A night in the ED with a child life specialist
Editor’s note: This post originally appeared on March 27, 2013.
A 3-year-old girl needs her bottom lip sutured. A 2-year-old sibling is bored to tears – literally – while she waits for her brother to be released so they can go home. A 7-year-old needs an IV start for blood draws and medicine.
Who are you going to call? The child life specialist.
On a recent weekday night in the Emergency Department, Mindy Teele, a certified child life specialist at Children’s Hospitals and Clinics of Minnesota, is in demand. A patient is about to have an IV start, so an RN asks Teele to explain the procedure ahead of time. In another exam room, a patient is waiting for results, so Teele brings toys. A few minutes later, she returns to the patient with the IV start to distract the patient during the procedure.
“Child life specialists focus on the psychosocial and developmental needs of children to minimize their fears, clarify misconceptions, build coping abilities and enhance understanding when kids are in the hospital,” said child life manager, Sheila Palm. “Being better prepared improves long-term adjustment to medical conditions, increases cooperation and reduces pain during procedures.”
Children’s deploys certified child life specialists throughout the hospital – to the medical-surgical, pre-surgery, critical care, and cancer and blood disorders units. Child life specialists work in home care and hospice, too. Children’s also has child life associates who help on some of the units and in the Sibling Play Area. Philanthropy helps support child life specialist services; their work is not reimbursable.
In the ED, Teele helps reduce the stress of what can be a traumatic visit by providing age-appropriate information, coping strategies and parent coaching, Palm said. Gaining cooperation from the patient and family can reduce the time of the procedure, need for sedation and need for an extended ED stay.
A 2008 Children’s study in the ED compared parental satisfaction with their child’s experience during a laceration repair in the presence and absence of child life services. Overall, there was greater satisfaction when a child life specialist was involved.
Patients experienced less anxiety when they left the ED when a child life specialist was involved in their care. Child life specialists received a significantly higher rating than other providers in their efforts to relieve anxiety. Children’s also received a rating of excellent from families more often when a child life specialist was present.
“I find the presence of child life services in our ER to be a tremendous asset. The care that they provide in alleviating the apprehension and pain of the sick and injured children we care for on a daily basis is wonderful. I appreciate working alongside such caring individuals and see their effect in many of the patients I come across during my shifts,” said Dr. Mark Schnellinger.
Teele has worked at Children’s for 13 years, 12 of which she’s spent in the ED. “I feel like my personality fits this environment,” she said. “I like the instant gratification.”
In the ED, time is not on Teele’s side. She often only has minutes to explain and prepare patients and families for a procedure. So she relies on analogies to explain them. Instead of calling herself a child life specialist, she tells patients she’s a teacher – a term kids can understand.
“Anyone can go into a room and tell a child what’s about to happen,” Teele said.
But, a child life specialist is able to assess the child and take him or her through the experience on their terms, she said. If a child needs a CT and loves princesses, Teele might develop a scenario from “Snow White.” If the child is obsessed with video games, Teele explains the procedure like it’s a video game with various levels for advancing.
On this recent weekday night, a little boy is minutes away from having a needle inserted into his hand for an IV and blood draws. Teele explains that the RN will use a J-tip, which helps minimize pain with needles, to make the area feel soft. An RN will then use “soap” to clean the skin. Using the same tools for the procedure, she shows him what everything is supposed to feel like. She shows him the “straw” and explains that, unlike a juice box straw, it will give him medicine to make him feel better.
Later in the evening, she’s called in to help during an IV start with another patient. The ED has run out of J-tips. Armed with a Disney book, Teele holds it up for him and together they identify the characters while the RN inserts the needle, draws blood and then gives the boy medication. Distraction works. The patient remains calm the entire time.
“I think I have a very rewarding job,” Mindy said.