Impact of Child Life in the Emergency Department – A Nurses Story
Written by Abdiel Nieves, RN, St. Paul Emergency Department
This February, I had a patient case that really highlights the importance of Child Life in aiding holistic patient care. I was the nurse for a two-year old female who was rushed back in the emergency room who had fallen with trauma to the head. This patient presented with increased fussiness, unsteady gait, and behavioral changes. The patient was inconsolable and the parents almost just as much. After evaluation, a Computer Tomography (CT) scan of the head was ordered by the MD and agreed upon with the care team to rule out a bleed or any other serious acute trauma related condition.
After the first attempt in the CT room to console the toddler failed, we went back to the room. The doctor discussed bringing in Child Life with the parents in place of the use of sedation. Partial sedation would absolutely work in this case to allow for the CT. The allure of sedation is that it will calm the child long enough to go through the CT. However, it is not the preferred method in this case because it can also mask the already present neurological symptoms and make a serious head injury harder to diagnose.
At this point, both parents were so anxious they began to argue amongst each other. Meanwhile, the toddler was still inconsolable. The Child Life Specialist came in and brought age-appropriate toys and distractions to help sooth the child. The child was very engaged with the Elsa doll that the Child Life Specialist used to aid in explaining the CT procedure. Everything from the Child Life Specialist’s choice of words to demeanor seemed to help not only the child, but also the parents; it seemed to be all-inclusive. Once the parents started feeling like part of the team, they were more engaged in helping to assist the specialist in the demonstration.
Once the child was what appeared to be calm enough to go through CT, we decided to go back to the CT room and attempt again. However, once the patient saw the CT “tube” she again was unable to stay still long enough for the CT. At this point, I prepared the medicine for sedation to quickly achieve results. One of the parents however was very concerned and emotional about sedating her while the other parent was on board. With this division, I did not feel comfortable sedating the child. The specialist then brought in an iPad with a visually stimulating and immersive program that allowed this child to be distracted just long enough to lay completely still for the CT to be completed.
Many would think that it sounds easy enough to simply bring an iPad and distract the child for a few seconds to complete the imaging. However, there is so much more involved than that. Imagine a two year old child already scared and bringing them to a dark room with a giant hamster tube. Now also imagine taking the child away from both parents and strapping the child down with a head band and velcro around the waist to keep the child in position, even calmly explaining at this point would still cause increased fear to say the least. Then finally the giant hamster tube begins to make a loud noise and begins to move. All of this sets up for a very difficult situation that without the tools, knowledge, and quick thinking by the Child Life Specialists would have made this situation so much more difficult in the end.
There are most certainly situations where time is more critical and chemical sedation would not only be quicker but also the preferred method. However, the majority of the time procedures become very difficult because children cannot contain fears and rationalize the way adults can. Clinicians often do not have the available time or resources to use techniques that could calm a child. However, when Child Life Specialists, as in this case, are available they help us incorporate the holistic care approach we are taught to implement.