Stepping Up: as in "step right up, don't be shy!" By mid-week I had lost count of the times my mentor sent me out on the floor alone. I tried my hand at a few new skills, and grew my skills in others. I'm checked off (meaning I can go out alone) on two more competencies (Procedural/Pre-Op Preparation, and Diagnosis Teaching.) This makes officially, half my competencies! Here's a peek at a few things I did this week . . .
I prepared a very anxious 7 year old for a Picc line placement (this is the "big brother" to an IV -- a very thin tube goes from the elbow, up the vein, to near your heart. It serves the same purpose as an IV, but lasts a lot longer -- weeks instead of days.) Once I explained it all to her, in terms appropriate to her age and understanding, I then stayed with her for the procedure, which took about 45 minutes, providing ample and creative distraction. It took everything from "I Spy" books, to flashing lights, to blowing whistles (to "blow away the pain") to making up silly songs to keep her distracted during the procedure. Distraction for a procedure like this is very important for children. An undistracted child often fights the staff, pulls their arm away, tries to escape, throws tantrums, throws up . . . . Even if they hold still, the stress of fear and crying will constrict the veins, making it that much harder to find a vein with the needle, and thread the tube.
I had a major breakthrough in my therapeutics skills. In some ways, therapeutics are the toughest of the competencies to learn. Prepping, support, diagnosis teaching . . . these are all pretty straight forward. But therapeutic interventions come in so many varieties and flavors, that knowing what kind of therapeutic a patient needs, let alone picking out a specific one, can be an overwhelming and daunting task. This week, my mentor really pushed me to figure this out on my own (always providing a safety net so I didn't screw up a patient's care with a bad choice). Turns out, that when I have to do it on my own . . . I'm perfectly capable!
For example, I had a nurse ask me for help with a specific patient, citing a need for "help with his coping skills." Well, that's pretty vague. . . This is only his second hospital stay, so does he need . . .
* An "environmental familiarization" therapeutic, like a hospital scavenger hunt to get to know all the parts of the hospital? Or making some wall decorations for his room to make it more "homey"? Or an "all about me" collage for his door to help the staff get to know him?
* Or maybe he's overwhelmed and frightened by all the strange equipment and routines at the hospital? We could do some therapeutic medical play, and have him use a doctor's kit to perform an exam on his stuffed animal? Or maybe he'd feel empowered to give the doll an IV?
* Maybe he's confused about why he's here? Should we do a body-outline drawing and see how he decorates it? Does he know where his tumor is?
* Maybe he's upset because his hair is falling out? Should I do something to work on his self-esteem?
* Maybe he needs help with pain management? Should we do a stress glove? Or some guided imagery? Or some breathing techniques?
* It could be he's missing his friends from home. We could make a video to send them, and ask them to do the same.
Well, you get the idea. I could write another 50 pages and still not hit all the possibilities. When it comes to choosing a therapeutic activity, there is no right answer. Heck, there's rarely only one right category! In the end, I spent some time with him, and discovered that pain management would be a good place to start. So we put some play-doh into a surgical glove, tied it shut, and then squeezed and squeezed. By the time we finished, he was completely distracted from his pain, and in a cheerful mood. We talked about how squeezing the glove helped him cope, and asked his family and nurses to help him to remember to use the stress-glove when he was hurting or sad. The next morning, I returned with a variety of whistles, and we practiced deep breathing and blowing the whistles, again talking about how these things could help him feel better when he's sad or hurting.
This week, I also had the amazing experience of working with the 3 year old sibling of a bone-marrow-transplant patient. The 3 year old will be a bone marrow donor for her little sister. After much planning and thinking, I choose to approach my session with her from a medical play standpoint. There's no method to meaningfully teach a young three year old about leukemia, bone marrow, and blood cells. But I could certainly help her to become more familiar and comfortable with the equipment she would encounter when donating her bone marrow. So we played with a doctor's kit, all real equipment, which she tried out on her mom, and we practiced drinking from a medicine cup (like she would on donation-day) -- she loved that part! -- and I gave her an anesthesia mask to take home and play with over the next week. While we played, we talked about her little sister, and why she was in the hospital. The 3 year old loves being a big sister, and sharing her toys. So we talked about how her sister's blood was sick. And that she could share some of her blood to help her sister get better. That went over pretty well.
So, remember how I said this was a week of "stepping up and stepping out?" Well, here's the stepping out part . . . as in, "stepping outside the usual routine." I'm nearing the end of my first rotation, and by now have a pretty good feel for what "normal" is for a Child Life Specialist working with a chronic population. But, of course, not every experience falls in the "normal" category. This week I met a patient that fell well, well, outside the realm of the "typical" for our floor. The patient had some challenging behavior patterns. By that I mean: in the course of a 10 minute tantrum, my mentor got punched, the nurse got kicked between the legs, and I got bit. Yes, bit. (Didn't break skin, thankfully!) We're all sporting a rainbow of bruises from hits and pinches. (And no, this was not in response to a painful procedure!) Later that day, one of the wonderful doctor's on the Pysch staff taught me how to do a "basket hold" which would allow me to control arms and legs without getting bit. It's really a brilliant move! That being said -- it is never Child Life's job to hold a patient! Physically restraining a patient is way, way, way outside of what we do, and very counter-productive to the rapport we're trying to build, and our role as the "safe" person in the hospital. So, hopefully I'll never need to use the basket-hold on a patient, but sometimes reality hits you in the face (or bites you, or kicks you) and you need to "step out" from your norm.
My high this week: feeling like I've got a handle on selecting and implementing therapeutics.
My low: one of my favorite nurses got chewed out by a stressed-out parent. She didn't deserve it, not in any way-shape-or-form! The nurse took it really hard. She's one of the best nurses on the floor, and I'm heartened to see the whole team rallying around her with love and support.
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