Distraction

Leave a comment Standard

During my internship, my supervisors would often challenge me to provide distraction for patients without using an iPad. I’d often shrug it off because, in the rush of getting called for a procedure while they’re already setting up, the patient already crying and tension rising, the iPad 9 times out of 10 would work like magic.

I love iPads for distraction! They’re big so they cover the view of the procedure. They’re interactive which promotes distraction, kids use them at home which promotes normalization, you can easily sanitize them, c’mon! Well, fast forward 1 month after my internship when I began my first job as a CCLS in the emergency department, not only did I not have an iPad, but I wasn’t approved to use an iPad even if I had one!

I spent 10 months working in the ER without an iPad and boy, did I become creative in my distraction interventions! It was during this time that I saw the real magic of child life. You guys, I once distracted a 2-year-old for an IV start with them laying on the bed alone by reading a sound book! Honest! I have witnesses! No one in the room, including the 2-year-old patient, could believe the #childlifemagic that happened that night.

Don’t get me wrong, as soon as I got approval for an iPad I surely put it to good use, but the tricks I learned during those 10 months of being iPad-less in a busy ER gave me confidence. I remember a great CCLS once told me that to be a CCLS you do not need anything but the head on your shoulders; “bubbles, toys, and gadgets help of course, but the only thing you need to be a CCLS is your knowledge and understanding of child life theory and practice.”  In hindsight, I now understand that this is very true! All that work and practice sans iPad gave me the confidence to be a CCLS that is called into a room with nothing but a dry erase marker in her pocket and doesn’t even think twice about going in.

Here’s a list of some of my favorite distraction itemsMusthaveDISTRACTIONitems.jpg

  1. Bubbles – classic
  2. Sound Books – great for toddlers/preschoolers
  3. Buzzy Bee Distraction Cards – I got a pack of these in my welcome bag at the 2017 FACLP conference. I use it all the time – definitely must have!
  4. Melissa & Doug Reusable Stickers – These are puffy too so no need to worry about them ripping
  5. Light Spinner – classic
  6. Find It – one of my forever favorites
  7. I Spy books – love these which you can find for different age groups in TONS of different character themes
  8. Bright Beats – coolest toy in the toy box! Very interactive, colorful, and musical. Great for toddlers

For a full list of my must-have distraction items, follow the link to my Amazon wishlist: http://a.co/6gscxMo

Again, I love using my iPad as a tool for distraction. It’s an incredible resource and has kept my patients calm and coping during difficult procedures. I have tons of go to apps but as for my favorite iPad app right now I’d definitely have to say the Spellbound app!

I was able to get my hands on a couple of augmented reality cards made by Spellbound. I love technology and was a huge fan of Pokémon Go so I was definitely looking forward to using Spellbound with my patients.

First & foremost, cards are made of wipeable material so you can sanitize in between use; YAY! Set up for the app was very easy – just download the app, enter your email, allow camera access, & you’re ready to see into another world.

My demo came with three cards and kept me and my patient completely distracted throughout an entire IV start and a little while afterward. I can definitely see how having a whole deck of these cards can lead to very distracted patients.

For more information on Spellbound AR follow the link to their website: http://spellboundar.com/

 

What are some of your favorite distraction tools?

Advertisements

Increasing Compliance

Comment 1 Standard

There are many times that I am asked to help a patient to increase compliance with their plan of care. This can be anything from helping a patient take their medicine to helping them walk around the unit post-op to simply helping them breathe after a breathing treatment. These are the times that creativity really kicks in and I need to have more than one trick up my sleeve. Here are some of the tools I use to help increase compliance:

 

