WEBVTT 00:00:06.059 --> 00:00:09.800 Welcome to the bed. We'll go ahead and give you 00:00:09.800 --> 00:00:12.580 the story. This is all going to happen super 00:00:12.580 --> 00:00:47.049 fast. Welcome to the emergency room. All right, 00:00:47.070 --> 00:00:48.390 let's do this. I want you to close your eyes 00:00:48.390 --> 00:00:51.149 for a second. When you picture pediatric nursing, 00:00:51.829 --> 00:00:54.590 what is the first thing that pops into your head? 00:00:54.810 --> 00:00:58.310 Be honest. Usually. It's kind of the Hollywood 00:00:58.310 --> 00:01:00.890 version. The cute patterned scrubs with cartoons 00:01:00.890 --> 00:01:02.810 on them. Maybe you've got a sticker collection 00:01:02.810 --> 00:01:05.829 in your pocket. Giving a brave kid a lollipop 00:01:05.829 --> 00:01:09.269 after a shot. It looks soft. It looks easy. Yeah, 00:01:09.409 --> 00:01:12.109 easy. Right. It's the soft side of nursing. But 00:01:12.109 --> 00:01:15.189 when we actually dig into the literature, and 00:01:15.189 --> 00:01:17.290 specifically this heavy hitter chapter we were 00:01:17.290 --> 00:01:20.450 looking at today on atraumatic care, you realize 00:01:20.450 --> 00:01:24.109 pretty quickly that the sticker and the lollipop 00:01:24.750 --> 00:01:27.170 They're just the tip of a very, very complex 00:01:27.170 --> 00:01:29.310 iceberg. Oh, absolutely. I mean, there is a massive 00:01:29.310 --> 00:01:31.689 clinical chasm between just being nice to a kid 00:01:31.689 --> 00:01:34.989 and practicing evidence -based atraumatic care. 00:01:35.170 --> 00:01:37.349 Absolutely. And the stakes are just incredibly 00:01:37.349 --> 00:01:40.349 high. It is literally the difference between 00:01:40.349 --> 00:01:43.590 a child who is traumatized by a simple procedure. 00:01:43.870 --> 00:01:46.069 We're talking screaming, fighting, requiring 00:01:46.069 --> 00:01:48.650 three adults to hold them down. versus a child 00:01:48.650 --> 00:01:51.909 who actually copes successfully and walks away 00:01:51.909 --> 00:01:54.209 with their dignity intact. And that is exactly 00:01:54.209 --> 00:01:57.030 what we are unpacking today. This concept of 00:01:57.030 --> 00:01:59.390 atraumatic care isn't just a buzzword. I mean, 00:01:59.510 --> 00:02:01.769 the source material calls it the prime directive 00:02:01.769 --> 00:02:04.269 of pediatric nursing. It's almost like the first 00:02:04.269 --> 00:02:08.330 do no harm principle. but specifically calibrated 00:02:08.330 --> 00:02:11.550 for a developing brain that has zero context 00:02:11.550 --> 00:02:14.530 for why a stranger in blue pajamas is coming 00:02:14.530 --> 00:02:16.849 at them with a sharp object. That's a perfect 00:02:16.849 --> 00:02:18.849 way to frame it, yeah. And for our listeners 00:02:18.849 --> 00:02:20.949 today, our learners, you know, whether you are 00:02:20.949 --> 00:02:23.949 a nursing student just sweating over NCLEX prep 00:02:23.949 --> 00:02:26.870 or a new grad stepping onto the PEDS floor for 00:02:26.870 --> 00:02:29.610 the first time, our mission today is really specific. 00:02:29.830 --> 00:02:31.830 We're going to strip away the fluff. We are looking 00:02:31.830 --> 00:02:33.889 at this chapter through the lens of the 80 -20 00:02:33.889 --> 00:02:36.840 rule. We want to identify that 20 % of the information 00:02:36.840 --> 00:02:38.699 that is going to help you answer 80 % of the 00:02:38.699 --> 00:02:41.319 exam questions, and frankly, solve 80 % of the 00:02:41.319 --> 00:02:42.740 problems you'll face in practice when it comes 00:02:42.740 --> 00:02:45.319 to communication, safety, and procedural prep. 00:02:45.639 --> 00:02:47.479 And we've got a stack of notes here from the 00:02:47.479 --> 00:02:51.180 source text really focusing on preventing stressors, 00:02:51.639 --> 00:02:53.500 the nuance of communication across different 00:02:53.500 --> 00:02:56.620 developmental stages, which is huge. And of course, 00:02:56.719 --> 00:02:59.960 the critical piece of family education. OK, so. 00:03:00.740 --> 00:03:02.460 Let's jump right in with the foundation. What 00:03:02.460 --> 00:03:06.199 is the actual textbook definition of atraumatic 00:03:06.199 --> 00:03:08.000 care we are working with here? Because I think 00:03:08.000 --> 00:03:11.039 people assume it just means painless, but it 00:03:11.039 --> 00:03:12.860 seems to be much more comprehensive than that. 00:03:13.039 --> 00:03:16.080 It is significantly broader. So the text defines 00:03:16.080 --> 00:03:19.740 ashramatic care as therapeutic care that minimizes 00:03:19.740 --> 00:03:21.979 or eliminates the psychological and physical 00:03:21.979 --> 00:03:24.560 distress experienced by children and their families. 00:03:26.020 --> 00:03:28.139 And I really need to highlight that last part. 00:03:28.919 --> 00:03:31.240 Families. Because in PEDS, you never just have 00:03:31.240 --> 00:03:33.840 one patient. You have a unit. Exactly. You cannot 00:03:33.840 --> 00:03:36.060 treat the child in a vacuum. It's a package deal. 00:03:36.479 --> 00:03:39.039 If the parent is spiraling, the child is spiraling. 00:03:39.599 --> 00:03:42.139 We often say anxiety is contagious in a pediatric 00:03:42.139 --> 00:03:44.539 room. So the text breaks this down into a framework. 00:03:44.599 --> 00:03:47.240 It's not just be nice. There are three specific 00:03:47.240 --> 00:03:49.639 principles listed in box 8 .1 that kind of act 00:03:49.639 --> 00:03:51.780 as your compass. Okay, let's drill down on these. 