Wednesday, April 30, 2008

The Five Stages of Death and Dying

Dr Elizabeth Kubler Ross was the first to identify the five stages of the process of Death and Dying. I have found that these five stages apply to not only death and dying issues but any crisis where you experience painful losses.

This includes but is not limited to moving away from family and friends, the loss of a pet, divorce or a close family moving away from you. I have seen patients who loose a limb also go through these five steps.

I will list the stages for you here and in the following blog entries I will give more information on each stage. It is important to understand these stages to better help you and your child cope with the current crisis. Understanding and identifying where you or your loved one are within the process will give you the patience to cope and the ability to find resources for assistance.

The five stages are:

Denial
Anger
Bargaining
Depression
Acceptance

More on each stage soon. For now, enjoy the moment.

Monday, April 28, 2008

Tip For The Day

My tip for today is to enjoy one moment at a time. For anyone, especially parents of a child dealing with a chronic or terminal illness, one moment at a time without pain is a blessing. One moment of laughter or a moment of sound sleep without vomiting, is pure bliss. A moment of peaceful rest is a gift.





Learn to take a deep breath and enjoy those 10 seconds of relaxation, guilt free. Practice letting go of the things you can't control, if only for a moment. Enjoy the first signs of spring, the smell of fresh air, the sunshine in the early morning, or the moon at night. The key here is to seek those precious few moments in time and to feel them, smell them, touch them, and to soak every last second of that time into your soul. That is how you find peace and gain energy to face whatever comes next.





My prayer for every parent watching their child go through an illness, is that they find those few moments of peace where they can look down at their resting child, be thankful and feel pure joy. Because, with all of the medical advances, we will never have all of the answers to why children become ill and even die. But we should grab every moment we can to love our children and feel pure joy, if for only a moment.





















Thursday, April 24, 2008

Grieving college students.....





I believe an overlooked group of people who suffer through grief would be college age students. These young men and women often come home from visits with terminally ill parents or siblings and are sent back to college to study hard. They are expected to go on with their lives. Most think this is a good distraction. Some think it will keep their minds off of what is happening at home or it will make their loss less because they are so focused on school.

Wrong.

These young men and women hurt, they grieve, and sometimes they feel very alone. That is what is so awesome about the organizations sprouting up on college campuses all across America. David Fajgenbaum started the first group after his own mother passed away. The National Students of Ailing Mothers and Fathers Support Network (http://www.studentsofamf.org/) has grown and expanded to support college students and empowering these students to grieve.It allows them to go beyond the grief to do something positive like raising funds to fight diseases like cancer and AlS. Visit their website for more information about these great young men and women and the impact they are making on campuses today.

They also recommend a book on their website titled: Always Too Soon...by author Allison Gilbert. This is an intimate collection from celebrities and other young men and women about how to deal with the death of a loved one and how they have coped. Visit the authors website for more about this moving book. It is very touching and heartfelt. I would recommend it as a thoughtful gift for others experiencing the deep loss of a parent or loved one. It is something that could be reread throughout periods of the grieving process. The site is http://alwaystoosoon.com/


The National Students of Ailing Mothers and Fathers Support Network has a free newsletter that students can receive via email when they sign up on the website. You can also see other ways to get involved with the group or to start your own chapter on your college campus. Kudos to David Fajgenbaum and his members for filling a need when they saw it and going beyond their grief to help others.


Monday, April 21, 2008

Book review


I love to share information about children, writing, health, and a variety of topics for kids including self esteem. Dr. Barbara Holstein is the author of a book for teen girls titled " The Truth: I'm a Girl, I'm Smart, and I Know Everything."
The title itself is empowering and I think teen girls today need that kind of positive role model. Check out her web site for positive information for women of all ages. Her website is www.enchantedself.com
Also, check out a great interview done by Donna McDine, one of our writers group members. Her site can be reached at http://donna-mcdine.blogspot.com
She is a children's author with good information on her web site for aspiring authors or parents interested in what their children read.
PS. See, I can read and write about more than death and dying issues. I do believe that positive role models for children and healthy family relationships make all the difference in the lives of children and adults dealing with a health crisis. It is all connected in one way or another, isn't it?

Saturday, April 19, 2008

Not a Death Sentence but a Life Sentence.....


