This week in the cardia pre-op clinic, a Nurse Practitioner (NP) named Dot told me about her patient needed child life and that she was not prepared for her surgery. The patient was an 8-year-old girl from Puerto Rico who spoke Spanish and some English. I met D. F. and her mother in the waiting area of the pre-op clinic. I accompanied D. F and her mother to the lab and assessed D. F. ’s understanding of why she was coming to the hospital.
D. F. told me that she had a murmur and when I said, “oh, a murmur in your heart,” she told me, “no, a murmur in my chest. Then I went back up to the pre-op clinic and spoke to Dot, asking her if the other had shared her understanding of the surgery and if there was any reason why she was not prepared for her surgery. Dot shared that the surgery had been moved up one week, and when she asked the mother that morning if D. F. had been prepared she did not realize the importance of preparing her child. I decided it would be best to talk with the mother first about preparing D. F. and giving her the option of preparing D. F. herself.
As a result of her cognitive development, I suggested to D. F. s mother that we could provide her with a tour of the inpatient unit to provide her with a concrete experience and allow her to ask questions throughout the tour. The mother and I decided that it would be best to show D. F. the inpatient unit and ask her if she had any questions about “fixing her heart. ” Before bringing D. F. to the inpatient unit I told her that she would be coming in the following day so that the doctors could fix her heart. She responded by saying she knew. I started the tour with D. F. , her mother, her father, and the translator.
About two minutes into the tour D. F. stopped walking, began to cry, and asked her parents if they could move the surgery so that she would have more time to prepare. I redirected the family to the pre-op clinic and confirmed to the parents that D. F. was processing this information and it was good that D. F. was sharing her feelings with us. When we arrived back at the pre-op clinic, I let the nurse know that we returned, and called the child life specialist from upstairs to ask if she could help to support the family. According to Piaget, D. F. is in the concrete operational stage of cognitive development.
During this stage children are able to problem solve and think in a concrete manner (Lightfoot, Cole, and Cole, 2009). When D. F. said “no, a murmur in my chest” when I said a murmur in her heart this could be as a result of her concrete thinking because her parents could have described her heart condition as being in her chest. D. F. asked many concrete questions to the child life specialist such as what her scar would change her body. Her cognitive development was demonstrated in her logical problem solving asking for the surgery to be pushed off to allow her more time to prepare for the procedure.
Communication: This week Maureen had to communicate with a toy company, Mary Meyer, because a parent in the cath lab found a sewing needle in the stuffed puppy his daughter had received. When the needle was found, Maureen took all of the puppies off of the floor to prevent possible harm as a result of a needle. Maureen filled out an SBAR to inform the clinical nurse manager and the child life director about the situation and action steps to resolve this situation. These action steps were to remove the puppies from the floor, communicate with other child life specialists who similar toys, and to contact to company.
She first emailed the company and requested to have a phone conversation with them. Maureen spoke with the owner of the company to confirm that it was safe to use these stuffed puppies and that the company had safety protocol to prevent similar incidents. He assured Maureen that this was an isolated incident and requested that Maureen email him a photo of the needle and send him another puppy from the box. Following the conversation with the company Maureen contacted the child life specialists throughout the hospital and the clinical nurse managers in the cath lab to informed them that the incident had been resolved.
Through observing this phone conversation and discussing this situation with Maureen, I was able to understand another aspect of the role of child life. Child life can be required to fill out a SBAR or another incident report to communicate situations that occurred and that were brought to their attention. This interaction further affirmed the importance of child life being able to communicate clearly because child life can be required to communicate with many different people, such as an owner of a company.
Medical Terminology: A medical term that was present in this week’s census in the Cardiac Pre-op clinic was Total anomalous pulmonary venous return (TAPVR). TAPVR is congenital heart disease that the oxygenated blood travels to and from the lungs but does not travel to the body. This is a result of the veins that transport oxygenated blood to the left side of the heart from the lungs are not properly attached. If this condition occurs with an Atrial Septal Defect this allows for the oxygenated blood to flow into the left side of the heart and out to the body.
