very badly behaved ped client

[anon456, BSN, RN]

I'm a nursing student, and I'm probably not going into peds. I have to write a journal entry about my experience in hem-onc last week, and I'm not sure if this is beyond my scope of duties or not . .

So I had this preschooler who had cancer. She had been very sick but was getting better, although she had a long road ahead of her. I felt sorry for her and her family-- I can't imagine how tough it must be. BUT this child was so incredibly rude, demanding, disruptive, and contrary. She would order everyone around and you could tell she enjoyed it-- it was not just that she didn't know about good manners. She growled at people if they tried to say something nice to her. She purposely ignored people. When a doctor was talking to the dad about some important info, she started calling to her dad because he was not for the moment focused on her. Totally normal preschool behavior. Dad said just a minute to her, and turned back to the doctor. She started calling "Hey!" to the doctor and he said let me talk to dad for a minute. She kept saying Hey, and then started throwing candy at him! And hit him in the belly a few times! Dad did nothing about it. Nurses tried to distract her but they were busy hanging a blood product. When nurses tried to assess her she would be very rude, complain about cold hands, etc. but then 2 minutes later would ask for an ice pack.

I know she's sick and all, but is it too much to ask for good manners? As a nurse is there much I can do or is this out of my scope of practice. I know if an adult treated me like this I would be having a nice talk with them about how I'm trying to help them, and would appreciate some respect (in a tactful way) because nurses should not take abuse from clients. But what about a child?

[klone, MSN, RN]

I'm not sure how to respond to this post without being totally rude.

It seems pretty clear to me that you're neither a parent, nor someone who has ever been treated for a terminal illness.

Don't judge another until you've walked a mile in their shoes, and all that...

[Flare, ASN, BSN]

i've run into that a few times where parents have a sick child and set no boundaries because they feel bad for their child. Unfortunately they don't understand that children crave routine and need to have limits set. Sure, it's okay to feel bad for a sick child, but thety're doing her no favors in learning how to assimilate into the real world once the illness has (hopefully) gone into remission.

If she were my patient I would have a discussion with her about how i am happy to take care of her and help her out, but that she needs to be polite and not throw things and so forth. Children that age often respond well if you turn the scenario around and ask them if they would like it if you were rude and yelled at them.

[MAISY, RN-ER, BSN, RN]

To her parents she is precious, regardless of her actions. I am sure they are happy to have her active and with the energy to be contrary.

Imagine how active toddlers are, now imagine one who has to do what she is told all the time...have procedures that hurt...have needles pinch her daily....feel sick....and not understand why...

I will not say you shouldn't go into pediatrics, but I think you should educate and expose yourself to alot of children and adults. If you can't understand the kids, then you will really love the adults who act this way. Nursing isn't for everyone.

M

[RN9742]

I'm not sure how to respond to this post without being totally rude.

It seems pretty clear to me that you're neither a parent, nor someone who has ever been treated for a terminal illness.

Don't judge another until you've walked a mile in their shoes, and all that...

As a parent of 4 children, one of which has a birth defect that has us at the hospital so much I call it my second home...

This is totally and completely off base!

I think the OP asked a legitimate question, and was respectful about it as well. I personally am not sure how I would deal with this situation as a Nurse, and look forward to the responses here.

I can say as a parent of a special needs child, this has always and will always be one of my biggest fears! I have done my best to make sure my son is respectful to those who are treating him. If he is not being respectful, it is dealt with even if he is in pain! I can honestly say I have had nurses who are surprised that I will reprimand him for being rude to them after he has had surgery. However, that is my job as a parent. He will undergo treatment for the rest of his life for his defects, and he needs to be taught how to respect others just as much as my other 3 children do!

[klone, MSN, RN]

As a parent of 4 children, one of which has a birth defect that has us at the hospital so much I call it my second home...

This is totally and completely off base!

I don't think it's off-base to caution her not to judge this child and family without knowing what it's like to deal with a baby who has a terminal illness.

Do I think she should allow the child to throw things at her? No, I would address that. But I read a lot of judgment in the OP, and it just breaks my heart to even imagine how difficult life must be for that child and her family.

[nurse2033, MSN, RN]

This sounds like a great learning experience. What did your preceptor(s) say? Did you ask them about it? This is exactly the kind of thing that will be useful to you later in your practice. I don't work with this type of patient but I am a parent. I disagree with the tone of the first comment which seems to imply that you are pond scum for even bringing it up. I do agree that it is best not to judge. The best parents would still parent their child even when sick, but who knows what you would do it such a situation? I have a friend who just lost her son to leukemia and she let a lot of things go because she just wanted him to be happy. You do have the right to expect to be treated with respect though. And we redirect adults, even though with dementia, withdrawal or whatever every day. Personally I would insist that the child treat me with respect, but how they treat others is the parent's job. I have taken care of many ill children and I find if you are up front, honest, and respectful to them, it is not hard to get them on board with medical care. I'll be interested to see what peds nurses contribute here. I still think your preceptors are the best source because this is what they do. Best of luck!

