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Hello from Brazil: Strong leadership with a focus on quality care

Patsy Stinchfield, a Pediatric Nurse Practitioner from Children’s, is in San Jose Rio Preto, Brazil to help the Hospital de Base better control their post-operative infection rates. The following is Patsy’s third update from Brazil.



It is hard to believe we have been here just four days and three days in the Hospital de Base.  I write this late in the day after a 16 hour day with the amazing CV ICU team at the hospital (that’s what everyone does on their vacation in Brazil, right?!).  The Children’s Heartlink program has a beautiful vision to bring the best cardiovascular care to children and our time here proves that many strides have already been made.

The passion and leadership of Dr. Ulisses Croti, the solo pediatric CV surgeon, is driving best practice in this hospital and the region on many fronts. The multidisciplinary team in this unit loves their work and it shows.  They do have more infections than they should — and we are leaving no stone unturned in trying to find out why — but as usual, there is no smoking gun, but many “fixable” issues.

Our focus this week on infection prevention in the CV ICU and pain management has been so fulfilling.  Dr. Kurachek and I have developed a subtle look we give each other when we realize they are doing a process better than we do in the US.

For example, each patient has a poster up of individual goals for the next shift on where to maintain the blood pressure, etc.  We admire their openness and willingness to take all advice on behalf of patient improvements.  There is no defensiveness or resistance to change.  The focus is clearly on quality care for tiny patients with big heart defects.

The complexities of the surgical procedures and the post-op care are like a great ballet–everyone knows their part and plays it elegantly. There are a number of fine tunings we will offer to get them from good to great but their culture of attention to quality will get them there faster.

Today, Dr. Kurachek provided a formal lecture on pain and sedation and I presented a formal lecture on blood stream infection prevention. We have been hammering the importance of hand hygiene all week and have appreciated the amount of time their ID doc and Infection Control nurse have given us.

We have had numerous conversations with small groups of staff with everything from considering a hospital acquired infection an emergency, to when do you stop antibiotics, to what is Empiric precautions, to what are the Fentanyl versus Morphine considerations (clearly that last one was Kurachek’s!).

What is impressive is the multi-disciplinary turn out for our talks.  My talk had 15 in attendance on the unit including intensivists, cardiologists, housekeeping staff, nursing, techs, therapists, students and infection control specialists.  They were very interested and able to learn together.  I was able to observe in the micro lab as well as the entire sterilization process, which is done well–bar coded and everything!

Dr. Kurachek was able to do morning rounds, meet with a vascular surgeon about non-surgical lymphedema treatment, do his pain talk twice, role play with me on how one points out a potential patient safety risk to a colleague and end the day with our team doing Safety rounds–and that was before dinner!

It has been a great day once again.  Big day tomorrow as we tour the new children’s hospital and help them prepare to prevent risks there.

Ciao for now (that rhymes!)


Hello from Brazil: Open-Heart Observations

Patsy Stinchfield, a Pediatric Nurse Practitioner from Children’s, is in San Jose Rio Preto, Brazil to help the Hospital de Base better control their post-operative infection rates. The following is Patsy’s second update from Brazil.



Our time in Brazil has been wonderful.  We finished our second day in the hospital today.  The surgeons, staff and specialists, including the Infection Control team who have devoted much of their week to being with us, have been outstanding.  They are approachable and interested in improving the quality of care they deliver despite their lack of resources.  They ask significant questions and push themselves to think of new ways to deliver care that is affordable.

Here on behalf of the marvelous Children’s Heartlink program, Dr. Kurachek and I are spending 12-13 hour days in the hospital (and then some serious Brazilian fine dining thereafter!).  I spent most of my day observing open heart surgery in the operating room of Dr. Ulisses Croti, a gifted surgeon and fine human being.

I focused on the process and details of the operating room procedures in relation to infection prevention. They do excellent work and have instituted such things as the pre-op and op “Time Out” on behalf of the safety of the patient and the clear goals of the team.  There are several minor suggestions I can offer, but for the most part feel they are doing great care for very, very sick patients.

