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Difficulty: HardGrief and Loss

A pediatric oncology nurse is caring for a 7-year-old client who is transitioning to the actively dying phase. The client's parents and 4-year-old sibling are present at the bedside. Which of the following nursing actions are most appropriate to support the family through the anticipatory grief process? Select all that apply.

  1. Use clear, concrete terms to explain to the 4-year-old sibling that the client's body will stop working.Answer
  2. B
    Tell the 4-year-old sibling that their older sibling is 'going to go to sleep for a very long time.'
  3. Encourage the parents to participate in physical care activities, such as providing oral care, if they express interest.Answer
  4. D
    State to the parents, 'I know exactly how you feel right now; everything happens for a reason.'
  5. Offer periods of therapeutic silence while remaining physically present in the client's room.Answer
  6. F
    Delegate the initial assessment of the family's cultural and spiritual preferences for end-of-life care to the unlicensed assistive personnel (UAP).

Answer

The appropriate nursing actions include using clear and concrete terms to explain death to the preschool-aged sibling, encouraging the parents to participate in physical care activities, and offering periods of therapeutic silence while remaining present in the room.
Using clear, concrete terms to explain death is essential for a 4-year-old due to their literal cognitive development stage. Encouraging parental participation in physical care empowers the parents, helps maintain their parental identity, and facilitates the anticipatory grieving process. Furthermore, providing therapeutic silence and physical presence demonstrates profound empathy and support without risking the use of minimizing verbal statements.

Step-by-Step Solution

1
Analyze the developmental stage of the 4-year-old sibling.
The sibling is in the preschool stage, characterized by literal and magical thinking.
To determine the most appropriate and safe way to communicate about death without causing unintended phobias.
2
Evaluate the proposed communication statements for therapeutic value.
Clichés and equating death to sleep are non-therapeutic and potentially harmful to the grieving process.
Therapeutic communication should validate the client's unique feelings and provide accurate, developmentally appropriate information.
3
Determine appropriate supportive interventions for parents experiencing anticipatory grief.
Encouraging participation in basic care and providing a silent, supportive presence are highly effective.
These actions empower the parents, validate their emotional experience, and prevent feelings of helplessness.
4
Assess the scope of practice for delegation regarding family psychosocial needs.
Initial psychosocial, cultural, and spiritual assessments must be conducted by the RN.
Assessments require nursing judgment and are strictly outside the scope of practice for a UAP.

Key Concept

Therapeutic Management of Anticipatory Grief and Pediatric Developmental Considerations
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Topics

Grief and Loss

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