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 --> 00:00:47.350 fast. Welcome to the emergency room. Okay, I 00:00:47.350 --> 00:00:49.049 want you to close your eyes for a second. Just 00:00:49.049 --> 00:00:51.210 picture a scenario. It's a two in the morning, 00:00:51.409 --> 00:00:53.590 you're in the emergency department. Right. The 00:00:53.590 --> 00:00:55.630 worst time. A worst time. And you're looking 00:00:55.630 --> 00:00:57.429 at this four -year -old girl. Let's just call 00:00:57.429 --> 00:01:00.179 her Emma. She's just been brought in after taking 00:01:00.179 --> 00:01:03.240 a really nasty fall off a playground slide. So 00:01:03.240 --> 00:01:05.319 we're dealing with a potential head injury, you 00:01:05.319 --> 00:01:08.120 know, likely a concussion, maybe even worse, 00:01:08.439 --> 00:01:12.019 the classic presentation. Exactly. But here's 00:01:12.019 --> 00:01:14.459 the thing. I want you to try to see the scene 00:01:14.459 --> 00:01:17.140 through her eyes. Her head is just throbbing. 00:01:17.219 --> 00:01:19.040 She's dizzy. She feels like she's going to be 00:01:19.040 --> 00:01:21.819 sick. And she's been dragged out of her safe 00:01:21.819 --> 00:01:25.500 warm bed into this. this place with blindingly 00:01:25.500 --> 00:01:28.200 bright lights. It's cold and it smells like rubbing 00:01:28.200 --> 00:01:30.959 alcohol and bleach. All of her senses are on 00:01:30.959 --> 00:01:33.299 high alert. It's a total sensory assault. A total 00:01:33.299 --> 00:01:35.540 assault. And she's surrounded by strangers and 00:01:35.540 --> 00:01:37.819 masks who are all moving really fast and talking 00:01:37.819 --> 00:01:41.000 really loud. It's the absolute classic pediatric 00:01:41.000 --> 00:01:44.420 nightmare. And if we're talking physiology, her 00:01:44.420 --> 00:01:47.599 cortisol is just spiking. It's through the roof. 00:01:47.840 --> 00:01:50.900 So for a child like Emma, the physical pain of 00:01:50.900 --> 00:01:55.010 the fall is. it's actually fighting for bandwidth 00:01:55.010 --> 00:01:58.250 with the sheer psychological terror of the environment 00:01:58.250 --> 00:02:00.650 itself. That's a perfect way to put it. The environment 00:02:00.650 --> 00:02:02.650 is as much of a threat as the injury in that 00:02:02.650 --> 00:02:05.090 moment. Right. And then the admission nurse walks 00:02:05.090 --> 00:02:08.349 in. Now, this nurse is, let's say, clinically 00:02:08.349 --> 00:02:11.120 brilliant. She can calculate a weight -based 00:02:11.120 --> 00:02:13.460 medication dose in her sleep. She hits the vein 00:02:13.460 --> 00:02:15.919 on the first try every single time. A total pro 00:02:15.919 --> 00:02:19.000 on paper. A total pro. But she walks in, ignores 00:02:19.000 --> 00:02:21.900 Emma completely, looks straight at the mom, and 00:02:21.900 --> 00:02:24.319 says, we need to put her on a stretcher, shoot 00:02:24.319 --> 00:02:26.400 some dye into her arm, and then put her to sleep 00:02:26.400 --> 00:02:29.639 for a test. Oh, no. Yeah. And just like that, 00:02:29.939 --> 00:02:32.719 with one sentence, despite all that incredible 00:02:32.719 --> 00:02:35.310 clinical skill, You've completely lost the patient. 00:02:35.490 --> 00:02:36.930 You've lost the patient and you haven't even 00:02:36.930 --> 00:02:38.710 touched her yet. To an adult, you know, that 00:02:38.710 --> 00:02:40.930 sentence is a coherent care plan. It makes sense. 00:02:41.310 --> 00:02:43.469 It's just information. But to four -year -old 00:02:43.469 --> 00:02:46.150 Emma, she just heard, we're going to stretch 00:02:46.150 --> 00:02:48.409 your body on a medieval rack, shoot you with 00:02:48.409 --> 00:02:50.550 a gun, put death in your veins, and then kill 00:02:50.550 --> 00:02:52.930 you like we did the family dog. And it sounds 00:02:52.930 --> 00:02:55.250 dramatic to us saying it like that, but that 00:02:55.250 --> 00:02:59.270 is literally word for word how a preschooler's 00:02:59.270 --> 00:03:04.020 brain processes. those specific words. It's terrifying. 00:03:04.199 --> 00:03:06.699 It is. And that disconnect, that gap between 00:03:06.699 --> 00:03:09.520 our clinical efficiency and the child's lived 00:03:09.520 --> 00:03:12.620 reality, that is exactly why we are dedicating 00:03:12.620 --> 00:03:15.620 this entire Deep Dive to Chapter 8, A Traumatic 00:03:15.620 --> 00:03:18.740 Care of Children and Families. Welcome back to 00:03:18.740 --> 00:03:22.020 the Deep Dive. Today we are unpacking A Traumatic 00:03:22.020 --> 00:03:23.860 Care. And I want to be really clear right off 00:03:23.860 --> 00:03:25.840 the bat, because I know we have a lot of serious 00:03:25.840 --> 00:03:28.060 learners, nurses, and medical pros listening. 00:03:28.599 --> 00:03:30.840 This isn't the soft skills episode. No, not at 00:03:30.840 --> 00:03:33.099 all. And that's probably the most common misconception 00:03:33.099 --> 00:03:34.960 we see in the source material, isn't it? I think 00:03:34.960 --> 00:03:36.939 so. People hear A Traumatic Care and they immediately 00:03:36.939 --> 00:03:39.199 think it's just about handing out stickers or 00:03:39.199 --> 00:03:41.080 wearing a scrub top with cartoon characters on 00:03:41.080 --> 00:03:43.319 it. Right, the fluff. But when you actually dig 00:03:43.319 --> 00:03:46.400 into the text, you realize... No, this is a core 00:03:46.400 --> 00:03:49.180 clinical competency. This is about safety, period. 00:03:49.379 --> 00:03:52.219 It's about the philosophy of do no harm. But 00:03:52.219 --> 00:03:54.699 what we're doing here is we're expanding the 00:03:54.699 --> 00:03:58.460 definition of harm. Exactly. Do no harm isn't 00:03:58.460 --> 00:04:01.620 just about not cutting the wrong artery or giving 00:04:01.620 --> 00:04:04.240 the wrong medication. It's so much bigger. So 00:04:04.240 --> 00:04:07.120 what does it include? Well, if you cannot get 00:04:07.120 --> 00:04:10.400 a child to cooperate without traumatizing them, 00:04:10.979 --> 00:04:13.939 you risk physical injury during procedures. A 00:04:13.939 --> 00:04:16.540 child flailing around is a real danger. Sure, 00:04:16.680 --> 00:04:18.459 you could miss with a needle, cause more damage. 00:04:18.540 --> 00:04:20.620 You could get inaccurate vital signs because 00:04:20.620 --> 00:04:23.660 their heart rate is 160 from pure panic, not 00:04:23.660 --> 00:04:26.519 from their medical condition. And, you know, 00:04:27.339 --> 00:04:30.199 maybe most importantly, you risk this long -term 00:04:30.199 --> 00:04:32.980 psychological scarring that makes them fear healthcare. 00:04:33.360 --> 00:04:35.139 for the rest of their lives. You're creating 00:04:35.139 --> 00:04:37.779 a phobia. You're creating a patient who will 00:04:37.779 --> 00:04:39.839 avoid going to the doctor as an adult because 00:04:39.839 --> 00:04:42.519 what happened when they were four? Wow. So our 00:04:42.519 --> 00:04:44.860 mission today is to really break down the framework 00:04:44.860 --> 00:04:47.040 for doing this right. We are going to master 00:04:47.040 --> 00:04:49.459 atraumatic care. We've got the core philosophy. 00:04:49.560 --> 00:04:51.639 The text calls it the three pillars. We also 00:04:51.639 --> 00:04:53.879 have a list of forbidden words from the text 00:04:53.879 --> 00:04:56.339 that, I'm not kidding, it legitimately blew my 00:04:56.339 --> 00:04:59.459 mind. The do not say list. It's a game changer 00:04:59.459 --> 00:05:01.779 when you see it. Yeah. And then we have the developmental 00:05:01.779 --> 00:05:04.920 hacks. How to basically game the system for every 00:05:04.920 --> 00:05:07.959 single age group, from tiny infants all the way 00:05:07.959 --> 00:05:10.199 up to teenagers. Plus, and we can't forget this, 00:05:10.220 --> 00:05:12.680 we need to talk about the parents. Because in 00:05:12.680 --> 00:05:16.420 pediatrics, you never, ever have just one patient. 