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


Pediatric Dying and Death

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