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Information

  1. AGES 1 TO 3
    1. No concept per se, but experiences separation anxiety and abandonment any time significant other disappears from view over a period of time.
    2. Coping means: fear, resentment, anger, aggression, regression, withdrawal.
    3. Nursing care plan/implementation—help the family:
      1. Facilitate transfer of affectional ties to another nurturing adult.
      2. Decrease separation anxiety of child who is hospitalized by encouraging family visits and rooming in, reassuring child that she or he will not be alone.
      3. Provide stable environment through consistent staff assignment.
  2. AGES 3 TO 5
    1. Least anxious about death.
    2. Denial of death as inevitable and final process.
    3. Death is separation, being alone.
    4. Death is sleep and sleep is death.
    5. "Death" is part of vocabulary; seen as real, gradual, temporary, not permanent.
    6. Dead person is seen as alive, but in altered form, that is, lacks movement.
    7. There are degrees of death.
    8. Death means not being here anymore.
    9. "Living" and "lifeless" are not yet distinguished.
    10. Illness and death seen as punishment for "badness"; fear and guilt about sexual and aggressive impulses.
    11. Death happens, but only to others.
    12. Nursing care plan/implementation (in addition to previous):
      1. Encourage play for expression of feelings; use clay, dolls, etc.
      2. Encourage verbal expression of feelings using children's books.
      3. Model appropriate grieving behavior.
      4. Protect child from the overstimulation of hysterical adult reactions by limiting contact.
      5. Clearly state what death is—death is final, no breathing, eating, awakening—and that death is not sleep.
      6. Check child at night and provide support through holding and staying with child.
      7. Allow a choice of attending the funeral and, if child decides to attend, describe what will take place.
      8. If parents are grieving, have other family or friends attend to child's needs.
  3. AGES 5 TO 10
    1. Death is cessation of life; question of what happens after death.
    2. Death seen as definitive, universal, inevitable, irreversible.
    3. Death occurs to all living things, including self; may express, "It isn't fair."
    4. Death is distant from self (an eventuality).
    5. Believe death occurs by accident, happens only to the very old or very sick.
    6. Death is personified (as a separate person) in fantasies and magical thinking.
    7. Death anxiety handled by nightmares, rituals, and superstitions (related to fear of darkness and sleeping alone because death is an external person, such as a skeleton, who comes and takes people away at night).
    8. Dissolution of bodily life seen as a perceptible result.
    9. Fear of body mutilation.
    10. Nursing care plan/implementation (in addition to previous):
      1. Allow child to experience the loss of pets, friends, and family members.
      2. Help child talk it out and experience the appropriate emotional reactions.
      3. Understand need for increase in play, especially competitive play.
      4. Involve child in funeral preparation and rituals.
      5. Understand and accept regressive or protest behaviors.
      6. Rechannel protest behaviors into constructive outlets.
  4. ADOLESCENCE
    1. Death seen as inevitable, personal, universal, and permanent; corporal life stops; body decomposes.
    2. Does not fear death, but concerned with how to live now, what death feels like, body changes.
    3. Experiences anger, frustration, and despair over lack of future, lack of fulfillment of adult roles.
    4. Openly asks difficult, honest, direct questions.
    5. Anger at healthy peers.
    6. Conflict between developing body versus deteriorating body, independent identity versus dependency.
    7. Nursing care plan/implementation (in addition to previous):
      1. Facilitate full expression of grief by answering direct questions.
      2. Help let out feelings, especially through creative and aesthetic pursuits.
      3. Encourage participation in funeral ritual.
      4. Encourage full use of peer group support system, by providing opportunities for group talks.
  5. YOUNG ADULTHOOD
    1. Death seen as unwelcome intrusion, interruption of what might have been.
    2. Reaction: rage, frustration, disappointment.
    3. Nursing care plan/implementation: all of previous, especially peer group support.
  6. MIDDLE AGE
    1. Concerned with consequences of own death and that of significant others.
    2. Death seen as disruption of involvement, responsibility, and obligations.
    3. End of plans, projects, experiences.
    4. Death is pain.
    5. Nursing care plan/implementation (in addition to previous): assess need for counseling when also in midlife crisis.
  7. OLD AGE
    1. Philosophical rationalizations: death as inevitable, final process of life, when "time runs out."
    2. Religious view: death represents only the dissolution of life and is a doorway to a new life (a preparatory stage for another life).
    3. Time of rest and peace, supreme refuge from turmoil of life.
    4. Nursing care plan/implementation (in addition to previous):
      1. Help person prepare for own death by helping with funeral prearrangements, wills, and sharing of mementos.
      2. Facilitate life review and reinforce positive aspects.
      3. Provide care and comfort.
      4. Be present at death.