Dr. Kurachek has been “holding court” in the ICU with all in attendance eagerly learning from him.  His second Heartlink trip here, he is well-known and well-loved, just like at Children’s.  He worked with the large multidisciplinary team to model rounds and the kinds of questions all should be asking each day: “What concerns you personally most about this patient from your perspective?”, etc.

He provided a long formal class on heart/lung hemodynamics that simplified the complexities of these challenging patients.

We have done many whole team dialogues, small group discussions from our fields and many one on one conversations, including with one amazing young Brazilian mother who is preparing to take her trached baby with Down’s syndrome home for the first time after seven months in the hospital. She said she felt comfortable stopping staff and visitors and asking them to please wash their hands before touching her baby knowing how hard he had fought to get to where he was.  She told me “My son is everything to me” and I told her “And you are everything to him”. Such strength from these moms.


Hello from Brazil: Arriving in San Jose Rio Preto

Children’s very own Patsy Stinchfield, recent recipient of the prestigious Pediatric Nurse Practitioner of the Year Award, is in San Jose Rio Preto, Brazil to help the Hospital de Base better control their post-operative infection rates. The following is Patsy’s first report from Brazil.



I have finished my first day in the Hospital de Base in a small town called San Jose Rio Preto.  It is a city of 400,000 people and is surrounded by beautiful farmland.  We are staying at a hotel called none other than, The Saint Paul Hotel!

I am consulting in the public hospital here called Hospital de Base, an 800 bed hospital with a full pediatric cardiovascular surgery ICU.  They are having trouble with post-operative infections and are seeking help for Infection Control considerations from me and my great traveling companion, Dr. Steven Kurachek, a Harvard trained pulmonologist who is consulting on intensive care management.

It was a marvelous day, filled with observations of wonderful care by smart, compassionate people (pediatric cardiologists, surgeon, anesthesiologists, nurses, nurse technicians and respiratory therapists).  They are a warm and open group, eager to continually take the best care possible of their very vulnerable patients some of whom were so malnourished it was heart-breaking.

We made rounds on their 4 patients in the cardiovascular ICU and 3 patients in their step-down area.  We observed their care, listened, asked questions, engaged the team in dialogue about how they prevent pneumonia in ventilated patients and tried to play CSI with where their systems are breaking down to cause their patients to have more infections than most other hospitals. It was “Magnifico!”  We found some problem areas, but also found some practices better than we do in the US.  As usual, the teachers will come back having learned more than they taught.

One unexpected surprise was to tour a beautiful manufacturing facility near the hospital called Braile Biomedica which makes 450 different products mostly for heart surgery. (Think Brazilian Medtronic).  We met with Dr. Domingo Marcolino Braile, the “retired” cardiologist who founded this company with brilliant engineers and his experience doing cardiovascular surgery by knowing there is always a better way to do things.  We watched the staff trim bovine tricuspid valves and hand sew them in preparation for patients needing a valve replacement.  Simply amazing work.

In the evening, our hosts, Dr. Ulisses Croti (pediatric cardiology surgeon) and his wife, Dr. Lilian Beani (a neonatologist) are intent on showing us a good time in Brazil.  Tonight we went with 4 of the cardiology team staff to a traditional Brazilian beef house (think Fogo de Chao X 10) where they bring the hot meats and carve individual slices at the table.  (After a day in the cardiac ICU we all passed on the BBQ chicken hearts…).

They speak Portugese, which has a little similarity to Spanish but is very fast with different accents.  Instead of HOla it is hoLA for hello.  We have 3 medical interpreters who are amazing because they know all the medical technical language and do simultaneous (they prefer we just talk, not pause for them) English to Portugese conversation (we all wear little ear pieces).

After just one day, we have a list of suggestions as well as recognitions for work well done.  We also have a list of things we want to improve back at Children’s based on what we see here and know we can improve at home.  We all deal with the same pathogens and people problems no matter where in the world we work.  It is fascinating!

I will try to write a bit everyday.