00:03:52.060 --> 00:03:54.240 If I'm taking notes right now, what are my three 00:03:54.240 --> 00:03:56.819 pillars? Okay, so pillar number one, prevent 00:03:56.819 --> 00:03:59.319 or minimize physical stressors. So that's the 00:03:59.319 --> 00:04:01.780 pain piece, right? Pain, yes, but it's more than 00:04:01.780 --> 00:04:05.280 just, you know, nociception. It includes sleeplessness, 00:04:05.560 --> 00:04:08.979 immobility, loud noises, or even just the inability 00:04:08.979 --> 00:04:13.409 to eat or drink. NPO status is a huge physical 00:04:13.409 --> 00:04:15.990 stressor for a child. Anything that physically 00:04:15.990 --> 00:04:19.189 taxes the body or just disrupts their physiologic 00:04:19.189 --> 00:04:21.829 norm. Got it. Okay. What's number two? Number 00:04:21.829 --> 00:04:25.550 two is prevent or minimize parent -child separation. 00:04:25.870 --> 00:04:27.790 This ties directly into that whole philosophy 00:04:27.790 --> 00:04:30.350 of family -centered care. And this seems so obvious 00:04:30.350 --> 00:04:33.189 now, but historically... This really wasn't the 00:04:33.189 --> 00:04:34.930 case, was it? I mean, I've heard horror stories 00:04:34.930 --> 00:04:37.449 from decades ago. Oh, not at all. In the old 00:04:37.449 --> 00:04:39.389 days of nursing, and we're not talking ancient 00:04:39.389 --> 00:04:42.350 history here, maybe 30 or 40 years ago, parents 00:04:42.350 --> 00:04:44.350 were routinely asked to leave the room during 00:04:44.350 --> 00:04:46.750 procedures. The thinking was that the child would 00:04:46.750 --> 00:04:49.389 behave better without an audience. It was very 00:04:49.389 --> 00:04:51.870 paternalistic. And the data now just tells us 00:04:51.870 --> 00:04:54.930 that is usually the absolute wrong move. Separation 00:04:54.930 --> 00:04:57.170 anxiety is a massive stressor, and it's often 00:04:57.170 --> 00:04:59.550 worse than the pain itself. Wow. So keeping them 00:04:59.550 --> 00:05:01.509 together is actually a clinical priority, not 00:05:01.509 --> 00:05:04.560 just just a courtesy. And the third pillar. Promote 00:05:04.560 --> 00:05:07.720 a sense of control. I mean, think about it. Hospitals 00:05:07.720 --> 00:05:10.040 are control stripping environments by design. 00:05:10.420 --> 00:05:12.399 You eat when we say, you sleep when we say, you 00:05:12.399 --> 00:05:14.819 get poked when we say, you wear this gown that 00:05:14.819 --> 00:05:17.910 opens in the back. For a child who is just learning 00:05:17.910 --> 00:05:21.189 autonomy, this is devastating. So, asthmatic 00:05:21.189 --> 00:05:23.970 care means aggressively giving that control back 00:05:23.970 --> 00:05:26.810 wherever possible, respecting rituals, giving 00:05:26.810 --> 00:05:29.189 choices, protecting privacy. I want to pause 00:05:29.189 --> 00:05:31.110 on that because this feels like a massive hack 00:05:31.110 --> 00:05:33.790 for answering test questions. I call it the Pareto 00:05:33.790 --> 00:05:36.269 Principle application here. If you get a tough 00:05:36.269 --> 00:05:38.819 scenario question like... Why is the nurse allowing 00:05:38.819 --> 00:05:40.800 the mother to hold a child's hand during the 00:05:40.800 --> 00:05:43.660 IV start? Or why are we asking the child which 00:05:43.660 --> 00:05:46.540 arm they want the blood pressure cuff on? The 00:05:46.540 --> 00:05:48.620 rationale almost always maps back to one of these 00:05:48.620 --> 00:05:51.139 three things. That's a great strategy. It really 00:05:51.139 --> 00:05:53.420 is. If you are stuck on a question, stop and 00:05:53.420 --> 00:05:55.800 ask yourself, does this answer choice support 00:05:55.800 --> 00:05:58.079 the parent staying? Does it give the child a 00:05:58.079 --> 00:06:00.300 choice? Does it reduce physical pain or discomfort? 00:06:00.939 --> 00:06:03.879 If the answer is yes, statistically, it is very 00:06:03.879 --> 00:06:06.279 likely the correct answer. The exam wants to 00:06:06.279 --> 00:06:08.319 see that you prioritize the child's emotional 00:06:08.319 --> 00:06:10.800 safety as much as their physical safety. So let's 00:06:10.800 --> 00:06:13.720 get specific on that first pillar, managing physical 00:06:13.720 --> 00:06:16.060 stress. Because the text brings up something 00:06:16.060 --> 00:06:18.180 that I think is a huge light bulb moment for 00:06:18.180 --> 00:06:20.720 a lot of students about how we physically handle 00:06:20.720 --> 00:06:24.939 children, the restraint trap. Yes. This is so 00:06:24.939 --> 00:06:27.759 critical because it addresses a practice that 00:06:27.759 --> 00:06:30.420 was standard for decades, but is now, you know, 00:06:30.600 --> 00:06:33.500 recognized as potentially harmful. Historically, 00:06:33.600 --> 00:06:36.579 if a child needed stitches or an IV, you'd have 00:06:36.579 --> 00:06:39.040 what was effectively a papoose board, which is 00:06:39.040 --> 00:06:41.060 exactly what it sounds like, a rigid board with 00:06:41.060 --> 00:06:43.759 Velcro straps. Oh, wow. Or you'd have three adults 00:06:43.759 --> 00:06:45.800 just holding the child down flat on the bed. 00:06:46.300 --> 00:06:48.180 Which, if you think about it from the child's 00:06:48.180 --> 00:06:51.660 perspective, is terrifying. I mean, being overpowered 00:06:51.660 --> 00:06:54.399 by giants, it's like an abduction scenario. It 00:06:54.399 --> 00:06:57.920 induces panic. And physiologically, panic increases 00:06:57.920 --> 00:07:00.699 heart rate. It increases vasoconstriction and 00:07:00.699 --> 00:07:02.980 muscle tension, which actually makes finding 00:07:02.980 --> 00:07:06.399 a vein harder, and it just burns trust. The source 00:07:06.399 --> 00:07:08.699 material here pushes very, very hard for a different 00:07:08.699 --> 00:07:11.579 concept called therapeutic hugging. I love that 00:07:11.579 --> 00:07:14.079 term. It sounds soft, but it's actually clinical 00:07:14.079 --> 00:07:16.560 technique, right? This isn't just cuddling. No, 00:07:16.560 --> 00:07:19.000 not at all. It is a defined clinical intervention. 