00:05:16.540 --> 00:05:20.040 You always have two, or three, or more. You always 00:05:20.040 --> 00:05:21.920 have a family system in that room. Okay, let's 00:05:21.920 --> 00:05:24.579 start at the very top. The definition. How does 00:05:24.579 --> 00:05:27.689 the source material define atromatic care? It 00:05:27.689 --> 00:05:30.569 defines it as therapeutic care that minimizes 00:05:30.569 --> 00:05:33.949 or eliminates psychological and physical distress. 00:05:34.389 --> 00:05:36.310 It sounds so simple when you put it like that. 00:05:36.430 --> 00:05:38.829 It does, but it implies something pretty heavy, 00:05:39.029 --> 00:05:41.949 which is that standard medical care by its very 00:05:41.949 --> 00:05:44.660 nature is inherently traumatic. You know, I'd 00:05:44.660 --> 00:05:46.240 never thought about it like that, but it's true. 00:05:46.459 --> 00:05:48.240 It is. I mean, think about it objectively for 00:05:48.240 --> 00:05:50.839 a second. We strip people of their clothes. We 00:05:50.839 --> 00:05:52.779 separate them from their routine and their home. 00:05:53.000 --> 00:05:55.759 We poke them with sharp objects. We invade their 00:05:55.759 --> 00:05:58.720 privacy, their personal space. We force them 00:05:58.720 --> 00:06:01.680 to lie still in these strange, sterile environments. 00:06:02.339 --> 00:06:04.819 For a child, that's the definition of trauma. 00:06:05.480 --> 00:06:08.439 So the goal of this framework is to strip away 00:06:08.439 --> 00:06:11.060 all the preventable trauma so that the actual 00:06:11.060 --> 00:06:13.600 healing can happen. Okay, so the text outlines 00:06:13.600 --> 00:06:17.199 these three pillars or principles. If I'm a student 00:06:17.199 --> 00:06:19.459 taking notes right now or a nurse trying to audit 00:06:19.459 --> 00:06:22.199 my own practice, what are the big three I need 00:06:22.199 --> 00:06:24.100 to write down? The first pillar, the big one, 00:06:24.759 --> 00:06:28.779 is prevent or minimize physical stressors. Okay, 00:06:28.800 --> 00:06:30.399 so that seems like the obvious one. We're talking 00:06:30.399 --> 00:06:33.199 pain management. Pain is the headline. For sure. 00:06:33.399 --> 00:06:35.199 That's what everyone thinks of first. And we 00:06:35.199 --> 00:06:37.360 use things like numbing creams, you know, lidocaine 00:06:37.360 --> 00:06:39.800 or those little buzzy bee devices to distract 00:06:39.800 --> 00:06:41.480 the nerves. I've seen those. They vibrate and 00:06:41.480 --> 00:06:44.120 have an ice pack. Exactly. But the text actually 00:06:44.120 --> 00:06:46.420 goes much broader than just pain. It includes 00:06:46.420 --> 00:06:49.680 things like sleeplessness, immemoriality, and 00:06:49.680 --> 00:06:52.660 the inability to eat or drink. Ah, so being an 00:06:52.660 --> 00:06:55.420 MPO, nothing by mouth. Imagine being a two -year 00:06:55.420 --> 00:06:57.560 -old who is an MPO for six hours before a procedure. 00:06:58.060 --> 00:07:00.579 You can't explain it to them. They don't understand 00:07:00.579 --> 00:07:03.259 why you're withholding food and water. So the 00:07:03.259 --> 00:07:06.339 kid isn't being bad or throwing a tantrum for 00:07:06.339 --> 00:07:09.560 no reason? No. They're starving and confused 00:07:09.560 --> 00:07:13.459 and scared. That is a profound physical stressor 00:07:13.459 --> 00:07:16.199 that almost always leads to a behavioral meltdown. 00:07:16.319 --> 00:07:19.399 And we label the kid difficult when we created 00:07:19.399 --> 00:07:22.139 the situation. That makes so much sense. Okay, 00:07:22.180 --> 00:07:24.079 under this physical pillar, there's a specific 00:07:24.079 --> 00:07:26.120 intervention the text highlights that I think 00:07:26.120 --> 00:07:28.339 we need to spend some real time on. It's called 00:07:28.339 --> 00:07:32.339 therapeutic hugging. Yes. Therapeutic hugging. 00:07:32.660 --> 00:07:34.519 I have to be honest when I first read that it 00:07:34.519 --> 00:07:36.319 sounds like something you'd pay extra for at 00:07:36.319 --> 00:07:38.620 a wellness retreat. Right, it sounds a little 00:07:38.620 --> 00:07:40.839 bit out there. But in a clinical setting this 00:07:40.839 --> 00:07:43.740 is a very specific technical term. And it's defined 00:07:43.740 --> 00:07:47.329 in direct contrast to what? To restraint. In 00:07:47.329 --> 00:07:49.970 the old days, and honestly in some facilities 00:07:49.970 --> 00:07:52.410 that are still behind the times, if a child needed 00:07:52.410 --> 00:07:55.649 a procedure like an IV start or a lumbar puncture, 00:07:56.149 --> 00:07:58.470 the standard practice was just brute force. We 00:07:58.470 --> 00:08:00.610 hold them down. You hold them down, you pin their 00:08:00.610 --> 00:08:03.470 limbs to the bed, maybe two or three people holding 00:08:03.470 --> 00:08:06.370 the small child down. Which, I can only imagine, 00:08:06.730 --> 00:08:09.970 triggers an immediate panic response. A massive 00:08:09.970 --> 00:08:12.290 panic response. You're talking full blown fight 00:08:12.290 --> 00:08:15.170 or flight. You were physically overpowering a 00:08:15.170 --> 00:08:18.110 child who was already terrified. It feels like 00:08:18.110 --> 00:08:21.329 an assault. It is. I mean, technically it creates 00:08:21.329 --> 00:08:23.569 compliance because they physically can't move, 00:08:23.970 --> 00:08:26.430 but it creates this massive psychological injury. 00:08:26.639 --> 00:08:29.680 It teaches the child deep in their core that 00:08:29.680 --> 00:08:31.800 the hospital is a place where they are helpless 00:08:31.800 --> 00:08:35.200 and overpowered. Okay, so how does therapeutic 00:08:35.200 --> 00:08:37.440 hugging flip the script? How does it actually 00:08:37.440 --> 00:08:40.179 work mechanically? If I'm the nurse, what am 00:08:40.179 --> 00:08:43.360 I asking the parent to do? You are using a secure 00:08:43.360 --> 00:08:46.139 but comfortable holding position. So usually 00:08:46.139 --> 00:08:48.200 this is something like chest to chest or with 00:08:48.200 --> 00:08:50.200 the child sitting on the parent's lap facing 00:08:50.200 --> 00:08:52.879 forward. So they're contained but they feel connected 00:08:52.879 --> 00:08:55.700 to their parent. Exactly. The parent's arms embrace 00:08:55.700 --> 00:08:57.860 the child. securing the child's arms and maybe 00:08:57.860 --> 00:09:00.019 even their legs between the parent's legs, but 00:09:00.019 --> 00:09:02.879 it feels like a hug. It's firm, but it's comforting. 00:09:03.480 --> 00:09:05.759 The text really emphasizes that this provides 00:09:05.759 --> 00:09:08.360 both comfort and safety. So you're not just letting 00:09:08.360 --> 00:09:11.059 them run wild. You still need the arm to be still 00:09:11.059 --> 00:09:14.559 for the needle, for example. Correct. You absolutely 00:09:14.559 --> 00:09:17.879 cannot have a moving target for an IV or an injection. 00:09:18.419 --> 00:09:20.500 That's dangerous for everyone involved. Yeah. 00:09:20.779 --> 00:09:24.000 But with therapeutic hugging, the child is anchored 00:09:24.000 --> 00:09:26.549 by their safe person. They aren't pinned to a 00:09:26.549 --> 00:09:29.350 cold, hard table by strangers? No. They're pressed 00:09:29.350 --> 00:09:32.110 against mom or dad. They can feel their breathing, 00:09:32.250 --> 00:09:34.190 maybe smell their scent. It lowers the heart 00:09:34.190 --> 00:09:37.169 rate, lowers the cortisol. It changes the entire 00:09:37.169 --> 00:09:39.110 experience. OK, but I have to play devil's advocate 00:09:39.110 --> 00:09:42.490 here. What if the parent is really squeamish? 00:09:42.710 --> 00:09:44.710 What if the dad looks like he's going to pass 00:09:44.710 --> 00:09:47.629 out if he even sees a needle? Yeah. Or what if 00:09:47.629 --> 00:09:49.909 the parent is so anxious themselves that they're 00:09:49.909 --> 00:09:52.870 actually making the kid worse? That is a very, 00:09:52.870 --> 00:09:56.090 very valid concern, and it's a common NCLEX trap 00:09:56.090 --> 00:09:59.690 question. The text is clear. Use the parent whenever 00:09:59.690 --> 00:10:02.549 possible. They are your first and best choice. 