  • Incentive charts – there are tons you can find online like this one that I found on Amazon. Lots of times a sticker chart alone is enough to help a patient increase compliance with their plan of care. Never underestimate the power of stickers, people!71KFeBlCzQL._SL1000_
  • Increase ambulation – this one is always tricky and requires a lot of back up plans. Depending on the age, there are various floor toys that require kids to walk, stand, or move around to engage in play. Again this will all depend on the specific patient and his/her likes, interests, and pain level when needing to walk. Think outside of the box when selecting toys; for example, I once had a teen soccer player who was reluctant to walk after his surgery. I brought out a soccer ball during one of his laps aro614sLwN22hL._SX355_und the unit and he lit up with excitement to be able to lightly kick the ball down the hallway. Another example was a 5-year-old patient that didn’t want to walk after having her appendix removed. I was called in to help after the nurse had tried for over 30 minutes to convince her to walk. As soon as I came into the room the patient exclaimed: “I’M NOT GOING TO WALK!” I validated her feelings and told her I wasn’t going to make her walk. However, I noticed her Rapunzel doll looked a little hungry so I asked the patient if she wanted me to bring in a play kitchen so she could make her some food. The patient eagerly accepted and spent over an hour walking, sitting, standing, and moving around her room as she played preparing food for her doll.
  • Increase PO intake – when it comes to food one must always be empathetic. I would never want to ruin a child’s relationship with food so I always use caution with these interventions. Depending on the age, fun plates/cups/utensils of their favorite characters will do the trick. Other times an incentive chart will help. I’v71PGEs0JBGL._SY355_e had a lot of success with simply changing the subject; stop talking about food and do something else. Leave the food around, engage in play, and the eating will often start organically. I mean, who doesn’t like to munch on some waffles while setting up Lego’s. It’s definitely a syrupy mess but hey, he ate! Providing play food and letting them freely play and feed their toys can also be helpful.
  • Incentive spirometer – many patients are required to use an incentive spirometer after certain breathing treatments. The ones at my hospital have fun designs on them that make them look like a game. However, I get consults to help with these patients all the time! Kids hate using them! So, leave it to me with my bag of tricks to get kids to breathe. Check out my previous post on yoga and deep breathing as this is always my first go to. I also like to give kids choices so I have kazoo’s, bubbles, string pipe toy, and other fun 61n+WVdutdL._SY355_breathing toys to get them to take those deep breaths. Even toddlers get in on the breathing fun by blowing out the candles on my birthday cake. There’s nothing toddlers love more than songs, repetition, and a cause and effect toy!

 

 

 

 

For a full list of resources to increase compliance, check out my Amazon list here:

Increasing Compliance
Link: http://a.co/1sKYUcg

Child Life Market

Comment 1 Standard

All week long I’ve shared with you some of my favorite resources I use to help my patients cope with hospitalization. Let’s end another week with a peek into my child life market, Coping + Normalization Edition!

 Normalization
Link: http://a.co/3sqZ08E

Coping Tools
Link: http://a.co/2uwX17K

Favorite Find

Leave a comment Standard

tanners totes

Tanners Totes is dedicated to providing cheer to preteen and teen patients undergoing long-term hospital treatments and stays. A Tanner’s Tote is unique in that it presents the patient with a wide variety of new, non-food, items to bring some greatly needed distractions and joy.

This is another organization that I hold near and dear to my heart. The resources they provide are perfect for preteens/teens that are experiencing long hospital stays. We all know how hard it is to have games/toys/activities/resources for teens so these big tote bags are a Godsend! They include various items such as a dry erase board, uno, water bottle, sketch book, markers, colored pencils, etc. My favorite item in the bag has to be the Staples “Easy Button”. My kiddo’s always get a kick out of that one and it truly makes a positive impact during their recovery. These totes are TOTES amazing!

For more on Tanners Totes, visit https://www.tannerstotes.com/child-life-specialist

For information on getting Tanners Totes to your hospital, visit https://www.tannerstotes.com/child-life-specialist

CCLS on the other side of pain 

Comments 2 Standard

As a CCLS, I’m no stranger to pain. Chronic pain, acute pain, sudden pain – it’s all in a day’s work to help our little superheroes overcome their hospital visit. Lately, however, I have been on the other side of pain as a patient.

In August of 2016, I woke up one morning with dull neck pain. I hadn’t done anything particularly odd prior to this morning, so I just shrugged it off as “I must’ve slept weird”. Little did I know that my assumed diagnosis was wrong & that this wasn’t just going to go away after a few days.

I’ve tried everything to rid my neck pain; everything! Cortisone injections, 2 MRI’s, X-Rays, visited a spine specialist, acupuncture, acupuncture with electrotherapy, changed my pillows, changed my diet to be sugar-free, visited a holistic doctor, two rounds of physical therapy treatments, muscle relaxers, chiropractic adjustments, regular massages, regular yoga, regularly applying peppermint oil on my neck – everything. All of this and yet the neck pain stays with me every minute of every day. Some days are better than others, but I can’t remember the last time I was a zero on a pain scale.

The most frustrating part of what I like to call my “neck pain saga”, has been the lack of support I’ve felt from doctors; many of which writing off my neck pain as just stress related. I know that I’m not stressed, especially not enough to have chronic neck pain! But no matter how much I’ve told my doctor’s this, they insisted it was, just stress related. One doctor even told me to ” suck it up, everyone lives with pain and this is just part of getting older”. Needless to say, this entire journey with chronic pain has been draining, expensive, and in some way a learning experience.