00:07:19.180 --> 00:07:22.060 It's a holding position, usually chest to chest 00:07:22.060 --> 00:07:25.000 or sitting on a lap, that provides close physical 00:07:24.839 --> 00:07:27.879 while still securing the limbs necessary for 00:07:27.879 --> 00:07:31.079 the procedure. Figure 8 .1 in the text illustrates 00:07:31.079 --> 00:07:32.759 this beautifully. So instead of pinning them 00:07:32.759 --> 00:07:35.120 to the bed, the child is sitting up, maybe even 00:07:35.120 --> 00:07:37.740 engaging with the parent. Right, exactly. So 00:07:37.740 --> 00:07:40.019 for an injection, the child sits on the parent's 00:07:40.019 --> 00:07:42.379 lap. The parent hugs the child's upper body and 00:07:42.379 --> 00:07:44.899 secures the free arm while maybe trapping the 00:07:44.899 --> 00:07:47.160 child's legs between their own legs. The goal 00:07:47.160 --> 00:07:49.420 is to replace holding down with holding close. 00:07:49.860 --> 00:07:51.860 You're leveraging the parent's body as a source 00:07:51.860 --> 00:07:54.759 of comfort, not as a restraint mechanism. And 00:07:54.759 --> 00:07:56.480 here's where it gets really, really interesting 00:07:56.480 --> 00:07:59.500 for the exam and for practice. there's a specific 00:07:59.500 --> 00:08:02.199 trap regarding the parent's role in this. Because 00:08:02.199 --> 00:08:04.819 you might think, great, mom is there, she can 00:08:04.819 --> 00:08:08.000 hold the arm down. Correct. And that is the NCLEX 00:08:08.000 --> 00:08:11.439 trap. You should never ask a parent to restrain 00:08:11.439 --> 00:08:14.279 their child. Wait, really? Even if they are right 00:08:14.279 --> 00:08:16.180 there and they're willing, even if they say, 00:08:16.339 --> 00:08:18.560 I've got him. Even if they are right there, you 00:08:18.560 --> 00:08:20.560 have to understand the psychology of the parent 00:08:20.560 --> 00:08:23.980 -child bond. The parent is the safe base. They 00:08:23.980 --> 00:08:27.379 are for comfort, protection, and holding. If 00:08:27.379 --> 00:08:29.920 the child needs to be firmly secured for a painful 00:08:29.920 --> 00:08:32.879 procedure and it requires force that might cause 00:08:32.879 --> 00:08:35.779 the parent distress, the nurse or another staff 00:08:35.779 --> 00:08:38.500 member should do the securing. Why is that distinction 00:08:38.500 --> 00:08:40.980 so important? Because you don't want the child 00:08:40.980 --> 00:08:43.279 associating the parent with the force being used 00:08:43.279 --> 00:08:45.720 against them. If mom is holding me down while 00:08:45.720 --> 00:08:48.019 I'm in pain, mom becomes part of the trauma. 00:08:48.580 --> 00:08:50.500 The parent's job is to whisper in their ear, 00:08:50.620 --> 00:08:52.879 hold their hand, distract them, and be the comforter 00:08:52.879 --> 00:08:55.659 immediately after. The nurse is the bad guy in 00:08:55.659 --> 00:08:57.580 that moment, if necessary, so the parent can 00:08:57.580 --> 00:09:00.259 remain the hero. That is such a crucial distinction. 00:09:00.519 --> 00:09:04.340 Parents' comfort, nurses' secure. But the text 00:09:04.340 --> 00:09:07.179 mentions another player in this game who is basically 00:09:07.179 --> 00:09:11.100 the MVP of atraumatic care, the Child Life Specialist, 00:09:11.259 --> 00:09:14.460 or CLS. Oh yes. If you see Child Life Specialist 00:09:14.460 --> 00:09:16.740 as an option on an exam question, you should 00:09:16.740 --> 00:09:19.539 strongly consider picking it. The text describes 00:09:19.539 --> 00:09:22.240 them as a quality benchmark of pediatric care. 00:09:22.379 --> 00:09:24.159 I think there's a misconception that they are 00:09:24.159 --> 00:09:26.779 just the play ladies or play guys who bring the 00:09:26.779 --> 00:09:28.980 iPad or the coloring books. It's a huge misconception. 00:09:29.120 --> 00:09:31.440 They are clinicians. They are trained in developmental 00:09:31.440 --> 00:09:33.840 psychology and the impact of illness on children. 00:09:34.340 --> 00:09:37.019 They provide non -medical preparation, advocacy, 00:09:37.279 --> 00:09:40.179 and therapeutic play. They bridge the gap between 00:09:40.179 --> 00:09:42.639 the scary medical world and the child's world. 