00:10:02.769 --> 00:10:04.789 Then not always. But you have to assess the parent. 00:10:04.889 --> 00:10:07.029 The parent says, I just can't do this. Or if 00:10:07.029 --> 00:10:08.950 you see them getting pale and hyperventilating, 00:10:09.210 --> 00:10:11.350 you have to respect that. You don't want a fainting 00:10:11.350 --> 00:10:13.529 parent on the floor. Now you have two patients. 00:10:13.649 --> 00:10:15.750 So what's the backup plan? In that case, you 00:10:15.750 --> 00:10:18.590 get another staff member, another nurse, a tech, 00:10:18.750 --> 00:10:21.090 someone the child has maybe built a little rapport 00:10:21.090 --> 00:10:23.570 with, and that person performs the therapeutic 00:10:23.570 --> 00:10:27.190 hug. The goal is always to avoid mechanical restraints, 00:10:27.350 --> 00:10:31.029 you know, straps, boards, unless it is absolutely, 00:10:31.210 --> 00:10:33.870 strictly necessary for safety. So the hierarchy 00:10:33.870 --> 00:10:36.889 is clear. It's parent hugs first. Then staff 00:10:36.889 --> 00:10:39.980 hugs. And only then... As a last resort, do we 00:10:39.980 --> 00:10:42.500 even look at restraints? Exactly. It's all about 00:10:42.500 --> 00:10:45.019 the least restrictive, most humane environment 00:10:45.019 --> 00:10:47.700 possible. OK, that's pillar one. Physical stressors. 00:10:47.840 --> 00:10:50.820 What's pillar two? Pillar two is prevent or minimize 00:10:50.820 --> 00:10:54.320 separation. And this is huge. From the parents? 00:10:54.440 --> 00:10:56.200 From the parents, from the primary caregivers. 00:10:57.279 --> 00:10:59.600 For a child, especially a child under the age 00:10:59.600 --> 00:11:03.480 of, say, five, the parent is their external hard 00:11:03.480 --> 00:11:05.759 drive for coping. I love that analogy. The parent 00:11:05.759 --> 00:11:07.799 is the external hard drive. They do not have 00:11:07.799 --> 00:11:10.039 the internal software yet to handle significant 00:11:10.039 --> 00:11:12.419 stress on their own. They literally borrow the 00:11:12.419 --> 00:11:15.200 parent's calm. So if you separate them, you are 00:11:15.200 --> 00:11:17.419 effectively removing their ability to process 00:11:17.419 --> 00:11:20.259 the event. You are. If you take the parent away, 00:11:20.460 --> 00:11:22.639 the child's system crashes. It just goes into 00:11:22.639 --> 00:11:26.090 overload. So that old school rule of parents 00:11:26.090 --> 00:11:27.649 need to go to the waiting room while we work 00:11:27.649 --> 00:11:29.830 because they just get in the way. That's completely 00:11:29.830 --> 00:11:31.990 out. It is completely out. The text is very, 00:11:31.990 --> 00:11:34.330 very clear on this. Promote family -centered 00:11:34.330 --> 00:11:37.629 care at all times. So you're treating the family 00:11:37.629 --> 00:11:40.629 as the unit of care, not just the child. You 00:11:40.629 --> 00:11:42.909 have to. You keep parents close. You respect 00:11:42.909 --> 00:11:45.490 their preferences. The evidence actually supports 00:11:45.490 --> 00:11:48.690 letting parents stay, even for things like resuscitations 00:11:48.690 --> 00:11:51.230 or invasive procedures. if they want to. Really? 00:11:51.370 --> 00:11:54.169 Even for something that intense? Yes. It actually 00:11:54.169 --> 00:11:57.190 helps the parents process the situation because 00:11:57.190 --> 00:11:58.970 they can see that everything possible is being 00:11:58.970 --> 00:12:01.850 done for their child. And for the child, just 00:12:01.850 --> 00:12:03.669 hearing a familiar voice, even if they're not 00:12:03.669 --> 00:12:06.370 fully conscious, can be calming. It makes perfect 00:12:06.370 --> 00:12:09.690 sense. The nurses change shifts every 12 hours. 00:12:09.889 --> 00:12:12.529 The doctors rotate. The parent is the only constant 00:12:12.529 --> 00:12:14.730 anchor in that room. They are the anchor. And 00:12:14.730 --> 00:12:17.330 if you remove the anchor, the ship just drifts. 00:12:17.549 --> 00:12:20.309 beautifully put. And that leads us directly into 00:12:20.309 --> 00:12:24.049 pillar three, which is promote a sense of control. 00:12:24.409 --> 00:12:26.429 This one is really interesting to me because, 00:12:26.429 --> 00:12:29.389 let's be honest, being a patient means losing 00:12:29.389 --> 00:12:32.110 almost all control. Sure. You wear the gown we 00:12:32.110 --> 00:12:34.210 give you, you eat the jello we give you, you 00:12:34.210 --> 00:12:36.490 wake up when we tell you to wake up for vitals. 00:12:37.090 --> 00:12:39.990 How on earth do you give control to a four -year 00:12:39.990 --> 00:12:43.649 -old without creating total chaos? You can't 00:12:43.649 --> 00:12:46.429 let them dictate the medical plan. No, of course 00:12:46.429 --> 00:12:48.549 not. That's not what it means. It means you give 00:12:48.549 --> 00:12:51.690 them choices. But, and this is probably the most 00:12:51.690 --> 00:12:53.870 critical distinction in the entire chapter when 00:12:53.870 --> 00:12:56.590 it comes to behavior management, you must give 00:12:56.590 --> 00:12:59.450 them valid choices. Okay, define an invalid choice 00:12:59.450 --> 00:13:01.409 for me. What does that look like? An invalid 00:13:01.409 --> 00:13:03.429 choice is walking into the room with a syringe 00:13:03.429 --> 00:13:06.129 in your hand and asking the toddler, can I give 00:13:06.129 --> 00:13:08.429 you this shot now? Right, because the answer 00:13:08.429 --> 00:13:11.299 is always, 100 % of the time, no. The answer 00:13:11.299 --> 00:13:13.980 is always no. And then what do you have to do? 00:13:14.139 --> 00:13:15.820 You have to do it anyway. So now you've lied 00:13:15.820 --> 00:13:18.419 to them. You've lied. You pretended they had 00:13:18.419 --> 00:13:21.100 a choice. They exercised that choice and you 00:13:21.100 --> 00:13:24.100 immediately overruled them. You just broke all 00:13:24.100 --> 00:13:27.059 trust. You taught them that their voice doesn't 00:13:27.059 --> 00:13:29.860 matter and that you are not a truthful person. 00:13:30.100 --> 00:13:33.100 So what's the valid choice in that exact scenario? 00:13:33.139 --> 00:13:35.799 How do we reframe that? A valid choice controls 00:13:35.799 --> 00:13:38.620 the environment or the method, not the necessity 00:13:38.620 --> 00:13:41.559 of the medical procedure. The procedure is non 00:13:41.559 --> 00:13:43.940 -negotiable. OK, so give me an example. You say, 00:13:44.419 --> 00:13:46.460 it is time for your medicine. That part isn't 00:13:46.460 --> 00:13:50.159 a choice. You're honest and direct. But do you 00:13:50.159 --> 00:13:52.159 want the red band -aid or the blue band -aid 00:13:52.159 --> 00:13:54.919 afterwards? Ah, so you're letting them control 00:13:54.919 --> 00:13:57.120 the parameters. The parameters. Do you want to 00:13:57.120 --> 00:13:59.399 sit on mommy's lap or hold your teddy bear while 00:13:59.399 --> 00:14:01.259 we do it? Do you want the medicine in your left 00:14:01.259 --> 00:14:03.559 leg or your right leg? It seems like such a small 00:14:03.559 --> 00:14:07.120 thing to us as adults. It's tiny to us. But for 00:14:07.120 --> 00:14:09.799 a child who feels completely powerless, that 00:14:09.799 --> 00:14:13.559 little bit of agency is everything. It grammatically 00:14:13.559 --> 00:14:16.200 reduces the feeling of helplessness. The text 00:14:16.200 --> 00:14:18.860 calls this empowering the child. Even something 00:14:18.860 --> 00:14:20.779 like letting them play with the stethoscope or 00:14:20.779 --> 00:14:23.259 the blood pressure cuff beforehand. Absolutely. 00:14:23.480 --> 00:14:26.059 That's a perfect example. You demystify the equipment. 