Setting up child life services in India: Success in the Face of Continued Challenges

As National Child Life Month draws to a close, we continue our spotlight on Jeanine Clapsaddle. Jeanine is a Child Life specialist from Children’s who is in India for two months to help set up Child Life services at Manipal Hospital.

Jeanine’s trip is in partnership with the Priyanka Foundation, which was established to fulfill the dying wish of a former Children’s patient who wanted other kids around the world to get the same care she received. Jeanine is documenting her experiences through this blog series.

This is the fourth report from her trip:


The Child Life office here at Manipal is located just off the waiting room to the vaccination clinic. I am provided with ample opportunity to watch families with children of all ages interact while they wait or recover from their visit. I have been invited to gaze upon babies who, quite frankly, are breathtakingly beautiful with their heads of full, lustrous hair and dark eyes.

On more than one occasion every day, I am treated to games of peek-a-boo with curious toddlers who delight with running in and out of the open office door. Some grab their parents by the hand and drag them to the door to show them what they’ve discovered.

Parents are always gracious and smile, sometimes sharing the child’s name or asking questions about where I come from and what I’m doing at Manipal.

Today, in this same waiting room, I was witness how far my students have come in the short time I have been here, as well as how far we have to go.

I was in the office with my student, Sunitha, when we heard, as we frequently do, the traumatic screams of a child being carried to the vaccination room.  Somehow this girl of about 6 was able to escape her father’s arms and run back out into the waiting room. She was hunkered down in a corner sobbing.

In the blink of an eye, without any prodding from me, Sunitha grabbed a bubble tumbler and took off to approach the girl. Although the girl did not want to blow the bubbles, she was able to watch Sunitha blow them and settle herself some. Sunitha was able to talk with her quietly until the girl’s father could come and sit down next to her.

When the father was able to pick his daughter up, he approached our office door and Sunitha explained that I was here training her and as such we could give him some help with the situation.  I explained the work of Child Life as quickly as I could, shared some strategies such as positioning for comfort and distraction, and walked with him to the vaccination room, hoping that this would be the in-road that I had been longing for with the staff.

No such luck. The nurse was quick to dismiss us and our suggestions to the point of shutting the door in our faces. Sunitha and I walked the 10 steps back to our office to endure the resulting screams. As they left the vaccination room, the father stopped by the office door and thanked us for our help.

Despite the less than optimal outcome, I couldn’t have been more proud of Sunitha’s initiative and genuine attempts to help this child. I have observed the work of my students consistently and know that their skills are progressing. We spend time discussing various aspects of child life practice, dissecting my observations as well as theirs and converting understanding into guided actions.

But in this moment, I was aware that at some point the culmination of teaching is the development of some internal instinct about the work. Sunitha didn’t stop and ask me if she should or how to intervene with this child.  She grabbed the bubbles and took off. And I stood in the doorway to not only to use the opportunity to observe her work, but to also appreciate the intuition that activated her.

Being a good advocate, like in this case, does not always secure the actions or outcomes we strive for, with staff or with families. In the past week, we have done presentations for nearly five hundred of the physicians and nurses in the hospital, introducing them to the work of Child Life. And although I would speculate that this vaccination clinic nurse didn’t attend any of the presentations, I know that new and innovative programs are often met with resistance.

There are lessons to be learned about approaching barriers with subtly and persistence.  There will always be medical providers of all sorts, in hospitals everywhere, who see the work of child life as an intrusion or unnecessary.

But knowing that we gave this child a moment of respite to catch her breath, and her father some tools that he can use in the future, is enough to know that we do make an important difference in the lives of children and their families.

I hope that this is something my students will learn along with the technical aspects of providing care.

Children’s Memorial Service Remembers with Love

Every year at Children’s Hospital we take time to remember those we have lost

The most difficult experience in life is to lose a child.  Whether to injury or to illness, the death of a child is the universe out of order.

Every year at Children’s Hospital, we gather  in friendship as parents, grandparents, caregivers and others for a non-denominational memorial service to remember – to call the names of the children we have lost, to light a candle in remembrance, to reflect among those who share the bond of common experience in  a service celebrating the children who are remembered with love.

