culture 3 peadiatric Flashcards
Paediatric Palliative Care: what kinds
of conditions are we treating here?
Genetic or congenital disorders Neurological disorders Cancers Respiratory disorders Cardiovascular disorders Metabolic Renal Immunological
Paediatric Palliative Care: how is it
different?
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
Parents’ concerns about paediatric
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.
Siblings’ concerns: paediatric
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.
physical concerns paediatric
identify pain or other symptoms, using strategies that are age or
developmental
stage appropriate
psychosocial concerns paediatric
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
spiritual concerns paediatric
discuss spiritual concerns
planning for end of life care paediatric
identify decision makers discuss anticipated illness trajectory identify goals of care consider concerns near end of life consider acute resuscitation plan if appropriate
practical concerns paediatric
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.
Communicating with children
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.
Children 2 years or younger death
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
Children aged 3 to 5 years
usually see death as temporary, a condition
from which you can return
Children aged 6 to 10 years
are much more curious about death, and
tend to ask many questions. They have the ability to understand that
death is forever.
Children aged 11 years and older
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
A child’s understanding of death is
also influenced by
their personality prior experience of death family norms and rituals film, television and books the experiences of their peers.
SPMI
severe and persistent mental illness(SPMI)
Background People with SPMI
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
People with an SPMI present very late for treatment for a life limiting
illness, for many reasons
social isolation, a high pain tolerance, an
unwillingness or inability to seek medical health or a denial of their
symptoms.
Patients who have a life-limiting illness often develop
p depression and anxiety.
➢ Therefore, patients who have an SPMI may develop another mental disorder
over and above their current disorder.
There are significant interactions between the medicines given
palliative
care and psychotropic drugs.
The challenges of providing palliative care to a
person with an SPMI who has a life-limiting illness
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.