The severity of this disease is connected to obstruction of the pulmonary veins because it can be fatal if the pulmonary veins are obstructed and surgery i not used to treat the disease quickly. The tests and procedures that are used for TAPVR include cardiac catheterization, electrocardiogram, echocardiogram, MRI, and chest x-ray. If this cardiac condition is treated the infant has a good prognosis, but if this condition is not treated the heart can become larger which wll lead to heart failure. There are many psychosocial issues associated with TAPVR.
A psychosocial issue is when the patient becomes symptomatic because this determines the severity of the disease. Another issue is the the continued or lengthy hospital stay related to surgeries. This can cause a child to be out of their routine, away from their friends and school. Another psychosocial issue is the effect upon siblings because siblings can feel left out, out of their routine, and concerned for their sibling. During these hospitalizations child life can offer these patients and families with developmental and sibling support.
A child life specialist can offer developmental support, developmentally appropriate language, and play opportunities to the child during the hospitalization. Child life specialists can offer sibling support by explaining the hospitalization in developmentally appropriate language, and offering opportunities for the sibling and patient to engage together. By including the sibling and providing them ways to engage with their hospitalized sibling, child life is able to promote connection between siblings.
Throughout the hospitalization child life can suggest comfort holds and distraction during lab draws and other procedures. Child life can provide referrals to programming, such as Music Therapy or Pet Therapy, to provide the patient and family with positive experiences in the hospital. Citation: Total anomalous pulmonary venous return : MedlinePlus Medical Encyclopedia. (2013, November 5). Retrieved November 20, 2015, https://www. nlm. nih. gov/medlineplus/ency/article/001115. htm Personal Reflection:
Something that went well this week was being provided increasing independence in both the inpatient and outpatient areas. On Thursday I had the opportunity to provide child life independently in the the cath lab, cardiac pre-op clinic, and the cardiology clinic. I carried and answered Maureen’s phone throughout the day. I checked in with the nurse practitioners and patients to determine if there were any child life needs. I followed up with a family to provide them a tour of the cardiac ICU and inpatient unit.
I took on many of the responsibilities that Maureen has on a daily basis. I was excited to be provided this opportunity to experience to many aspects of being a child life specialist. Something that I had difficulty with was working with D. F. and her mom to prepare her for her surgery. This was difficult for me because I had not prepared a child for surgery before on my own, and I felt that this family deserved someone with more child life experience. As a result I called the child life specialist on the inpatient unit and asked if she would help me to prepare this family.
It was hard for me to admit that I needed help, but I realized that I had to put my feelings aside to help the family. After this I realized that this was actually a positive event, that I was able to collaborate with a child life specialist to provide the family with the best care. Professional Growth: An situation that was helpful to my learning this week was the bracelet making event that I planned and implemented with Caroline, who works out of the teen and family resource room. During this event we had siblings, patients, and mothers participate in bracelet and necklace making.
This event allowed for patients to connect with other patients, create a bracelet, and to normalize the hospital experience by allowing them to do an activity to do an activity that other individuals their age would do outside of the hospital. This situation helped me to discover how programing can connect patients and families while providing them an activity that they would have outside of the hospital. While talking to a mother who had attended the event she shared with me the importance of providing parents with respite care so they will be able to best care for their child.
This conversation helped me realize that child life can play an important role in helping parents care for themselves which then will affect the care the patient receives. References Hughes, F. (2010). Children, play, and development (4th ed. ). Los Angeles, CA: Sage. Lightfoot, C. , & Cole, M. (2009). The development of children (6th ed. ). New York, New York: Worth. Chart note (11/19/2015): This child life student intern introduced the role of child life to a patient and her mother in the cardiac pre-op clinic waiting area. This student intern offered to escorted the patient and mother to the lab for a labdraw.
The mother shared that the patient had only received a labdraw once at the doctor’s office and that it helped to have the patient sit next to her. This student intern confirmed to the mother that parental presence is helpful for 3-year-olds. This student intern asked the mother if her daughter enjoyed books or videos on a phone and suggested that the mother could use these methods for further distraction during the labdraw. This child life student intern provided this patient with “If you Give a Mouse a Cookie. ” Child life will continue to follow this patient on day of procedure.
