Transcript Airgas template - Pediatric Nursing

The Dying Child
Chapter 9
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Caring for a Family Facing the
Death of Their Child
• Offer sensitive, gentle physical care and comfort
measures for the child
• Provide continuing emotional support for the child,
the family caregivers, and the siblings
• Understand own feelings about death and dying
• Know the grieving process that terminally ill patients
and their families experience
• Possess willingness to become involved
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Team Members Involved in
Caring for the Dying
• Nurse (usually coordinates the care)
• Physician
• Chaplain
• Social worker
• Psychiatrist
• Hospice nurse
• Thanatologist (a person [sometimes a nurse]
trained especially to work with the dying and
their families)
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Factors That Influence a Child's
Understanding of Death
• Stage of development
• Cognitive ability
• Prior experiences with death
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Infant and Toddler Perceptions of Death
• Have little if any understanding of death
• May fear separation from beloved caregivers
• Have no recognition of the fact that death is
nearing and irreversible
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Care Measures for the Dying
Infant/Toddler
• Answer questions simply and honestly
• Encourage family caregivers to stay with the
child to provide comfort, love, and security
• Maintain routines as much as possible to give
the toddler a greater sense of security
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Preschoolers’ Perception of Death
• They may believe they caused a person or pet to
die by thinking angry thoughts (egocentric
thinking)
• Magical thinking plays an important part in their
beliefs about death
• Many view death as a kind of sleep
• They may view personal illness as punishment
for thoughts or actions
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School-Age Children’s Perception of Death
• 6 or 7 years old
– Still view death in the magical thinking stage of
the preschool child
• 8 or 9 years old
– Children gain the concept that death is universal
and irreversible
– Death is personified and may be called the devil,
God, a monster, or the bogeyman
– Often they view death as another new
experience
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Adolescent’s Perception of Death
• The adolescent has an adult understanding of death
but feels immortal
• The adolescent facing death may express
helplessness, anger, fear of pain, hopelessness, and
depression
• The adolescent may be upset by the results of
treatments that cause weakness and altered
appearances
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Children’s Awareness of Impending Death
• Children know they are dying
– They sense and fear what is going to happen,
even if they cannot identify it by name
– Their play activities, artwork, dreams, and
symbolic language demonstrate this knowledge
• Involvement of the health care staff is important
– They may dispel misunderstandings by giving
honest, specific answers
– They may help the child and the family resolve
any problems or unfinished business
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Types of Death Caregivers Grieve
• Terminal illness
– The family faces decisions about the child’s
physical care, as well as learning to live with a
dying child
– The family is encouraged to talk to their child
about dying
• Sudden or unexpected death
– The family has not had the opportunity to go
through anticipatory grief
– The family may have excessive guilt and
remorse for something they felt they left unsaid
or undone
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Decisions Caregivers Face When a
Child Dies Unexpectedly
• Organ donation
• Funeral arrangements
• Autopsy
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Nursing Care for the Dying Child
• Reassuring the child that he or she will not be alone
at the time of death
• Reminding family members not to say anything
around the unconscious child that would not be said
if the child were fully conscious
• Using gentle touching and caressing to provide
comfort
• Giving medications for pain intravenously
• Keeping mucous membranes clean
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Nursing Care for the Dying Child (cont.)
• Applying petroleum jelly to the lips to prevent
drying and cracking
• Moistening the conjunctiva of the eyes with normal
saline eye drops
• Keeping the skin clean and dry
• Turning and positioning regularly to prevent skin
breakdown
• Talking to the child and explaining everything that is
being done
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Settings for Care of the Dying Child
• Hospice care
• Home care
• Hospital care
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Factors Contributing to the Decision to
Care for a Child at Home
• Concerns about costs for hospitalization and
nonmedical expenses
– Family’s travel, housing, and food
• Stress from repeated family separations
• Loss of control over the care of the child and family
life
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Assessments of the Dying Child
• The child’s developmental level
• The influence of cultural and spiritual concerns
• The family’s support system
• Present indications of grieving (e.g., anticipatory
grief)
• Interactions among family members
• Unfinished business
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Goals for the Dying Child and the Family
• Goals for the child
– Minimizing pain
– Diminishing feelings of abandonment by peers
and friends
– Relieving anxiety about the future
• Goals for the family
– Helping cope with the impending death
– Identifying feelings of powerlessness
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Nursing Measures to Relieve Pain
• Positioning
• Using pillows as needed
• Changing linens
• Providing conscientious skin and mouth care
• Protecting skin surfaces from rubbing together
• Offering back rubs and massages
• Administering antiemetics, analgesics, and stool
softeners as appropriate
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