00:09:43.000 --> 00:09:44.659 So if I have a six -year -old who is absolutely 00:09:44.659 --> 00:09:47.019 terrified of an upcoming surgery, I'm not just 00:09:47.019 --> 00:09:49.950 winging it. I'm calling the CLS. Exactly. They 00:09:49.950 --> 00:09:53.450 have tools you don't have. They can use anatomical 00:09:53.450 --> 00:09:55.789 dolls to show what an IV looks like. They can 00:09:55.789 --> 00:09:58.490 take the child on a tour of the OR to demystify 00:09:58.490 --> 00:10:01.210 the room. They can advocate for the child's needs 00:10:01.210 --> 00:10:04.490 during the procedure. The takeaway here is utilize 00:10:04.490 --> 00:10:07.289 them. It's an interdisciplinary team, and the 00:10:07.289 --> 00:10:10.049 CLS is the expert in coping. OK, moving on to 00:10:10.049 --> 00:10:11.850 what I think is really the meat and potatoes 00:10:11.850 --> 00:10:16.029 of this deep dive. Section three. Communication 00:10:16.029 --> 00:10:19.350 and preparation by age. Because let's be honest, 00:10:19.450 --> 00:10:21.629 how you talk to a two -year -old is completely 00:10:21.629 --> 00:10:24.470 useless if you try that same strategy on a 12 00:10:24.470 --> 00:10:26.669 -year -old. It's worse than useless. It can be 00:10:26.669 --> 00:10:29.509 detrimental. You absolutely have to match your 00:10:29.509 --> 00:10:32.110 communication to their developmental stage. This 00:10:32.110 --> 00:10:34.009 is where those questions about which statement 00:10:34.009 --> 00:10:36.110 by the nurse is appropriate come from on the 00:10:36.110 --> 00:10:37.850 boards. And this is where we can really lean 00:10:37.850 --> 00:10:39.769 on those developmental theories, you know, Piaget 00:10:39.769 --> 00:10:41.389 and Erickson, that are usually running in the 00:10:41.389 --> 00:10:43.110 background of these chapters. So let's break 00:10:43.110 --> 00:10:45.419 it down chronological order. starting with infant's 00:10:45.419 --> 00:10:48.179 birth to one year. They can't understand your 00:10:48.179 --> 00:10:49.820 explanation of a procedure. They don't know what 00:10:49.820 --> 00:10:52.480 a needle is, so what matters? It's all about 00:10:52.480 --> 00:10:56.519 sensory input, touch, sight, hearing. The text 00:10:56.519 --> 00:10:59.480 emphasizes soft vocal tones, cuddling, rocking, 00:10:59.879 --> 00:11:02.980 singing. From an Erickson standpoint, this is 00:11:02.980 --> 00:11:05.779 the trust versus mistrust stage. Everything we 00:11:05.779 --> 00:11:07.740 do should reinforce that the world is a safe 00:11:07.740 --> 00:11:11.269 place. But there's a key safety tip here regarding 00:11:11.269 --> 00:11:13.690 the stranger anxiety. Oh, right. That kicks in 00:11:13.690 --> 00:11:15.490 around six to eight months, usually. Exactly. 00:11:15.809 --> 00:11:17.769 Before about six months, they're usually pretty 00:11:17.769 --> 00:11:20.629 chill with whoever holds them. But once stranger 00:11:20.629 --> 00:11:23.009 anxiety hits, if you just walk in and immediately 00:11:23.009 --> 00:11:25.210 swoop down to pick up a nine -month -old, you're 00:11:25.210 --> 00:11:27.429 going to trigger a meltdown. So what's the play? 00:11:27.509 --> 00:11:29.669 How do you assess a baby who hates your face? 00:11:30.090 --> 00:11:33.269 The strategy is talk to the parent first. Keep 00:11:33.269 --> 00:11:35.509 your distance initially. Let the baby watch you 00:11:35.509 --> 00:11:37.610 interact safely with the parent. Stand at the 00:11:37.610 --> 00:11:40.549 doorway, use a soft voice. Once the baby sees 00:11:40.549 --> 00:11:42.850 mom trusts this person, mom is smiling at this 00:11:42.850 --> 00:11:44.889 person, they will take their cue from the parent 00:11:44.889 --> 00:11:47.269 and warm up. That's the warm up period. Essential. 00:11:47.649 --> 00:11:50.289 OK, moving up to the chaos agents. Toddlers, 00:11:50.409 --> 00:11:52.570 one to three years, and preschoolers, three to 00:11:52.570 --> 00:11:56.990 five. This is a fun group, but tricky. Very tricky. 00:11:58.009 --> 00:12:00.029 Cognitively, this is where Piaget calls them 00:12:00.029 --> 00:12:03.539 egocentric. They see the world entirely from 00:12:03.539 --> 00:12:06.019 their own perspective. They can't view things 00:12:06.019 --> 00:12:08.620 from another person's point of view. If their 00:12:08.620 --> 00:12:10.620 eyes are closed, they genuinely think you can't 00:12:10.620 --> 00:12:13.240 see them. And they interpret things so literally. 00:12:13.379 --> 00:12:15.220 And we'll definitely get to the vocabulary in 00:12:15.220 --> 00:12:17.500 a minute. Right. And they engage in what we call 00:12:17.500 --> 00:12:20.200 magical thinking. So they might think their illness 00:12:20.200 --> 00:12:24.120 is a punishment for being bad. Reassurance is 00:12:24.120 --> 00:12:27.000 absolutely key. So how do we prep them? If I 00:12:27.000 --> 00:12:28.899 have to do a dressing change on a three -year 00:12:28.899 --> 00:12:32.059 -old, what am I doing? For toddlers, you want 00:12:32.059 --> 00:12:34.720 to use parallel play. They might not play with 00:12:34.720 --> 00:12:37.080 you, but they'll play next to you. So you start 00:12:37.080 --> 00:12:39.740 playing with a toy near them. For preschoolers, 00:12:39.799 --> 00:12:42.440 you can use puppets or storytelling. But the 00:12:42.440 --> 00:12:44.360 high -yield fact here, the one you absolutely 00:12:44.360 --> 00:12:46.940 need to memorize, is the timing of the preparation. 00:12:47.200 --> 00:12:49.679 This is a classic test question. When do I tell 00:12:49.679 --> 00:12:51.879 a two -year -old they're getting a shot? For 00:12:51.879 --> 00:12:54.240 a toddler, immediately beforehand. Immediately? 00:12:54.320 --> 00:12:58.600 Yes. Their concept of time is basically non -existent. 00:12:58.799 --> 00:13:00.440 If you tell them in the morning, you're getting 00:13:00.440 --> 00:13:03.159 a shot this afternoon, you have just condemned 00:13:03.159 --> 00:13:05.340 them to hours of anxiety they can't process. 00:13:05.440 --> 00:13:07.019 They will act out. They won't eat. They will 00:13:07.019 --> 00:13:09.139 cry. You tell them right as you are about to 00:13:09.139 --> 00:13:12.379 do it. And for preschoolers, a little different. 