create tangible or digital keepsakes, yet bedside teams may feel uncertain about when and how to offer these practices without adding distress. This evidence-based practice article synthesizes recent pediatric palliative care, bereavement, and critical care literature and translates it into a nurse-led bedside framework for the PICU. The proposed LEGACY-PICU framework moves from listening to what matters most, through explaining options gently, guiding participation in a choice-centered way, acknowledging culture and faith, and creating keepsakes safely, to yielding space for privacy and ritual. PICU-specific actions include preparing supplies; integrating child life, palliative care, chaplaincy, and social work; coordinating timing around withdrawal of life-sustaining therapies or organ donation; and unburdening staff through role clarity and debriefing. A structured but flexible approach may help nurses and interdisciplinary teams offer memory-making as a compassionate invitation rather than a task.