00:14:26.440 --> 00:14:29.080 You turn a scary object into a toy. It gives 00:14:29.080 --> 00:14:31.340 them a sense of ownership and familiarity. Speaking 00:14:31.340 --> 00:14:34.100 of demystifying, I really want to pivot to the 00:14:34.100 --> 00:14:36.179 section of the text that I found the most jarring, 00:14:36.379 --> 00:14:39.039 and honestly the most impactful, the communication 00:14:39.039 --> 00:14:43.279 section. Specifically, the table in there, the 00:14:43.279 --> 00:14:47.480 bad words list. Ah, yes. Table 8 .2 in the source. 00:14:48.240 --> 00:14:51.059 Alternatives for confusing or misunderstood terms. 00:14:51.450 --> 00:14:54.470 I read this table and I literally gasped out 00:14:54.470 --> 00:14:57.190 loud. Because these are words we use every single 00:14:57.190 --> 00:14:59.809 day as adults. They are standard medical vernacular. 00:14:59.830 --> 00:15:01.690 They are. But when you look at them through the 00:15:01.690 --> 00:15:04.820 lens of a literal -minded child... My gosh, it's 00:15:04.820 --> 00:15:07.460 a horror movie script. It really is. We have 00:15:07.460 --> 00:15:09.200 to constantly remind ourselves that children, 00:15:09.600 --> 00:15:12.720 especially preschoolers, like our Emma, are incredibly 00:15:12.720 --> 00:15:15.059 literal thinkers. They don't get nuanced. They 00:15:15.059 --> 00:15:17.299 don't get metaphor or professional jargon. They 00:15:17.299 --> 00:15:19.720 interpret language based on their very limited 00:15:19.720 --> 00:15:22.279 life experience. Exactly. And their life experience 00:15:22.279 --> 00:15:24.899 is, oh, it's pretty small. Let's just run through 00:15:24.899 --> 00:15:26.700 a few of these because I think it's so important. 00:15:27.000 --> 00:15:29.120 We already mentioned put to sleep in our intro. 00:15:29.279 --> 00:15:31.460 The classic trap. We say it all the time for 00:15:31.460 --> 00:15:34.409 anesthesia. The doctor's gonna put you to sleep 00:15:34.409 --> 00:15:37.169 now. And the child's reference point for put 00:15:37.169 --> 00:15:40.070 to sleep is? It's often Buster, the family's 00:15:40.070 --> 00:15:42.649 14 -year -old golden retriever who went to the 00:15:42.649 --> 00:15:46.169 vet last year to be put to sleep and never came 00:15:46.169 --> 00:15:48.169 back. So they think you were euthanizing them. 00:15:48.210 --> 00:15:50.769 That is just heartbreaking. It is. They interpret 00:15:50.769 --> 00:15:53.460 it as death. They think they're being sent away 00:15:53.460 --> 00:15:56.600 forever and they won't wake up. So the tech suggests 00:15:56.600 --> 00:15:59.360 saying something like special sleep Special sleep 00:15:59.360 --> 00:16:02.019 or a special medicine to help you take a nap 00:16:02.019 --> 00:16:04.820 until the doctor is all done You have to explicitly 00:16:04.820 --> 00:16:07.559 clarify that they will wake up afterwards That 00:16:07.559 --> 00:16:09.659 feels like the most crucial addition and then 00:16:09.659 --> 00:16:11.200 you will wake up. You have to close the loop 00:16:11.200 --> 00:16:14.220 for them Okay, next one from the list die as 00:16:14.220 --> 00:16:17.720 in contrast die for a CT scan This is a purely 00:16:17.720 --> 00:16:22.620 auditory issue to a child's ear die Sounds exactly 00:16:22.620 --> 00:16:25.840 like die. So you're walking in and cheerfully 00:16:25.840 --> 00:16:28.480 saying, Hi, I'm going to put some dye in your 00:16:28.480 --> 00:16:31.639 veins now. And the child hears, I'm going to 00:16:31.639 --> 00:16:34.860 put death in your veins. That is absolutely terrifying. 00:16:34.940 --> 00:16:37.299 Why would any child agree to that? Exactly. If 00:16:37.299 --> 00:16:39.600 a giant stranger in a mask told you they were 00:16:39.600 --> 00:16:42.200 about to inject you with death, you'd fight for 00:16:42.200 --> 00:16:44.340 your life. And that's what they do. So what's 00:16:44.340 --> 00:16:46.740 the alternative? You make it functional. You 00:16:46.740 --> 00:16:49.100 explain what it does, not what it is. So you 00:16:49.100 --> 00:16:51.360 say, this is some special medicine to help the 00:16:51.360 --> 00:16:53.679 doctor see pictures inside your tummy. Simple. 00:16:53.740 --> 00:16:56.480 Makes sense. OK, stretcher. We say this 50 times 00:16:56.480 --> 00:16:59.379 a shift. Let's move him to the stretcher. Stretcher 00:16:59.379 --> 00:17:01.039 sounds like an action verb, like you were going 00:17:01.039 --> 00:17:03.259 to stretch her. Like a medieval torture rack. 00:17:03.440 --> 00:17:05.440 That's exactly what they picture, that their 00:17:05.440 --> 00:17:08.279 body is going to be pulled apart. No, don't stretch 00:17:08.279 --> 00:17:10.900 me. I can just hear a kid screaming that in the 00:17:10.900 --> 00:17:13.839 ER. It happens all the time. Instead, the text 00:17:13.839 --> 00:17:16.980 says to call it a rolling bed or a bed on wheels. 00:17:17.359 --> 00:17:19.900 Simple, literal, non -threatening. How about 00:17:19.900 --> 00:17:23.680 the word shot? Shot implies violence. It's an 00:17:23.680 --> 00:17:25.660 aggressive word. They think of guns, of being 00:17:25.660 --> 00:17:28.920 shot. So what do we say instead? The text recommends 00:17:28.920 --> 00:17:31.740 medicine under the skin. That feels a little 00:17:31.740 --> 00:17:33.339 bit wordy though, doesn't it? I need to give 00:17:33.339 --> 00:17:35.519 you some medicine under your skin. It is wordy, 00:17:35.539 --> 00:17:38.000 but what it is is accurate and neutral. You've 00:17:38.000 --> 00:17:40.900 removed the violence from the word. Or even a 00:17:40.900 --> 00:17:43.529 quick poke. That's better. A quick pinch. Another 00:17:43.529 --> 00:17:47.170 one that tricks people up constantly is using 00:17:47.170 --> 00:17:50.470 clinical words for bodily functions, like stool. 00:17:50.849 --> 00:17:54.329 Stool, as in poop. Yes. If you ask a four -year 00:17:54.329 --> 00:17:58.109 -old, have you had any stool today, they're going 00:17:58.109 --> 00:18:00.430 to look around the room for a small chair. They 00:18:00.430 --> 00:18:02.029 have no idea what you're asking them. Or urine. 00:18:02.210 --> 00:18:05.529 They hear, urine. It's just confusing. The text 00:18:05.529 --> 00:18:08.089 gives a great rule of thumb here. Use the child's 00:18:08.089 --> 00:18:09.849 terminology. So you have to ask the parents. 00:18:10.119 --> 00:18:12.259 You pull the parents aside quietly and you ask, 00:18:12.359 --> 00:18:14.680 what words do you use at home? Is it pee and 00:18:14.680 --> 00:18:18.319 poop? Is it kaka? Is it number two? And then 00:18:18.319 --> 00:18:21.240 you use that exact word with the child. You're 00:18:21.240 --> 00:18:23.799 speaking their language. It builds instant rapport. 00:18:24.019 --> 00:18:26.819 It's like code switching for toddlers. It is. 00:18:26.940 --> 00:18:29.680 And there's a general rule that sort of overlays 00:18:29.680 --> 00:18:33.440 all of the specific vocabulary, which is be honest, 00:18:33.880 --> 00:18:37.880 but be gentle. The text warns very strictly against 00:18:37.880 --> 00:18:40.549 ever saying it won't hurt. if it's going to hurt. 00:18:40.789 --> 00:18:43.150 Because that's the fastest way to lose all trust 00:18:43.150 --> 00:18:45.569 forever. It's a one strike and you're out situation. 00:18:45.950 --> 00:18:49.369 If you lie about the pain, they will never ever 00:18:49.369 --> 00:18:51.869 believe another word you say. So what's the honest 00:18:51.869 --> 00:18:54.529 but gentle way to say it? You say, this will 00:18:54.529 --> 00:18:56.799 feel like a quick pinch or. It's going to hurt 00:18:56.799 --> 00:18:58.759 for just a second, but then it will be all over. 00:18:59.319 --> 00:19:01.799 Or you can compare it to something they already 00:19:01.799 --> 00:19:03.920 know, like a mosquito bite or a little scratch. 00:19:04.240 --> 00:19:06.359 You give them a frame of reference. This is so 00:19:06.359 --> 00:19:08.180 critical. I want to move on to the developmental 00:19:08.180 --> 00:19:10.799 stages because a conversation with four -year 00:19:10.799 --> 00:19:13.079 -old Emma is obviously very different from a 00:19:13.079 --> 00:19:15.200 conversation with 14 -year -old Emma. The text 00:19:15.200 --> 00:19:17.119 breaks this down by age group, which is super 00:19:17.119 --> 00:19:19.599 helpful for structuring care. Let's start with 00:19:19.599 --> 00:19:22.569 the littlest ones, infants. With infants, you 00:19:22.569 --> 00:19:24.769 have to remember they are purely sensory creatures. 