00:13:12.480 --> 00:13:14.559 You can give them a little more runway about 00:13:14.559 --> 00:13:17.720 one hour prior. It's just enough time to process, 00:13:17.879 --> 00:13:20.220 maybe play it out with a doll, ask a question, 00:13:20.600 --> 00:13:22.960 but not enough time to stew on it all day. Control 00:13:22.960 --> 00:13:25.399 is big here, too. Right. Because toddlers are 00:13:25.399 --> 00:13:28.480 all about autonomy. That Me Do It stage. Huge. 00:13:28.799 --> 00:13:30.759 But it has to be a valid choice. This is the 00:13:30.759 --> 00:13:33.779 classic Ricky mistake. Asking a toddler, can 00:13:33.779 --> 00:13:36.080 I check your blood pressure now? Because they 00:13:36.080 --> 00:13:38.779 will say no. Every single time. And then what? 00:13:38.899 --> 00:13:41.000 You have to do it anyway, and you've just broken 00:13:41.000 --> 00:13:43.179 trust. You made them think they had a choice, 00:13:43.259 --> 00:13:45.500 and then you overruled them. So how do we frame 00:13:45.500 --> 00:13:47.879 it then? The correct approach is, do you want 00:13:47.879 --> 00:13:50.080 the blue cuff or the red cuff? Or do you want 00:13:50.080 --> 00:13:52.700 to sit on mom's lap or the chair? You give them 00:13:52.700 --> 00:13:55.940 a choice where the outcome, the procedure, is 00:13:55.940 --> 00:13:58.720 not up for negotiation, but the method is. I 00:13:58.720 --> 00:14:00.700 love that. Do you want the blue Band -Aid or 00:14:00.700 --> 00:14:04.509 the red one? It seems so small to us, but for 00:14:04.509 --> 00:14:06.590 a three -year -old, that's their whole world. 00:14:06.750 --> 00:14:08.950 They control the band -aid. Exactly. It turns 00:14:08.950 --> 00:14:12.350 a violation into a collaboration. And it fulfills 00:14:12.350 --> 00:14:15.590 that Eric's in need for autonomy versus shame 00:14:15.590 --> 00:14:18.350 and doubt. Okay. Graduating to school -age kids, 00:14:19.049 --> 00:14:21.350 six to 12 years. This is where they start to 00:14:21.350 --> 00:14:24.950 get a bit more logical. Now we see a shift. Cognitively, 00:14:24.950 --> 00:14:27.309 they're interested in the why and the how. They 00:14:27.309 --> 00:14:29.429 want to know how things work. They are in that 00:14:29.429 --> 00:14:31.750 industry versus inferiority stage. They want 00:14:31.750 --> 00:14:33.629 to master things. They want to know what the 00:14:33.629 --> 00:14:35.610 blood pressure cuff does. So this is where we 00:14:35.610 --> 00:14:38.950 can pull out the diagrams. Yes. Diagrams, illustrations, 00:14:39.110 --> 00:14:41.450 videos. Show them the equipment. Let them touch 00:14:41.450 --> 00:14:44.509 the stethoscope. Demystify the tools. They are 00:14:44.509 --> 00:14:47.110 also very responsive to third party stories. 00:14:47.549 --> 00:14:49.169 What does that look like? So you can say something 00:14:49.169 --> 00:14:51.210 like, some children tell me this feels like a 00:14:51.210 --> 00:14:53.590 pinch, but then it goes away. It validates their 00:14:53.590 --> 00:14:55.570 fear without telling them exactly how they have 00:14:55.570 --> 00:14:58.750 to feel. It normalizes the experience. It helps 00:14:58.750 --> 00:15:00.649 them feel like they aren't the only one who has 00:15:00.649 --> 00:15:03.389 ever had to do this. And timing for prep here. 00:15:03.710 --> 00:15:05.950 A few days in advance, they have a better concept 00:15:05.950 --> 00:15:08.450 of time. They need a few days to think about 00:15:08.450 --> 00:15:11.470 it, ask questions, and mentally prepare. Okay, 00:15:11.570 --> 00:15:14.929 and finally, adolescence. The 13 to 18 crowd, 00:15:15.429 --> 00:15:18.190 this can be a tough crowd to win over. The priority 00:15:18.190 --> 00:15:20.710 here shifts completely to psychosocial needs. 00:15:21.160 --> 00:15:24.559 privacy, body image, and independence. This is 00:15:24.559 --> 00:15:27.659 Erickson's identity versus role confusion. They 00:15:27.659 --> 00:15:29.679 are trying to figure out who they are separate 00:15:29.679 --> 00:15:31.399 from their parents. You need to talk to them 00:15:31.399 --> 00:15:34.860 like adults, respect confidentiality, and realize 00:15:34.860 --> 00:15:37.559 their peer group is, well, everything. And what 00:15:37.559 --> 00:15:39.120 about parents being in the room? The 15 -year 00:15:39.120 --> 00:15:41.139 -old, that dynamic totally changes. You should 00:15:41.139 --> 00:15:43.440 offer the choice. Do you want your mom to stay 00:15:43.440 --> 00:15:45.440 for the exam, or would you prefer she step out? 00:15:45.980 --> 00:15:48.080 Given the autonomy, they might want mom there 00:15:48.080 --> 00:15:50.179 but are too embarrassed to ask, or they might 00:15:50.179 --> 00:15:51.919 desperately want her out so they can ask you 00:15:51.919 --> 00:15:54.320 a private question. And prep can be up to a week 00:15:54.320 --> 00:15:56.639 prior. Yes. You can treat them as partners in 00:15:56.639 --> 00:15:58.779 the decision -making. Explain the long -term 00:15:58.779 --> 00:16:01.179 benefits. Engage their abstract thinking skills. 00:16:01.500 --> 00:16:03.620 There's a note in the text here about regression 00:16:03.620 --> 00:16:05.720 that I think is worth flagging before we move 00:16:05.720 --> 00:16:07.919 on, because parents freak out about this. Oh 00:16:07.919 --> 00:16:11.200 yeah. Regression is a defense mechanism. It's 00:16:11.200 --> 00:16:14.039 when a child under stress reverts to an earlier 00:16:14.039 --> 00:16:17.269 developmental behavior. A fully potty -trained 00:16:17.269 --> 00:16:19.610 four -year -old might start wetting the bed in 00:16:19.610 --> 00:16:22.309 the hospital. An independent 14 -year -old might 00:16:22.309 --> 00:16:24.269 suddenly want their teddy bear or want to be 00:16:24.269 --> 00:16:27.730 hand -fed. Oh, no, we've lost all our progress. 