Death and Dying Flashcards
Factors Influencing Loss, Grief, and Coping Ability
Interpersonal relationships and social support networks.
Type and significance of loss.
Culture and ethnicity.
Spiritual and religious beliefs and practices.
Prior experience with loss.
Socioeconomic status.
Anticipatory Grief
when death is expected or a possible outcome
Complicated Greif
Extends for more than 1 year following the loss:
Intense thoughts.
Distressing yearning.
Feelings of loneliness.
Distressing emotions and feelings.
Disturbances in personal activities, such as sleep.
Can require referral to an expert in grief counseling.
Parental Grief
Intense, long-lasting, and complex.
Secondary losses related to the death of the child, such s absence of hope and dreams, disruption of the family unit, loss of identity as a parent.
Differences in maternal and paternal grief.
Sibling Grief
Differs from adult/parental grief.
Reactions depend on age and developmental age.
Infant/Toddler Stage of Development R/T Death (birth-3y)
Have little to no concept of death.
Egocentric thinking prevents their understanding death (toddler).
Mirror parental emotions (sadness, anger, depression, anxiety).
React in response to the changes brought about by being in the hospital (Change in routine, painful procedures, immobilization, less independence, separation from family).
Can regress to an earlier stage of behavior.
Preschool Children Stage of Development R/T Death (3-6y)
Egocentric thinking.
Magical thinking allows for the belief that thoughts can cause an event such as death (as a result, child can feel guilt and shame).
Interpret separation from parents as punishment for bad behavior.
View dying as temporary because of the lack of concept of time and because the dead person can still have attributes of the living (sleeping, eating, breathing)
School Age Children Stage of Development R/T Death (6-12y)
Start to respond to logical or factual explanations.
Begin to have an adult concept of death (inevitable, irreversible, universal), which generally applies to older school-age children (9-12).
Experience fear of the disease process, death process, the unknown, and loss of control.
Fear can be displayed through uncooperative behavior.
Can be curious about funeral services and what happens to the body after death.
Adolescent Stage of Development R/T Death (12-20y)
Can have an adult like concept of death.
Can have difficulty accepting death because they are discovering who they are, establishing and identity, and dealing with issues of puberty.
Rely more on peers than the influence of parents, which can result in the reality of a serious illness causing adolescents to feel isolated.
Can be unable to relate to peers and communicate with parents.
Can become increasingly stressed by changes in physical appearance due to medications or illness than the prospect of death.
Can experience guilt and shame.
Factors that can increase the family’s potential for dysfunctional grieving following the death of a child:
Lack of support system/
Presence of inadequate coping skills.
Association of violence or suicide with the death of a child.
Sudden or unexpected death of a child.
Lack of hope or presence of pre-existing mental health issue.
Assessment
Knowledge regarding diagnosis, prognosis, and care.
Perception and desires regarding diagnosis, prognosis, and care.
Nutritional status, as well as growth and development patterns.
Activity and energy level of the child.
Parents wishes regarding the child’s end of life care.
Presence of a DNR order.
Family coping and available support.
Stage of grief the child and family are experiencing.
Physical Manifestations of Death
Sensation of heat when the body feels cool.
Decreased semsationand movement in lower extremities.
Loss of senses (hearing is the last to be lost).
Confusion or loss of consciousness.
decreased appetite and thirst.
Swallowing difficulties.
Loss of bowel and bladder control.
Bradycardia, hypotension.
Cheyne-Stokes respirations.
Nursing Interventions
Allow an opportunity for anticipatory grieving, which impacts the way a family will cope with the death of a child.
Provide consistency among nursing personnel who are caring for the client.
Encourage parents to remain with the client.
Attempt to maintain a normal environment.
Communicatie with the client honestly and respectfully.
Encourage independence.
Stay with the client as much as possible.
Administer analgesics to control pain.
Provide privacy.
Soften lights.
Offer soft music if desired.
Assist with arranging religious or cultural rituals desired bt the client and family.
Assist the client with unfinished tasks.
Provide support for the family and client.
Palliative Care
Consider the clients, siblings, and parents as the units of care.
Provide an environment that is as close to being like home as possible.
Consult with the client and family for desired measures.
Respect the family’s cultural and religious preferences and rituals.
Provide and clarify information and explanations.
Encourage physical contact; address feelings; and show concern, empathy, and support.
Provide comfort measures (warmth, quiet, noise control, dry linens).
Provide adequate nutrition and hydration.
Control pain:
Give medications on a regular schedule.
Treat breakthrough pain.
Increase doses as necessary to control pain.
Encourage use of relaxation, imagery, and distraction to help manage pain.
Care for Grieving Families During the Dying Process
Provide information to the client and family about the disease, medications, procedures, and expected events.
Encourage and support parents to participate in caring for the client.
Encourage parents to remain near the child as much as possible.
Encourage the client’s independence and control as developmentally and physically appropriate.
Allow for visitation of family and friends as desired.
Emphasize open, honest communication among the client, family, and health care team.
Provide support to the client and family with decision making.
Provide opportunities for the client and family to ask questions.
Assist parents to cope with their feelings and help them understand the clients behaviors.
Use books, movies, art, music, and play therapy to stimulate discussion and provide and outlet for emotions.
Provide and encourage professional support and guidance from a trusted member of the health care team.
Remain neutral and accepting.
Give reassurance that the client is not in pain and that all efforts are being made to maintain comfort and support fo the clients life.
Recognize and support the individual differences of grieving. Advised families that each member can react differently on any given day.
Give families privacy, unlimited time, and opportunities for any cultural or religious rituals. Respect the family’s decisions regarding care of the client.
Encourage discussion of special memories and people, reading of favorite books, providing favorite toys./objects. physical contact, sibling visits, and continued verbal communication, even if the client seems unconscious.
After Death
Allow the family to stay with the body as long as they desire.
Allow family to rock the infant or toddler, if desired.
Remove tubes and equipment.
Offer to allow family to assist with preparation of the body.
Assist with preparation involving the death ritual.
Encourage parents to prepare siblings for the funeral and related death rituals.
Remain with the family and offer support.
Allow the family to share stories about the clients life.
Refer to the client by name.
Allow all family members to communicate feelings.
