Concept presentation 22

3/28/2021
concept analysis on pediatrics palliative care
1
Concept Analysis on Pediatrics Palliative Care
Yoseph Bahiru(Bsc IN Nursing,Msc in chid
health nursing student)
Department of Pediatrics and Child Health Nursing,
School of Nursing and Midwifery,
College of Health Science,
University of Addis Ababa
GNUR511:Theoretical Foundation of Nursing
Mr.Niguse Tadele BSc, MSc,(Asst.Professor)
February 16, 2021
Addis Ababa, Ethiopia

3/28/2021
2
Group members
1.Mulualem Keneni,
2.Dereje Temesgen
3.Yoseph Bahiru
4.Nuru Tadesse,
5.Demlie Zewdu,
6.Daba Chala
7.Kamil Mensur

Presentation Outlines
3/28/2021
3
o Objective of the session
o Back ground of concept analysis
o Significance of concept analysis
o Assumption and Goal of the concept
o Oxford Dictionary and Literature definition of the concept
o Model and contrary case
o Borderline and related of the concept
o Defining criteria of the concept
o Application of concept to nursing
o Conclusion
o Acknowledgment

Objective
3/28/2021
4
At the end of this lesson audience will able to;
o List the goal of concept analysis
o Describe defining criteria, model concept ,border case,
related concept, and contrary concept of pediatric
palliative care.
o Define palliative care in pediatric context

Reference
3/28/2021
5
o Behrman, R. E., Kliegman, R., & Jenson, H. B. Nelson textbook of pediatrics: Saunders.
o Clark, D., Seymour, J., & Clark, D. (1999). Reflections on palliative care: sociological
and policy perspectives: Open University Press Buckingham.
o Knapp, C. A., Shenkman, E. A., Marcu, M. I., Madden, V. L., & Terza, J. V. (2009).
Pediatric palliative care: describing hospice users and identifying factors that affect
hospice expenditures. Journal of palliative medicine, 12(3), 223-229.
o Palliative. (2010). In Oxford Advanced Learner's Dictionary Online.Retrieved
from http://www.oup.com/elt/oald.
o Pediatrics, A. A. o. (2000). Committee on bioethics and committee on hospital care.
Palliative care for children, 106, 351357.
o Rapoport, A., Beaune, L., Weingarten, K., Rugg, M., & Newman, C. (2012). Living life
to the fullest: Early integration of palliative care into the lives of children with chronic
complex conditions. Current Pediatric Reviews, 8(2), 152-165.
o Stayer, D. (2012). Pediatric palliative care: a conceptual analysis for pediatric nursing
practice. Journal of Pediatric Nursing, 27(4), 350-356.
o Sepúlveda, C., Marlin, A., Yoshida, T., & Ullrich, A. (2002). Palliative care: the World
Health Organization's global perspective. Journal of pain and symptom management,
24(2), 91-96.

Back ground of analyze pediatrics palliative care concept
3/28/2021
6
o Pediatrics palliative care is a relatively new field and has not been
well defined in the Pediatrics literature,
o less than 1% of the children approximately(5,000) who die
annually receive any type of palliative care services and are most
likely involved in exclusively curative therapy preceding the
point of death (Stayer, 2012).
o Therefore, the purposes of concept analysis on pediatric
palliative care is that presents pediatric nurses with fundamental
information regarding this concept and to increase their ability to
understand, identify, provide, and subsequently meet and enhance
the needs of those children with a life-limiting illness and their
families,
o With this enhanced understanding of pediatric palliative care,
pediatric nurses will continue to improve and provide quality, safe
nursing care for this vulnerable population of children with life-
limiting illnesses(Pediatrics, 2000).

Significance of analyze pediatrics palliative care concept
3/28/2021
7
o According to American Academic pediatrics, the death of a child is
a devastating and unnatural event as children typically are expected
to outlive their parents,
o Although there have been significant advances in medical
technology, thousands of children continue to die annually.
o Congenital heart defects, respiratory conditions, complications of
prematurity, sudden infant death syndromes, and intentional and
unintentional injuries are a few examples of life-limiting illnesses
children and families encounter.
o Children who are facing these life-limiting illnesses should have
access to competent, compassionate, and developmentally
appropriate palliative care offered at time of diagnosis(Pediatrics,
2000).

Concept analysis on pediatric palliative care cont.
3/28/2021
8
Assumption
o As a group, our common assumption towards Pediatric palliative
care are;
o Pediatric palliative care is a care giving for seriously ill and dying
child.
Goal
o The goal is used to clarify and define concepts in a common
language to those of interest.

