Entertaining pt

  1. First the case, a pedi vent pt between 2-3yo who is cognitively all there but has severe muscle weakness. He is able to grasp and move his arms but has very little fine motor control. I've been with this client for over a year and really haven't seen any improvement in muscle tone. Speech has obviously gotten a bit better but can only really say 10 words. Also has PT and ST twice a week.

    Recently the mother has been making noise about how it makes her SO SAD to come into the room and he isn't being played with. Now this is a family who comes in 1, maybe 2 times a day yet both parents are unemployed and living with relatives while having 24/7 care. When this happens I'm usually documenting.

    I work nights so I really don't have to entertain him much. However, I do want to try and be helpful and would love to suggest activities that are age appropriate yet he could do. Currently he is addicted to TV and to be frank so are the parents.

    How much should a nurse be required to entertain clients? After all we do have treatments/ notes to do as well. I know we are to provide 'appropriate play therapy and developmental stimulation' but it's a bit hard when all there is are teething toys and stuffed animals, how is the day shift suppose to entertain him for 12 hours!?
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  2. 14 Comments

  3. by   middleagednurse
    You can continue the activities that PT/OT do. Talk to him, read to him, can he play with play-dough to strengthen his hands?, Listen to music, maybe try to sing along? Can he use crayons to color?, can you hand him items of different textures to touch? Maybe get a laser pen and have him track the light with his eyes? Can he put his hands into a bowl of rice, and try to move his hands?
  4. by   smartnurse1982
    I work nights because most times the patients are sleeping.

    I never understood why parents expect the nurses to play and interact 24/7 when the parents barely do it themselves.

    We are there for the nursing care primarily;everything else is secondary.
  5. by   allyl
    Already talk, read, and sing to him. We've been trying to get the parents to buy some crayons but they haven't yet. I'm not about to buy anything as several nurses have already gotten into trouble for buying things. That's a whole different topic though. I like the rice idea though.
    It's not like I'm ignoring him but am lacking the supplies to keep him entertained.
  6. by   rnrg
    I completely understand what you are expressing. I have worked for multiple agencies, and so far my current agency was the only one to offer assistance with this. I reported my concerns to our office manager and she was able to locate a few age appropriate developmental toys to get donated in excellent used condition. I think that in many cases where there is 24h care being provided the family seems to automatically expect the nurses and therapy staff to provide all of the interaction and tools to complete interaction which is not true. If these parents can not afford to purchase a 50 cent box of crayons and a few coloring books for 1$ or less that is grossly unfortunate. I'm not sure which state you are in but in my state at the age of 3yo children who are differently abled must be registered for special services schooling which does provide a much nicer and larger structured environment for a child to flourish in.
    If purchasing things is off limits, I would suggest looking into a way to have some things donated to the family for the child to use with the nursing staff for developmentally appropriate use. After all, there is no way to "play" if all you are offered is teething devices and stuffed animals. That is not providing age appropriate developmentall stimulation. Also perhaps you could call your case manager and explain your concerns to him/her and have the CM talk to the primary care givers? I know you mentioned they were both unemployed, maybe money is an issue. There are many ways to look into donation possibilities especially in these situations.
  7. by   caliotter3
    When a client starts to voice complaints to you, I see the countdown to "oh, we need a different nurse for, insert reason, number one being language fluency in their language other than English". You are working on night shift. The child is supposed to be resting and the unemployed parents should be asleep themselves, preparing for another day of job hunting. Stimulating the child is in the realm of the day shift and swing shift nurses. Look out for yourself now that the requests are getting to be a little on the unreasonable side.
  8. by   smartnurse1982
    Not to intrude on the original question,but how are we to entertain children who are not cognitively aware?
    Meaning children who cannot track,does not respond to voice,etc.
  9. by   caliotter3
    I talk to these children, and as much as possible, attempt to interact as if they are cognitively aware. Any deeper than that, no, because no one has trained me in this area. Any time I have asked questions of supervisors, I have pretty much only been given vague answers.
  10. by   smartnurse1982
    Quote from caliotter3
    I talk to these children, and as much as possible, attempt to interact as if they are cognitively aware. Any deeper than that, no, because no one has trained me in this area. Any time I have asked questions of supervisors, I have pretty much only been given vague answers.

    Me too.

    When i had to school with kiddos who were not cognitively aware,i was stuck and did not know what to do.
    Even the teachers did not know what to do. They left the actual teaching up to me,which was unfair.

    Nights are the best!
  11. by   Kitiger
    Quote from smartnurse1982
    Not to intrude on the original question, but how are we to entertain children who are not cognitively aware?
    Meaning children who cannot track,does not respond to voice, etc.
    I would hold the child, and gently rock him, sing to him, stroke his arms & face (firm touch, no tickles), do passive range of motion, gently massage, continue with any OT/PT therapies that he has, use various textures (smooth, bumpy, rough, slippery, fuzzy, squishy, etc.) to stimulate his sense of touch, use various aromas (orange peel, cinnamon, perfume, etc. - as long as he isn't allergic) to stimulate his sense of smell.

    Age doesn't matter. If he is too big to hold on my lap, I can still rock him in his bed (put him on his side and tip him forward and backward) or hold him close to me for a hug. I've had older kids - some in their teens - who relax and coo when held or rocked. Touch is so important!

    I talk to him all day long. I talk about what we're doing, tell him about the weather, the season, family news, what time his mom is coming home, what kids do in school. If I do something and he shows that he likes it, I comment on that, and I tell him, "You're welcome." (He is thanking me the only way he can when he shows that he likes something by relaxing, smiling, or cooing, etc.)
  12. by   ventmommy
    I heart you, Kitiger RN.

    Your post is perfect.
  13. by   poppycat
    Kitiger, I've always done exactly what you're talking about. If I have an older Peds client who isn't cognitively intact, I talk to them the same way I would talk to one who is intact. I equate that with talking to an infant who most likely has no idea what I'm talking about but likes to hear the sound of a human voice. These kids can definitely "tell" us what they think about what we're doing with them.
  14. by   Orion81
    Quote from smartnurse1982
    Not to intrude on the original question,but how are we to entertain children who are not cognitively aware?
    Meaning children who cannot track,does not respond to voice,etc.
    Exactly what I've been wanting to ask. My 10 y/0 or doesn't even go to school. Can't make eye contact, can't move unless it's reflexive...She loves music during morning care, and the sound of cartoons during the day. I bring out toys that make noises, but at what point do I draw the line between nurse and babysitter? A parent, sister or grandma is ALWAYS home. I feel like I'll play with her for 30 minutes, then go to chart a s thats when family walks in. I'm thinking, why couldn't you walk in when I was engaging her, instead walk in when it looks like I'm doing nothing.

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