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?
I worked pediatrics for 7 years and have had the same frustrations as the OP. chronically ill kids that have learned to never allow a med or procedure without seeing what they could get in exchange, parents that bribe for the simplest things (like eating) and you KNOW it's going to come back to bite them. The capper was a 10yo developmentally delayed boy who spit on and bit the nurses during vitals. The parents felt he couldn't understand, but he certainly understood toys and rewards. You can teach a dog not to bite- there was no reason to allow that type of behavior.
Then my niece got cancer. She had at best a 50% chance of making it through the chemo and surgery, and who knows what the numbers were for long term therapy. The docs also said she would very likely get leukemia as a teen because of the high test chemo she needed as a child. She was 3 when it started, and had a good start on "please" and "thank you" and trying to understand the feelings of others.
My sister and her husband were living at their breaking point of coping every day, and couldn't manage any teaching or discipline. If they had a decent day, when my niece was feeling well enough to comprehend why someone said "no" they din't want to spend the time and energy, they just wanted to enjoy her. So they'd distract her with a trinket, or bribe her, or just give in, so the family could have a happy day. In the hospital they were always trading stickers or small toys for fingersticks and procedures. What works in the short term is not necessarily good over the course of 18months. But if a 3yo is not likely to survive, everyone just wants to make her happy, right? Visitors and relatives from away sent her every dollar store toy in existence, they didn't mean a thing to her after awhile, she just wanted to feel better. If she couldn't feel better, she wanted a payoff.
She is 8 now and we are still working on discouraging manipulation, and always bargaining to have the best and the most of everything. She was a little hellion the first year of decent health after the treatment, but so much better now. I'd love to see someone do a study on behavioral care during long term illness. I have a hunch that all the bribes are doing the sickest kids a disservice.
We did not see that problem with another cousin who had leukemia at the same time, but he was able to stay home more and have a routine. His illness was much less life threatening too. I worked a lot with cystic fibrosis kids, and saw a lot less of the behavior problems you describe. Perhaps parents know they will be living with the disease for years, and that brings in better coping skills, as opposed to more of a crisis mind set.
Maybe there's a NP that has more information on this topic. As a nurse there was one child I just couldn't work with during her illness because I felt her behavior was unacceptable, but there was another family that I loved and other nurses dreaded. Trade off as much as you can, and ask the parents what they want...."We have to get this medicine in, do you want some time alone with her, or should I just give it" but only after you've done as much patient teaching and supporting as possible. I think 10 minutes of positive nonhealth related chatting with a child goes a long, long way. Give them a chance to be a kid, with kid worries, and it takes the pressure off for a blessed few seconds.
I talked to my sister this evening. She said one of the most helpful things she was told during the recovery period was that kids feel out of control during their illness. If parents don't impose boundaries on their behavior they feel even more out of control. She didn't realize that as a parent, and it gave her permission to discipline her sick child. Maybe a fear of judgement by staff stops a lot of parents from responding the way they normally would to bad behavior.
I know one of my little peeves is when a parent promises stickers to a child that hasn't actually had to do anything besides get weighed, or when they up the number of stickers the louder a child screams. Sometimes we are rewarding bad behavior.
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.
canoehead, BSN, RN
6,909 Posts
I worked pediatrics for 7 years and have had the same frustrations as the OP. chronically ill kids that have learned to never allow a med or procedure without seeing what they could get in exchange, parents that bribe for the simplest things (like eating) and you KNOW it's going to come back to bite them. The capper was a 10yo developmentally delayed boy who spit on and bit the nurses during vitals. The parents felt he couldn't understand, but he certainly understood toys and rewards. You can teach a dog not to bite- there was no reason to allow that type of behavior.
Then my niece got cancer. She had at best a 50% chance of making it through the chemo and surgery, and who knows what the numbers were for long term therapy. The docs also said she would very likely get leukemia as a teen because of the high test chemo she needed as a child. She was 3 when it started, and had a good start on "please" and "thank you" and trying to understand the feelings of others.
My sister and her husband were living at their breaking point of coping every day, and couldn't manage any teaching or discipline. If they had a decent day, when my niece was feeling well enough to comprehend why someone said "no" they din't want to spend the time and energy, they just wanted to enjoy her. So they'd distract her with a trinket, or bribe her, or just give in, so the family could have a happy day. In the hospital they were always trading stickers or small toys for fingersticks and procedures. What works in the short term is not necessarily good over the course of 18months. But if a 3yo is not likely to survive, everyone just wants to make her happy, right? Visitors and relatives from away sent her every dollar store toy in existence, they didn't mean a thing to her after awhile, she just wanted to feel better. If she couldn't feel better, she wanted a payoff.
She is 8 now and we are still working on discouraging manipulation, and always bargaining to have the best and the most of everything. She was a little hellion the first year of decent health after the treatment, but so much better now. I'd love to see someone do a study on behavioral care during long term illness. I have a hunch that all the bribes are doing the sickest kids a disservice.
We did not see that problem with another cousin who had leukemia at the same time, but he was able to stay home more and have a routine. His illness was much less life threatening too. I worked a lot with cystic fibrosis kids, and saw a lot less of the behavior problems you describe. Perhaps parents know they will be living with the disease for years, and that brings in better coping skills, as opposed to more of a crisis mind set.
Maybe there's a NP that has more information on this topic. As a nurse there was one child I just couldn't work with during her illness because I felt her behavior was unacceptable, but there was another family that I loved and other nurses dreaded. Trade off as much as you can, and ask the parents what they want...."We have to get this medicine in, do you want some time alone with her, or should I just give it" but only after you've done as much patient teaching and supporting as possible. I think 10 minutes of positive nonhealth related chatting with a child goes a long, long way. Give them a chance to be a kid, with kid worries, and it takes the pressure off for a blessed few seconds.