3/28/2021
9
Oxford Dictionary Definition
o Pediatrics is the branch of medicine that involves the medical
care of infants, children, and adolescents.
o Palliative is lessening the severity of pain, disease, without
curing the underlying disease (Palliative,2010; Oxford Advanced
Learner's Dictionary Online).
o Care is define in medicine and public health as the general term
for the application of the knowledge to the benefit of community
or individual patient or client.

Concept definition cont.
3/28/2021
10
Literature definition
o In (2009) knapp etl. Define Palliative care is a philosophy of
care that evolved from the hospice philosophy to meet the gaps in
care for seriously ill and dying patients
o In (1999) Clark, Seymour, & Clark. Define palliative care is
used interchangeably with hospice care and remained firmly
linked to cancer services and it is the period of immediately
before the death.
o In (1990) WHO definition of palliative care it is An approach
that improves the quality of life of patients and their families
facing the problems associated with life-threatening illnesses,
through the prevention and relief of suffering by means of early
identification and impeccable assessment and treatment of pain
and other physical, psychosocial, and spiritual
problems(Sepúlveda, Marlin, Yoshida, & Ullrich, 2002)

literature definition cont.
3/28/2021
11
o According to American Academic Pediatrics (2000), palliative
care for children is “Sensitivity to and respect for the child's
and family's wishes;
o It includes the control of pain and other symptoms and
addresses the psychological, social, or spiritual problems of
children (and their families) living with life-threatening or
terminally ill conditions;
o the goal of palliative care is the achievement of the best quality
of life for patients and their families, consistent with their
values, regardless of the location of the patient” (Pediatrics,
2000).

3/28/2021
12
o According to Stayer (2012) Palliative care are mitigating
physical and psychological suffering associated with the disease
process through effective management of all symptoms assessed
frequently and comprehensively throughout the illness including
end-of-life.
o In (2012) Rapoport, Beaune, Weingarten, Rugg, & Newman
define paliative care is Providing effective and
developmentally appropriate open communication regularly
with the child and family is essential concerning prognosis,
planning, and treatment.
o The Parents of sick children value health care providers who
communicate clearly, accurately, honestly, and empathically.

3/28/2021
13
o According to Stayer, (2012) definition Palliative care
Incorporating; an interdisciplinary health care approach to
treatment/therapies throughout course of illness being respectful
of the child and family's wishes.
o These interdisciplinary team will follow the child and family
across settings through active treatment including end-of-life
when necessary
o It Providing individualized and holistic pediatric palliative care at
time of diagnosis along with curative treatment throughout
trajectory of the illness and through bereavement.
o This care will maximize growth and development to the extent the
child is able, adding quality not simply quantity to life

Model case
3/28/2021
14
o A 6 year old male child, presented to the clinic with his parents
voicing some concerns regarding his health. His parents noted
that he has shortness of breath with minimal exertion, fatigues
easily, has been taking naps, and his appetite has decreased over
the last few weeks.
o Physical findings indicate that he has tachycardia and has an
enlarged liver. Chest x-ray reveals an enlarged heart,
specifically a dilated left ventricle.
o From these findings, it is suspected that he has dilated
cardiomyopathy, a very serious and often fatal disease.
o Biopsy for confirmation, medical management with probable
heart transplantation would be the course of treatment offered to
him and his parents.

Model case cont.
3/28/2021
15
o Upon entering the room to discuss the findings with the parents,
the attending health care providers introduced him, nurses, child
life specialists, social workers, pastoral care, and psychological
support for the parents and clients,
o they provide emotional, spiritual, physical, or psychological
support to the parents and child’s as well they discuss about the
probable cases of disease process, approach to the illness, and
course of treatment to be followed.
o The health care providers anticipated that the child’s condition
worsening quickly based on the current findings.
o Medical management would be initiated in an attempt to
alleviate and to control of the present physical symptoms.

Model case cont.
3/28/2021
16
o Health care providers were optimistic that aggressive
medical management would possibly allow for a greater
survival chance until an organ became available.
o Nurse, child life specialists, social workers, pastoral care,
and psychological support would also be involved and
available to the parents if they so requested.
o These services would be available to assist the child and
family with whatever issues or concerns they may be
facing in an effort to enhance quality of life.