00:16:27.950 --> 00:16:30.610 Right. And the nurse's job is to reassure the 00:16:30.610 --> 00:16:32.970 parents that this is a normal stress behavior 00:16:32.970 --> 00:16:35.929 and it is not permanent. Don't shame the child. 00:16:36.029 --> 00:16:38.110 Don't say, you're a big boy. Why are you acting 00:16:38.110 --> 00:16:40.750 like a baby? Just support them. And when the 00:16:40.750 --> 00:16:43.149 stress resolves, the skills will come back. So 00:16:43.149 --> 00:16:45.269 important. Now, speaking communication, let's 00:16:45.269 --> 00:16:47.870 move to section four, the vocabulary of fear. 00:16:48.330 --> 00:16:49.649 This is one of my favorite parts of the chapter 00:16:49.649 --> 00:16:51.330 because it's just so eye opening. We use these 00:16:51.330 --> 00:16:53.299 medical words every day. They're just technical 00:16:53.299 --> 00:16:56.019 terms to us. But to a kid, they can sound like 00:16:56.019 --> 00:16:59.100 a horror movie script. It's that literal thinker 00:16:59.100 --> 00:17:02.779 problem again. Table 8 .2 in the text is a goldmine 00:17:02.779 --> 00:17:06.900 for this. It lists terms to avoid and terms to 00:17:06.900 --> 00:17:10.339 use. If you just memorize this table, your interactions 00:17:10.339 --> 00:17:12.420 will improve overnight. Let's run through the 00:17:12.420 --> 00:17:14.759 taboo list. I'll give you the medical term. You 00:17:14.759 --> 00:17:16.140 tell me what the kid hears and what we should 00:17:16.140 --> 00:17:19.769 say instead. First one, die. Like, we're going 00:17:19.769 --> 00:17:22.950 to put some dye in your IV for the CT scan. To 00:17:22.950 --> 00:17:27.230 a child, dye sounds exactly like die, as in death. 00:17:27.910 --> 00:17:30.390 You are effectively telling a literal thinking 00:17:30.390 --> 00:17:32.930 child, we are going to put something in your 00:17:32.930 --> 00:17:35.210 veins that makes you die. That is absolutely 00:17:35.210 --> 00:17:37.430 terrifying. I can't even imagine the panic. So 00:17:37.430 --> 00:17:39.730 what do we say instead? Special medicine to help 00:17:39.730 --> 00:17:42.329 the doctor see inside you better. OK, next one. 00:17:42.819 --> 00:17:44.799 Stretcher. Sounds like stretcher, like some kind 00:17:44.799 --> 00:17:46.940 of medieval torture device. Imagine a four -year 00:17:46.940 --> 00:17:48.359 -old thinking you're going to put them on a machine 00:17:48.359 --> 00:17:50.660 that stretches them out. Yikes. So a better option. 00:17:50.900 --> 00:17:54.059 Rolling bed or bed on wheels. Keep it descriptive 00:17:54.059 --> 00:17:57.000 and simple. How about monitor? Sounds like monster. 00:17:57.180 --> 00:17:59.779 It's an easy slip. Just use TV screen. And here's 00:17:59.779 --> 00:18:03.019 a big one. Deaden or put to sleep. This is a 00:18:03.019 --> 00:18:05.980 huge trap. So many children have had a pet, a 00:18:05.980 --> 00:18:08.680 dog or cat, that was put to sleep. And that pet 00:18:08.680 --> 00:18:11.579 never came back. That pet is buried in the backyard. 00:18:12.319 --> 00:18:14.220 If you tell a child, we're going to put you to 00:18:14.220 --> 00:18:16.640 sleep for surgery, they might actually think 00:18:16.640 --> 00:18:18.900 you are euthanizing them. I never thought about 00:18:18.900 --> 00:18:21.359 that connection, but wow, it makes total sense. 00:18:21.960 --> 00:18:25.039 So special sleep. Special sleep, or numbing medicine, 00:18:25.400 --> 00:18:27.220 and you have to make it explicitly clear they 00:18:27.220 --> 00:18:29.420 will wake up. You will have a special sleep so 00:18:29.420 --> 00:18:31.680 you don't feel anything, and then we will wake 00:18:31.680 --> 00:18:34.339 you up when we are all done. You have to bridge 00:18:34.339 --> 00:18:37.400 the gap to the waking up part. One more. Taking 00:18:37.400 --> 00:18:40.380 your vitals. Take your blood pressure. The word 00:18:40.380 --> 00:18:42.539 taken implies stuffed. I'm going to take your 00:18:42.539 --> 00:18:44.660 blood pressure. The child is thinking, wait, 00:18:44.660 --> 00:18:47.240 I need that. Don't take it away from me. It sounds 00:18:47.240 --> 00:18:50.400 funny to us, but it's logic to them. It is. Instead, 00:18:50.539 --> 00:18:52.900 say, I'm going to measure how warm you are, or 00:18:52.900 --> 00:18:55.299 hug your arm to see how strong your heart is. 00:18:55.579 --> 00:18:57.759 It's amazing how these small word choices can 00:18:57.759 --> 00:19:01.660 prevent a massive anxiety spike. It really emphasizes 00:19:01.660 --> 00:19:05.000 that language is a clinical tool. We have to 00:19:05.000 --> 00:19:07.680 be as precise with our words as we are with our 00:19:07.680 --> 00:19:11.000 dosages. Precisely. It costs nothing to change 00:19:11.000 --> 00:19:13.519 your vocabulary, but the payoff in atraumatic 00:19:13.519 --> 00:19:17.039 care is immense. You are removing the accidental 00:19:17.039 --> 00:19:19.859 trauma we inflict just by speaking carelessly. 