What's your psych/social 'ace' up your sleeve?

A&OxNone, MSN, RN · Apr 26, 2017

For little ones, I always talk about whatever they are doing/wearing/watching. I'll be like "ohh, those are some pretty shoes. Show me your toy. Does this baby (stuffed animal or whatever) have a name? Your dress is so pretty!" I dont know. Just make stuff up and talk about things that they enjoy and it really does help them warm up.

When chronic kid's parents disagree with the plan, I straight up just get the provider in there to explain further. Sometimes, those parents really do know their kid better than i do, and I'm not about to try to talk a parent into the plan of care if they disagree.

For frustrated parents, they really just want somebody to agree with them and give them a little control. So sometimes I'll be like, "we can let the baby sleep now and change the diaper in 2 hours or we can do it now and we dont have to again for 4 hours" or whatever it may be to give the parents a little control in their situation. Hope some of this is helpful!

Kunzieo · May 7, 2017

For toddlers- the sillier the better. "ok, I've got medicine here? Where do I put this? In the pillow? Nooooo! In your belly button? Nooooo. Should we give some to your bear? Yeah? Ok, num num num (fake feed it to bear) .. now your turn! (put in a few drops) Now Bear's turn!"

For stressed out parents, I'm not a real touchy feely person. I deal in facts, and give them facts. Lot of parents freak out when the monitor dings, when it's usually just artifact. I look them straight in the eyes and tell them "that thing is going to ding and beep all night. If you jump up every time it does, you will give yourself a heart attack. Listen- I will tell you when it's time to worry. Right now, I'm not worried. I WILL tell you if there is something to worry about." I will offer to go over every line and cord and number and piece of equipment in the room, both so they realize I know what I'm talking about and that we are doing things, even when it looks like nothing is happening- and it gets them more comfortable with everything and they start to realize that not everything is panic-worthy!

I don't work with many chronic kids, I work PICU/acute care. But I let them tirade a bit, then try to boil it down to the basic problem. What exactly would they like me to do (or not do.) Then we work from there. A lot of time these parents have a lot of frustrations built up, and get exasperated easily within a system that doesn't acknowledge them as an expert. Talk to the family- what are their expectations, and what can we do to accommodate them? Usually if you can get something to go the way they want, then they are more willing to allow other things that they refused at first.

Pediatric Critical Care Columnist · May 7, 2017

I don't work with many chronic kids, I work PICU/acute care.

I find that an interesting statement, since a lot of what WE do, especially in the winter and spring, is provide critical care to children with chronic conditions. And then there are the children who, despite our best efforts, are still too ill to be cared for outside the ICU. These could be the kids with prematurity-related lung disease who have failed weaning from the ventilator and now have tracheostomies and require escalation of their ventilatory support in times of even mild illness. They could be kids with cardiac conditions that led to them requiring a ventricular assist device. They could be kids who are waiting for transplant and are near death... or are post-transplant and are too ill to be cared for on a general peds ward. They could even be those kids whose kidneys have failed who just arent' stable enough for hemodialysis and require continuous renal replacement therapy... which requires the PICU. We consider any child who has been a PICU patient for more than two weeks to be "chronic", meaning their families will have extraordinary psychosocial support needs. And remember, their parents are the only ones who have been there EVERY day and have ALL the information about why their child is there, what has been done already, what works and what doesn't. Our hospital doesn't have a high-dependency unit for these children, so they stay with us until they can be cared for on a general peds ward.

Kunzieo · May 8, 2017

Ugh, I typed out a comment and now I don't see it- so sorry if this posts twice-

I don't work at a standalone children's hospital. We have 3 such facilities within our metro area, so most children with chronic conditions have established care at one of those facilities, as they have WAY more peds specialists than we do. Our specialty is trauma, acute care, and med-surg. So although we do get chronic kids occasionally, it's more the exception than the rule in our PICU.