Therapeutic Activity:
Our floor serves all the kids with cystic fibrosis -- a genetic disease that effects the lungs and pancreas. CF patients are particularly vulnerable to lung infections, and there are even a whole variety of germs that find CF lungs an especially fun place to settle in. The net result being that we have extra infection control rules to protect our CF patients. The two big ones are that all CF patients must wear masks when they leave their rooms, and all CF patients must remain at least 6 feet away from any other CF patients.
Right now, we have several teenagers with CF on our floor. And, as you know, the most important thing (developmentally speaking) for a teenager is hanging out with other teenagers. Having CF sucks, drastically reducing your life span (average is now 37 years), and really impairing your quality of life with a regime of daily treatments. So, teens facing all this have a lot in common, and can really relate . . . from 6 feet away. At least they can text each other, right?
So, this week, I went "way outside the box" and planned a fairly elaborate therapeutic activity for my teens with CF. We used a large area in the hospital to stage a human board game. The large room was the board, and the patients the pieces on the board. On their turn, patients would roll the dice to see how many steps they could take. If they came within 6 feet of another patient, that person had to move backwards, in order to maintain the 6 foot infection control rule. I gave the patients 6 foot poles to measure distance with. Patients could earn "bonus cards" on their turn by drawing a card and answering the therapeutic question on it. Questions addressed lots of issues specific to CF and teens. If they answered, they got to keep the card, and use it to get extra movement on their turn. The goal is to move in such a way as to "push" the other players out-of-bounds.
All in all, it was a big hit, and the patients seemed to really enjoy it. It gave them a chance to talk with other teens about their disease, and things they had in common. Two kids in particular really hit it off, and ended up spending the rest of the week becoming best buds. There was some tug-of-war with the infection control rules, but eventually they settled into being "texting buds." At least when the grown-ups were around . . .
Diagnosis Teaching:
I haven't had a lot of opportunities to practice my skills in diagnosis teaching in the last few weeks, let alone demonstrate them for my teacher. So, I was quite delighted when the perfect situation fell right into my lap. I was sitting in the playroom (which adjoins our office) playing with a school-age patient, helping distract her while she waited for her upcoming procedure. The office door was open, where my teacher was sitting doing paperwork, a lucky hearing-distance from the patient and myself. While we played, I asked her if she had any questions about her upcoming test. Turns out that she had quite a few, and soon I had out my teaching doll, and was explaining the purpose of different organs, and showing her how the test worked. She kept asking questions, so we kept talking, until we worked our way around to her core concern, about a possible surgery she might need, based on the results of her test. Fortunately, I already knew all the info she was after, so the teaching went pretty smoothly. And my teacher got to listen to all of it, unobtrusively from her desk, and give me feedback after to help me improve my skills.
Procedure Preparation and Support:
Another big "high" this week, was working with a sweet pre-schooler. My first interactions with the family were providing play opportunities for him while he was in the hospital for testing. Mom came to me to ask for help with an upcoming procedure, and I was happy to help. The procedure involved placing a long tube down the patient's nose, which then had to stay there for 24 hours. Needless to say, this is an incredibly invasive and uncomfortable procedure under any circumstance. Now imagine it on a pre-schooler. He was understandably upset with the insertion, and stayed mad for most of the 24 hours following. The moment it came out, he snapped right back to his charming, playful self. Mom was crushed to learn that the doctors wanted a follow up test only a few hours later, that involved more things going into her son's nose. I was called in again.
"Ciliary brushing," involves putting a very small brush up the nose to take samples from the sinuses. It's very uncomfortable, but luckily pretty quick. Neither my teacher, nor I, had ever heard of this procedure before, let alone seen it. Here comes the "high" for me -- my teacher left it all in my hands, and I handled it on my own. First I tried the internet medical sites, finding little-to-nothing. Next, I asked the nurse about it -- she'd never seen it before, but was able to show me the tool that would be used. It looked like a barbie-sized mascara brush, but on the end of a two foot wire. To a pre-schooler's eyes, it would look very much like the hated tube that had just come out only a few hours before. My next stop was chatting with the resident who would do to procedure, who explained how far in it would go, and that it would be quick but painful.
Given the age and developmental stage of the patient, I advocated with the medical team for the procedure to take place in the treatment room. Keeping the patient's bed and hospital room as a "safe place" empowers coping skills at this age. If nothing "bad" happens in bed, then it's a safe place to rest, play and sleep. The team agreed to my request, and set up in the treatment room, as I set off to prepare the patient.
He was happy to play with my distraction-toys, but not much interested in hearing about what was about to happen. In the end, I chose to keep things very simple, especially considering his age. I asked him "do you ever brush your teeth?" Turns out he loved to brush his teeth, and told me all about his toothbrush when I asked. He was able to tell me that the toothbrush's job was to clean away the food on his teeth. I told him that the doctor had a special brush, much smaller than a toothbrush, that she would use to brush his nose. "To clean away the boogers?" he asked. For a pre-schooler, that was certainly close enough. He was actually quite charmed with the idea of having his nose brushed. So charmed, in fact, that I took the time to explain that this was a special way to clean out boogers that only the doctor in the hospital does. At home, we just use a tissue.
Tune in next week for the exciting conclusion of my 15 week Internship Series!
1 comment:
Great work!
I love the board game idea with the teenagers!
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