00:19:20.640 --> 00:19:22.440 Let's zoom out a bit to the bigger picture in 00:19:22.440 --> 00:19:25.359 section five. Family -centered care and cultural 00:19:25.359 --> 00:19:28.559 safety. The text says, treat the family as the 00:19:28.559 --> 00:19:31.140 patient. That is the philosophy. The family is 00:19:31.140 --> 00:19:33.519 the constant in the child's life. We're just 00:19:33.519 --> 00:19:36.299 visitors. We're there for a shift or a few days. 00:19:36.799 --> 00:19:38.380 The family is there forever. If you don't win 00:19:38.380 --> 00:19:40.160 over the family, you won't win over the child. 00:19:40.299 --> 00:19:42.460 And a big part of that is respecting cultural 00:19:42.460 --> 00:19:45.319 diversity and addressing language barriers. Box 00:19:45.319 --> 00:19:48.299 8 .4 talks about interpreters. And this is a 00:19:48.299 --> 00:19:50.880 critical safety issue for the NCLEX and for real 00:19:50.880 --> 00:19:53.180 life. I feel like we see this mistake happen 00:19:53.180 --> 00:19:55.460 all the time in practice. We do. And the golden 00:19:55.460 --> 00:19:58.519 rule here is absolute. Do not use family members 00:19:58.519 --> 00:20:00.599 as interpreters. Not even if the teenage daughter 00:20:00.599 --> 00:20:03.440 speaks perfect English and offers to do it? Especially 00:20:03.440 --> 00:20:06.220 not then. There are three reasons why this is 00:20:06.220 --> 00:20:10.039 so dangerous. First, it's a breach of confidentiality. 00:20:10.440 --> 00:20:12.160 The patient might not want their child knowing 00:20:12.160 --> 00:20:15.640 their medical business. Second, medical terminology 00:20:15.640 --> 00:20:18.960 is complex. A teenager might not know how to 00:20:18.960 --> 00:20:21.680 accurately translate congestive heart failure 00:20:21.680 --> 00:20:25.359 or informed consent. And the third reason. It 00:20:25.359 --> 00:20:28.240 puts an immense emotional burden on that family 00:20:28.240 --> 00:20:31.000 member. I mean, imagine asking a child to tell 00:20:31.000 --> 00:20:33.960 their parent they have cancer. Or asking a sibling 00:20:33.960 --> 00:20:36.920 to explain a painful procedure. That is not their 00:20:36.920 --> 00:20:39.880 job. You must use a qualified medical interpreter. 00:20:40.059 --> 00:20:42.000 And there's a specific technique for how to use 00:20:42.000 --> 00:20:43.900 the interpreter, right? When the interpreter 00:20:43.900 --> 00:20:46.660 is there, or on the iPad, who do you look at? 00:20:46.859 --> 00:20:49.180 You look at the family. You talk to the family, 00:20:49.259 --> 00:20:51.740 not the interpreter. It builds rapport. If you 00:20:51.740 --> 00:20:53.359 stare at the interpreter the whole time, the 00:20:53.359 --> 00:20:55.420 family feels excluded from the conversation about 00:20:55.420 --> 00:20:57.599 their own child. You look at the mom, you speak, 00:20:57.759 --> 00:20:59.380 the interpreter translates, you keep looking 00:20:59.380 --> 00:21:01.839 at the mom. Good point. And pacing matters too. 00:21:02.059 --> 00:21:05.609 Oh yeah, speak slowly. Pause every few sentences 00:21:05.609 --> 00:21:08.069 to let the interpreter catch up. Don't deliver 00:21:08.069 --> 00:21:10.009 a five -minute monologue and then expect the 00:21:10.009 --> 00:21:12.230 interpreter to remember all of it. Now, connecting 00:21:12.230 --> 00:21:15.049 to that is health literacy. The text throws out 00:21:15.049 --> 00:21:17.369 a statistic that is honestly a bit shocking. 00:21:17.789 --> 00:21:20.569 The average American reads at a sixth grade level 00:21:20.569 --> 00:21:22.750 or below. And that's the general population on 00:21:22.750 --> 00:21:25.049 a good day. When you add the stress of a sick 00:21:25.049 --> 00:21:28.250 child, sleep deprivation, hospital noise, and 00:21:28.250 --> 00:21:32.069 fear, that comprehension level drops even further. 00:21:32.430 --> 00:21:35.309 You cannot handle and apparent a dense medical 00:21:35.309 --> 00:21:37.759 pamphlet. written at a 12th grade level and expect 00:21:37.759 --> 00:21:39.859 them to understand it. How do we assess if they 00:21:39.859 --> 00:21:41.400 aren't getting it? Because most people won't 00:21:41.400 --> 00:21:43.619 say, I can't read this or I'm not smart enough 00:21:43.619 --> 00:21:45.740 to understand this. Correct. There is immense 00:21:45.740 --> 00:21:47.900 shame attached to a literacy or low literacy. 00:21:48.039 --> 00:21:50.119 So you look for red flags. I forgot my glasses 00:21:50.119 --> 00:21:52.819 or I'll read it when I get home or handing you 00:21:52.819 --> 00:21:55.240 back forms that are incomplete or filled out 00:21:55.240 --> 00:21:58.500 incorrectly. These are classic signs of low health 00:21:58.500 --> 00:22:01.359 literacy. So what's the strategy? How do we ensure 00:22:01.359 --> 00:22:03.700 they actually know what to do? The teach back 00:22:03.700 --> 00:22:06.039 method. This is the gold standard. You don't 00:22:06.039 --> 00:22:08.859 ask, do you understand? Because they will just 00:22:08.859 --> 00:22:11.779 nod. They will nod every single time. You ask, 00:22:12.240 --> 00:22:14.420 in your own words, can you explain to me how 00:22:14.420 --> 00:22:15.839 you're going to give this medicine when you get 00:22:15.839 --> 00:22:17.500 home? I want to make sure I explained it clearly. 00:22:18.180 --> 00:22:20.559 You put the burden on yourself. In visual aids, 00:22:20.700 --> 00:22:23.319 I'm guessing. Visuals, videos, models. Show them. 00:22:23.319 --> 00:22:25.619 Don't just tell them. The text says visuals are 00:22:25.619 --> 00:22:28.480 far superior to text alone. Circle the dosage 00:22:28.480 --> 00:22:31.480 on the syringe. Draw a picture of the wound care. 00:22:32.380 --> 00:22:35.299 Moving into section six. Teaching and learning 00:22:35.299 --> 00:22:37.920 principles. We have to teach the parents and 00:22:37.920 --> 00:22:41.160 the child, but they learn differently. Right. 