2. Pediatric Dying and Death
How children die
Final hours
Field & Behrman, 2003

3. Pediatric Death is a Unique Experience
No typical pediatric death
Developmental issues
Family is the unit of care
Interdisciplinary team approach

4. Role of the Nurse in the Final Days
Advocate
Educate
Coach
Interdisciplinary team collaboration

5. Role of the Nurse in the Final Days (cont.)
Physical care
Spiritual comfort
Culture
Memory-making

6. The Dying Child
Awareness of dying
Disclosure
Communication

7. The Family Parents Siblings—involve a child life specialist
Extended family

8. The Love of a Family

9. Site of Death Hospital Home Physical environment
Changes should be avoided

10. Communication in Last Days
Provide information in simple terms, based on readiness
Child’s awareness of death
Presence

11. Education about Last Hours
Empowerment
Keep instructions simple; repetition
Signs, symptoms of dying process
Family involvement

12. The Imminently Dying Child
Estimating prognosis
Signs/symptoms only a guideline
Dying process

13. Psychosocial and Spiritual Issues
Fear
Near death awareness
Withdrawal
Spiritual care

14. Family Practice/Ritual
Family may have cultural or religious practices surrounding death and dying
Always ask about preferences—don’t assume
Rituals

15. Physical Symptoms Onset Confusion, disorientation, delirium
Weakness, fatigue
Pain changes
Restlessness and/or terminal agitation

16. Physical Symptoms (cont.)
Alertness/sleep changes
Temperature changes
Gastrointestinal changes
Decreased oral intake

17. Physical Symptoms (cont.)
Vital sign changes
Breathing pattern changes
Incontinence or urinary retention
Seizures
Continued assessment

18. The Death Vigil Family presence Common fears
Being alone with the child
Painful death
Time of death
Giving “last dose”
Lo, 1996

19. Death: When the Time Comes
Signs and symptoms
Parental presence or absence
Death pronouncement

20. Communicating the Death
Grief
Interdisciplinary team approach

21. Death in the NICU Communication Continuity of care
Withdrawal of interventions
Family involvement

22. The Nightmare Begins

23. Care Following Death Removal of tubes, equipment
Bathing and dressing the child’s body
Encourage family participation
Respect cultural preferences

24. Care Following Death (cont.)
Compassionate/sensitive removal of body
Rigor mortis
Embalming
Siblings
Funeral home

25. Care Following Death (cont.)
Assistance with calls, notifications
Destroying medications
Autopsy

26. Care Following Death (cont.)
Assisting with arrangements
Initiating bereavement support

27. Impact on Nurse Emotional burden Individual response
Parallel suffering

28. Support for the Nurse Ask for help Verbalize Post-clinical debriefing
Self care/self awareness

29. A Brief Life