hi guys we're going to talk about chapter 30 and this is going to review a traumatic care of children and families and you're going to hear this terminology quite a bit as we work through each as we work through this course really so a traumatic care so how do we define a traumatic care this is chapter 30 in your book and we're gonna get started here atraumatic hair is defined as therapeutic care that minimizes or eliminates psychological and physical distress that can be experienced by children and their families and our health care system this concept is based on the underlying premises of do no harm as nurses we can decrease the child's exposure to stressful situations and prevent and minimize pain and bodily injury so let's look at each of these principles and what are some of the suggestions of a traumatic care so the first one that we're going to look at is to prevent or minimize physical stressors that means pain discomfort maybe they're immobile maybe they haven't slept really well for several days they don't have that ability to eat or drink or they have changes in elimination right those are all going to increase our stressors physically so how can we prevent or minimize that we can think about using numbing techniques such as emola cream or other um techniques such as our buzzy bee um we want to make sure we're doing those comfort holds that therapeutic hugging which we're going to talk about here in just a little bit we want to maybe decrease the noise maybe that means we need to move them a little bit further away from the nurses station or we need to quiet the monitors in their room we can also implement some pharmacological interventions we want to just remember that we want to perform some of these procedures as safe but as quickly as possible to minimize that stress for the child and the family the next principle for traumatic care is the prevention or minimization of that parent-child separation depending on the age of the child remember those little ones they're going to want to have that familiar face you're a stranger to them so how can we prevent or minimize that parent child separation and we can promote some real family-centered care so what does that look like so that looks like we can provide those comfortable accommodations um for our families at children's mercy we have that ronald mcdonald house right it gets um exhausting to try to sleep on some of those pull out sofas that are in the bed so maybe we're going to reach out to our social work our team and try to make different accommodations where that parent and child may have some separation but we can accommodate for that separation during bedtimes um nap times things like that um maybe we'll want to also offer our family a choice of staying for any of those innovate invasive procedures sometimes just educating our family on what's going to happen then we can give them that choice do you want to stay or is that going to be too stressful for you to stay it also might mean bringing or letting that child bring in a toy from home um especially if that family member cannot be there for some of the procedures um so allowing some of that separation i mean allowing some of that prevention to that separation is that second component or principle of a traumatic care and the last one we can talk about is that promotion of sense of control i'm sure any of you that have been in the hospital it's like you lose a lot of your own control um the nurses are coming in and giving you meds um they're dictating when you need to brush your teeth or bathe or any of those things right you lose some of that sense of control so how can we promote some of that back um we can maintain that child's home routine right if they get up um and they want to eat breakfast and they want to relax a little bit before they brush their teeth let them do that right it gives them back some of that control if they have any security items let them have those maybe that's going to reduce some of their fear again it gives them back some of that opportunity for control empower that family but by providing some education um elicit their knowledge and then provide the education um and then help them know when participating in their own child's care is okay and is acceptable right so those three principles are huge when we're talking about a traumatic care prevent or minimize physical stressors prevent or minimize parent child separation and promote some of that sense of control back so again what is a traumatic care right it's therapeutic communication it's very goal directed it's focused it's very purposeful it provides we can do therapeutic play which can provide some emotional outlet or coping devices make sure we're educating help that child help that family understand the reasons for why they are hospitalized or the reasons why they have to go through certain procedures and then parental education again engaging that parent as an active participant in their child's health care as a part of that team pediatric nurses must be vigilant for situations that can cause distress and therefore we must be able to identify those potential stressors make sure we're reading those nonverbal cues especially um during some of those procedures that we have to do on our kiddos so let's talk a little bit about the role of a child life specialist especially when it comes to a traumatic care so if you are at children's mercy or even some of the school districts may have some of these child life specialists remember atraumatic care is where we're talking about minimizing preventing pain discomfort and mobility sleep deprivation the health care or hospital is a very unfamiliar environment for the child and that family and it can be very intimidating families may feel anxious they may feel fearful helpless and have no sense of control so how do we prevent some of those physical stressors on the child and their family we can utilize that child life specialist the child life specialist can decrease the child's anxiety and fear while helping improve and encourage that child's understanding and cooperation this is a program to help prepare children for hospitalization and painful procedures these are non-medical support people during medical procedures they cannot perform these medical procedures they are there to help support they can utilize therapeutic play in activities to support normal growth and development this might include handling some of the equipment using dolls to show how that procedure is going to be done they help teach and support with coping and pain management strategies if they need if the siblings need support they can advocate for that child in the family they are also very good at their job with grief and bereavement support we put our kiddos through numerous diagnostics and therapeutic procedures so how can we prevent remember this is principle number one how can we prevent or minimize those physical