I. Care of Infants, Children, Youth, and Families
F. The ability to provide teaching, specific to the population served, including psychological preparation for potentially stressful experiences, with infants, children, youth, and families.
Selected Knowledge Areas/Skillsets
Knowledge
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Identify basic terminology, processes, and expected plan of care for the population served.
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Identify teaching techniques for use with individuals of diverse developmental levels and learning needs.
Skill
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Determine realistic goals and objectives for learning in collaboration with family members and professionals and identify an action plan to achieve these goals.
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Use minimally threatening, developmentally supportive language.
Within the role of child life, it is important to utilize our developmental backing and tools of assessment, planning, intervention, and evaluation [APIE] to guide our interactions. However, of equal importance, is the ability to convey this knowledge to children and families and empower their independent use of child life tools. This practice involves the ability to collaborate with multidisciplinary and medical staff, identify best learning methods as they relate to developmental and chronological age, and unique family dynamics, and empower families to use these tools during moments of heightened stress.
In my own experience, at Boston Children's Hospital I was able to observe my supervisor's in their explanations and descriptions of common medical terms and procedures. Using this knowledge, I practiced providing step by step explanations, comfort positioning, and developmentally-appropriate distraction methods during procedures such as the VCUG, Tracheostomy changes, Lung Perfusion Scans, Port Accessing, and more. Following my initial provision of these materials or education, I would debrief with parents about my reasoning and assessments, as related to comfort and benefits for the child. Many caregivers reported that simply having somehow to model these methods or make suggestions, helped to "demystify" the experience, allowing them to feel comfortable supporting their child in the future. In addition to teaching during procedures, I created patient and sibling education books to promote long-term education and understanding, while using developmentally-appropriate and supportive language.
Additional opportunities for teaching included the experience of making a picture schedule and goal based presentation about the differences in palliative versus hospice care, during my internship placement at Good Shepherd Community Care Pedi Pal. The use of the visual schedule was deemed appropriate as it reflected the needs of a patient on the Autism-Spectrum who communicates non-verbally. This schedule allows for clearer interpretations of his daily routine and promotes opportunities control as the patient can move the items using a velcro board with the images attached. [ To view the hospice v. palliative care slideshow you can visit the Goals and Objectives page on my website under “Internships→ Good Shepherd Community Care”]
Evidence
BCH Journal Entry Week 3… The next two days down in radiology, we had a large variety of patients coming in for VCUGs ranging from a 1-year-old to a 25-year-old patient. In each of the encounters, I wanted to work on comfortability engaging with caregivers and noticing any commonalities between Angela’s approach in the treatment room. During two separate appointments, both with varying levels of patient upset and parental stress, Angela began demonstrating positive touch and using “shhh” as a background sound to encourage silence in the room. Within a few minutes, caregivers began to model this practice in comforting their child and both reflected afterwards that despite it being a hard procedure, they felt the child coped well. Developmentally these patients were at different stages, however, parental presence is a useful tool whenever possible as these caregivers know their child better than we ever can. By educating and modeling coping behaviors, we can empower parents to maintain an active role in the comforting process for their child.
BCH Journal Entry Week 6… …By working to build a rapport, it felt much easier to stand with the parents at the head of the table and support them during the VCUG, even as the child became upset and cried. I worked to model soft touch and distraction with musical toys, along with verbally reassuring them that upset at this age is likely stemming from lack of bodily control, discomfort, and a new environment, rather than any pain. This baby proved distractible at multiple points during the exam and returned to a happy, playful baseline quickly after it ended, which I made sure to reflect on positively with his parents.
BCH Journal Entry Week 12… Looking over the morning census, I was able to do quick chart reviews on newly admitted patients before attending rounds, to better understand the physician's perspective on the patient’s status. One of the patient’s, a 4yo girl, had previously been in the MICU during my time at BCH and was well known to child life based on her social and playful personality. With that in mind, I prioritized dropping off art materials, a doctor’s kit, and a “little people” playhouse to her room, early in the day to ensure the environment was more comfortable and familiar to her prior hospitalizations. Specifically, I chose these materials as she is grounded in the preoperational stage of development and with this line of thinking is able to partake in imaginative, expressive play. Having been present during her last admission, I know that being left alone and being poked are two main fears, so by providing toys to help act out and express routines and rituals, we were able to talk about her family and practice for upcoming procedures.
BCH Journal Entry Week 5… This patient had experienced a variety of medical procedures in the past and was familiar with expectations to hold her body still and alert us of any feelings of discomfort. The patient only expressed verbal distress at one point during the test at the site of the blue catheter clamps, which appear very similar to scissors. She started to shift her body slightly and whispered to her mother “they’re using scissors, are they going to hurt me?” which her mother then passed along to me. I quickly grabbed the clamps and demonstrated that the dull ends were not painful or sharp. By increasing her education and advocating for her to touch and understand the materials being used during the VCUG, the patient was able to calm down and return to her coping with the use of the iPad and comfort from her mother.
BCH Journal Entry Week 7… In the MICU, Lauren and I had a busy Thursday working to fill patient’s needs including introductions for new admissions, check-ins on long term patients, and memory making help for an end-of-life code. One patient I assisted in care for was a 14 y/o typically developing male, presenting to the ICU for increased work of breathing with a newly found cancer diagnosis which he would be notified of that day. With this knowledge, Lauren and I wanted to introduce child life and better understand this patient’s coping skills prior to this diagnostic meeting. At fourteen years old, this patient was centered in the identity versus role confusion stage and highlighted passions of video gaming, playing sports, and family projects. To meet these needs in the hospital setting we provided an Xbox system and brainstormed ways he could personalize his room and find ways for sports like competition during long admissions. After receiving his new diagnosis, the patient appeared to be quieter and more reflective but through communications with his bedside nurse and chaplaincy both reported his family maintained a hopeful attitude and were coping as expected. This experience was extremely significant for me, as I was able to engage with a typically developing patient on 11S and saw how crucial the family-centered care aspect was in this new diagnosis. Lauren debriefed with me about ways she helped model language, body positioning, and comfort during the delivery of news to the patients. In considering such intense, likely scary medical news, these considerations are crucial, and it was interesting to think about how that process may have differed without child life presence.
Example of a Sibling Education Book
Patient names have been changed for confidentiality.
Example of a Visual Schedule
Patient names have been removed for confidentiality.