00:22:41.460 --> 00:22:44.339 For the parents, we rely on adult learning theory. 00:22:44.839 --> 00:22:47.240 Adults are self -directed and problem -focused. 00:22:47.720 --> 00:22:49.579 They need to know why this matters right now. 00:22:49.819 --> 00:22:52.859 So not just, here's how to do the dressing change, 00:22:53.099 --> 00:22:56.359 but doing this dressing change correctly will 00:22:56.359 --> 00:22:58.900 prevent infection and help your child go home 00:22:58.900 --> 00:23:01.559 three days sooner. Exactly. Give them the motivation. 00:23:01.740 --> 00:23:03.599 connect it to their goal, which is getting their 00:23:03.599 --> 00:23:06.359 kid healthy and home. They need practical, immediate 00:23:06.359 --> 00:23:08.420 application. And for the child. It goes right 00:23:08.420 --> 00:23:11.279 back to development. For preschoolers, keep it 00:23:11.279 --> 00:23:13.960 short, use those soft words we talked about, 00:23:14.240 --> 00:23:16.839 and involve play. Let them put a band -aid on 00:23:16.839 --> 00:23:19.380 the doll. For school -age kids, involve them 00:23:19.380 --> 00:23:21.900 in the task. Let them hold the tape. Let them 00:23:21.900 --> 00:23:24.579 open the alcohol swab package. It gives them 00:23:24.579 --> 00:23:26.480 that sense of control we talked about earlier. 00:23:26.619 --> 00:23:29.720 Yes. It transforms them from a victim of the 00:23:29.720 --> 00:23:31.940 procedure to a participant in the procedure. 00:23:32.160 --> 00:23:35.019 And for adolescents. Collaborate. Treat them 00:23:35.019 --> 00:23:37.900 as a partner. We need to figure out a schedule 00:23:37.900 --> 00:23:40.880 for your insulin. What works best with your school 00:23:40.880 --> 00:23:43.299 schedule? Do you want to do it before lunch or 00:23:43.299 --> 00:23:46.069 after? If they help build the plan, they are 00:23:46.069 --> 00:23:48.329 far more likely to follow it. If you dictate 00:23:48.329 --> 00:23:50.750 the plan, they are likely to rebel. That makes 00:23:50.750 --> 00:23:52.950 total sense. Okay, we've covered a ton of ground 00:23:52.950 --> 00:23:55.210 here. We've looked at the philosophy of atraumatic 00:23:55.210 --> 00:23:57.490 care, the physical positioning like therapeutic 00:23:57.490 --> 00:24:00.109 hugging, the communication strategies from infants 00:24:00.109 --> 00:24:03.069 to teens, vocabulary traps, and the whole family 00:24:03.069 --> 00:24:05.529 education piece. It is a lot, but it all connects. 00:24:05.630 --> 00:24:08.170 It's a very holistic approach. So let's wrap 00:24:08.170 --> 00:24:10.430 this up with our If You Remember Nothing Else 00:24:10.430 --> 00:24:13.289 summary. If a listener is driving to their exam 00:24:13.289 --> 00:24:15.529 right now or walking onto the floor for their 00:24:15.529 --> 00:24:18.150 shift, what is the one mental model they need 00:24:18.150 --> 00:24:22.470 to hold onto? The mental model is... preparation 00:24:22.470 --> 00:24:25.309 prevention preparation equals prevention yes 00:24:25.309 --> 00:24:28.490 whether it is choosing the right words special 00:24:28.490 --> 00:24:31.069 medicine instead of die or choosing the right 00:24:31.069 --> 00:24:34.349 timing one hour prior for a preschooler or choosing 00:24:34.349 --> 00:24:36.829 the right position therapeutic hugging instead 00:24:36.829 --> 00:24:40.490 of restraints your job as the nurse is to anticipate 00:24:40.490 --> 00:24:43.250 the fear and neutralize it before it starts don't 00:24:43.250 --> 00:24:45.210 wait for the child to panic and then try to fix 00:24:45.210 --> 00:24:47.700 it build the safety net first. That's powerful. 00:24:48.099 --> 00:24:50.339 It really shifts the nursing role from reactive 00:24:50.339 --> 00:24:52.740 to proactive. And I want to leave everyone with 00:24:52.740 --> 00:24:54.500 a final provocative thought that stood out to 00:24:54.500 --> 00:24:56.900 me from the reading. It's this idea of compliance 00:24:56.900 --> 00:24:59.200 versus alliance. Well, you have to ask yourself, 00:24:59.720 --> 00:25:01.480 are we just trying to get the kid to sit still? 00:25:01.619 --> 00:25:03.940 That's compliance. So we can get the job done 00:25:03.940 --> 00:25:06.640 quickly. Or are we building a relationship where 00:25:06.640 --> 00:25:10.359 they trust us with their body and alliance? The 00:25:10.359 --> 00:25:12.680 source material really suggests that at -traumatic 00:25:12.680 --> 00:25:14.640 care isn't just about getting through the shift. 00:25:15.160 --> 00:25:17.880 It's about building a trust that impact how that 00:25:17.880 --> 00:25:20.259 child interacts with healthcare for the rest 00:25:20.259 --> 00:25:22.660 of their life. If you traumatize a four -year 00:25:22.660 --> 00:25:24.660 -old now, you might create a 40 -year -old who 00:25:24.660 --> 00:25:27.190 avoids the doctor until it's too late. That is 00:25:27.190 --> 00:25:30.210 the so what. That's the whole point. We are shaping 00:25:30.210 --> 00:25:32.450 their future healthcare behavior. That is why 00:25:32.450 --> 00:25:34.789 this chapter matters so much. Mic drop. All right, 00:25:34.930 --> 00:25:36.829 learners, take that do no harm mindset and go 00:25:36.829 --> 00:25:38.809 crush your exam. You've got this. You've got 00:25:38.809 --> 00:25:40.329 this. See you in the next Deep Dive.