Sunday in the Park

I spent part of the day outdoors today. My husband and I had a lovely picnic lunch in the park. There were lots of families with children spending time together hiking, biking, swimming, walking dogs. Everyone was having such a good time, engaged in play and conversation. It was a great Sunday afternoon and I was grateful to have the time to relax and recharge. It also reminded me of the importance of simply being outside. One of things I hope to remember in my work is to bring the outside in to the hospital as much as I can. Things I can do to incorporate nature into time spent with children in the hospital:

• Advocating and helping to arrange for outdoor time for children who are well enough to spend time out-of-doors. This can range from playing on the playground to simply wheeling a wheelchair to a shady spot in the garden near the hospital.
  
• For room-bound patients, I can create activities that involve looking outside the window (keeping track of the weather, I-Spy games, looking for signs of the seasons, etc.)
  
• For long-term patients consider planting seeds in a window container and watching them grow.
• Use natural materials such as leaves and rocks in art projects
• Have children visit one of the aquariums throughout the hospital, help feed the fish

These are just a few of my ideas. Feel free to leave any suggestions for other activities in the comments section.

Tools of the Trade: Bubbles

Photo by jurvetson from Flickr

To an outsider, it might appear that child life specialists just carry around lots of random toys. And, sometimes, if things are really crazy you do have to grab what is available and close at hand. But most of the time, CCLS choose activities, toys, and distraction items very carefully based on the goals of the interaction and the age/developmental level of the patient. So, I thought I'd highlight items that are useful in a series of postings called Tools of the Trade.
To begin: Bubbles. Indispensable. They are inexpensive, have great distraction capabilities, and people of all ages love them. There is something really magical and delightful about delicate, floating bubbles. I keep small bottles of party favor bubbles with me pretty much all the time. Here are some of the ways I think they are most useful:
1. Building rapport, especially with very young or frightened children. Blowing and popping bubbles is a familiar activity to most kids and helps reinforce the idea that you are not there to poke or prod them. Bubbles lighten the mood.

2. For distraction during short procedures. For children who do not want to watch a blood draw, IV insertion or other short procedure, bubbles are great. They provide a visual focal point that is a good complement to conversation and encouragement.

3. To encourage deep breathing. Having the child blow bubbles can be a great way to demonstrate and practice deep breathing. You can show how a deep intake and slow, gentle breathing out produces many bubbles. This technique can be used during key parts of difficult procedures as a way to help children relax and cope.

4. To aid guided imagery or serve as a point of focus in pain management. You can use bubbles in many different ways as part of guided imagery/pain management. You can use bubbles to teach deep breathing, helping the child remain calm and more relaxed. You can have the child imagine floating like a bubble, or imagine "blowing away" their pain. Having something concrete to focus on can help children maintain attention.

Bubbles are a great tool, but you should always check with your hospital area regarding their use. Some units serving immunocompromised patients may not allow bubbles as part of infection control (this is often because the water in the bubble solution might not be clean). You can ask about the possibility of creating your own "clean" solution for use in these areas.

A Child's Point of View

Perhaps the most important part of the job as a child life specialist is using knowledge of child and family development to attempt to see the world of the hospital through their eyes. What is likely to seem unfamiliar or threatening? Is medical terminology too advanced, foreign, scary? Who are all these different people and what role do they play in healthcare? Observation of patients/families/multidisciplinary team members is incredibly important and provides a history of interactions that can serve as a guide for better interventions in the future. That is why volunteer experience, practicum, and internship are such integral parts of child life training. In addition to observation and hands-on experience, books can provide historical and theoretical background that is indispensible. There are some amazing books out there that do a wonderful job of presenting the hospital/illness experience from the child's perspective. The following books are a few of my favorites and proved an excellent foundation and complement to my experience:

The Private Worlds of Dying Children (1978) by Myra Bluebond Langner

Bluebond-Langner is the founding director of the Center for Children and Childhood Studies at Rutgers University. This ground breaking anthropological work examined the world of children with terminal cancer. While hospital policies and pediatric cancer treatment is vastly different today, the stories of children and families in this book are incredibly moving. Bluebond-Langer demonstrates that children understand far more than many adults believe. She presents the stories of many children but I rememeber the case of Jeffrey, a school age boy, most clearly. While parents and staff go to great lengths to hide the seriousness of his diagnosis, Jeffrey knows that he is probably dying. He acts out and explains to Myra that he hopes his bad behavior will make his mother miss him less when he is gone. This book shows us how far we have come in making the hospital a better place for children, but reminds us of why we must continue to advocate for their participation in treatment.

Biting Off the Bracelet: A Study of Children in Hospitals by Ann Hill Beuf

This sociological study was first published in the early 1980s. The author conducted fieldwork in a large pediatric teaching hospital. While she gives plenty of short patient stories and anecdotes of patient/family experiences, the focus of this book is understanding the hospital as a social institution. Beuf explores how the hospital creates a social space with unique customs and rules and how children learn to inhabit the role of "patient". She spends time discussing different coping strategies for children, coping strategies of staff, and recommendations for how to improve the environment for both patients and healthcare workers.

In Sickness and In Play (2003) by Cindy Dell Clark

Clark interviewed over 40 families of children with asthma and diabetes. She explores how these families make sense of life with chronic illness and establish "normalcy". She conducted lengthy interviews with children in their homes utilizing play, allowing the kids to lead the discussion and provide insight about their experiences with disease and treatment. One of the strengths of this work is hearing the perspectives of different members within the same family, and how different individuals within the family cope with and think about illness. The writing is accessible and relevant to anyone who works with children.

Starting Out

I'm training to become a certified child life specialist (CCLS). Child life specialists are professionals trained to address the psychosocial needs of children and families in healthcare settings. Basically, child life specialists help to explain illness, procedures, and other aspects of the hospital experience in age-appropriate ways. Child life specialists also provide play and social experiences for children of all ages in the hospital, and provide support for their siblings and families. I follow many wonderful health care blogs, but have not found any written by child life staff. Hence the beginning of this blog.
I have just finished a master's degree and am currently working toward professional certification. I am currently an intern at a children's hospital where I will train full time for several months. After that I have to pass the certification exam given by the Child Life Council (professional organization and certifying body) and apply for jobs. I will be posting a little about my training experiences and issues relevant to the child life profession. But mainly I will be posting about activities, resources, and materials for use with children in the hospital. Out of deep respect for the children and families I will be helping in the hospital I will not be publishing patient stories. Any mention of children or patients will be fiction based on my experience working with many children.