This year’s Memorial Service is being held on Saturday, May 5. Invitations will be mailed to families who have had a child die in the last two years by the end of March.

For more information phone (612-813-7216) or email [email protected].

If you are unable to attend, but would like more information about Children’s grief counseling services, visit our Chaplaincy information page.

Parent comments about Chaplaincy  at Children’s Hospital are welcome here!

Setting up child life services in India: Meeting Nischit

March is National Child Life Month, which honors those in the Child Life profession. It’s the perfect opportunity to continue our spotlight on Jeanine Clapsaddle. Jeanine is a Child Life specialist from Children’s who is in India for two months to help set up Child Life services at Manipal Hospital.

Jeanine’s trip is in partnership with the Priyanka Foundation, which was established to fulfill the dying wish of a former Children’s patient who wanted other kids around the world to get the same care she received. Jeanine is documenting her experiences through this blog series.

This is the third report from her trip:


The two students I am training here have been working in the hospital for nearly a year, providing patients with opportunities for normative play.  They have a well-established rapport with patients and families who identify them by that all too familiar title; the play lady. Patients, parents and staff alike have all identified the immense impact these women and their toys have had on the healthcare experience.

On my first day at Manipal, I met a nearly 4 year old boy named Nischit, who is four months into treatment for leukemia. During the initial portion of his visit to the outpatient clinic for labs, and chemotherapy, he clung to his mother, was tearful and apprehensive. He cried through his port accessing, labs and related cares.

Although he was slow to warm up to the toys and chose items that were intended for a much younger child, he was able to quietly engage in play after some time. This was a consistent response for Nischit during subsequent sessions despite attempts to engage him in distraction during his port accessing.

When the new toys I had sent from the U.S. arrived, I had the Child Life Practitioner working with him put a play doctor kit among the toys that he was able to choose from. Although he responded to the cares as he had in the past, Nischit was curious about the medical play kit, and opted to engage in play sooner than he had previously.

Over the next several visits to the hospital, Nischit became captivated by the doctor kit. He was quickly able to develop mastery of the medical toys, generalize the toys to his own experience, compare the play equipment with the real equipment, and not only model how the equipment works, but his role in the process.  He has successfully ‘treated’ his mother, the stuffed duck that tags along with the medical kit, and all the staff that care for him.

When I come to observe the sessions with Nischit now, he actively engages in distraction for his port accessing and is eager to play when the ‘work’ is over. His mood is more stable.  He has become quite talkative and he displays better resilience to unexpected stressors, such as hospital admission due to fever.

Today he was able to tell the student, “I come for chee-bee-chee (CBC) test.” In all honesty, seeing this smiling face with cheeks puffy from steroids try and spit out CBC test, particularly knowing how much he struggled with his cares just a short time ago, is almost too much for me.

Nischit will always stand out as a prime example of why I became a Child Life Specialist and why I came to India. Surviving and thriving can be part of the same experience, and I believe the aim of Child Life is to diminish the gap that exists between them.

The young girl, for whom the Priyanka Foundation is named, knew this. She saw it first hand when she visited India.  Children were surviving, certainly.  Thriving throughout their treatment was less likely.

I continue to feel incredibly honored to be living Priyanka’s vision and helping to spread the work of Child Life through this teaching endeavor.

Jeanine Clapsaddle
Child Life Specialist
Children’s Hospitals and Clinics of Minnesota


The first report from her trip can be read here.
The second report from her trip can be read here.

Rock the Cradle 2012

MPR photo / Eamon Coyne

Last Sunday, Children’s partnered with 89.3 The Current to present Rock the Cradle 2012. This day of family fun saw over 15,000 people, young and old, pack the Minneapolis Institute of Arts and Children’s Theatre Company for a day of live music, dancing, storytelling and a community art project.

What a great day it was! Research has shown that the arts, both making and enjoying, can positively impact cognitive, motor, language and social-emotional development. We were so happy to be part of such a great event that promotes the importance of creativity and the arts for our community’s children.

