culture 3 peadiatric

Question 1

Paediatric Palliative Care: what kinds

of conditions are we treating here?

Answer 1

 Genetic or congenital disorders
 Neurological disorders
 Cancers
 Respiratory disorders
 Cardiovascular disorders
 Metabolic
 Renal
 Immunological

Question 2

Paediatric Palliative Care: how is it

different?

Answer 2

 Embraces the whole family as well as the child
 Involves health professionals who are specialised in the care of children
 Supports the family in the care of the sick child as well as other children
 Needs to consider the child’s understanding of the concepts of treatment
and symptoms and death.
 Because of the uncertainties of a child’s prognosis, palliative care in
children is delivered to ensure the best quality of life in a “hope for the
best, plan for the worst” scenario.
 smaller number of children requiring palliative care
 wider, more diverse range of conditions
 each child’s developmental factors need to be considered with their care
 different physiology and pharmacokinetics
 parents often involved in decision making
 siblings require developmental appropriate individualised support
 child’s life-‐limiting illness has profound effects on all aspects of family life
 most children with life-‐limiting conditions are cared for at home

Question 3

Parents’ concerns about paediatric

Answer 3

fear and anxiety over the suffering and potential loss of their child.
Financial burden of medical costs and loss of income
A decline in parental physical, mental and relationship health.

Question 4

Siblings’ concerns: paediatric

Answer 4

Increased responsibility
Stress from upheaval of family
Feelings of guilt they may have about their feelings towards their sick sibling.
Anxiety over sibling and also their separation from parents.
Feelings of being embarrassed by their sibling’s illness.

Question 5

physical concerns paediatric

Answer 5

identify pain or other symptoms, using strategies that are age or
developmental
stage appropriate

Question 6

psychosocial concerns paediatric

Answer 6

identify the child’s and family’s fears and concerns
identify coping and communication styles
discuss previous experiences with death, dying or other traumatic life events
assess resources for bereavement support

Question 7

spiritual concerns paediatric

Answer 7

discuss spiritual concerns

Question 8

planning for end of life care paediatric

Answer 8

identify decision makers
discuss anticipated illness trajectory
identify goals of care
consider concerns near end of life
consider acute resuscitation plan if appropriate

Question 9

practical concerns paediatric

Answer 9

plan communication and coordination of health care team
identify child and family preferences for location of care
discuss child’s home or school environment
assess child’s current and future functional status
identify possible financial consideration on family.

Question 10

Communicating with children

Answer 10

tailor communication to meet the child’s developmental stage
 use age appropriate methods of communication such as drawings, books,
action based toys
 be honest and maintain trust, be clear with responses to questions
 take time to be together and communicate, not just about their illness
 allow children to have a break away from family and carers
 be prepared to listen to and revisit conversations about care.

Question 11

Children 2 years or younger death

Answer 11

cannot comprehend what death means.
However, they do have a sense of someone significant being absent.
They react to disruption in their normal routine and are sensitive to nonverbal
cues and will pick up on the emotional atmosphere around them

Question 12

Children aged 3 to 5 years

Answer 12

usually see death as temporary, a condition

from which you can return

Question 13

Children aged 6 to 10 years

Answer 13

are much more curious about death, and
tend to ask many questions. They have the ability to understand that
death is forever.

Question 14

Children aged 11 years and older

Answer 14

have a more sophisticated and realistic
view of death. They realise it is final but they also appreciate that those left behind need
to grieve, find meaning, and remember

Question 15

A child’s understanding of death is

also influenced by

Answer 15

 their personality
 prior experience of death
 family norms and rituals
 film, television and books
 the experiences of their peers.

Question 16

SPMI

Answer 16

severe and persistent mental illness(SPMI)

Question 17

Background People with SPMI

Answer 17

SPMI who develop a life-limiting illness are one of the most
vulnerable and marginalised groups of people.
➢ Overwhelming evidence shows that these people die 15-20 years
earlier than the general population.
➢ They die more often of cancer and at an earlier stage

Question 18

People with an SPMI present very late for treatment for a life limiting
illness, for many reasons

Answer 18

social isolation, a high pain tolerance, an
unwillingness or inability to seek medical health or a denial of their
symptoms.

Question 19

Patients who have a life-limiting illness often develop

Answer 19

p depression and anxiety.
➢ Therefore, patients who have an SPMI may develop another mental disorder
over and above their current disorder.

Question 20

There are significant interactions between the medicines given

Answer 20

palliative

care and psychotropic drugs.

Question 21

The challenges of providing palliative care to a

person with an SPMI who has a life-limiting illness

Answer 21

Mental health nurses need to have an understanding of the needs of
patients requiring palliative care.
➢ Collaboration between them and the palliative care team is imperative
➢ It is good that both mental health and palliative care specialities are
underpinned by similar values.
➢ These include addressing the needs of the whole person and developing a
therapeutic relationship.