00:19:24.869 --> 00:19:27.329 They don't understand your words at all. So atraumatic 00:19:27.329 --> 00:19:29.849 care for them is all about controlling the environment. 00:19:30.710 --> 00:19:34.390 Touch, sight, hearing. Soft voices, dim lights 00:19:34.390 --> 00:19:37.910 if possible, minimizing any sudden jerky movements. 00:19:38.650 --> 00:19:40.869 But the biggest thing the text mentions for this 00:19:40.869 --> 00:19:44.089 age group is learning to read their cues. Infants 00:19:44.089 --> 00:19:47.569 have very subtle stress signals that are often 00:19:47.569 --> 00:19:51.119 missed by busy staff. You mean like crying. Crying 00:19:51.119 --> 00:19:53.900 is actually the late sign. Crying is the, I've 00:19:53.900 --> 00:19:56.140 had enough and I'm totally overwhelmed, scream. 00:19:57.140 --> 00:19:59.539 Long before they start crying, they will give 00:19:59.539 --> 00:20:02.380 other signals. Like what? What should I be looking 00:20:02.380 --> 00:20:04.380 for? They'll turn their head away from you. They 00:20:04.380 --> 00:20:06.819 might yawn excessively, which is often a stress 00:20:06.819 --> 00:20:08.900 release mechanism, not just a sign of tiredness. 00:20:08.960 --> 00:20:10.400 Oh, that's interesting. I didn't know that about 00:20:10.400 --> 00:20:12.539 yawning. Yeah, or they might get really irritable 00:20:12.539 --> 00:20:14.779 or splay their fingers out wide. Those are all 00:20:14.779 --> 00:20:17.460 signs of overstimulation. So if a baby is looking 00:20:17.460 --> 00:20:19.200 away from me and yawning while I'm trying to 00:20:19.200 --> 00:20:21.220 do an assessment, they aren't bored, they're 00:20:21.220 --> 00:20:24.000 overwhelmed. Exactly. They are communicating 00:20:24.000 --> 00:20:27.480 very clearly in their own language, I am overstimulated, 00:20:27.680 --> 00:20:30.220 I need a break right now. And atraumatic care 00:20:30.220 --> 00:20:33.180 means respecting that pause. Stop the procedure 00:20:33.180 --> 00:20:36.359 if you can, let the parent soothe them, squaddle 00:20:36.359 --> 00:20:38.660 them, and then try again once they've had a moment 00:20:38.660 --> 00:20:41.259 to reset. Okay, let's move up to toddlers and 00:20:41.259 --> 00:20:44.579 preschoolers. This seems like by far the hardest 00:20:44.579 --> 00:20:47.480 group to manage. It can be, yeah. They are mobile, 00:20:47.839 --> 00:20:49.480 they have very strong opinions, they can scream 00:20:49.480 --> 00:20:52.180 no, but they don't have any real logic yet. This 00:20:52.180 --> 00:20:55.819 is the peak concrete thinker stage, but it's 00:20:55.819 --> 00:20:58.559 also mixed with a heavy dose of magical thinking. 00:20:59.140 --> 00:21:01.619 And this is the age where the fear of bodily 00:21:01.619 --> 00:21:04.480 injury and mutilation is at its absolute peak. 00:21:04.819 --> 00:21:07.400 Bodily mutilation, that sounds really intense. 00:21:07.640 --> 00:21:10.720 It is for them. They have very, very poor body 00:21:10.720 --> 00:21:13.279 boundaries. So if a toddler gets a small cut, 00:21:13.619 --> 00:21:16.700 they often believe, genuinely, that all of their 00:21:16.700 --> 00:21:19.180 insides, all their blood, are going to leak out 00:21:19.180 --> 00:21:21.240 through that tiny hole. That's a horrifying thought. 00:21:21.279 --> 00:21:22.880 So they think they're going to deflate like a 00:21:22.880 --> 00:21:25.380 balloon. Essentially, yes. And that's why band 00:21:25.380 --> 00:21:27.539 -aids are practically currency for this age group. 00:21:27.819 --> 00:21:29.579 A band -aid isn't just a cute little covering. 00:21:29.880 --> 00:21:32.319 For them, it's a magical seal. It keeps their 00:21:32.319 --> 00:21:35.859 insides in. It fixes the leak. You should never 00:21:35.859 --> 00:21:38.299 ever underestimate the power of offering band 00:21:38.299 --> 00:21:40.640 -aid to a three -year -old. Wow, okay. So for 00:21:40.640 --> 00:21:43.740 this very literal, very scared group, how do 00:21:43.740 --> 00:21:46.480 we prepare them for a procedure? Do we try to 00:21:46.480 --> 00:21:49.380 explain the steps? You keep it incredibly simple, 00:21:49.859 --> 00:21:54.420 but your number one best tool is play. The text 00:21:54.420 --> 00:21:57.720 strongly suggests using puppets or dolls as a 00:21:57.720 --> 00:21:59.960 third -party tool. So if you need to listen to 00:21:59.960 --> 00:22:02.099 their heart, you listen to the doll's heart first. 00:22:02.279 --> 00:22:04.759 Then you let them use the stethoscope to listen 00:22:04.759 --> 00:22:07.200 to the doll's heart. You're making the scary 00:22:07.200 --> 00:22:10.619 cold object familiar and less threatening. You're 00:22:10.619 --> 00:22:13.539 demystifying it through play. Exactly. And the 00:22:13.539 --> 00:22:16.000 timing of your explanation is absolutely crucial 00:22:16.000 --> 00:22:19.859 here. The text has a very specific rule. For 00:22:19.859 --> 00:22:22.859 toddlers, so say one to three years old, you 00:22:22.859 --> 00:22:24.740 tell them about the procedure immediately before 00:22:24.740 --> 00:22:26.480 it happens. So you don't tell them in the morning 00:22:26.480 --> 00:22:28.460 if the shot is happening in the afternoon? Absolutely 00:22:28.460 --> 00:22:31.000 not. They have no real concept of future time. 00:22:31.119 --> 00:22:33.660 If you tell them at 9 a .m. about a shot happening 00:22:33.660 --> 00:22:36.279 at 2 p .m., you have just given them five hours 00:22:36.279 --> 00:22:39.160 of undefined escalating anxiety. They will just 00:22:39.160 --> 00:22:41.720 ask, is it now? Is it now? Every five minutes. 00:22:42.079 --> 00:22:44.019 And for preschoolers, like our four -year -old 00:22:44.019 --> 00:22:45.779 Emma... For them, you can prep them maybe an 00:22:45.779 --> 00:22:47.720 hour before. They can handle a slightly longer 00:22:47.720 --> 00:22:50.119 window. But you still want to keep that window 00:22:50.119 --> 00:22:53.839 very, very short. OK, moving up the ladder to 00:22:53.839 --> 00:22:57.079 school -aged children. So we're talking roughly 00:22:57.079 --> 00:23:00.160 6 to 12 years old. These are your little scientists. 00:23:00.349 --> 00:23:02.690 This is the age group that wants to know why 00:23:02.690 --> 00:23:05.730 and how. They are full of questions. Why do I 00:23:05.730 --> 00:23:07.970 need blood work? How does the x -ray machine 00:23:07.970 --> 00:23:10.730 see my bones? Will the medicine make me feel 00:23:10.730 --> 00:23:12.930 weird? So for this group, this is where you can 00:23:12.930 --> 00:23:15.170 finally pull out the diagrams and the models. 00:23:15.730 --> 00:23:18.809 Diagrams, simple books, short videos. You can 00:23:18.809 --> 00:23:21.170 even start using correct medical terminology, 00:23:21.430 --> 00:23:23.970 as long as you explain it in simple terms. They 00:23:23.970 --> 00:23:25.970 really appreciate being treated like they're 00:23:25.970 --> 00:23:28.410 smart enough to understand. And what about the 00:23:28.410 --> 00:23:30.950 timing for them? For this group, you can prepare 00:23:30.950 --> 00:23:33.690 them a few days in advance. They actually benefit 00:23:33.690 --> 00:23:35.809 from having some time to process the information, 00:23:36.329 --> 00:23:38.789 think of questions, and mentally prepare themselves. 