If you weren’t able to attend, there are plenty of places to see photos and videos from the event:

Thanks to everyone who attended.

Setting up child life services in India: appreciating cultural differences while embracing our similarities

Jeanine Clapsaddle is a Child Life specialist from Children’s who is in India for two months to help set up Child Life services at Manipal Hospital.

Jeanine’s trip is in partnership with the Priyanka Foundation, which was established in memory of a former Children’s patient who wanted other kids around the world to get the same Child Life services she received during her cancer treatment.  Jeanine is documenting her experiences through this blog series.

This is the second report from her trip:


Several days ago, I met a boy, Ballal, who was admitted to the PICU with an injury from an accident. He left his home in search of something fun to do and wandered into a factory that was in full operation. He came into contact with a machine that wrenched his right arm off at the shoulder and left him with a gash from above his eyebrow, down his nose to his chin. He is 6 years old.

A referral was made to Child Life from the attending nurse to “bring him toys and make him happy.”  I hear this request at Children’s as well and understand that it is an easy way to compartmentalize a creative and varied therapeutic practice.  In this case the statement was less about knowing the full offerings of Child Life, but more about a cultural belief that children should not be unhappy, for any reason, and playing with toys is a curative for unhappiness.

Although I may not speak the language, the gestures of pacifying and soothing are universal, as are some of the coping reactions some parents lean on when a child is in pain.  Things like shushing to the point of a parent putting their hands on a child’s mouth to get them to stop crying, giving them money or prizes to soothe them, tricking them into coming to the hospital or not properly informing children about the need for their healthcare experience so as not to upset them—these are all easy traps to fall into that can actually increase tension for a child.

In Ballal’s case, he was attempting to talk to his mother about his accident to better understand what had happened to him, to sort through emotions of guilt and shame, and to plead with her to stop the antibiotic infusions, which he found painful.

His mother was afraid of upsetting him so she shushed him and told him not to talk about it. We were able to talk with Ballal’s mother and explain the potential reasoning behind his questions. We also developed a plan for giving him some basic information to help him cope with the infusions as well as provide some diversion for him during the infusions. Although she did not come to a point where she could engage her son’s questions, Ballal’s mother was able to make room for services that could support him and she witnessed his decreased stress level through play.

When I came to India, I anticipated that the cultural rules and mores would be so different from my own that it would take me the entire duration of my stay for me to begin to see and vaguely understand these customs. What I have come to find is that the dynamic between parents and children is one that changes very little regardless of where you are at on the globe.

Ballal’s story is not so far removed from patients who come to Children’s who are involved in farming accidents, children who are too young to be left unsupervised, children who just do not want to be in the hospital, and parents who do not want their children to suffer, emotionally or physically.  How many times have I approached new families at Children’s and faced parents reluctant to educate their children because the medical information is too frightening for them as parents that it is too scary for them to know how to share with their children.

Sometimes when we meet families who come from a cultural background that is different from our own, we quickly call to light the differences between us in hopes of acknowledging and respecting those differences. Somehow, when thinking about Ballal and his mother, I am reminded of the small ways in which we are the same and how much progress can be made by acknowledging our sameness.

Jeanine Clapsaddle
Child Life Specialist
Children’s Hospitals and Clinics of Minnesota


The first report from her trip can be read here.

Setting up child life services in India: introduction to Manipal

Jeanine Clapsaddle is a Child Life specialist from Children’s who is in India for two months to help set up Child Life services at Manipal Hospital.

There to fulfill the dying wish of a former Children’s patient who wanted other kids around the world to get the same care she received, Jeanine is documenting her experiences through this blog series.

Here is the first report from her trip:


After my first days at Manipal Hospital, I feel hard pressed to capture all that I have experienced in a way that does justice to the people I’ve met and the unmistakable presence of hope that lives here.

Much like Children’s, Manipal is in a perpetual state of renovation and construction. Some areas we toured are quite archaic by our standards; multiple patient beds in the same room (children and adults together), metal beds with peeling paint, IV bags that run on gravity rather than with any sort of pump, dented metal bowls used as bedpans for children, parents sleeping on the floor next to their child’s bed, dim and sporadic lighting, etc.

