COMMENTARY

Talking to the Deceased Child

Betty R. Ferrell, PhD, RN

Disclosures

March 10, 2015

Speaking to the Deceased Child: Australian Health Professional Perspectives in Paediatric End-of-life Care

Forster EM, Windsor C
Int J Palliat Nurs. 2014;20:502-508

Finding Meaning in Post-mortem Care

This study addresses the very sensitive area of supporting a dying child and family at the time of the child's death. This is one of the most difficult aspects of care faced by health professionals in pediatric end-of-life care. A study of parents and healthcare professionals in Australia constructed meanings around post-mortem care, highlighting the practices of healthcare professionals in speaking to a child after death. This practice, which was the focus of the study, conveyed respect for the personhood of the deceased child, recognized the presence of the deceased child, and encouraged parental involvement in their child's post-mortem care. Talking to the deceased child appeared to be a socially symbolic practice that may promote a continued bond between parent and child.

This study included interviews of 14 bereaved parents and 10 healthcare professionals who had been involved in the care of a deceased child. Professionals described the parents' interactions with the decreased child as humanizing, lessening the medicalization of death, and honoring the child's spirit was a sign of respect. Nurses described their practices in post-mortem care as a means of caring for the deceased child with the same attention as if the child were alive—for example, by bathing the child in warm water and dressing in warm pajamas. Nurses also felt that it was helpful to model such care as speaking to and touching the deceased child to guide parents to feel comfortable in doing the same.

Professionals also expressed some opposing views in that encouraging parents to continue speaking to the deceased child could foster disbelief in the reality of the death. The continued post-mortem care is said to extend the "mothering" and "fathering" and to avoid the physical distancing from the body of the child and ending this phase of the relationship.

The findings of the study illustrate the importance of this phase of care following the death of a child, and how interaction with the child after death has implications for the parents' bereavement.

Viewpoint

This study builds on previous research that has reported on the needs of parents to spend time with their children following death.[1,2,3] These interactions have included holding the child, bathing, listening to music, reading to the child, and other acts of this final time together.[1,2,3] This extended time of bonding, or "more gentle separation," is recognized as essential to the grief process. In this study, the modeling by nurses in talking to the children while they provided post-mortem care has been described in previous literature as helpful because this can be a frightening experience for parents.

This research builds on theoretical understandings of concepts such as attachment, relationships, and grief. The very powerful descriptions provided by both parents and professionals of the time spent with a deceased child indicate how important it is to continue this research and understanding.

As with all aspects of end-of-life care, there are vast differences in this very personal, intimate time of life. The place of death, whether in an intensive care unit, emergency department, neonatal unit, home, or hospice, is likely to be a factor in the experience, as is the nature of the death (acute injury, chronic illness, or terminating life support). Although this study was focused on deaths of children, this is also a very important issue following deaths of adults.

Across settings and circumstances, a clear message of this study and related literature is that both patients and professionals need support during this phase of care beyond life. Care following death is more than just physical care of the body; it is also a sacred time with deep meaning for all involved. To provide this care, professionals require education and support.[4]

Abstract

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