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1、Nursing care of the dying child and family,前言 影響兒童死亡概念的因素 Childrens understanding of death and possible behavioral responses P280 The dying child Bereavement Sibling Parents Staff reactions to the death of a child,Childs experience,Stressor to the child Table 8-1 Coping mechanisms Nursing care of th
2、e child with a life-threatening illness or injury P267,Nursing care of the child with a life-threatening illness or injury P267,Nursing diagnosis: Impaired verbal communication Impaired social interaction Spiritual distress Ineffective family coping Physical mobility,Sleep pattern disturbance Divers
3、ional activity Altered growth and development Body image disturbance Self-esteem Hopelessness Anticipatory grieving,Nursing implementation：,Promote a sense of security Provide education about the illness or injury and prepare the child for procedures. Facilitate the use of play. Promote a sense of c
4、ontrol.,The Child Coping with a Life Threatening Illness or Injury P268,Care plan Anxiety（child ）related to separation from parents, foreign environment, strangers as caretakers, invasive procedures. Powerlessness（moderate）related to inability to communicate, and control relinquished to the health c
5、are team. Pain related to injuries, invasive procedures, surgery.,影響兒童死亡概念的因素,內在因素 家庭和社會的影響 宗教的影響 傳播媒體的影響 認知發展的影響,The dying child P280,Childrens psychological reactions to dying and nursing care P280 Childrens psychological reactions P280 Nursing care of the dying child Nursing care of psychological
6、 reactions P281 Nursing care of physiological reactions 補 Siblings reactions and nursing care P276 Parents reactions and nursing care P271,Childrens psychological reactions -Preschooler,5 y/o can sense when they are seriously ill. P280第2段 Develops more rapidly when he or she is experiencing the prog
7、ression of a disease and related medical treatment. Often learn about death and their own illness from exposure to other seriously ill and dying children . Can see their body deteriorate and feel the toxic effects of chemicals.（body changes）P280第3段 Changes in self-concept occur as they perceive thes
8、e body changes. They often describe their illness in terms of mutilation to their body. They may realize that they are dying because of these physical changes.,Childrens psychological reactions -School-Age Child,Fears about body integrity and anxieties about the seriousness of their illness. P281第2段
9、 Death anxiety occurs in children even though they are unable to conceptualize or describe death at an adults level of understanding. Even if children have not been told they are dying, they know their condition is worsening. 第3段 They usually do not have the same fears about dying that adults do. So
10、me children keep most of their thoughts about death to themselves. If they have not been told that they are dying, they may feel isolated and get the message not to discuss their condition. Children fear desertion more than death. Believe that expressing their awareness of death and their fears will
11、 place added emotional burdens on family members.,Childrens psychological reactions -Adolescent,They are struggling to establish their own identity and plans for the future. P281第5段 Body image is extremely important. Isolated from peers. May be angry.,Childrens reactions to dying and death,心理反應 (補)1
12、.否認期2.憤怒期3.磋商期4.憂鬱期5. 接受期,Nursing care of psychological reactions P281,Maintain contact with peers. 第1段第2行 Provide opportunities for fantasy play, drawings, and storytelling.（Death imagery or anticipated experiences with treatment）.第2段 Assist children and families with discussions. P282第2段最後1行 Provi
13、de activities to help teens channel their feelings. P282第3段第2行 Be available to listen. 第4行 Promote friendships with other teens having similar interests or problems. 第5行 Provide teens with as much independence and control over their situation as possible. Palliative care & hospice care. P282 第5段,Ass
14、ist children and families with discussions P282第2段最後1行,Development age Previous knowledge Honesty The types of questions that children most frequently ask. P281最下面 Themes that may assist parents in discussing possible death with children,Death, like birth, is part of the natural order of things. Dea
15、th has social significance. Death is a separation. The loss is never complete. The child will not be alone at death and after death. The child should be reassured that all feelings are normal. The childs memory will live on in mind and spirit.,Themes that may assist parents in discussing possible de
16、ath with children,Data from Whaley & Wongs Nursing care of the infant and children. P952 Box 23-3,Palliative care & hospice care P282 第5段,Palliative care combines active and compassionate therapies. Aimed at reducing or curing the illness and treating symptoms. More aggressively than hospice care. Hospice carealert, without pain, and with choices and dignity. It does not seek to prolong life.,
