Am I the only one?

Pediatric Critical Care Columnist · Jul 27, 2010

You're not rowing alone in that boat, Auntie. Usually the ones that do that are the parents of chronically ill or medically complex kids who have been around, seen a lot and have picked up the lingo but don't necessarily understand what they've learned. When all is said and done though, they do know their child, their child's special needs and their child's history better than we ever can. For me, if it's a matter of what works best when giving G-tube meds (some kids gag, have cramps or feel nauseated if their meds are given too quickly), or which position is more comfortable, or which med for sedation works best, I have no problem going along with it. There are times when I feel quite happy to just step back and let the mom or dad do the task at hand.

About this time last year I was assigned to care for a child who had a long history of airway issues that had been mismanaged and her mom was quite (understandably) distrustful of all health care providers as a result. The kiddie had been on the unit for several days and had mostly been cared for by junior staff members. Mom was exhausted and hypervigilant by this time. We were planning to extubate in the morning so the kiddie's sedation had been drastically cut back and she was... umm... active. Mom went out for a bit of a break, planning to spend the whole night sitting at the bedside "being there" for her little one... and watching me work. While she was gone I gave the girl a quick bath, got her comfortable, rubbed her back and stroked her hair, all the while speaking to her in a soft voice. In no time she was sound asleep. When her mom came back half an hour or so later, she was stunned to see her child sleeping. I told the mom that I was going to disturb the little one as infrequently as I could overnight so that she could rest, that she needed to learn to settle herself when she was upset and that she was probably going to be hospitalized again in the future and should start developing some coping skills. Then I told Mom she should take advantage of the opportunity to get some sleep herself, since her exhaustion was affecting her daughter and making her more anxious than she needed to be. I explained how self-care is not selfish, but actually beneficial to the child because their parents are better equipped to deal with things when they're rested and fed. She looked at me like I'd suggested she take poison. I didn't push and she sat down on the chair with a scowl on her face. After some time had passed with the little girl was still soundly asleep and me quietly doing what I needed to do without waking her, mom got up and said she was going home. The next time I worked, the little girl had been discharged and I forgot all about her.

Well, this spring they were back, this time just for a short stay following a simple surgical procedure. I wasn't assigned to care for the little girl but I did have occasion to pass by the bed a few times. I said hi to Mom on one of my trips and she stopped me. She said, "I want to tell you something. I was so angry with you that night when you told me to go home. I thought, How dare you? But you know, I've thought a lot about what you said about taking care of myself, especially the part about how my mood sometimes makes her upset. I know now that you were right and that you said what you said with the best of intentions. Thank you." I nearly died!

Next time a parent tells you how to do your job, think about why for a second. If it's not violating some policy or protocol to do it their way, is it really a big deal? You might find that you're building trust and creating a partnership.

JenRN30, BSN · Aug 9, 2010

You're not rowing alone in that boat, Auntie. Usually the ones that do that are the parents of chronically ill or medically complex kids who have been around, seen a lot and have picked up the lingo but don't necessarily understand what they've learned. When all is said and done though, they do know their child, their child's special needs and their child's history better than we ever can. For me, if it's a matter of what works best when giving G-tube meds (some kids gag, have cramps or feel nauseated if their meds are given too quickly), or which position is more comfortable, or which med for sedation works best, I have no problem going along with it. There are times when I feel quite happy to just step back and let the mom or dad do the task at hand.
About this time last year I was assigned to care for a child who had a long history of airway issues that had been mismanaged and her mom was quite (understandably) distrustful of all health care providers as a result. The kiddie had been on the unit for several days and had mostly been cared for by junior staff members. Mom was exhausted and hypervigilant by this time. We were planning to extubate in the morning so the kiddie's sedation had been drastically cut back and she was... umm... active. Mom went out for a bit of a break, planning to spend the whole night sitting at the bedside "being there" for her little one... and watching me work. While she was gone I gave the girl a quick bath, got her comfortable, rubbed her back and stroked her hair, all the while speaking to her in a soft voice. In no time she was sound asleep. When her mom came back half an hour or so later, she was stunned to see her child sleeping. I told the mom that I was going to disturb the little one as infrequently as I could overnight so that she could rest, that she needed to learn to settle herself when she was upset and that she was probably going to be hospitalized again in the future and should start developing some coping skills. Then I told Mom she should take advantage of the opportunity to get some sleep herself, since her exhaustion was affecting her daughter and making her more anxious than she needed to be. I explained how self-care is not selfish, but actually beneficial to the child because their parents are better equipped to deal with things when they're rested and fed. She looked at me like I'd suggested she take poison. I didn't push and she sat down on the chair with a scowl on her face. After some time had passed with the little girl was still soundly asleep and me quietly doing what I needed to do without waking her, mom got up and said she was going home. The next time I worked, the little girl had been discharged and I forgot all about her.
Well, this spring they were back, this time just for a short stay following a simple surgical procedure. I wasn't assigned to care for the little girl but I did have occasion to pass by the bed a few times. I said hi to Mom on one of my trips and she stopped me. She said, "I want to tell you something. I was so angry with you that night when you told me to go home. I thought, How dare you? But you know, I've thought a lot about what you said about taking care of myself, especially the part about how my mood sometimes makes her upset. I know now that you were right and that you said what you said with the best of intentions. Thank you." I nearly died!
Next time a parent tells you how to do your job, think about why for a second. If it's not violating some policy or protocol to do it their way, is it really a big deal? You might find that you're building trust and creating a partnership.

Great response and story. Thank you for this.