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Title: Nursing%20care%20of%20the%20dying%20child%20and%20family


1
Nursing care of the dying child and family
  • ??
  • ???????????
  • Childrens understanding of death and possible
    behavioral responses P280
  • The dying child
  • Bereavement
  • Sibling
  • Parents
  • Staff reactions to the death of a child

2
Childs experience
  • Stressor to the child Table 8-1
  • Coping mechanisms
  • Nursing care of the child with a life-threatening
    illness or injury P267

3
Nursing care of the child with a life-threatening
illness or injury P267
  • Nursing diagnosis
  • Impaired verbal communication
  • Impaired social interaction
  • Spiritual distress
  • Ineffective family coping
  • Physical mobility
  • Sleep pattern disturbance
  • Diversional activity
  • Altered growth and
  • development
  • Body image disturbance
  • Self-esteem
  • Hopelessness
  • Anticipatory grieving

4
Nursing implementation
  • Promote a sense of security
  • Provide education about the illness or injury and
    prepare the child for procedures.
  • Facilitate the use of play.
  • Promote a sense of control.

5
The Child Coping with a Life Threatening Illness
or Injury P268
  • Care plan
  • Anxiety(child )related to separation from
    parents, foreign environment, strangers as
    caretakers, invasive procedures.
  • Powerlessness(moderate)related to inability to
    communicate, and control relinquished to the
    health care team.
  • Pain related to injuries, invasive procedures,
    surgery.

6
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  • ????
  • ????????
  • ?????
  • ???????
  • ???????

7
The dying child P280
  • Childrens psychological reactions to dying and
    nursing care P280
  • Childrens psychological reactions P280
  • Nursing care of the dying child
  • Nursing care of psychological reactions P281
  • Nursing care of physiological reactions ?
  • Siblings reactions and nursing care P276
  • Parents reactions and nursing care P271

8
Childrens psychological reactions --Preschooler
  • 5 y/o can sense when they are seriously ill.
    P280?2?
  • Develops more rapidly when he or she is
    experiencing the progression of a disease and
    related medical treatment.
  • Often learn about death and their own illness
    from exposure to other seriously ill and dying
    children .
  • Can see their body deteriorate and feel the toxic
    effects of chemicals.(body changes)P280?3?
  • Changes in self-concept occur as they perceive
    these body changes.
  • They often describe their illness in terms of
    mutilation to their body. They may realize that
    they are dying because of these physical changes.

9
Childrens psychological reactions --School-Age
Child
  • Fears about body integrity and anxieties about
    the seriousness of their illness. P281?2?
  • Death anxiety occurs in children even though they
    are unable to conceptualize or describe death at
    an adult's level of understanding.
  • Even if children have not been told they are
    dying, they know their condition is worsening.
    ?3?
  • They usually do not have the same fears about
    dying that adults do. Some children keep most of
    their thoughts about death to themselves.
  • If they have not been told that they are dying,
    they may feel isolated and get the message not to
    discuss their condition.
  • Children fear desertion more than death.
  • Believe that expressing their awareness of death
    and their fears will place added emotional
    burdens on family members.

10
Childrens psychological reactions -Adolescent
  • They are struggling to establish their own
    identity and plans for the future. P281?5?
  • Body image is extremely important.
  • Isolated from peers.
  • May be angry.

11
Childrens reactions to dying and death
  • ???? (?)
  • 1.???
  • 2.???
  • 3.???
  • 4.???
  • 5. ???

12
Nursing care of psychological reactions P281
  • Maintain contact with peers. ?1??2?
  • Provide opportunities for fantasy play, drawings,
    and storytelling.(Death imagery or anticipated
    experiences with treatment).?2?
  • Assist children and families with discussions.
    P282?2???1?
  • Provide activities to help teens channel their
    feelings. P282?3??2?
  • Be available to listen. ?4?
  • Promote friendships with other teens having
    similar interests or problems. ?5?
  • Provide teens with as much independence and
    control over their situation as possible.
  • Palliative care hospice care. P282 ?5?

13
Assist children and families with discussions

P282?2???1?
  • Development age
  • Previous knowledge
  • Honesty
  • The types of questions that children most
    frequently ask. P281???
  • Themes that may assist parents in discussing
    possible death with children

14
Themes that may assist parents in discussing
possible death with children
Death, like birth, is part of the natural order
of things. Death has social significance. Death
is a separation. The loss is never complete. The
child will not be alone at death and after
death. The child should be reassured that all
feelings are normal. The childs memory will live
on in mind and spirit.
  • Data from Whaley Wongs Nursing care of the
    infant and children.
  • P952 Box 23-3

15
Palliative care hospice care P282 ?5?
  • Palliative care combines active and compassionate
    therapies.
  • Aimed at reducing or curing the illness and
    treating symptoms.
  • More aggressively than hospice care.
  • Hospice care-alert, without pain, and with
    choices and dignity. It does not seek to prolong
    life.