This last year of pain has taught me a great amount and I truly feel that it’s made me a better CCLS. Here are some tips & tricks I’ve learned along the way:

  • The freezy spray really works! When getting my Toradol/lidocaine injections into my neck the freezy spray really takes the sting out of the initial needle poke. However, the actual liquid medication going into the muscle is clearly felt.
  • Deep breathing exercises have saved me. While getting injections, waiting for diagnostic results, having my neck manipulated, laying in an MRI, and even sitting in traffic feeling the burning neck pain; I wouldn’t have been able to get through it if I didn’t know how to breathe. Click here for more on deep breathing  
  • There are lots of apps that help you track your pain. My favorite has been Symple. Tracking my pain has helped me find patterns in my pain and really be mindful when assessing how I’m feeling. This can definitely be a helpful tool for teens when transitioning to adult care from pediatrics.
  • Sometimes all I needed was someone to validate my pain – not tell me how to fix it. Having my pain be dismissed so frequently by doctors made me question how real my pain even was. Which is, of course, ridiculous because I’m the only person who can feel my pain and believe me: it’s real and always present. Now when my patients tell me that they are in pain I always, first and foremost, validate their pain.
  • It is incredibly frustrating to be told that I am in pain because of something I have control over (i.e., “you have neck pain because you eat too much sugar”, “you have too much stress; you need to relax”, “your posture isn’t perfect”, “you stare at your phone too much”, “the pillow you use is too fluffy”, “the pillow you use is too flat”, “you’re seeing a chiropractor? you should see a spine specialist”, “you’re seeing a neurologist? you should go do acupuncture”, etc). Whenever addressing someone’s pain, be mindful of how you’re wording your kind advice/suggestions. I know it’s coming from a good place & I certainly appreciate the concern. However, the last thing a person in pain wants is to be kicked while they’re down by being told they’re doing it all wrong.
  • Talking about my pain isn’t always comforting. Being asked on a daily basis by friends and family how my neck feels brought on more feelings of guilt and disappointment, rather than comfort in knowing others care about my health. Especially with chronic pain, whenever I’m asked how my neck is doing I know the other person wants to hear “I feel great! the pain is gone! Thank you for asking” but to say that would be a lie. Instead, I say the truth, that I am still in pain, which then leads to feelings of guilt on my part and disappointment on their part. Trust me, from personal experience and having witnessed my patients this last year, when the pain does get better the patient wants to tell the world!

As for my pain, luckily, by some random movie-like coincidences, I stumbled into a new clinic where I finally feel like I’m being taken care of. I’ve even been given an actual diagnosis; cervical kyphosis – not just stress related! I am still undergoing treatment at this clinic but I am very hopeful that this is where my neck pain will end.

Have you ever experienced the patient side of pain/healthcare? What are some things you were able to apply to your work with children afterward?

Yoga + Child Life – Part I

Comments 2 Standard

You may remember at the end of last year I enrolled in the Rainbow Kids Yoga teacher training ( see post here ).  Let me start off by saying I am by no means an expert Yogi! I enrolled in this course not to deepen my practice or ditch child life to become a yoga teacher but rather to use the theory of yoga in my day to day as a CCLS. Fast forward 7 months after the Rainbow Kids Yoga training: it’s worth it!

I use the skills I learned with Rainbow Kids Yoga almost on a daily basis with my patients. So, what did I learn and how am I applying it to child life? For starters, it’s important to realize that yoga is more than just poses and flexibility. In fact, I don’t use yoga poses at all with my patients. What I do use is deep breathing exercises and guided imagery practices.

I have so much information and resources to share on this topic that I’ve decided to break up this post into 2 parts so stay tuned for more!

As a lover of free resources, I have set up a google drive where I’ve uploaded tons of freebies from teacherspayteachers.com on this subject. Click the link below to view:

https://drive.google.com/drive/folders/0B7up2fwr6___OXJ4MUlJRnNoNjg?usp=sharing

Part I:

Deep Breathing

download.jpg

Any wise 7-year-old will be quick to tell you that breathing is important – we have to do it to stay alive! And while this is quite true, our breath also has a big impact on our mind and how we cope with experiences.  image-4722.jpgSee this picture example of how our breath changes as we become stressed. This is where yoga comes into action! By teaching children different breathing exercises during times of stress/anxiety, they will be able to slow their breathing thus helping them cope, remain calm, and feel a sense of control.