stressors we can engage the child in identifying what would make them more comfortable right if they're at an age we can ask them what's going to make you more comfortable that's going to help minimize those stressors use positions that are comfortable to the child and that might look like this um front to front or you might hear it called straddle or you might hear it called chest to chest right you hold the child on the lap with their chest facing your chest putting their arms around them and again that's a comfort hole to minimize some of that physical stressor the next hole we can look at is back to front and where that child is sitting in the lap they're seated on a table and you're standing behind them so the back is against your chest um you can hold firmly but gently um and making sure that we're praising that child after they've done a really well job the next one is side sitting so that's that just child sitting in your lap and they can face left or right um depending on which extremity the nurse needs to get to again a gentle but firm hold of that child's body cradle this is usually done with infants right you're holding the baby in your arms their face up at you so you can talk to them that you can smile at them but again you can have that really um gentle firm hold for that patient that's comforting for them to minimize some of those stressors other comfort holds that you might see are a bear hug or a swaddle sometimes those swaddles can also be called wrapping them like a burrito right we're swallowing them up really tight which is very comforting for those infant children so this is just a care cards really directly from children's mercy and when do you use those comfort positions it talks to you there about shots when we're placing our ivs blood draws if we're placing an ng tube down right we want to use those positions comfort positions really can be used anywhere almost all the time so exam rooms outpatient labs hospital rooms procedure rooms we can use those comfort holds and why do we do this um because the children prefer to sit up rather than lying on a table um right if it's you or me right we would rather be able to see what's going on but feel comforted when i think when something per invasive is going on so the next thing we want to talk about is the use of destruction um when we use destruction methods um we can think about different techniques so think about some of the techniques you might consider when we're doing destruction for our kiddos so some of those might be pointing their toes wiggling their toes right what happens when i say okay point your toes and wiggle them their brain automatically goes to that part and it kind of distracts them from what's going on squeezing your hand counting out loud singing a song you'll notice if you're at children's and we're doing some type of invasive procedure lots of songs are being sang right abc's twinkle twinkle whatever you want to sing um having the child sing along i'm pointing at pictures on the ceiling we have these great lights that go up on the ceiling that they can look at blowing bubbles playing music i can remember vividly um a little boy that we had it's been a couple years ago who really loved bruno mars right we all like a little bruno um so bruno mars we partied in his room with bruno mars right if he had to get blood draws that's what the nurses were playing that's what they were singing and dancing to right it was a distraction method for that child and it worked geniusly [Music] all right so let's look at what happens before the procedure we've got um a task to do we have a child patient what are we going to do to help with a traumatic care before the procedure the first thing we want to think about is decreasing anxiety whose anxiety are we decreasing right we're decreasing the child's anxiety and the family's anxiety when we have a child patient it is not just the child we are taking care of we are taking care of the entire family so decreasing anxiety both with the child and the family we want to promote the child's cooperation um that can come in explaining what's going to happen educating what's going to happen right again we've got to be aware of the developmental stage of our child i'm talking to a three-month-old it's going to be a lot different than talking to a three-year-old which is going to be a lot different than talking to a 13 year old so where are they at developmentally and how can we promote their cooperation with whatever we need we want to support the family we want to improve coping skills talk through those coping skills that might help we want to improve recovery implementing interventions that are going to help with that and we are always always building that trusting relationship with our patients and building that nurse patient rapport when we think about during the procedure we want to use a firm confident and positive approach it really gives that family a sense of security you're going to go into a pediatric patient's room and it may be the first time you've placed an ng tube on a real patient right we've done it in lab but this might be the first time you actually have a real human sitting in front of you go in firm go in confidently and you're gonna have the sense of security from that family allow the child to express any anxiety or feelings right they need to express those emotions this might be their way of communicating and coping if you meet resistance from our toddlers and our preschool schoolers which you probably will it doesn't matter how much you prep them um they're gonna resist you um you may have to use some alternative methods um if you are unable to be able to perform your task being held down or restrained is very traumatizing so make sure we're doing every possible um a traumatic care that we can before we have to resort to that and then older children destruction can be very helpful during the procedure after the procedure um hopefully mom and dad are the caretaker there and they can hold and comfort that child they can cuddle or sue that baby if they aren't um that's when that nurse can maybe step in and do those things um distract with a toy or a puppet can help with play especially if it's seven eight nine year olds right um that might distract them from the emotionals or the emotions that they're feeling um we can provide older child to express those feelings especially if they want to be comforted a lot of times our 13 14 year olds need that comfort even though they're older they still need to have those feelings um expressed and comforted and always remember to praise the child regardless of the response that they have given you so general guidelines any invasive procedure should be performed in a treatment room not in that child's room the child's room should remain a safe and secure area right they sleep there they eat there they go the bathroom in there um so that space needs to be safe so if