16
Nursing care of physiological reactions
  • ??????????
  • Loss of sensation and movement.
  • Sensation of heat although body feels cool.
  • Loss of senses.
  • Confusion, loss of consciousness, slurred speech.
  • Muscle weakness.
  • Loss of bowel and bladder control.
  • Decreased appetite / thirst.
  • Difficulty swallowing.
  • Change in respiratory pattern.
  • Weak, slow pulse decreased blood pressure.
  • ????
  • ???????
  • ??
  • ???????
  • Data from Whaley Wongs Nursing care of the
    infant and children.
  • P961 Box 23-6, 23-7

17
Siblings reactions and nursing care P276
  • Siblings experience P276?1?
  • May feel left out ?2?
  • From jealousy or envy to resentment, guilt and
    hostility, anger, insecurity, regression, and
    fear. ?4?
  • Often have nightmares. ?1????2?

18
Nursing management--Sibling
  • Tell siblings about their brother or sister using
    language and concepts appropriate to their ages
    and developmental levels. ?2??1?
  • Allowed to visit hospital. ?2??2?
  • Preparation for the visit. ?3??1?
  • Demonstrate how to talk to and touch the ill
    child and encourage the siblings to do the same
    .(Figure 8-6). ?4??1?
  • Discuss with siblings what they saw and felt.?2?
  • By sending pictures, drawings, cards, and
    messages recorded on audiotapes or
    videotapes.(Figure 8-7). ?4????2?
  • Encourage parents to call the siblings at home at
    a regular time each night. ?5??1?
  • Table 8-3(P276 )

19
Parents reactions and nursing care
  • Parents experience P271
  • Shock and disbelief P272
  • Anger and guilt
  • Deprivation and loss
  • Anticipatory waiting
  • Readjustment or mourning

20
Nursing management --parents P274
  • Provide information and build trust.
  • Promote parental involvement.
  • Provide for physical and emotional needs.
  • Facilitate positive staff-parent relationships
    and communication.
  • Maintain or strengthen family support systems.
  • P273 Table 8-2

21
Siblings experience P278
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  • Will have received less attention from
    parents.?1??2?
  • May fear that they caused their brother or sister
    to be injured or become ill, or worry that bad
    thoughts on their part brought on the illness.
  • They need help in adapting to their parents'
    distraction, grief, and increased protectiveness
    of them (McIntier, 1995 Schonfeld, 1993).
  • Need to hear that their parents' grief in no way
    diminishes the love they have for them.
  • Grieving process. P280

22
Grieving process P280 ??
  • Early stageThey understand the death occurred,
    while using self-protective mechanisms to block
    the full emotional impact of the loss.
  • Middle stageThey accept and rework the loss
    while experiencing the intense psychologic pain.
  • Late stageThey integrate the loss experience
    into their identity and resume age-appropriate
    developmental progress.

23
Sibling --Nursing management P278?2?
  • Honesty ?1?
  • Provide explanations in language that is
    developmentally appropriate.
  • Reassure. ?2?
  • Allow the siblings to ask questions. ?4?
  • Acknowledge childs emotions.
  • Ask how they feel about saying good-bye to the
    dying child. ?5?
  • Prepare the siblings before they see the dying
    child. P279?1??1?
  • Answer questions truthfully. ?3?
  • May have to repeat information several times.
  • Permitted to participate in planning funeral
    service. P279?2??1?
  • Make sure other caregivers and teachers know
    about the sibling's loss. P279?3??1?
  • Let the child express feelings other than sadness
    (e.g., guilt and anger).
  • Encourage them to express grief through art,
    stories, and writing.

24
Parents reaction P277
  • When the loss is sudden and unexpected, the
    abruptness adds a dimension of shock that may
    last for 4 to 5 weeks. ?1??1?
  • Grief and mourning are normal, necessary
    processes. ?1???1?
  • Many factors influence the parents' grief
    responses ?2??1?
  • Perception of the preventability of the illness
    or injury.
  • The suddenness and other circumstances of the
    death.
  • The nature of their attachment to the child.
  • Previous losses.
  • Spiritual or religious orientation, and culture.
  • Suicide produces agonizing anger, guilt, and
    confusion.
  • The time line and nature of the grief process
    differ for each individual. P278?2??1?
  • Pain and shock
  • Anger, guilt, depression, and loneliness
  • Again begin to enjoy life experience
  • Spouses may need additional support when they are
    at different levels of grieving to prevent a
    sense of loneliness and isolation. P278?2??5?

25
Bereavement -- Parents
  • Nursing management P278 P277 Table 8-4

26
Staff reactions to the death of a child P282
  • Nurses often cope by distancing themselves
    socially from the dying child and family to
    maintain composure and a professional demeanor.
    P282?1??5?
  • Caring for the dying child may be especially
    difficult for nurses with young children of their
    own. P282?2??1?
  • Their own personal defenses against their sense
    of helplessness. P283?1??3?
  • Anger, frustration, sadness, and powerlessness.

27
Staff reaction ?
  • Denial
  • Anger and depression
  • Guilt
  • Ambivalence(????)
  • Frustration(??)

28
Adaptation
  • Self-awareness
  • Knowledge and practice
  • Support systems
  • Support systems may include discussions with
    peers or debriefing group sessions with mental
    health professionals that provide an opportunity
    to discuss their feelings and concerns (Figure
    8-8). P283?3??4?
  • Other strategies
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