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Pediatric Dying and Death
How children die Final hours Field & Behrman, 2003
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Pediatric Death is a Unique Experience
No typical pediatric death Developmental issues Family is the unit of care Interdisciplinary team approach
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Role of the Nurse in the Final Days
Advocate Educate Coach Interdisciplinary team collaboration
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Role of the Nurse in the Final Days (cont.)
Physical care Spiritual comfort Culture Memory-making
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The Dying Child Awareness of dying Disclosure Communication
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The Family Parents Siblings—involve a child life specialist
Extended family
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The Love of a Family
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Site of Death Hospital Home Physical environment
Changes should be avoided
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Communication in Last Days
Provide information in simple terms, based on readiness Child’s awareness of death Presence
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Education about Last Hours
Empowerment Keep instructions simple; repetition Signs, symptoms of dying process Family involvement
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The Imminently Dying Child
Estimating prognosis Signs/symptoms only a guideline Dying process
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Psychosocial and Spiritual Issues
Fear Near death awareness Withdrawal Spiritual care
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Family Practice/Ritual
Family may have cultural or religious practices surrounding death and dying Always ask about preferences—don’t assume Rituals
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Physical Symptoms Onset Confusion, disorientation, delirium
Weakness, fatigue Pain changes Restlessness and/or terminal agitation
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Physical Symptoms (cont.)
Alertness/sleep changes Temperature changes Gastrointestinal changes Decreased oral intake
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Physical Symptoms (cont.)
Vital sign changes Breathing pattern changes Incontinence or urinary retention Seizures Continued assessment
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The Death Vigil Family presence Common fears
Being alone with the child Painful death Time of death Giving “last dose” Lo, 1996
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Death: When the Time Comes
Signs and symptoms Parental presence or absence Death pronouncement
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Communicating the Death
Grief Interdisciplinary team approach
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Death in the NICU Communication Continuity of care
Withdrawal of interventions Family involvement
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The Nightmare Begins
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Care Following Death Removal of tubes, equipment
Bathing and dressing the child’s body Encourage family participation Respect cultural preferences
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Care Following Death (cont.)
Compassionate/sensitive removal of body Rigor mortis Embalming Siblings Funeral home
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Care Following Death (cont.)
Assistance with calls, notifications Destroying medications Autopsy
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Care Following Death (cont.)
Assisting with arrangements Initiating bereavement support
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Impact on Nurse Emotional burden Individual response
Parallel suffering
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Support for the Nurse Ask for help Verbalize Post-clinical debriefing
Self care/self awareness
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A Brief Life
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