Download This child is dying.

This child is dying.
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Educating the Nurses of
Tomorrow on Pediatric
Palliative Care
Imagine being a
nursing student, with
a family, being told
that their child was
dying.
Julie Lindsay, MSN, RN
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Why is this important
Why Children Die
Infants
Approximately 53,000 children
die a year.
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Nearly 17% of all annual
pediatric deaths are
unexpected (CDC, 2006).
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Congenital Anomalies
Respiratory Distress Syndrome
Factors related to prematurity and low birth weight
Sudden Infant Death Syndrome
Accidents
Sepsis
Maternal Complications of pregnancy such as
infection, placenta complications, etc.
(CDC, 2006)
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Why Children Die
Why Children Die
Children ages 1-4
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Children ages 5-9
Accidents
Congenital malformations
Malignant neoplasm's
Assault (homicide)
Diseases of the heart
Influenza and pneumonia
(CDC, 2006)
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Why Children Die
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Youths ages 15-19
Injuries (unintentional and intentional)
Malignant Neoplasm's
Suicide
Congenital Malformations
Diseases of the heart
(CDC, 2006)
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What Affects a Child Concepts
of Death?
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Accidents
Suicide
Homicide
Malignant Neoplasm's
Heart Disease
(CDC, 2006)
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Infants
• Age, cognitive developmental
stages
• Prior experience with loss, death,
illness/injury, family separation,
moving
• Family’s emotion and how they
deal with death
• Communication styles within the
family
• Child’s personality
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Why Children Die
Children ages 10-14
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Injuries
Malignant Neoplasm's
Congenital Anomalies
Homicide
Heart Disease
(CDC, 2006)
• Death has little significance to
children under 6 months of age.
Their cognitive formation has not
begun.
• After the parent-child attachment
and development of trust is made,
a loss even temporary, has impact.
• Prolonged separation during the
first several years of life can affect
future growth (physical, emotional,
and social).
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Toddler’s
Toddlers
• Toddlers are egocentric and think
about things concerning them.
• Toddlers have limited
understanding of fact and fantasy.
• Toddlers are limited on how they
comprehend death.
• Toddlers are affected more by
lifestyle changes than death.
• Toddlers may regress.
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• This age group reacts more to pain
and discomfort than the thought of a
possible fatal illness.
• This age group needs rituals.
Changes in rituals can lead to
anxiety.
• This age group reacts to their parents
anxiety and sadness.
• They may react as if the person who
died is still alive.
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Preschoolers
• If they become seriously ill, they may
think it is a punishment.
• They may feel guilty and responsible
if a sibling dies.
• They fear separation from their
parents or caregivers (greatest fear).
• They may deny death.
• They may regress to distance
themselves from loss.
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School Age
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School Age
• May have fears of illness, reasons
for illness, communicability,
consequences, and fear the dying
process.
• Fear of the unknown is great fear.
• Realize that death is a threat to
their sense of security.
• Have interest in post-death
services.
• Curious about what happens to the
body.
• May still associate misdeeds/bad thoughts
as causing death. They may feel guilt or
responsibility for loss.
• Fear mutilation and punishment and may
associate with death.
• Can comprehend logical explanations.
• Personify death as the devil or a monster.
• By the age of 9 or 10, begin to realize that
death is inevitable, universal, and
irreversible.
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Preschoolers
• May believe their thoughts of
guilt, shame, and punishment
nay have caused a death.
• Death may be seen as
temporary.
• Do not understand the
inevitability of death.
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Adolescents
Adolescents
• Have a mature understanding
of death.
• Are influenced by some
magical thinking.
• Still coping with transition
from childhood to adulthood.
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• Have difficulty coping with
death.
• Believe they are invincible.
• Least likely to accept the
cessation of life, especially their
own.
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Other Issues/Symptoms
Pain
And the fear of being
alone.
Dyspnea
Fatigue
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As educators we must realize that…
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Anxiety
Nursing students have very little
formalized training in dealing
with death and dying,
especially with the needs,
of children and their families.
This can also be true of our
peers working in hospitals.
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Many of these children facing their
own death experience anxiety. For
toddlers and young children,
this may be an extension
of the feeling felt
by their family and caregivers.
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Anxiety
Anxiety
Anxiety may be related to feelings or
concerns about what will happen to
them in this stage of their life. They
may wonder if their needs such as
food, warm and being cared for will
be met.
They may worry about what will
happen to them after they die or what
may happen to their family when they
are gone.
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Families may also have feelings/fears of
being abandoned for themselves and
their children when they are told
there is no longer a cure.
They also have financial concerns-time
away from work, loss of income,
expenses not covered by insurance.
They are attempting to balance work,
ill child and sometimes other children
as well.
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Educating the nurses of
tomorrow, as well as today,
includes teaching them how to
deal with difficult patient
situations. Students are
exposed to more acutely ill
patients. Students need to be
prepared to use critical
thinking and communication
skills in death and dying
situations.
Are our students as well as
our peers prepared to care
for these children
and their families?
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Do we teach the
appropriate interventions
to help work with a child
and their family who is
dying?
The death of a child is difficult
for anyone. Many times
emotions and feeling occur
that we, as healthcare
professionals feel unprepared
to deal with.
We experience anger, sadness,
questioning, and a sense of
loss.
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Classroom Simulation
Theory????
Combining lecture and
simulation allowed for active
learning in a safe environment.
Allow students to address
questions and concerns
about pediatric
deaths-sudden
and expected.
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Bandura
Watson
Kolbola
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Simulation?
Who’s Billy?
Students portraying roles
with a simulator make the
experience come alive.
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The parents arrived and are
greeted by the chaplain who
explains what is happening to
Billy. They ask to see Billy.
After checking with the
physician and staff
who are attempting to
resuscitate Billy,
the parents are brought into
the room.
Billy is a little boy found not
breathing by his parents.
They call EMS and he is
brought into the Emergency
Room in full cardiac arrest.
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After observing and asking
questions of the physician
and chaplain about Billy’s
prognosis, the parents ask
for the resuscitation to stop.
The monitor goes into
asystole and Billy is
pronounced dead by the
physician.
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The parents are then
allowed to hold their
child.
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Time for reflection and
discussion.
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