A close family friend has been diagnosed with a terminal cancer this week and was told he wouldn't make it through spring. His daughter is getting married in June and he has a new grandbaby on the way. Needless to say, the news is devastating. The time frame is horrible and for most people, it would be considered a death sentence. But our friend is awsome. He has things to do and things to say. He wants to teach his wife about the furnace, the water heater, and how to run the tractor to mow the lawn. He wants to be there for his daughter's wedding and so promises to do that. He feels blessed to know what he has, what time frame he is looking at, and now he can live everyday to the fullest. How can I help him? For what it is worth, this is what I have done. I purchased two small journals. Using my scrapbooking supplies, I decorated each one differently and added ribbons for ties to secure the journal closed. Then I enlosed a note which reads simply: Journals for you to write the words that may be too difficult to say now... words of your wisdom and love, your dreams and your wishes for both of your children and grandchildren. They will cherish your words forever.
That's it... That is all I can do for now. Will he make it to the wedding or will his daughter change the date.. that remains to be seen. But for now, I have done something. After all, we are all going to die someday, we just aren't as blessed to know when. He has chosen to live the rest of his life sentence to the fullest and maybe we all can learn something from that. Live life. Speak the truth. And love, always love.

Thursday, April 17, 2008

Help With Discussing Death and Dying with Children

I took care of a dying young woman last evening and I have to say it was a really terrible night.
And part of the difficulty comes from parents, family, staff, and the nurses all being on different pages regarding the best care for the patient. This doesn't happen often, because parents usually have had time after a terminal diagnosis and weeks or months of treatments, to come to some kind of terms with the issue of dying. This young woman was different because she was not diagnosed until 5 weeks ago and her course of treatment caused her health to fail very quickly. The facts from the medical standpoint are that she is in complete organ failure, has metastasis to bones, organs, and brain, and has no hope of recovery. The cancer doctors and the intensive care doctors agree. Mom does not. From a nursing standpoint, we cannot provide the comfort measures, bathing, massage, pain control, suctioning, and basic palliative care the patient deserves because every time we touch her she drops her heart rate, drops her blood pressure, and bleeds from every orifice. (Sorry to be so graphic here but I am trying to demonstrate the fine line nurses function under.) Because mom wants everything done medically to keep her heart going and to keep her here, the nurses have orders to touch only when needed, use the rotating bed instead of massaging and physically turning, use medications to keep her blood pressure up, and avoid doing anything that would cause her vital signs to decline. The patient still gets nursing care, but with minimal stimulation. This is not quality of life, and this is where nurses become distraught. We want to comfort, provide massage and touching, change linens every hour if needed instead of once a shift, suction frequently, turn, and make the patient's transition from living to dying as pleasant and comfortable as possible. But we need the family on board. Instead, we are caught in a situation like last night, where the dying word is not spoken. We spend our shift hanging drips of medications to keep the heart going; we draw blood to send to the lab to make sure the breathing machine is doing it's job; and we reinforce dressings over every bleeding or oozing area with minimal touching so as not to cause a change in vital signs for one more night.
In the end, every family must make their own decisions for their child and the medical staff will support it, no matter how personally difficult it is. However, if you have months and years to come to grips and discuss issues of death and dying it makes a monumental difference in the end result... quality of life for the patient. Families who discuss opinions and research options before they are faced with this are even richer for the experience and find peace. Those family members know in their hearts what a patient would want for them self because it has been discussed. The burden of making these hard choices is lessened when everyone is on the same page.
I have listed a beginning website for research. It is sponsored by the American Cancer Society. Their organization is a wealth of information from treatments, prognosis, research, to end of life issues. Visit this site for information as you personally decide how and when to talk to your family members about death and dying issues. From my personal experience, families who take time to discuss and learn about each other, have more hope and more peace in any medical situation.

http://www.cancer.org/docroot/NWS/content/NWS_2_1x_Discussing_Death_with_a_Dying_Child.aspDiscussing Death with a Dying Child... A new study may help parents make one of the most difficult decisions they could ever face: whether to discuss death with a child dying of cancer.------No matter who you are, the American Cancer Society can help. Whether you've got questions about cancer treatment, are looking to stay healthy, want to learn more about cancer, or just want to get involved--ACS has an entire online community devoted to people just like you.Visit us at http://www.cancer.org/ to find answers, get the facts, see the latest cancer news, share your experience, and learn how you can make a difference. Please do not send any replies to the automated cancer.org email address above. To contact the American Cancer Society online, please go to http://www.cancer.org/docroot/cus/cus_0.asp.

