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This child is dying. Free template from www.brainybetty.com 2 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 Free template from www.brainybetty.com 3 Why is this important Why Children Die Infants Approximately 53,000 children die a year. • • • • • • • Nearly 17% of all annual pediatric deaths are unexpected (CDC, 2006). Free template from www.brainybetty.com 5 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) Free template from www.brainybetty.com 6 1 Why Children Die Why Children Die Children ages 1-4 • • • • • • Children ages 5-9 Accidents Congenital malformations Malignant neoplasm's Assault (homicide) Diseases of the heart Influenza and pneumonia (CDC, 2006) Free template from www.brainybetty.com • • • • • 7 Why Children Die Free template from www.brainybetty.com Youths ages 15-19 Injuries (unintentional and intentional) Malignant Neoplasm's Suicide Congenital Malformations Diseases of the heart (CDC, 2006) Free template from www.brainybetty.com 9 What Affects a Child Concepts of Death? • • • • • Accidents Suicide Homicide Malignant Neoplasm's Heart Disease (CDC, 2006) Free template from www.brainybetty.com 10 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 Free template from www.brainybetty.com 8 Why Children Die Children ages 10-14 • • • • • • 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). 11 Free template from www.brainybetty.com 12 2 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. Free template from www.brainybetty.com • 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. 13 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. 15 School Age Free template from www.brainybetty.com 16 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. Free template from www.brainybetty.com 14 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. Free template from www.brainybetty.com Free template from www.brainybetty.com 17 Free template from www.brainybetty.com 18 3 Adolescents Adolescents • Have a mature understanding of death. • Are influenced by some magical thinking. • Still coping with transition from childhood to adulthood. Free template from www.brainybetty.com • Have difficulty coping with death. • Believe they are invincible. • Least likely to accept the cessation of life, especially their own. 19 Free template from www.brainybetty.com 20 Other Issues/Symptoms Pain And the fear of being alone. Dyspnea Fatigue Free template from www.brainybetty.com 21 As educators we must realize that… 22 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. Free template from www.brainybetty.com Free template from www.brainybetty.com 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. 23 Free template from www.brainybetty.com 24 4 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. Free template from www.brainybetty.com 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. 25 27 Free template from www.brainybetty.com 28 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? Free template from www.brainybetty.com 26 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. Free template from www.brainybetty.com Free template from www.brainybetty.com 29 Free template from www.brainybetty.com 30 5 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. Free template from www.brainybetty.com Bandura Watson Kolbola 31 Free template from www.brainybetty.com 32 Simulation? Who’s Billy? Students portraying roles with a simulator make the experience come alive. Free template from www.brainybetty.com 33 34 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. Free template from www.brainybetty.com Free template from www.brainybetty.com 35 Free template from www.brainybetty.com 36 6 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. Free template from www.brainybetty.com The parents are then allowed to hold their child. 37 Free template from www.brainybetty.com 38 Time for reflection and discussion. Free template from www.brainybetty.com 39 7