Anna (age 35) and Tom (age 36) Jones have an appointment with you for an evaluation of their son, Joshua, who is 5 years old. They bring all their children to the appointment, including Tommie (6 months), Joshua (5), Sally (7), Mari (11), and Janey (15). You quickly recognize that the entire family needs assistance, not just Joshua.

Joshua was recently diagnosed with acute myeloid leukemia, and he is not expected to live more than a few months. He has been withdrawn and irritable, is crying a lot, and has not been interested in playing or doing the things he used to enjoy before his diagnosis. Also since the diagnosis, his siblings have been fighting a lot at home with each other and their parents and refusing to do their chores. Mari and Janey, the two oldest, are refusing to go to school.

In your initial post, answer the following questions from your perspective as their psychiatric nurse practitioner.

Based on Joshua’s presentation, how would you relate his developmental milestones to his clinical presentation and perception of death and dying? When providing grief therapy, what information would you provide Joshua and his parents regarding Joshua’s perception of his terminal illness?
Select one of the Jones’ children (except Joshua) and identify the normal developmental milestones you would expect based on their current age. Identify an age-appropriate national or community resource related to grief or a sibling with cancer and explain the benefit of the resource you provided.
What, if any, cultural considerations should you apply when working with the Jones family?