Pediatric Dying and Death

Module 8:Care at the Time of Death in Pediatric Palliative Care

CCEENNLLEEEnd-of-Life Nursing Education Consortium

Pediatric Palliative Care

CCEENNLLEE Pediatric Palliative Care

How children die Final hours

Field & Behrman, 2003

Pediatric Death is a Unique Experience

No typical pediatric death Developmental issues Family is the unit of care Interdisciplinary team approach

Role of the Nurse in the Final Days

Advocate

Educate

Coach Interdisciplinary team

collaboration

Role of the Nurse in the Final Days (cont.)

Physical care Spiritual comfort Culture Memory-making

The Dying Child

Awareness of dying Disclosure Communication

The Family

Parents

Siblings—involve a child life specialist

Extended family

The Love of a Family

Site of Death

Hospital Home Physical environment Changes should be avoided

Communication in Last Days

Provide information in simple terms, based on readiness

Child’s awareness of death Presence

Education about Last Hours

Empowerment Keep instructions simple;

repetition Signs, symptoms of dying

process Family involvement

The Imminently Dying Child

Estimating prognosis Signs/symptoms only a guideline Dying process

Psychosocial and Spiritual Issues

Fear Near death awareness Withdrawal Spiritual care

Family Practice/Ritual Family may have cultural or

religious practices surrounding death and dying

Always ask about preferences—don’t assume

Rituals

Physical Symptoms

Onset Confusion, disorientation,

delirium Weakness, fatigue Pain changes Restlessness and/or terminal

agitation

Physical Symptoms (cont.)

Alertness/sleep changes Temperature changes Gastrointestinal changes Decreased oral intake

Physical Symptoms (cont.)

Vital sign changes Breathing pattern changes Incontinence or urinary retention Seizures Continued assessment

The Death Vigil

Family presence Common fears

Being alone with the child Painful death Time of death Giving “last dose”

Lo, 1996

Death: When the Time Comes

Signs and symptoms Parental presence or absence Death pronouncement

Communicating the Death

Grief Interdisciplinary team approach

Death in the NICU

Communication Continuity of care Withdrawal of interventions Family involvement

The Nightmare Begins

Care Following Death

Removal of tubes, equipment Bathing and dressing the child’s

body Encourage family participation Respect cultural preferences

Care Following Death (cont.)

Compassionate/sensitive removal of body

Rigor mortis Embalming Siblings Funeral home

Assistance with calls, notifications

Destroying medications Autopsy

Assisting with arrangements Initiating bereavement support

Impact on Nurse

Emotional burden Individual response Parallel suffering

Support for the Nurse

Ask for help

Verbalize

Post-clinical debriefing

Self care/self awareness

A Brief Life

Pediatric Dying and Death

Documents

Transcript of Pediatric Dying and Death

Epilogue Death and Dying

Death and Dying Workbook

Death and Dying Poll

Death and dying practice

The Experience of Death and Dying - Stanislav · PDF fileThe Experience of Death and Dying: ... dying patients and of individuals in near-death situations until ... experience of dying

Death and-dying

Death and dying quotes

dying and death eBook

Death & Dying

Deliver “gold standard” neonatal and pediatric death ... · • GAIN in-depth understanding of the long-term impact of dying and death Deliver “gold standard” neonatal and

Loss, Grief, Dying, and Death Loss, Grief, Dying, and Death

U10 death & dying

Bioethics - Death and Dying

The END: Pediatric Death and Dying Kevin M. Creamer M.D. Pediatric Critical Care Walter Reed AMC.

Death & Dying Thanatology- study of death and dying.

DEATH AND DYING CHAPTER 19. Learning Objectives DYING AND DEATH ACROSS THE LIFESPAN.

Death and Dying Concept

On Death And Dying

Dying And Death

Psy210 Death and Dying