00:23:38.970 --> 00:23:40.650 The text mentions something interesting about 00:23:40.650 --> 00:23:43.130 their emotional reaction, that they might try 00:23:43.130 --> 00:23:47.009 to be brave. Yes, the stoic school agar. It's 00:23:47.009 --> 00:23:49.170 a very common phenomenon. They might sit very 00:23:49.170 --> 00:23:51.049 still and stiff and act like they're totally 00:23:51.049 --> 00:23:53.029 fine because they don't want to cry and look 00:23:53.029 --> 00:23:56.779 like a baby. But inside, they're terrified. Inside, 00:23:57.180 --> 00:23:59.180 their heart is pounding, their palms are sweaty, 00:23:59.519 --> 00:24:02.059 their heart rate is 140. So the key takeaway 00:24:02.059 --> 00:24:05.519 here is, don't mistake silence for comfort. You 00:24:05.519 --> 00:24:07.619 still need to intervene. You still need to offer 00:24:07.619 --> 00:24:09.859 comfort and praise them for their bravery. But 00:24:09.859 --> 00:24:12.240 you also need to check in with them. Validate 00:24:12.240 --> 00:24:14.440 that it's okay to be scared. You can say something 00:24:14.440 --> 00:24:16.240 like, you are being so brave right now, but it's 00:24:16.240 --> 00:24:19.099 okay to cry if it hurts. You give them permission 00:24:19.099 --> 00:24:22.119 to release that stress. And finally, our last 00:24:22.119 --> 00:24:26.740 group, the adolescents. Teenagers. This is a 00:24:26.740 --> 00:24:28.900 whole different ballgame, a completely different 00:24:28.900 --> 00:24:32.359 set of priorities. The focus here shifts dramatically 00:24:32.359 --> 00:24:35.880 to privacy, body image, and independence. And 00:24:35.880 --> 00:24:38.339 their friends, the peer group. The peer group 00:24:38.339 --> 00:24:41.380 is everything. An illness or a hospitalization 00:24:41.380 --> 00:24:43.180 separates them from their social group, which 00:24:43.180 --> 00:24:45.740 is their absolute lifeline, so they feel incredibly 00:24:45.740 --> 00:24:47.960 isolated. They have this massive fear of missing 00:24:47.960 --> 00:24:50.019 out. I can imagine the approach to privacy is 00:24:50.019 --> 00:24:51.480 really tricky. You've got the parents sitting 00:24:51.480 --> 00:24:54.349 right there in the room. It is. The text advises 00:24:54.349 --> 00:24:56.809 that you talk to them like they're adults. Don't 00:24:56.809 --> 00:24:59.329 use baby talk or condescending language. But 00:24:59.329 --> 00:25:01.250 you also have to find a way to respect their 00:25:01.250 --> 00:25:03.349 confidentiality. So there are times you need 00:25:03.349 --> 00:25:05.869 to ask the parents to leave. Yes. There will 00:25:05.869 --> 00:25:08.910 be times, maybe when you need to ask about sexual 00:25:08.910 --> 00:25:11.750 history or substance use or mental health, where 00:25:11.750 --> 00:25:13.650 you need to ask the parents to step out for a 00:25:13.650 --> 00:25:16.150 few minutes. That can be such a tense moment. 00:25:16.630 --> 00:25:18.829 How do you handle that without making the parents 00:25:18.829 --> 00:25:21.190 feel suspicious or shut out? You frame it as 00:25:21.190 --> 00:25:24.009 a standard policy. You could say, it's our hospital's 00:25:24.009 --> 00:25:26.569 policy to give all our teen patients some private 00:25:26.569 --> 00:25:28.829 time with the doctor to ask any questions they 00:25:28.829 --> 00:25:30.509 might be embarrassed to ask in front of their 00:25:30.509 --> 00:25:33.710 parents. It normalizes it. It makes it not about 00:25:33.710 --> 00:25:36.210 them personally. And I noticed the text says 00:25:36.210 --> 00:25:38.650 you should specifically discuss how their care 00:25:38.650 --> 00:25:41.190 might affect their appearance. That is one of 00:25:41.190 --> 00:25:43.750 their biggest, if not the biggest, fear. Will 00:25:43.750 --> 00:25:46.569 this procedure leave a scar? Will the chemotherapy 00:25:46.569 --> 00:25:49.130 make me lose my hair? Will the steroids make 00:25:49.130 --> 00:25:52.250 my face puffy? And we might see that as vanity, 00:25:52.509 --> 00:25:54.690 but for them. For them, it's their entire world. 00:25:55.109 --> 00:25:57.970 You cannot brush it off. To a 16 -year -old, 00:25:58.230 --> 00:26:00.190 their appearance and how they fit in with their 00:26:00.190 --> 00:26:02.930 friends is their reality. So you have to address 00:26:02.930 --> 00:26:06.029 that head -on. And honestly, minimizing that 00:26:06.029 --> 00:26:09.980 concern is itself. Dramatic. So we've got the 00:26:09.980 --> 00:26:12.619 core philosophy, the right language to use, and 00:26:12.619 --> 00:26:15.740 the age -specific hacks. But let's be realistic. 00:26:16.140 --> 00:26:18.339 Hospitals are busy places. Nurses are overwhelmed. 00:26:18.440 --> 00:26:20.400 We can't always do all of this alone. No, you 00:26:20.400 --> 00:26:23.099 can't. The text introduces a specific role that 00:26:23.099 --> 00:26:25.859 acts as a kind of force multiplier for atraumatic 00:26:25.859 --> 00:26:29.279 care. The Child Life Specialist. The CLS. And 00:26:29.279 --> 00:26:31.960 I cannot stress this enough. The Child Life Specialist 00:26:31.960 --> 00:26:34.500 is not just the lady who brings the toys. I feel 00:26:34.500 --> 00:26:36.539 like that's the common stereotype, right? Oh, 00:26:36.660 --> 00:26:38.539 Child Life is here to play Uno with the kids. 00:26:38.660 --> 00:26:41.240 It's a massive, massive undervaluation of their 00:26:41.240 --> 00:26:43.920 role. A CLS is a highly trained professional, 00:26:44.059 --> 00:26:46.619 they often have a master's degree, who specializes 00:26:46.619 --> 00:26:49.019 in child development and the psychosocial impact 00:26:49.019 --> 00:26:51.579 of illness and hospitalization. So their entire 00:26:51.579 --> 00:26:53.859 job is to be the expert on this stuff. Their 00:26:53.859 --> 00:26:56.380 job is to translate the medical world into the 00:26:56.380 --> 00:26:58.519 child's world. They are the bridge. So they are 00:26:58.519 --> 00:27:00.480 the ones doing that detailed procedural prep 00:27:00.480 --> 00:27:03.000 with the dolls that we talked about. Yes. They 00:27:03.000 --> 00:27:04.619 are the ones with the specialized dolls that 00:27:04.619 --> 00:27:07.440 can show Emma exactly what the IV will look like 00:27:07.440 --> 00:27:09.319 and where it will go. They are the ones coaching 00:27:09.319 --> 00:27:11.799 the parents on the best language to use. They 00:27:11.799 --> 00:27:14.579 also do things like advocacy for the child and 00:27:14.579 --> 00:27:17.400 even grief and bereavement support. The text 00:27:17.400 --> 00:27:20.279 actually uses the phrase quality benchmark to 00:27:20.279 --> 00:27:23.430 describe them. That's such a key line. The American 00:27:23.430 --> 00:27:25.569 Academy of Pediatrics says that the presence 00:27:25.569 --> 00:27:28.890 of Child Life Services is an indicator of excellence 00:27:28.890 --> 00:27:31.950 in pediatric care. So, if you're a nurse and 00:27:31.950 --> 00:27:34.069 you're feeling overwhelmed or you have a particularly 00:27:34.069 --> 00:27:36.930 difficult procedure coming up... Call Child Life. 00:27:37.130 --> 00:27:39.509 The text says it clearly. When in doubt, consult 00:27:39.509 --> 00:27:42.670 the CLS. Use them. They are your absolute best 00:27:42.670 --> 00:27:45.200 resource. Let's widen the links a bit now to 00:27:45.200 --> 00:27:47.160 the whole family. We talked about family centered 00:27:47.160 --> 00:27:50.240 care is one of the pillars, but the text gets 00:27:50.240 --> 00:27:52.799 into some specific rules here, especially around 00:27:52.799 --> 00:27:55.559 culture and communication. Cultural humility 00:27:55.559 --> 00:27:58.579 is essential. You have to go in with the understanding 00:27:58.579 --> 00:28:01.059 that you are not the expert on that family's 00:28:01.059 --> 00:28:03.599 beliefs. You have to respect that different families 00:28:03.599 --> 00:28:05.880 handle health and illness in very different ways. 00:28:05.900 --> 00:28:08.500 Right. But there is one safety rule in the text 00:28:08.500 --> 00:28:11.220 regarding communication that is just absolute 00:28:11.220 --> 00:28:13.549 dynamite. It's about the use of interpreters. 