There are TONS of kids breathing exercises you can find with a quick google search. For example one of my favorites is Snake Breath – take a big breath in and as you exhale make a “Sssss” sound as long as you can. Another favorite of mine is Lion Breath – take a big breath in and as you exhale stick out your tongue and make sure to make your meanest lion roar face. Find inspiration online or make up your own! I made up Bubble Breath – inhale and pretend you’re blowing one really really big bubble as you exhale // inhale and pretend you’re blowing out millions of really little bubbles as you exhale. For some little ones the concept of “inhale” and “exhale” may not be appropriate so change up your terminology to something like “smell the flowers, blow the leaves” or “smell the birthday cake, blow out the candles”.

In an effort provide a visual for the patients and to help me remember so many different breathing techniques, I created a laminated breathing cards with different clip art depicting the type of breath.  Shout out to Gretchen Blackmer for the inspiration for these breathing cards http://www.everydaywarrioryoga.com/ 

715232d3ee5601d314728edc1002f59b--coping-skills-pediatrics.jpg

Another great tool to use to show patients the effects of breath is to use a  Hoberman Sphere.This is one of my favorite resources to help kids really understand how lungs open and close with each breath. Plus it’s an overall really cool toy and instant rapport builder in my opinion. I’ll guide my patients in doing the different breathing exercises with the Hoberman sphere so they can see the full effect.

Another great tool I’ve used to support my breathing exercises is the book “Breathe, Chill: A Handy Book of Games and Techniques Introduced Breathing, Meditation, and Relaxation to Kids and Teens” by Lisa Roberts. This book breaks down various types of breath and how/when/why to use them. After I purchased this book I read the testimonials on the back and saw one of them was written by a CCLS! Just goes to show how beneficial yoga practice can be in the field of Child Life. You can find this book here on Amazon. 51NfLPIAGjL._SX346_BO1,204,203,200_.jpg

I’ve had many kiddos that really enjoy doing these deep breathing practices before/during/after procedures. I even had a patient choose my breathing cards over my iPad for distraction during her first IV! Not only do these skills help them cope with the present situation, but they walk away with a new coping technique in their pocket for future use & that’s what child life is all about!

 

 

Fun for EVERYONE

Comments 2 Standard

I believe it’s important for every CCLS working in the hospital environment be knowledgeable on how to meet the unique needs of kids with developmental disabilities and their families. Often times, developmental disabilities are associated with chronic health conditions resulting in some sort of medical intervention(s) during their lifetime. That being said, these kiddo’s are often a top priority for me when I check my census each morning. So, how do I help these patients? Lots of ways!

  1. Play! Here’s a tactile stimulation activity I set up for one of my patients. Even though some kids are non-verbal, they still have likes and dislikes even when it comes to play. Ask mom/dad/caregiver for any preferences the patient may have. If it’s just you and the patient, figure it out! Talk to them,  laugh with them, play with them, see how they react when you help them engage in the different activities. The patient I took this activity to LOVED the feathers but she absolutely did NOT like the slime – haha!  IMG_6052.JPG
  2. Volunteers! Just like their typically developing peers, kids with special needs get bored too! Especially spending long hours in the hospital setting away from their routines. Don’t be afraid to have your volunteers visit these patients. Introduce your volunteer to the patient and model some appropriate play opportunities. Often times when I have patients that are admitted without family members at the bedside, I create an “about me” board as if written by the patient along with toys/activities I know the patient will enjoy. The “about me” boards are bright, handwritten, and easy to spot by any volunteer or staff that goes into the patient’s room. I write something along the lines of:
    • Hello Friend! My name is ______ and I am ____-years-old. Thank you for stopping by my room to play with me! Some of my favorite things to do are: listen to friends read to me, listen to the radio, squeeze play-doh in my hand, hold toys in my hand, and just have fun. There is a basket by the window where you will find some of my favorite toys and activities. If I need anything while we’re hanging out, my nurse’s phone number is on my whiteboard. I can’t wait to start having fun!Love, _________
      and Diane, my child life specialist (extension #)
  3. Resources! I’ve found many items that have proven to be very helpful for pediatric patients with special needs. Whether for support/distraction during a procedure, for relaxation and coping, or for recreational play, I’ve compiled a list of some of my favorites. Click: http://a.co/2wbxj0E   What are some of your favorite resources to offer this population?

There are tons and tons and TONS of resources out there on working with kids with developmental disabilities in the hospital. Do your research!