Tuesday, April 15, 2008

Helping Teens With Grief





Teens offer a special challenge when helping them cope with grief or loss. They sometimes push those they love far away, when in fact what they need or want is to be loved and held. Author Jeannette Curtis offers several tips in her article on WebMD titled Key Points To Helping A Teen Through Grief. She states it is important to know what is normal teen behavior, listen and watch, don't force a teen before he or she is ready, and make time for the teen. Check out WebMD to read the rest of her article. I found her information right on target for a teen feeling the loss from the death of a loved one. I also want to remind parents that for a teen, any loss of something they love can cause grief. The death of a pet, divorce, or loss of a friendship can cause a teen to feel deep grief. Allowing the teen time and letting your teen know that you are there for them is vital for healthy recovery. A resource listed on WebMD is http://www.rainbows.org/. It is an international organization where peer support is offered for children and their families who are suffering grief from death, divorce, or other family transition. Check out www.webmd.com/balance/helping-teens-who-are-grieving for the entire article. Also check out http://www.rainbows.org/ to find a local chapter for more resources or to find out how you can train and open a rainbows chapter in your area.

Sunday, April 13, 2008

Make-A-Wish


As a pediatric critical care nurse, I know all too well how a child and his or her parents can be robbed of their JOY. Make-A-Wish Foundation of America is a non profit agency that works hard to grant wishes for children and to return some JOY to them if for only a short time. The organization was started in 1980 by granting their first wish to a boy who wanted to become a policeman. You can read his story at the Make-A-Wish web site at
www.wish.org There you can explore the agency, their mission, how to contribute, and how to become a volunteer. Just reading some of the wishes that have been granted makes you smile. The organization grants wishes at the rate of one wish every 40 minutes. Now, that is alot of wishes. The organization depends on local chapters to decide on recipients. Children must be diagnosed with a life threatening , progressive, or malignant illness to be considered. It also depends on fundraising, donations, volunteers, and corporations to keep this so successful. Check out the web site for more information or to become a volunteer. With great organizations out there like Make-A-Wish we should all be able to find a cause to support with our prayers, time, or money. Also check out the world branch of the organization at www.worldwish.org to see how this great team gives to children across the world suffering from life threatening diseases.

Friday, April 11, 2008

Where Can We Donate Where It Will Do The Most For Children


We sometimes wonder where we can donate a monetary gift and it will do the most good. I can recommend at least one legitimate charity where your money will provide better medicine, education, and preventative health care for children.
The Children's Miracle Network was founded by The Osmond Family and John Schneider in 1983. The monetary gifts go to help over 170 hospitals in The United States and Canada. The funds help the affiliated hospitals to improve the medical care they give by providing equipment and state of the art technology. The Network also provides funding for life-saving research and preventative educational programs. Visit the website for answers you might need about the charity and for a list of affiliated hospitals in your community. This is a nation wide organization where your money truly goes to children.
The site can be reached at http://www.childrensmiraclenetwork.org/ and by mail at:
Children's Miracle Network
4525 South 2300E
Salt Lake City, Utah 84117
This charity raises over $250 million each year for children and the affiliated hospitals. Check out their website the next time you have a gift to give. Or look for the orange and red hot air balloons at your local stores. Corporate partners like Walmart take your dollar donation and send it directly to Children's Miracle Network, where it will be used by your community sponsored hospital. This is a charity you can feel really good about.

Monday, April 7, 2008

Link to great articles for grieving parents and grandparents......


I want to introduce author, Jewel Sample. I was introduced to this writer through my online writing group and I had to share the link to her blog. She has written a book to help kids deal with the death of a sibling. Check out her site by clicking on the article title I have added to my blog. Make sure you scroll up to capture the entire article written by her guest blogger, and browse her site for great tips on dealing with grief. I look forward to getting to know Jewel through my writing group and will continue to share with the reader her insights. The book is titled Flying Hugs And Kisses. It is a great storyline and children as well as adults will find the ideas and tips helpful. Another good resource to help families facing this saddness.

~ Jewel's Sand Box News ~: Grief Tips by Guest Blogger Lucille Zimmerman#links

~ Jewel's Sand Box News ~: Grief Tips by Guest Blogger Lucille Zimmerman#links

What to Expect When Your Child is Admitted to The Intensive Care Unit



When a child of any age needs admission to the pediatric unit it is stressful. If a child is admitted to a pediatric intensive care it takes stress to another level all together for the parents of that child. The intensive care unit in and of itself is an intimidating environment. The machines,the alarms ringing, lights and monitors flashing and the over all feeling of serious illness, overwhelms most parents.

The admission process can be scary as well because the child is ill, he or she can be crying and upset, or worse yet so sick they aren't responding. This is what to expect if you find yourself in this situation.
First, expect to have to answer the same questions over and over for every new member of the health care team involved. If it is a teaching institution, that can mean as many as 10-12 nurses, doctors, residents, or medical students asking you things like "when did you notice this symptom," or "how long has he had such and such disease." Every team member will ask you the child's allergies, medicines, and medical history. It is not because we are a lazy group and don't read what the others have written. It is because that stress causes parents to forget to mention key points. If several team members ask the same type of questions, important information about your child and the current illness will not be overlooked.

