5. Develop a family-centered nursing care plan for Zachary's family during end-of-life care.
Nursing dx and interventions will be designed for Zachary including:
a. Promotion of pain management/comfort
- Pain assessment using developmentally appropriate tool, e.g. FLACC to assess/evaluate medication and comfort measures
- Administer pain medications/sedatives titrated to optimal comfort goal
- Position Zachary so that his respiratory efforts are optimized; suction (and/or medicate) if he has increased secretions.
- Utilize other comfort measures designed by family, e.g. have family member rock or hold Zachary (or lay in the bed with him); massage, music, low lighting, etc.
b. Assisting child for a peaceful death
- If he is alert and able to participate, help family talk to him about death in terms a 3 year old understands. Often times, child life specialists have books/stories that help a 3 year old understand what to expect.
- Help family have private time with him
- Create a peaceful environment once child is no longer to enjoy activities due to physiological/mental status. If possible, dc monitors (or lower the alarm volume), decrease lighting, utilize music)
c. Assisting the family to provide comfort and care for Zachary
- Assist with planning rituals or providing environment for spiritual care.
- Help family plan/implement comfort measures for Zachary, e.g. time with him at the bedside, holding, rocking him; watching movies, reading books to him, etc.
d. Assist the family to cope with Zachary's impending death
- Let the family know what to expect as Zachary's physical status declines and death is imminent and answer questions for them
- Coordinate/ communicate with chaplain, social worker, outside clergy/community resources to have them assist family with their feelings, planning for memorial service/remembrance of Zachary, creating a website for communication re. Zachary's status/journey (such as through caringbridge.org).
- Listen to their memories, desires, grief; assist with praying or rituals that are helpful to them
- Encourage them to let others help them....food (or subsidized meals in hospital), setting up sleeping arrangements, including space for one parent at the bedside
e. Assist to set up follow-up for family after child's death
- Connect them to available resources, which may include hospice/grief support groups, e.g Candlelighters support group (oncology pts); special resources for Marilee (support group, camps, counselor, etc).