[kvisintine, BSN, RN]

As a mother of a previous hem-onc preschooler, I can tell you that the bad behavior can stem from so many different things... This child could be acting out emotionally from all the stress and change in routine from hospital stays, ect. The child is sick and on an emotional and physical rollercoaster, in an unnatural setting.

Even with preschoolers who are not ill, sometimes you have to know when to choose your battles. Speaking from experience, to compound the matter, I imagine that the parents are emotionally drained too, so they may be understandably lax in disciplining their sick child.

As nurses, it is our job to care for the patient... and sometimes that means emotionally as well as physically. If I had been in your situation and I had the free time, I would have tried to help the parent distract the child, rather than to have judged a struggling family who needs help.

[RN9742]

I don't think it's off-base to caution her not to judge this child and family without knowing what it's like to deal with a baby who has a terminal illness.

Do I think she should allow the child to throw things at her? No, I would address that. But I read a lot of judgment in the OP, and it just breaks my heart to even imagine how difficult life must be for that child and her family.

She was not judging the family however, the child was indeed acting in a very disrespectful manner. She simply was asking if it was wrong of her to expect respect, and wanted to know how to handle the situation.

Personally I do not think it is wrong to expect a child, no matter how sick to act in a respectable manner. Is an ill child going to be rude and disrespectful at times - Most likely Yes, especially at that age... Is it wrong to correct the behavior in a gentle manner - No Absolutely not.

[marsy]

First off I think that a tone of a message can get quickly turned depending on the reader's mood/connection with statement. Because there were no CAPITAL LETTERS or !!!!!! I read OPs message as more of a concerned "I'm trying to understand how I could have handled this situation be I come entangled in it again" But that's just my point of view....

As for the message I know this might come out cold but please don't think that. I cannot stand when people say "I feel sorry for..." As nurses I feel as though it is not our job to feel sorry for anyone. We are here to help, offer assistance, knowledge and care. I work with developmentally disabled adults and once someone hears that I get a sideways tilt of the head, puppy dog eyes "aww, that's so good of you. You must feel really sorry for them" Sorry, no I don't. These guys/gals are enjoying their lives to the fullest. They have round the clock care, have plenty of friends, girlfriends/boyfriends, they go on trips, vacations, go to social dances/events, they love life and I'm super happy for them.

Now to the message...side note: I am not a parent but have been a nanny for 12 plus years prior to my life as a nurse. I've taken care of special needs children, children of rich parents, children of middle class parents, etc. I find that nowadays parents are so unwilling to discipline due to what other people will think or because they feel sorry for their child. Now what kind of children are we raising here? Like I said, I know I'm not a parent (yet..) but in no way would I allow my child to be so completely rude to people who are there to care for them. I understand the attention seeking when the father was speaking to the MD, but throwing something and hitting? When this child goes into the "real" world how do you expect other people to react to her? Shouldn't you as parents raise your child to be respectful and good-natured with a side of mannerism?

OP I'm not sure if I would have said something immediately to the father/child but I'm sure I would have asked for a little more respect in the future...best of luck if/when dealing with something like this again.

[MassED, BSN, RN]

children have a wide range of behaviors/attitudes, some environmental, others are genetic and learned from their parents. Of course this child needs to be treated with respect in order for her to learn respect. It's a difficult thing to have a rude child, but I have always tried to say, you know, we're being nice to each other, we share, that's how we do things here. I am having good manners with you, so for us to be friends, you need to have good manners with me. Getting down to her 4 or 5 year old brain. If all else fails, bribe her. Having respect for adults and other people is something a child that age knows and can understand. Whether or not she has that kind of support from her parents or family you cannot control. They may feel guilty with her having cancer to impose any kinds of rules, so she is acting out of control. Imposing limits and setting boundaries makes the child and others around her happy and a balanced environment. Maybe parents need some education too, because they don't know how to discipline without feeling guilty.

[leslie :-D]

I know she's sick and all, but is it too much to ask for good manners?

this would be a great question to ask your instructor, when you guys are in conference.

this little girl could be acting out for a million reasons, but seriously, is her behavior the priority right now?

no.

healing her, is.

besides, any interventions, would have to be a team effort and approach.

it'd have to be careplanned. (i know...*groan*)

do you think she has any insight as to why she's acting as she is??

i seriously doubt it.

and so, any corrective action, wouldn't be very therapeutic anyway.

if i were to focus on her behavior, it'd be when she's home and has resumed a 'normal' routine.

that is the time that she will finally feel safe/secure...

and not until then.

still, your question was perfectly legitimate.

don't let anyone make you feel differently.

and keep asking those questions.:)

leslie