Second, be ready for the child to be hooked up to several monitor cords while in the intensive care unit. The usual monitoring system will show the child's heart rate, blood pressure, respiratory rate, and sometimes temperature. These rates will show up on a monitor screen either in the child's room or on a screen at a central desk outside of the room. It can seem very intimidating to parents to see their child so wired. As a parent, ask questions and make sure you understand the reason behind all of the monitoring devices.

The third thing you should be prepared for is that your child will have an IV or intravenous infusions to receive medicines and fluids. This tubing adds to the confusion of the monitors and wires so the entire scene can be overwhelming. The most important thing to keep in mind is that it is all for the benefit of keeping accurate information on your child and his or her condition.

Intensive Care means just that, intensive watching over your child. Monitors, IV infusions, and numerous repeated questions are the first things to expect when your child is admitted to an intensive care. Be patient with the health care team as they treat your child the best way possible and ask questions when you are unsure of what is happening. Working together with the health care workers will ease you stress and help the team to give your child the best care available.

Thursday, April 3, 2008

5 Questions Parents Will Be Asked When Bringing A Child To The Emergency Room



When an emergency room visit is needed, it is usually a stressful time. Parents don't always remember the most important information that health care workers will ask upon arrival at the ER. Follow these tips to organize your child's health information and keep it in your wallet for those unfortunate and unexpected visits to the ER.

1. Have a list of your child's allergies and current daily medications. Include vitamins and over the counter medicines and food allergies with this list. This is important information for the doctor when deciding what medicine to give your child for the current problem.

2. Have a current shot or immunization list for each of your children. This is especially important if the visit to the ER is due to an injury requiring stitches or sutures.

3. Know when your child last ate and what it was that was consumed. This is important if surgery is needed for example, to fix a broken bone or for an appendectomy ( removal of appendix) Most surgeons will not take a child to surgery if they have had something to eat or drink in the last 4-6 hours. During a procedure is not the time to discover the child has a full belly.

4. Know your child's past medical and surgical history. For most healthy children, this is easily recalled, but for chronically ill children that information can become muddled. This information also includes knowing when your child had chicken pox and other childhood diseases. A written list is a safe way to relay this information to the health care team.

5. Know your child's approximate weight and note to the nurse or doctor if there has been a recent weight loss or gain. These symptoms are very important when diagnosing diabetes, eating disorders, dehydration or absorption disorders, and other illnesses that are difficult to pick up on. Parents often don't notice a weight loss or gain until it is mentioned from a professional, yet this can be an indication of when a problem began.


It doesn't take long to jot this information down on a 3x5 card to keep with you. I also recommend that dad has a copy in his wallet too just in case he is the one being asked the questions. This saves valuable time when emergency care is needed and prevents an error in medical care when this information is current. All of this will assist the health care team in providing what is needed when it is needed most for your child.

Tuesday, April 1, 2008

Welcome to all who read my blog today. I have added a few elements for readers, a slide show, a link to my favorite new blog sites from my writers group, and a question of the week on death and dying. Feel free to email me with any other information I might be able to provide for you.


With that in mind ,I hope everyone who reads this blog is taking time to be grateful for one thing today. Here in the Midwest, it is cloudy and dull, For some of you your personal health crisis or situation may also feel cloudy and dull. However, I find if we all take the time to focus on one thing everyday that we are grateful for , it does improve the mood for the day. I credit the sick kids I care for in the intensive care unit for showing me how true these words are.

Never a shift goes by that one of the kids or their parents don't show gratitude. It is amazing to me how children who are dying and their parents can still take the time to thank me for a pillow. They show gratitude for the simple things that I take for granted, like ice in their water, a popsicle, pain medicines given on time or before they have to ask. They thank me for the care that they should expect and the care that God calls me to give. Yet they thank me. And it feels good.

So when I am feeling cloudy and dull myself, (notice I avoid the word depression as I feel at this time of year we all feel cloudy and dull waiting on spring to arrive), I try my best to be thankful for someone or something. It isn't always easy, sometimes I really want to whine. But when I do it, I really do feel better and can be more productive with both my nursing care and my writing.

So today I am thankful that I don't have to face anyone in person, I can stay in my old sweats all day, and I can still get online and be productive. Oh yea, and I am making a pan of fudge. That I am most grateful for. And please keep visiting, as I am also grateful to you, the reader of these words. Know that I truly appreciate each and everyone of you. Have a great day.