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An enquiry into death and dying at the Adelaide Children's Hospital: a useful model?
Author(s) -
Ashby Michael A,
Kosky Robert J,
Laver Halina T,
Sims Eric B
Publication year - 1991
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1991.tb121022.x
Subject(s) - grief , psychosocial , medicine , palliative care , family medicine , nursing , service (business) , pediatrics , psychiatry , economy , economics
As a result of a desire amongst the hospital staff to improve the management of dying children and their families, a four person subcommittee was appointed to investigate this area of care. Nineteen persons were interviewed (15 hospital liIfaff members and four parents) and 12 written sub missioris were received (10from staff and two from parents) over a 10week period. An analysis of one year's deaths of Adelaide Children's Hospital patients showed that most took placein the hospital and a bout one in five were at home. Nearly'60% occurred in childrenaged0‐5years,15%in thoseaged 6‐10 years, 15%in those aged 11‐15 years, and13%in children age dmore than 15years. The four commonest causes of death were: cancer (27%), congenital abnormalities (19%),suddeninfant death syndrome(5105) (16%), and trauma (11%). Sudden unexpected deaths are most common, particularly for infants. Recommendations included improved privacy for families and friends; more sensitive body viewing, mortuary, autopsy and funeral arrangements; and better in‐service education for staff and information giving for families. Areas of insufficient staff support were identified and the appointment of a specialistpalliaflve care clinical nurse consultant was proposed. Stronger links with palliative andhospiCe care teams, general practitioners and community nurses were suggested. Addressing the issues of living and dying, and working through the stages of grief are integral parts of long term clinical care. The need for good continuity of psychosocial support was a recurring theme. More awareness of the availability of the specialised pain relief service was required. Ethical issues should be addressed as part of the general development of education and information services. The I advantages and limitations of the enquiry are discussed and the model is proposed as a potentially useful one for both paediatric and adult palliative care and hospice care service development.