we're doing something very traumatic we need to take them out of that safe space so that when they come back into that room it still feels like a safe space all right let's talk a little bit about family centered care um right this is a partnership between the child the family and the health care team family-centered care enhances confidence in the caregiver and helps prepare that child to assume responsibility for some of their own care needs so where does this start it starts with these core principles we have to respect the child and the family they may not always choose the choices you or i would choose but we have to respect the choices that they do make if they have any cultural racial or ethnic diversities we need to recognize those and make sure that we're meeting those those care experiences to what they are choosing to do we want to identify and expand on any of the family strengths this is really pertinent information if we see a strength we want to identify it and then we want to expand on it remember we're supporting those family choices um we're maintaining some flexibility um we are educating them right that empowers them um with education honest unbiased information in an affirming useful approach we want to assist with any emotional or other supports collaborate with families and then empower those families and education is the best way to do that so if we have really good family centered care there's lots of positive outcomes that can come from that anxiety is decreased children are calmer and their pain management is usually enhanced recovery times are shorter families become more confident with their problem solving skills communication between the health care team and the family is improved there's decrease in our health care costs and health care resources are used more effectively so family centered care is very vital for these positive outcomes so the another the second um principle or another principle of a traumatic hair is that sense of control again remember if you or i have ever been hospitalized there's been a couple of times i've been hospitalized and you do feel like you lose a lot of your own sense of control um so patients and family can experience an extreme sense of loss so how do we give some of that back we can provide effective communication through education and obtaining necessary information and resources effective communication is critical in a traumatic care it's the foundation of that nurse patient relationship if you've never had the opportunity to talk to children it can be very challenging but getting on that child's level eye to eye letting them warm up to you especially if they are shy and incorporating play can help them feel more at ease find a balance between neutral and effective communication remember verbals and nonverbals are both forms of communication so being aware of your non-verbals um use developmental techniques for communicating with children and then again assess that parent and child's learning needs education can enhance and empower which gives that family and that child back a lot of their control some specific learning principles that are related to children these are pretty um self-explanatory establish the rapport right with your child that's the first step we've got to establish that trusting nurse patient relationship agent developmental levels are going to come into play create a teaching plan that addresses those developmental stages of that child adolescents are particularly sensitive about maintaining that body image and we'll talk a lot about that next week so making sure that we remember that body image is huge for that adolescence that control and that autonomy are also two very key things with adolescence so how do we improve learning um we can use several different techniques we want to make sure we slow down and repeat information often i feel like nurses get on this quick quick quick like we're running around right and sometimes we just need to slow down we need to slow down and repeat information often for some of those parents make sure we're sitting down with the patient and the family because remember they're in a foreign setting um so listening is going to be maybe the last thing they're doing um so speak in a conversational style plain language layman terms don't use all of the medical jargon um you can chunk information um and teach it in small bites um don't plan to go in and do a 30 to 45 minute conversation um about ng feeds or um picc line antibiotics um right we might need to choke that information so that they get the most important things first and that's that next point prioritizing information and giving the most important things first use of visuals can be huge drawing pictures printing x-rays that can really help solidify some information teaching using interactive hands-on approach a lot of times that's that teach-back we teach them something and then we have them show us back using that hands-on approach um teach using demonstration return demonstration and teach back or tell back a lot of times in discharge that's a great way um what questions do you have what did you understand from the discharge so that they're telling it back to you and then we want to evaluate the learning um can they demonstrate this skill so at children's we do pcu which is just that patient um centered care really um we kind of tell the parent you're really in charge you pretend like you're at home we're just here as a backup for questions um but they have to actually be able to demonstrate all of the skills so that we know they're going to be capable of doing it at home the child or family repeats back or teaches back the information in their own words that's a really good evaluation the child or family answers open-ended questions or the child and family responds to a pretend scenario in their own home so you can give a scenario so if you get home and your child pulls out their ng tube what is the first thing that you want to do right give them some scenarios and then i think a lot of times nurses forget to document teaching you should always document your education right if you don't document your education and that family comes back in three days and says oh nobody told me that right if it's not documented then it's not done right so make sure you are documenting everything that you teach um what were the goals of the child education did that goal get met what teaching method did you use did you talk about medications did you talk about diets or nutritional needs medical equipment follow-up care right we want to document all of that so that we can say we have told the parent all of this information so when they come back and have questions we can just reiterate what has previously been taught and that concludes chapter 30. if you have any questions we will chat a little bit about this chapter in class and you can bring those questions to class thanks guys