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Pediatric Dying and Death

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

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Pediatric Dying and Death

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  1. Pediatric Dying and Death • How children die • Final hours Field & Behrman, 2003

  2. Pediatric Death is a Unique Experience • No typical pediatric death • Developmental issues • Family is the unit of care • Interdisciplinary team approach

  3. Role of the Nurse in the Final Days • Advocate • Educate • Coach • Interdisciplinary team collaboration

  4. Role of the Nurse in the Final Days (cont.) • Physical care • Spiritual comfort • Culture • Memory-making

  5. The Dying Child • Awareness of dying • Disclosure • Communication

  6. The Family • Parents • Siblings—involve a child life specialist • Extended family

  7. The Love of a Family

  8. Site of Death • Hospital • Home • Physical environment • Changes should be avoided

  9. Communication in Last Days • Provide information in simple terms, based on readiness • Child’s awareness of death • Presence

  10. Education about Last Hours • Empowerment • Keep instructions simple; repetition • Signs, symptoms of dying process • Family involvement

  11. The Imminently Dying Child • Estimating prognosis • Signs/symptoms only a guideline • Dying process

  12. Psychosocial and Spiritual Issues • Fear • Near death awareness • Withdrawal • Spiritual care

  13. Family Practice/Ritual • Family may have cultural or religious practices surrounding death and dying • Always ask about preferences—don’t assume • Rituals

  14. Physical Symptoms • Onset • Confusion, disorientation, delirium • Weakness, fatigue • Pain changes • Restlessness and/or terminal agitation

  15. Physical Symptoms (cont.) • Alertness/sleep changes • Temperature changes • Gastrointestinal changes • Decreased oral intake

  16. Physical Symptoms (cont.) • Vital sign changes • Breathing pattern changes • Incontinence or urinary retention • Seizures • Continued assessment

  17. The Death Vigil • Family presence • Common fears • Being alone with the child • Painful death • Time of death • Giving “last dose” Lo, 1996

  18. Death: When the Time Comes • Signs and symptoms • Parental presence or absence • Death pronouncement

  19. Communicating the Death • Grief • Interdisciplinary team approach

  20. Death in the NICU • Communication • Continuity of care • Withdrawal of interventions • Family involvement

  21. The Nightmare Begins

  22. Care Following Death • Removal of tubes, equipment • Bathing and dressing the child’s body • Encourage family participation • Respect cultural preferences

  23. Care Following Death (cont.) • Compassionate/sensitive removal of body • Rigor mortis • Embalming • Siblings • Funeral home

  24. Care Following Death (cont.) • Assistance with calls, notifications • Destroying medications • Autopsy

  25. Care Following Death (cont.) • Assisting with arrangements • Initiating bereavement support

  26. Impact on Nurse • Emotional burden • Individual response • Parallel suffering

  27. Support for the Nurse • Ask for help • Verbalize • Post-clinical debriefing • Self care/self awareness

  28. A Brief Life

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