Nursing care of the dying child and family

前言

影響兒童死亡概念的因素

Children’s understanding of death and possible behavioral responses P280

The dying child

Bereavement

Sibling

Parents

Staff reactions to the death of a child

Child’s experience

Stressor to the child Table 8-1

Coping mechanisms Nursing care of the child with a life-

threatening illness or injury P267

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-esteemHopelessnessAnticipatory grieving

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.

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.

影響兒童死亡概念的因素 內在因素

家庭和社會的影響

宗教的影響

傳播媒體的影響

認知發展的影響

The dying child P280

Children’s psychological reactions to dying and nursing care P280

Children’s psychological reactions P280 Nursing care of the dying child

Nursing care of psychological reactions P281 Nursing care of physiological reactions –補

Siblings’ reactions and nursing care P276

Parents’ reactions and nursing care P271

Children’s psychological reactions --Preschooler 5 y/o can sense when they are seriously ill. P280 第 2 段 Develops more rapidly when he or she is experiencin

g 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 第 3 段 Changes in self-concept occur as they perceive these body c

hanges. They often describe their illness in terms of mutilatio

n to their body. They may realize that they are dying because of these physical changes.

Children’s psychological reactions --School-Age Child Fears about body integrity and anxieties about the seriousness of

their illness. P281 第 2 段 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. 第 3 段

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 w

ill place added emotional burdens on family members.

Children’s psychological reactions -Adolescent

They are struggling to establish their own identity and plans for the future. P281 第 5 段

Body image is extremely important. Isolated from peers. May be angry.

Children’s reactions to dying and death

心理反應 – ( 補 )

1. 否認期 2. 憤怒期 3. 磋商期 4. 憂鬱期 5. 接受期

Nursing care of psychological reactions P281 Maintain contact with peers. 第 1 段第 2 行 Provide opportunities for fantasy play, drawings, and storytel

ling. （ Death imagery or anticipated experiences with treatment ） . 第 2 段

Assist children and families with discussions. P282 第 2 段最後1 行

Provide activities to help teens channel their feelings. P282 第3 段第 2 行

Be available to listen. 第 4 行 Promote friendships with other teens having similar interests

or problems. 第 5 行 Provide teens with as much independence and control over th

eir situation as possible. Palliative care & hospice care. P282 第 5 段

Assist children and families with discussions

P282 第 2 段最後 1 行 Development age Previous knowledge Honesty The types of questions that children most fr

equently ask. P281 最下面 Themes that may assist parents in discussin

g 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 child’s memory will live on in mind and spirit.

Themes that may assist parents in discussing possible death with children

Data from Whaley & Wong’s Nursing care of the infant and children. P952 Box 23-3

Palliative care & hospice care P282 第 5 段 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.

Nursing care of physiological reactions 接近死亡時之生理反應 Loss of sensation and movement. Sensation of heat although body feels c

ool. Loss of senses. Confusion, loss of consciousness, slurr

ed speech. Muscle weakness. Loss of bowel and bladder control. Decreased appetite / thirst. Difficulty swallowing. Change in respiratory pattern. Weak, slow pulse decreased blood pres

sure.

照護方向 肌肉緊張度降低 疼痛 體力差、易疲倦

Data from Whaley & Wong’s Nursing care of the infant and children. P961 Box 23-6, 23-7

dying

Siblings’ reactions and nursing care P276

Siblings’ experience P276 第 1 段 May feel left out 第 2 行 From jealousy or envy to resentment, guilt and

hostility, anger, insecurity, regression, and fear. 第 4 行

Often have nightmares. 第 1 段倒數第 2 行

dying

Nursing management--Sibling Tell siblings about their brother or sister using languag

e and concepts appropriate to their ages and developmental levels. 第 2 段第 1 行

Allowed to visit hospital. 第 2 段第 2 行 Preparation for the visit. 第 3 段第 1 行 Demonstrate how to talk to and touch the ill child and encou

rage the siblings to do the same .(Figure 8-6). 第 4 段第 1 行 Discuss with siblings what they saw and felt. 第 2 行

By sending pictures, drawings, cards, and messages recorded on audiotapes or videotapes.(Figure 8-7). 第 4 段倒數第 2 行

Encourage parents to call the siblings at home at a regular time each night. 第 5 段第 1 行

Table 8-3 （ P276 ）

dying

Parents’ reactions and nursing care

Parents’ experience P271

Shock and disbelief P272

Anger and guilt Deprivation and loss Anticipatory waiting Readjustment or mourning

dying

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

bereavement--往生後

Siblings’ experience P278

Will have received less attention from parents. 第 1 段第 2行

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

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bereavement--往生後

Grieving process P280 右上 Early stage ： They understand the death occurre

d, while using self-protective mechanisms to block the full emotional impact of the loss.

Middle stage ： They accept and rework the loss while experiencing the intense psychologic pain.

Late stage ： They integrate the loss experience into their identity and resume age-appropriate developmental progress.

bereavement--往生後

Sibling --Nursing management P278 第 2 段 Honesty 第 1 行 Provide explanations in language that is developmentally appropriate. Reassure. 第 2 行 Allow the siblings to ask questions. 第 4 行 Acknowledge child’s emotions. Ask how they feel about saying good-bye to the dying child. 第 5 行 Prepare the siblings before they see the dying child. P279 第 1 段第 1 行 Answer questions truthfully. 第 3 行 May have to repeat information several times. Permitted to participate in planning funeral service. P279 第 2 段第 1 行 Make sure other caregivers and teachers know about the sibling's loss.

P279 第 3 段第 1 行 Let the child express feelings other than sadness (e.g., guilt and anger). Encourage them to express grief through art, stories, and writing.

bereavement--往生後

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. 第 1 段第 1 行 Grief and mourning are normal, necessary processes. 第 1 段最後 1 行 Many factors influence the parents' grief responses 第 2 段第 1 行

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 第 2 段第 1 行 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 第 2 段第 5 行

bereavement--往生後

Bereavement -- Parents

Nursing management P278 & P277 Table 8-4

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 第 1 段第 5 行

Caring for the dying child may be especially difficult for nurses with young children of their own. P282 第 2 段第 1 行

Their own personal defenses against their sense of helplessness. P283 第 1 段第 3 行

Anger, frustration, sadness, and powerlessness.

Staff reaction– 補

Denial Anger and depression Guilt Ambivalence （情感矛盾） Frustration （挫折）

Adaptation Self-awareness

Knowledge and practice

Support systems

Support systems may include discussions with peers

or debriefing group sessions with mental health profe

ssionals that provide an opportunity to discuss their f

eelings and concerns (Figure 8-8). P283 第 3 段第 4 行

Other strategies