Developmental Considerations for End of Life Care

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Outline

Overview

End of life care should be coordinated with developmental and life stage in mind.
Death is associated with the elderly, but can happen at any age.
Concepts of death vary with developmental stages and cognitive abilities.

Nursing Points

General

Nursing care for end of life should be planned with developmental stages in mind to ensure proper language is used and age appropriate interventions are in place.

Assessment

Concepts of death and grief by age-
1. Infants
  1. Capable of responding to loss by 10 months of age
2. Toddler
  1. Separation is temporary
3. Preschooler
  1. Believes death is reversible
  2. Employs magical thinking
    1. Example- bad behavior may have caused illness or death
  3. Fear of abandonment
4. School-Age
  1. Realizes death is permanent
  2. Finds it helpful to attend funeral services for closure
  3. Doesn’t understand their own mortality
  4. May show anger and guilt after the death of a loved one
5. Adolescent
  1. Capable of abstract thinking and understanding long-term effects
  2. Extreme fear of pain and discomfort in dying
  3. Often denies their mortality, engaging in risky activities
6. Young Adulthood
  1. Major causes of death are preventable (accidents and violence)
  2. Strong feelings of denial surrounding death
7. Middle Adulthood
  1. Possible added distressed by leaving behind a partner and young children
8. Late Adulthood
  1. Concern for leaving a legacy and tying up loose ends before death

Therapeutic Management

Address physical, emotional and spiritual needs of the dying patient
Consider cognitive development when discussing death with patients and families.
1. Example
  1. When speaking to the parents of a school-age child diagnosed with a terminal illness
    1. Remind them that their child may lack the ability to comprehend mortality
Encourage use of legal tools
1. Advanced Directive
2. Living Will
3. Do Not Resuscitate Orders

Nursing Concepts

Grief
1. Grief is an emotional response to loss and is affected by developmental and congitive stages.
Human Development
1. Experiences of end of life care are influenced by developmental and cognitive stages.
End of Life Care
1. End of life care should be coordinated with the developmental stages in mind.

Patient Education

Patients should be educated on the stages of grief to help them process their emotions.
Parents should be educated on childhood developmental stages to aid in their understanding of childhood reactions to death.

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Transcript

So, I think the statements on this slide are pretty obvious but also really important to remember. We usually associate death with the elderly, but it can and does occur at any stage of life. And with each stage of life there are unique developmental needs and concepts of death and grief may vary greatly.

We are primarily going to talk about end of life considerations for the patient, but obviously it’s important to think about the patient’s family also as they are going to right there in the mix- impacting end of life care, making decisions even.

So, when we think about our nursing assessment for end of life care we need to be aware of how those concepts of death and grief vary with each stage, so i’m just going to run through some of these differences. Then- you need to just make sure these are considered when creating plans of care for end of life. Like said, we are mostly talking about patient’s but if you imagine a family trying to say goodbye to a dying family member- it helps to know what the kids in the room might be thinking.

So infants- aren’t going to have much of an awareness, but some research has shown that infants can respond to grief by as early as 10 months.

Toddlers and preschoolers both have difficulty understanding time so they are believe the separation of death is just temporary and likely won’t grieve and experience emotion in the say way an older child would. Explaining this to parents can help them understand why their 3 year old is still playing and laughing during such a difficult time. Preschoolers may also believe that death is reversible- this goes along with their magical thinking that may also cause them to believe that something they thought or did caused the illness or death.

School age children are able to process and understand the fact that death is permanent, but they still will process their own mortality in a different way and may not be able to fully grasp it. From experience though, I will say kids tend to understand more than people think they will- so always speak to them and find out how they are thinking and feeling to make sure they aren’t getting overlooked in the process.

Adolescents are capable of understanding the complexities of death, but they feel invincible and will deny their own mortality.

Young adults continue to have feelings of denial about death- and risky behaviours continue in the early 20’s.

Patients in middle adulthood may begin to feel distress over the idea of death and this can present in the form of a mid-life crisis. They are also likely to begin seeing their peers become diagnosed with complex illnesses and may even experience having peers die.

Patients in late adulthood are concerned with leaving a legacy- so they may be very focused on tying up loose ends and making sure all of their affairs are in order.

For management, the most important thing is to just consider the developmental needs and cognitive abilities of both the patient and the families when creating end of life care plans. When you do this, you can be sure to use correct language, and guide the expectations of those involved.

It will also help you encourage patients and families to make a plan together – emphasizing communication, specific needs and the use of appropriate legal tools.

Your priority nursing concepts when providing end of life care are grief, human development and end of life care.

Your key points for this lesson are- keeping in mind that end of life care isn’t specific to the elderly, it can happen at any age. Because of this we have to adapt nursing care to meet individual cognitive and developmental needs. So this may entail changing the language we use and helping guide expectations.

Make sure you learn the age specific variations regarding perception of death – these are very testable and link into what you need to know about childhood development!

And lastly- make sure our nursing care includes encouraging planning and communication to ensure that people’s needs are met in the best and most specific ways possible.

That’s it for our lesson on growth and developmental considerations for end of life care.. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!