00:28:13.650 --> 00:28:17.130 The interpreter rule. This feels like a major 00:28:17.130 --> 00:28:21.529 NCLEX highlight. A big red flag. It is a major 00:28:21.529 --> 00:28:23.990 patient safety standard. So here's the classic 00:28:23.990 --> 00:28:26.190 scenario. You have a family that doesn't speak 00:28:26.190 --> 00:28:28.869 English fluently. You have a complex, serious 00:28:28.869 --> 00:28:32.329 medical diagnosis to explain. But their 10 -year 00:28:32.329 --> 00:28:34.210 -old daughter speaks perfect fluent English. 00:28:34.549 --> 00:28:37.009 What do you do? The temptation is so obvious. 00:28:37.049 --> 00:28:38.789 You ask the daughter to translate for her parents. 00:28:38.809 --> 00:28:41.089 She's right there. It's fast. She knows the context. 00:28:41.289 --> 00:28:44.130 And the text says, you must never ever do that. 00:28:44.250 --> 00:28:46.849 Why is it such a hard no? Is it just about the 00:28:46.849 --> 00:28:49.670 accuracy of the translation? Well, the accuracy 00:28:49.670 --> 00:28:52.069 is a huge part of it. It's fundamentally unsafe. 00:28:52.710 --> 00:28:55.089 A 10 -year -old does not have the medical vocabulary 00:28:55.089 --> 00:28:59.210 to accurately translate hypoglycemia or informed 00:28:59.210 --> 00:29:02.650 consent. You risk major medical errors because 00:29:02.650 --> 00:29:05.480 of a simple mistranslation. OK. That makes sense 00:29:05.480 --> 00:29:08.160 from a safety standpoint, but what's the trauma 00:29:08.160 --> 00:29:11.619 aspect? You're putting a massive unfair emotional 00:29:11.619 --> 00:29:15.440 burden on a child. Imagine making a child be 00:29:15.440 --> 00:29:17.740 the one to tell their own parent you have cancer 00:29:17.740 --> 00:29:21.579 or the baby is very, very sick. Oh, wow. I never 00:29:21.579 --> 00:29:23.599 thought of it that way. That is not their job. 00:29:23.819 --> 00:29:25.720 It creates this terrible role reversal where 00:29:25.720 --> 00:29:27.720 the child is forced to emotionally care for the 00:29:27.720 --> 00:29:30.119 parent. You are actively traumatizing that child 00:29:30.119 --> 00:29:32.480 by forcing them to be the bearer of bad news. 00:29:32.539 --> 00:29:34.140 That really puts it in a different perspective. 00:29:34.220 --> 00:29:37.160 So what is the absolute unbreakable standard 00:29:37.160 --> 00:29:39.920 of care? The standard is you always use a trained 00:29:39.920 --> 00:29:42.420 professional medical interpreter, whether that's 00:29:42.420 --> 00:29:44.960 in person or over the phone or on a video service 00:29:44.960 --> 00:29:46.940 period. And when you're using an interpreter, 00:29:47.019 --> 00:29:49.410 what's the best practice? Here is the pro tip 00:29:49.410 --> 00:29:51.769 from the text that really separates the rookies 00:29:51.769 --> 00:29:55.349 from the pros. When you speak, you look at the 00:29:55.349 --> 00:29:57.750 family, not at the interpreter. Right, because 00:29:57.750 --> 00:29:59.869 you are talking to them. The interpreter is just 00:29:59.869 --> 00:30:02.750 the tool. Exactly. You speak in short, simple 00:30:02.750 --> 00:30:05.849 sentences. You pause to let the interpreter translate. 00:30:06.670 --> 00:30:08.809 But you keep your eye contact and your body language 00:30:08.809 --> 00:30:12.130 focused on the patient and the parents. It shows 00:30:12.130 --> 00:30:14.569 respect and it builds the relationship. If you 00:30:14.569 --> 00:30:17.089 just stare at the iPad or the interpreter, the 00:30:17.089 --> 00:30:19.309 family feels completely excluded from their own 00:30:19.309 --> 00:30:22.049 care. This brings us to the final piece of this 00:30:22.049 --> 00:30:25.170 whole puzzle. Education. Because eventually, 00:30:25.430 --> 00:30:28.230 hopefully, Emma is going to go home. And her 00:30:28.230 --> 00:30:30.150 parents need to know how to take care of her. 00:30:30.490 --> 00:30:32.170 Patient education is where the rubber meets the 00:30:32.170 --> 00:30:34.400 road. I mean, if we do incredible care in the 00:30:34.400 --> 00:30:36.660 hospital but send them home confused and scared, 00:30:37.079 --> 00:30:39.240 they'll just be back in the ER in 24 hours. But 00:30:39.240 --> 00:30:41.039 there's a huge problem, right? There's a huge 00:30:41.039 --> 00:30:43.640 problem. The text cites a statistic that is just 00:30:43.640 --> 00:30:46.740 staggering. It says that 45 % of Americans have 00:30:46.740 --> 00:30:49.359 low health literacy. Nearly half the population. 00:30:49.700 --> 00:30:52.589 Nearly half. It means that almost half the people 00:30:52.589 --> 00:30:55.170 you talk to on any given day might have trouble 00:30:55.170 --> 00:30:57.730 processing complex health information, reading 00:30:57.730 --> 00:30:59.890 prescription bottles, or understanding discharge 00:30:59.890 --> 00:31:02.430 instructions. And I imagine that stress makes 00:31:02.430 --> 00:31:05.009 literacy drop even lower. It absolutely does. 00:31:05.549 --> 00:31:08.549 Stress makes us all stupid. When your cortisol 00:31:08.549 --> 00:31:12.170 is up, your prefrontal cortex, the logical thinking 00:31:12.170 --> 00:31:15.200 part of your brain, basically shuts down. So 00:31:15.200 --> 00:31:17.519 a parent who is normally very sharp and on top 00:31:17.519 --> 00:31:19.839 of things might really struggle when their kid 00:31:19.839 --> 00:31:22.299 is sick in the hospital. The text gives us some 00:31:22.299 --> 00:31:25.700 red flags to watch out for. How can we spot potential 00:31:25.700 --> 00:31:28.599 low -health literacy without making someone feel 00:31:28.599 --> 00:31:31.259 embarrassed? You watch for the behavioral cues. 00:31:31.779 --> 00:31:33.799 If a parent says, oh, I forgot my reading glasses 00:31:33.799 --> 00:31:35.839 at home when you hand them a form to read. A 00:31:35.839 --> 00:31:39.119 classic excuse. A classic. Yeah. Or if they fill 00:31:39.119 --> 00:31:41.500 out the form, but they leave a lot of it incomplete. 00:31:42.250 --> 00:31:44.269 Or, and this is the most common one, if they 00:31:44.269 --> 00:31:47.289 just nod and smile and say okay to everything 00:31:47.289 --> 00:31:49.289 you say, but they never ask any questions. The 00:31:49.289 --> 00:31:51.289 compliance nod. They don't want to look stupid 00:31:51.289 --> 00:31:53.490 by admitting they don't understand. Exactly. 00:31:53.690 --> 00:31:55.529 They are likely completely overwhelmed or just 00:31:55.529 --> 00:31:57.730 don't understand, but all the social norms say 00:31:57.730 --> 00:32:01.809 they should just nod along. So as a nurse, you 00:32:01.809 --> 00:32:04.210 cannot assume understanding just because they 00:32:04.210 --> 00:32:06.869 nodded. You have to verify it. And the gold standard 00:32:06.869 --> 00:32:09.599 tool for that is the teach back method. This 00:32:09.599 --> 00:32:11.779 is it. This is the single best tool we have. 00:32:12.359 --> 00:32:15.180 It is the only way to truly confirm that learning 00:32:15.180 --> 00:32:18.039 has occurred. Walk us through how that sounds 00:32:18.039 --> 00:32:19.920 in a real conversation, because I think a lot 00:32:19.920 --> 00:32:21.740 of people feel awkward doing it. They feel like 00:32:21.740 --> 00:32:24.160 they're giving the parent a pop quiz. It really 00:32:24.160 --> 00:32:26.180 shouldn't feel like a quiz. The key is how you 00:32:26.180 --> 00:32:29.200 frame it. So instead of saying, do you understand? 00:32:29.529 --> 00:32:32.089 which just invites a simple yes or no answer. 00:32:32.589 --> 00:32:34.769 You put the onus back on yourself. How do you 00:32:34.769 --> 00:32:36.690 do that? You say something like, you know, I 00:32:36.690 --> 00:32:38.710 want to make sure that I explain this clearly. 00:32:39.089 --> 00:32:41.470 Can you tell me in your own words how you were 00:32:41.470 --> 00:32:43.990 going to give Emma this medicine when you get 00:32:43.990 --> 00:32:47.269 home? That's a really subtle, but powerful shift. 00:32:47.549 --> 00:32:49.269 Make sure I explained it clearly. You aren't 00:32:49.269 --> 00:32:51.089 testing them. You're testing your own teaching. 