DEATH AND DYING

Overview
Parental Response to Death

A. Major life stress event

B. Initially parents experience grief in response to potential loss of child
1. Acknowledgment of terminal disease is a Struggle between hope and
despair with resultant awareness of inevitable death.
2. Parents will be at different stages of grief at different times and constantly
changing.

C. Parental response is related to age of child, cause of death, available social

support, and degree of uncertainty; response might include denial, shock, disbelief,
guilt.
D. Parents often confronted with major decisions such as home care versus hospital
care, use of investigational drugs, and continuation of life supports.
E. May have long-term disruptive effects on family system
1. Stress may result in divorce.
2. May contribute to behavioral problems or psychosomatic symptoms in
siblings.
F. Bereaved parents experience intense grief of long duration.

Child’s Response to Death

A. Child’s concept of death depends on mental age.
1. Infants and toddlers
a. Live only in present.
b. Are concerned only with separation from mother and being alone and
abandoned.
c. Can sense sadness in others and may feel guilty (due to magical
thinking).
d. Do not understand life without themselves.
e. Can sense they are getting weaker.
f. Healthy toddlers may insist on seeing a significant other long after that
person’s death.

2. Preschoolers
a. See death as temporary; a type of sleep or separation.
b. See life as concrete; they know the word “dead” but do not
understand the finality.
c. Fear separation from parents; want to know who will take care of
them when they are dead.
d. Dying children may regress in their behavior.

3. School-age
 a. Have a concept of time, causality, and irreversibility (but still
question it).
b. Fear pain, mutilation, and abandonment.
c. Will ask directly if they are dying.
d. See death as a period of immobility.
e. Interested in the death ceremony; may make requests for own
ceremony.
f. Feel death is punishment.
g. May personify death (bogey man, angel of death).
h. May know they are going to die but feel comforted by having
parents and loved ones with them.

4. Adolescents
a. Are thinking about the future and knowing they will not
participate.
b. May express anger at impending death.
c. May find it difficult to talk about death.
d. Have an accurate understanding of death.
e. May wish to write something for friends and family, make things
to leave, or make a tape.
f. May wish to plan own funeral.

Nursing Implications

Communicating with Dying Child

A. Use the child’s own language.
B. Do not use euphemisms.
C. Do not expect an immediate response.
D. Never give up hope.

Care Guidelines at Impending Death

A. Do not leave child alone.
B. Do not whisper in the room (increases fears).
C. Know that touching child is important.
D. Let the child and family talk and cry.
E. Continue to read favorite stories to child or play favorite music.
F. Let parents participate in care as far as they are emotionally capable.
G. Be aware of the needs of siblings who are in the room with the family.