Death
Interventions recommended prior to death (4)
1. offering choices instead of decisions whenever possible
2. provide privacy and areas for contemplation
3. frequent contacts to support/answer questions
4. refer support staff
3 levels of consent (informed permission of risks, benefits, burdens, expected outcomes as explained by medical professionals)
1. children entirely without decisional capacity (due to age or illness severity, etc) = parents decide
2. children with developing capacity that remains insufficient = parents are to provide informed permission in combination with their child's assent
3. children has sufficient decisional capacity = the parents should service as consultants but the child makes the final decision
3 stages of separation anxiety from Bowbly and Robertson
1. protest
2. dispair
3. detachment
What is the concept of "caring" and relate to healthcare.
Caring attends to both feelings and the mind, involves developing empathy and care about others.
Why is it necessary for effective multidisciplinary collaboration?
-Insight into child's illness/treatments, etc
-Standard of JCAHO and CCHSA
-building relationships and sharing workload
interventions at the time of death (4)
1. continue to involve parents in care
2. involve siblings/extended family
3. engage in memory making
4. escort family carefully from facility when appropriate
Grisso and Appelbaum's views on decisional capacity (4 essential elements)
1. an understanding of relevant treatment information
2. an appreciation for the possible impact/concequeces of available options
3. a rationale or path of reasoning that demonstrates application of personal values of available alternatives/outcomes
4. ability to actually derive and express a choice/preference
Common major responses and reactions prior to and following simnifically intrusive medical events such as surgery
-Tearfulness
-Nightmares
-Fear of doctors/hospitals
-Tatrums
What is FICA? (Pulchalski)
Tool used for taking spiritual or faith history
F- Faith or beliefs
I-Importance or degree of influence
C-Community (regularity of church attendance example)
A-Address (desire to talk about with healthcare staff)
4 types of professional provider-patient relationships common in medical care today
1. clinical (technical and routine)
2. therapeutic (primary support and resource enhancer)
3. connected (people first, roles second)
4. over involved (enmeshment overrides appropriate treatment selection)
1. Children are developing relatively adult views of death and loss, will grasp it quickly.
2. Display somewhat morbid interests (blood, bones, gruesome details)
3. Use humor to cope
4. Common behaviors include grief, anger, withdrawal and acting out
Grisso and Vierling's views on decision making capacity (5)
1. ability to focus on essential issues
2. carefully consider issues
3. appraise both pros and cons
4. weigh anticipated risks/benefits
5. utilize both inductive and deductive reasoning
EXTRA 200 POINTS!!
There are many play activities and strategies that are used with children in health care settings, the most beneficial and effective among them tend to be those that are 1)high- energy and emotion-eliciting 2) very structured and directed 3) open-ended; or 4) quiet and passive
3) open ended
What is family systems theory?
Conceives every individual as an interrelate part of many other roader social systems and are seen as important individuals with own experiences, values, etc;
EXTRA 200 POINTS!!!
Deliberate behavior focused on managing specific fears and distressing thoughts is referred to as: 1) balance-focused coping 2) solution-focused coping 3) emotion-focused coping 4) feelings-focused coping
3. Emotion focused coping (identification of specific fears and intrusive thoughts)
Recommendations for support surrounding death for 9-12 year olds (4)
1. Use explanations with greater detail
2. respond to specific questions and measure child's interest and readiness to hear
3. explore feelings, allow spiritual questioning, and confirm family beliefs
4. create traditions to memorialize
5. use creative avenues of personal expression
8 cultural terms that health care staff should know
1. cultural competence = enhanced awareness of cultural concerns
2. cultural imposition = imposing personal cultural perspectives on others
3. culture =makeup of values, beliefs, traditions, etc
4. ethnic = a specific group sharing a common race/nationality and language
5. language = form of speech
6. mainstream = majority views
7. nationality = country of origin
8. race = distinctive physical characteristics genetically inherited
3 coping strategies and practical interventions recommended for inclusion in preparatory programs and which one is most successful in outcomes
1- primary control (consisting of behaviors to revise ensuing circumstances)
2- secondary control (efforts to adjust self to circumstances) ***most effective***
3- relinquished control (deferring to others)
Importance of spirituality to health at times of illness
-Children more aware of faith at time of illness
-Following spirituality lead from child and family is in best interest
-Important for professionals to offer appropriate support with or without mention of spirituality according to family's needs
Ways for CCLS's to enhance communication skills
1. reading professional publications
2. share articles with other professionals
3. provide presentations within community
4. engaging in discussions with teams about patients
5. clarify about child life interventions purposes with team and families
6. read medical record
7. provide in-services/case study presentations
8. attend presentations by other disciplines
9. complete review of area (playrooms, waiting areas, etc) projects
10. become a reflective practitioner
Advantages (7) and disadvantages (4) of dying at home
Advantages:
1. the family remains together in their home
2. family can provide most care
3. extended family more easily involved
4. familiar food
5. privacy
6. no hospital routines
7. friends, possessions, pets
Disadvantages:
1. family cannot provide constant attention to deterioration
2. caregiving is without support at night
3. fears about dying alone may be prominent
4. medical complications are first handled by family
Primary functions of culture and their relevance to healthcare professionals
Possible discussion points (providing a worldview, producing underlying behavioral motivations, shaping group identity, defining relevant value systems, predisposing certain modes of communication, discussion of 90% nurses being Caucasian)
Identify some of the major post-discharge emotional and psychological burdens children may sustain from unsupported hospitalization experiences
1. Sleep disturbances
2. Behavioral problems
3. persistent separation anxiety
4. undue problems with authority
5. Teens- adjustment difficulties
List 7 of 14 spiritual terms useful in talking with patients and families
1. belief
2. faith
3. faith communities
4. God
5. human spirit
6. religion
7. religiosity
8.spiritual care
9. spiritual development
10. spiritual distress
11. spiritual health/well-being
12. spiritual needs
13. spiritual pain
14. spirituality
4 values of scientific/biomedical health model (discuss weaknesses of model)
1. determinism (cause and effect)
2. mechanism (life arises from structures like a machine)
3. reductionism (everything can be reduced and disassembled)
4. dualism (mind and body are separate entities)
Weaknesses include, piecemeal health services, preventative medicine reflect, little or no consideration to linkages of mind/health, focus on symptoms over root disease causes, and "prescription-ism" or over prescribing