Still feeling a little nervous about helping patients with special needs? There’s no need to be nervous! They are just like their typically developing peers – yes… really, they are! One of my favorite pages on Facebook will prove it to you. Click here:  https://www.facebook.com/specialbooksbyspecialkids/

 

Grape medicine cups 

Comments 2 Standard


Taking medicine isn’t always easy – especially when it needs to be taken every day for an extended period of time. Non-compliance with taking medicine can also cause a great deal of stress for parents, especially when it’s the one thing keeping the patient from being discharged. One of my patients was having a hard time with this task so to make things a bit more tolerable, we decorated her medicine cups. This patient really wanted it to be grape flavor however we couldn’t give her that option for this particular medication. To try and fix her grape craving, we stuck with the grape theme for her medicine cups. The medicine is still unpleasant, but creating these cups & giving her choices made the whole process a little more tolerable. What are some ways you help patients be compliant with taking their meds?

Helping non-verbal patients have a voice

Leave a comment Standard

I recently had a patient that was unable to speak after a surgical procedure. She was developmentally appropriate and had no prior history of hospitalization so all of this was new and very frustrating for her. Her nurses came to me asking for help because she was having a very hard time communicating with them.

Here’s what I knew: she enjoyed playing on the iPad but did not have the strength to hold it up to type, she didn’t have the fine motor skills she once had to be able to use a marker/paper to write, and she had no family at his bedside to speak for her. I began to think of what she can do rather than what she can’t…. that’s when my creativity light bulb lit up! I created  a communication chart for her.

One thing that she could do is move her arm/hand around and point. That was perfect! I found a chart with a couple of key phrases and emotions on it via google images by searching “communication chart”. I also created an empty template for her and her nurses to include more personalized phrases. I put both sheets into a sheet protector with a piece of cardboard in between so that it was sturdy and ta-dah!

My patient and the medical team working with her loved this communication chart and it truly helped her have a voice again.

 

Providing Support for Children with Special Needs

Comment 1 Standard

IMG_6003

This is a topic that I hold very near and dear to my heart, so much so that I am working on my masters degree in developmental disabilities! As like any new Child Life Specialist, it’s already challenging enough to master the art of effectively matching appropriate interventions to a patient’s temperament, family influence, and medical procedure, while working alongside the multidisciplinary team and balancing everything else that comes with the job. Now throw into the loop a child with a developmental disability with whom you have little or no experience in providing support and services for, things can surely become overwhelming. Remember, I work in an emergency room so my scenarios (with any patient) are often quick, urgent, and stressful. So, what’s my game plan? How can I provide Child Life services in a situation where my usual go-to interventions may not be as effective?

First and foremost: ask the parent/caregiver! This is your best source of information because they know exactly what their child needs to cope and feel most comfortable. I will often introduce myself to the patient and the family and then ask them how I can help their child – what form of distraction works best for them? are there any particular environmental changes I can make to help him/her feel more comfortable (dimming the lights, allowing him/her to sit on a chair vs the bed, warmer temperature in the room)? what is his/her favorite cartoon/character?

After speaking with the parent/caregiver, I will have some information in my back pocket on how I can adjust my interventions for this unique situation. Also, I always make sure and have specific toys set aside for kids with special needs – tactile sensory toys, toys that light up, toys that make noise, puzzles with pegs, etc.

I had a chance to ask parents of children with special needs what they felt are some things that heath care professionals can keep in mind when working with their child. Below are their responses:

Please be mindful that just like their typically developing peers, children with special needs are all unique in their own ways – there is no “one size fits all” intervention. What may work for one child may not for another, regardless of their disability/diagnosis.

  • iPad for distraction
  • Asking the doctor to remove his/her white lab coat before entering the room
  • Providing sensory friendly toys
  • Dimming the lights
  • Providing ear mitts to reduce all the noise (it’s easy to forget how noisy the hospital setting really is – everything is beeping, overhead PA, constant new people walking into the room, phones ringing, medical equipment, etc.)
  • Fluorescent light blocker
  • Lead vest to weigh down on the child (maybe your radiology department has an extra one they can lend you!)
  • Bean bag toy ( http://www.orientaltrading.com/reinforced-bean-bags-a2-61_4000.fltr?Ntt=bean%20bag )
  • Disney Soundtrack
  • Not spending a long time in the waiting room, being a priority to get into a room and be seen
  • Having animal figurines for him/her to play with
  • Having candy such as bubblegum, lollipops, or skittles (this one depends on a LOT, be sure to not only check with the parent/caregiver if you can provide this, but first and foremost the nurse/doctor)

Do you have any tips I didn’t mention? Comment below and let me know!