I discovered that the inpatient units of the hospital are separated not by diagnosis or specialty, but rather by an individual or family’s ability to pay for the healthcare. This unit is for people who cannot afford better healthcare. The most luxurious rooms in the hospital are utilized by celebrities, dignitaries or people from other countries who can afford to pursue healthcare wherever they choose.

The more technical areas of the facility such as radiology are quite modern and similar to what one would find in the US. In some ways it is difficult to grasp the extremes between these two settings and simply chalk it up to the renovation process.

I have met many children and their families as well. Regardless of where they are, every family has nothing but praise for their healthcare experiences, and the hospital itself. Families travel by plane and train from all over India and in some cases Asia to receive care here. The bulk of their pediatric Hematology/Oncology service is made up of children with Acute Lymphocytic Leukemia (ALL) or Thalassemia. They have had some children with other cancers but they are considered uncommon.

I have been able to talk with many parents and in some cases their children about their experiences in the hospital. Their first response is consistently about how much their healthcare has improved since the introduction of the Play Therapy/Child Life services. Their commentary seems to stem from a place of true gratitude and excitement for the possibilities that come with my time here.

In one case, I talked with a father of a child with Thalassemia for over an hour about the need for more toys and how he could help with that project.  The two women who are currently providing play therapy services have enough toys, primarily puzzles and games, to fill one average double door kitchen cabinet – no play-doh, no video games or Barbies, no beads for necklaces, no toys with lights and sounds or other toys that at one time seemed commonplace to me, but now seem like a bit of an indulgence.  What a challenge to take a game that a child has played over and over again, and make it a new and different experience for them.

I have also seen the unpleasant side of life in India – the extreme poverty, homeless animals eating garbage for food, and filth beyond understanding. I’m not sure what the Indian equivalent of yin and yang is, but it is a palpable experience here.

I find myself tired at the end of the day from the simple mental dexterity that comes with being here and sorting through all the information coming my way – whether it is trying to piece together what someone is saying to me, even in English, as the accent is heavy here or trying to make sense of the cultural context in which things are happening. Despite the, at times, heart-wrenching realities of life here, I look forward to each day with hopeful anticipation.

Jeanine Clapsaddle
Child Life Specialist
Children’s Hospitals and Clinics of Minnesota

Celebrating our heroes – A Hero’s Journey workshops

What’s it like to stay in the hospital for a week? A month? What’s it like to visit the hospital once a week for a year in order to receive treatment? What would it be like to do all of this as a kid?

No matter the duration, no matter the treatment and no matter the age, a prolonged stay, or repeated visits to the hospital take a toll. At Children’s, we wanted to help the kids we serve further process their individual healing journeys, beyond simple follow up visits.

That’s why, in partnership with The Guthrie Theater, Children’s has created a program called A Hero’s Journey. We think of the kids that come to us not just as patients, but as heroes. They are young people who show great courage as they face health challenges and the challenges that come from having their “normal life” interrupted with healthcare visits.

Part of our Arts and Healing initiative, A Hero’s Journey workshops offers Children’s patients a unique opportunity to explore their health care experiences. Kids can let their creative juices flow under the guidance of Guthrie artists and teachers, who will use theatre games, music, storytelling, and movement to explore and affirm each child’s inner strengths – the hero inside each one of them!

A Hero’s Journey workshops are open to children and teens ages 8 to 14. The workshops will be held one Saturday per month starting in March, with two workshops each Saturday (one morning, one afternoon), each 2-1/2 hours long. Patients with chronic conditions, repeated hospitalizations or appointments, and those who have been hospitalized for at least three days are prime candidates. Children may be patients at any of Children’s locations, including outpatient clinics and our main hospitals.

The first A Hero’s Journey workshops will be Saturday, March 24. Families interested in participating can learn more from primary care providers at Children’s or by calling the Child Life Department at 612-813-6259. Children’s and the Guthrie are excited to help patients discover their inner hero!