Model case cont.
3/28/2021
17
o A core team of specialists to provide consistency in care
would be developed in collaboration with parents.
o This team would then follow clients and his family
throughout this process.
o The health care providers team indicated to child,
parents that they are an essential part of the team in that
they know their son best and can assist in managing the
physical and psychological symptoms that may arise

Model case cont.
3/28/2021
18
o The nurse also informed the parents that daily family
centered rounds occur. These rounds include parents and
all the members involved in child care.
o It is where the client response to treatment is discussed,
questions are answered, and the plan of care for the day is
established.
o Clint would not be present during this time of detailed
discussion. Child life would involve him in play therapy
during family centered rounds.

Model case cont.
3/28/2021
19
o After rounds, the attending physician, his bedside nurse,
parents, and child life specialist, and whoever else is requested
by the parents would discuss the plan of care at his level of
understanding and allow him the opportunity for questions as
well.
o After an extensive and emotional discussion, the client parents
verbalized a good understanding of what was occurring and
what needed to occur.
o It was agreed that they would take the child to home that night
and speak with him about his “heart being sick and needing to
be fixed” and the necessary trip to the hospital.
o It was decided between all parties that the child would be
admitted the next day for the needed of biopsy and course of
treatment to begin.

Contrary Case
3/28/2021
20
o A 14 year old girl has just been transferred to an acute
care institution.
o She has a rapidly progressive brain tumor with a new
onset of left leg weakness.
o After reviewing her medical record and tests, the client
is, unfortunately, not a candidate for any curative
treatment, and this tumor carries a poor prognosis.
o The nurses communicate with Doctor. That the parents
have expressed they do not want the client to know of
her diagnosis or poor prognosis.

Contrary Case cont.
3/28/2021
21
o Her parent's preference is to allow the child to believe
that some type of rare disease is responsible for her being
unable to walk and that the doctors are still looking into
different types of treatment to help her.
o During the change of shift report, the night nurse
communicates that every time she entered the room, the
child had asked about her condition.
o Upon entering her room to do an assessment, client’s first
question to the day shift nurse is “What is really wrong
with me and when will I be able to walk again?

Contrary Case cont.
3/28/2021
22
o Unequivocally, this is a challenging situation . The parents
are generally motivated by a sense of beneficence and
want to protect their child from the bad news
o Palliative care cannot be initiated at the time of initial
diagnosis because the child has not been given the truth
regarding her health condition.
o In addition, it will be very difficult to mitigate symptoms
because the family is not allowing disclosure of the child
true illness.

Contrary Case cont.
3/28/2021
23
o An interdisciplinary approach will also be difficult to
explain to the child as to why she needs these extra
services.
o After several family meetings with the client parents, her
parents were unable to be convinced that telling the truth
regarding her condition could be beneficial to child.

3/28/2021
24
Related concept;
o Hospice care; provides compassionate care for people in the
last phases of incurable disease so that they may live as fully
and comfortably as possible
Borderline;
o Seriously ill individual with unknown disease progress.

3/28/2021
25
Defining criteria; include all
o effective communication with parents and child at appropriate
developmental level,
o initiation of palliative care at diagnosis, support for the child
and family,
o interdisciplinary approach to illness and treatment,
individualized and holistic care, and
o lessening of physical and psychological symptoms of illness
while respecting the family's wishes.

Application to nursing
3/28/2021
26
o Model case; include all defining criteria
o Related concept; Hospice care used alternatively with palliative
care for end life disease.
o Borderline; child case seems to required all defined criteria.
o Contrary case; care that not including all defining criteria

Conclusion
3/28/2021
27
o According to American Academic pediatrics, the death of a
child is a devastating. Although there have been significant
advances in medical technology, thousands of children
continue to die annually.
o Congenital heart defects, respiratory conditions, complications
of prematurity, sudden infant death syndromes, and intentional
and unintentional injuries are a few examples of life-limiting
illnesses children and families encounter
o Pediatrics palliative care is a care given for child which
initiated at the diagnosis, as interdisciplinary approach that
lessening the physical and psychological symptom, with
effective communication with in child and parent, while
respecting family wish

Acknowledgement
3/28/2021
28
o First of all, we would like to say thanks almighty of GOD, for
being of hear. And our heart felt thanks goes to ins’ Niguse T.
for his unreserved effort of lecturing and giving chance to
prepare concept analysis presentation.
o Finally, our deepest gratitude goes to our class mate for their
warm and fruit full discussion on the presentation.

Concept presentation 22

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Concept presentation 22

Similar to Concept presentation 22 (20)

Recently uploaded

Recently uploaded (20)

Concept presentation 22