00:32:51.470 --> 00:32:53.730 Smart, right? Yeah. It totally saves face for 00:32:53.730 --> 00:32:56.789 them. And then if they can't explain it back 00:32:56.789 --> 00:32:58.690 to you correctly, you know, you need to reteach 00:32:58.690 --> 00:33:01.470 it. But you don't just repeat the same words 00:33:01.470 --> 00:33:04.569 louder. You try a different way. Like using visuals. 00:33:04.829 --> 00:33:07.509 The text emphasizes visuals. Absolutely. Maybe 00:33:07.509 --> 00:33:09.410 you draw a simple picture. Maybe you color -code 00:33:09.410 --> 00:33:12.009 the medication bottles. You use a video. You 00:33:12.009 --> 00:33:13.789 do a demonstration. And you have to remember 00:33:13.789 --> 00:33:16.730 the difference between how adults learn and how 00:33:16.730 --> 00:33:18.769 children learn. Adults are problem -focused, 00:33:18.869 --> 00:33:21.309 right? They need the why. Yes. Adults have to 00:33:21.309 --> 00:33:24.170 know the why. Why do I need to give this antibiotic 00:33:24.170 --> 00:33:26.089 for all 10 days if she feels totally better in 00:33:26.089 --> 00:33:28.880 three? If you don't explain the why... you know, 00:33:29.059 --> 00:33:31.240 about drug resistance, about the infection coming 00:33:31.240 --> 00:33:33.599 back stronger, they won't do it. Children, on 00:33:33.599 --> 00:33:35.940 the other hand, learn through play, through stories 00:33:35.940 --> 00:33:39.000 and repetition. So for Emma, you might play a 00:33:39.000 --> 00:33:41.140 hospital with her doll to teach her about her 00:33:41.140 --> 00:33:43.980 care. But for her mom, you explain the science 00:33:43.980 --> 00:33:46.039 behind the treatment plan, and then you use the 00:33:46.039 --> 00:33:48.539 teach -back method to confirm she gets it. Precisely. 00:33:48.819 --> 00:33:51.299 You are tailoring the education just like you 00:33:51.299 --> 00:33:53.000 tailor every other part of the medical care. 00:33:53.180 --> 00:33:55.420 This has been such an eye -opener. It's funny, 00:33:55.539 --> 00:33:58.640 we started with a topic that on the surface sounds 00:33:58.640 --> 00:34:00.900 like it's about being gentle, but we've covered 00:34:00.900 --> 00:34:03.059 more critical safety protocols and some of our 00:34:03.059 --> 00:34:05.259 more technical deep dives. That's the absolute 00:34:05.259 --> 00:34:07.819 reality of pediatrics. The so -called soft stuff 00:34:07.819 --> 00:34:10.639 is the safety stuff. If you can't communicate 00:34:10.639 --> 00:34:13.519 effectively, if you can't gain trust, if you 00:34:13.519 --> 00:34:16.579 can't get a child to cooperate without terrifying 00:34:16.579 --> 00:34:19.179 them, you simply cannot provide safe medical 00:34:19.179 --> 00:34:21.610 care. So let's bring it all back home. Back to 00:34:21.610 --> 00:34:23.889 Emma. She's on the unit now. You're the nurse 00:34:23.889 --> 00:34:26.789 walking into her room. Based on everything we've 00:34:26.789 --> 00:34:28.670 learned today, the pillars, the language, the 00:34:28.670 --> 00:34:31.130 developmental hacks, how does her admission go 00:34:31.130 --> 00:34:34.480 now? Ideally. You walk in. You don't tower over 00:34:34.480 --> 00:34:37.079 her bed. You get down on one knee, so you're 00:34:37.079 --> 00:34:40.380 at her eye level. You smile. You introduce yourself 00:34:40.380 --> 00:34:43.019 to her and to her parents. You use simple, non 00:34:43.019 --> 00:34:45.500 -threatening words. Hi, Emma. My name is Chris. 00:34:45.599 --> 00:34:47.440 I'm a nurse, and I'm here to help your head feel 00:34:47.440 --> 00:34:50.579 better. No stretchers, no dye, no shots. No, 00:34:50.900 --> 00:34:52.699 none of that. You say, we're going to take a 00:34:52.699 --> 00:34:54.719 little ride on a rolling bed so we can take some 00:34:54.719 --> 00:34:56.659 special pictures of your head to see why it's 00:34:56.659 --> 00:34:59.019 hurting. You give her a valid choice. Do you 00:34:59.019 --> 00:35:00.920 want to bring your teddy bear with you or your 00:35:00.920 --> 00:35:02.989 special blanket? And when it's time for that 00:35:02.989 --> 00:35:05.630 ivy start. You use numbing cream if you have 00:35:05.630 --> 00:35:08.869 time. You call the child life specialist to be 00:35:08.869 --> 00:35:11.889 there to distract her with bubbles or an interactive 00:35:11.889 --> 00:35:15.469 book on an iPad. And you use therapeutic hugging. 00:35:16.070 --> 00:35:19.369 Her mom holds her chest to chest. Emma feels 00:35:19.369 --> 00:35:22.329 safe. She's anchored. She might cry a little 00:35:22.329 --> 00:35:24.610 bit because it's a pinch, but she isn't being 00:35:24.610 --> 00:35:27.789 held down and overpowered by strangers. She retains 00:35:27.789 --> 00:35:30.469 her dignity in this situation. And afterwards, 00:35:30.630 --> 00:35:32.489 she gets the red Band -Aid that she chose. And 00:35:32.489 --> 00:35:34.309 her parents understand exactly what to watch 00:35:34.309 --> 00:35:36.510 for at home, because you used the teachback method 00:35:36.510 --> 00:35:39.050 before they were discharged. That is a traumatic 00:35:39.050 --> 00:35:42.289 care. You took a scary, chaotic event, and you 00:35:42.289 --> 00:35:45.809 made it manageable. You did no harm. In fact, 00:35:46.010 --> 00:35:48.510 you did good. It's powerful stuff when you see 00:35:48.510 --> 00:35:50.190 it all come together like that. It really is. 00:35:50.210 --> 00:35:52.110 And if I can leave our listeners with just one 00:35:52.110 --> 00:35:54.710 final thought on this. Go for it. We talked about 00:35:54.710 --> 00:35:59.039 that 45 % health literacy statistic. Now think 00:35:59.039 --> 00:36:01.000 about that number in the context of informed 00:36:01.000 --> 00:36:05.219 consent. In medicine, we are obsessed with getting 00:36:05.219 --> 00:36:07.760 the signature on the form. Right. The paperwork 00:36:07.760 --> 00:36:10.159 has to be done. But if we are rattling off a 00:36:10.159 --> 00:36:13.000 list of risks and benefits to a tired, stressed 00:36:13.000 --> 00:36:16.340 parent using a bunch of medical jargon, and we 00:36:16.340 --> 00:36:18.179 don't stop to check for their understanding, 00:36:19.050 --> 00:36:21.510 Are they really consenting? Or are they just 00:36:21.510 --> 00:36:24.030 submitting? Exactly. Are they actually giving 00:36:24.030 --> 00:36:26.309 informed consent? Or are they just submitting 00:36:26.309 --> 00:36:28.429 to authority because they feel overwhelmed and 00:36:28.429 --> 00:36:31.250 don't want to look stupid? True anti -traumatic 00:36:31.250 --> 00:36:33.730 care isn't just about the needle. It's about 00:36:33.730 --> 00:36:35.969 ensuring that the family isn't traumatized by 00:36:35.969 --> 00:36:38.710 their own confusion. It has to extend to the 00:36:38.710 --> 00:36:40.940 parent's understanding too. If they leave the 00:36:40.940 --> 00:36:42.860 hospital feeling empowered and capable, you've 00:36:42.860 --> 00:36:45.199 done your job. If they leave feeling confused 00:36:45.199 --> 00:36:47.460 and scared, the trauma just continues at home. 00:36:47.820 --> 00:36:50.800 That is a mic drop moment right there. Are they 00:36:50.800 --> 00:36:52.639 consenting or just submitting? I think that's 00:36:52.639 --> 00:36:54.460 something every single clinician needs to ask 00:36:54.460 --> 00:36:56.719 themselves before they uncap a pen for a signature. 00:36:57.119 --> 00:36:58.960 It's the difference between being a technician 00:36:58.960 --> 00:37:01.650 and being a healer. Well, on that note, we're 00:37:01.650 --> 00:37:04.289 going to wrap up this deep dive. To all the learners 00:37:04.289 --> 00:37:06.670 out there, whether you're prepping for the NCLEX 00:37:06.670 --> 00:37:09.610 or just trying to be a better, more compassionate 00:37:09.610 --> 00:37:12.650 human, go out there and be the nurse who makes 00:37:12.650 --> 00:37:15.329 the hospital just a little less scary for all 00:37:15.329 --> 00:37:17.530 the emas of the world. Do no harm. Thanks for 00:37:17.530 --> 00:37:18.869 listening. We'll see you on the next one.