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Emergency Dept Child Life
lauren faldution 21 September 2013
Transcript of Emergency Dept Child Life
Create and provide in-services
present at trauma panels/conferences
Provide in-services for nurses worth C.E.U. credit
Debrief with staff after procedures/interventions
Get involved in nursing and new resident orientation
"Child Life Tip of the Month" (Bulletin board to share research/articles)
Implement a recognition/rewards system
Utilize incentives that enhance the caregiver/patient relationship (ex: small distraction items)
Make a positive example of staff to encourage others to do the same
Be physically present as much as possible
Attend and participate in staff meetings
Chart on the unit. Hang out at the nurse's station. Eat lunch and take your break in the break room with other E.D. staff.
Utilize communication boards - make it EASY for staff to get in touch with you
"Seeing is Believing"
Be PROACTIVE and aware of any orders
Start small: focus on a certain procedure (ex: lac repairs) and ensure you are present for each one.
Introduce self and role to new staff members
Importance of greetings, small talk, and goodbyes
Invest in your multidisciplinary team. They will become your greatest asset!
The 411 to your E.D. Child Life 911
Lauren Falduti, Danielle Furio, Heather Mahony
I. Part One: Building a successful Child Life program in your Emergency Department
Current Child Life coverage in the E.D.
A look ahead: program growth and future goals
II. Part Two: Open panel discussion between audience and Emergency Department Attending Physician, Physician's Assistant, and Nurse.
To provide insight into the various perspectives of Child Life’s role in the Emergency Department and how to use this information to reach a common goal in the multidisciplinary approach to family centered care.
To stimulate creative thought and reasoning for how to improve and utilize CL services in an Emergency Department setting
MCH ED had been without Child Life coverage for over six years!
39 bed unit + 2 bed major room/trauma bay
In 2010 the E.D. saw 87,547 patients
Staff & Coverage
2 Full-time ED Child Life positions created (40 hours/week)
Monday - Thursday: 10:30am- 9pm + every other Sunday 10:30am- 9pm
Tuesday - Friday 1:30pm-11pm + every other Saturday 1:30pm-11pm
Lacked consistent weekend coverage (only one weekend day per week which alternated between Saturday and Sunday)
Child Life Who?! Child Life What?!
"toy ladies": referred primarily for normalization/diversionary activities and to restock Waiting Room activities/supplies
CCLS initiated Child Life presence during procedures
No time to prepare patients/families before procedures
Papoose utilized for a majority of procedures (ex: Laceration Repairs, IV placement)
More Child Life to meet the needs of the growing unit and increasing patient load (the E.D. will be expanding to a 76 bed unit + 4 bed trauma bay by 2014!)
Role in design of new ED rooms
Night shift coverage (currently no Child Life coverage from 12am-10am)
New Resident education
Continued strong presence in Traumas (One Voice)
Pain Management (nitrous)
Expansion of CL services to other outpatient centers/urgent care clinics
A look ahead: Future Goals
What was your perception of Child Life when you first started working with us?
"I thought it was annoying and unnecessary. I Would never call them and just felt like they were in the way." - Sam, LPN
The E.D. is growing!....
58 bed unit + 2 bed major room/trauma bay
In 2012, the E.D. treated 95,384 patients (a 9% increase since 2010)
Staff & Coverage
Four full-time Child Life Specialists + 1 full-time Outpatient Child Life Supervisor
Coverage: Sunday-Saturday 10am-midnight
Child Life Assistants provide weekend inpatient playroom coverage
Appropriate consults (Laceration repair, IV placement, blood draws, lumbar punctures, I&Ds, orthopedics, conscious sedation, new diagnosis teachings, psychosocial assessment/support)
Wait for CL to provide psychosocial preparation before beginning procedures
Asked to provide CL In-services to nursing students and multidisciplinary team
Decrease in use of Papoose and an Increase in Comfort Positioning
What is your perception of Child Life services now?
"I hate when they are NOT here! Once I made more of an effort to work with them, I realized how valuable they are. They make our job so much easier. Keep up the good work. We love you guys!"
- Sam, LPN
"They're (the E.D. staff) spoiled now! They can't do it without you!"
-Dr. Baker, E.D. Medical Director
How'd we do it?
How to create and implement your E.D. Child Life program (or grow the one you already have)
"Trust men and they will be true to you: treat them greatly and they will show themselves great." — Ralph Waldo Emerson
Reach out to E.D. leadership (ED Director, Clinical Director, Nurse Managers, Clinical Educator)
Schedule meetings to problem solve & increase program involvement
Ask management to place Child Life on the agenda at staff meetings (discuss incentives, coverage, tip of month, end by acknowledging your "Superstars")
Become part of the Trauma Team (represent Child Life at monthly multidisciplinary Trauma Quality Management meetings)
With Medical Staff...
Enhance the medical staff to patient relationship
Do NOT create barriers (ex: “Don't worry, I’m not a doctor or nurse; I won’t hurt you”)
This "us" vs. "them" mentality can not only increase patient anxiety, but can also create a divide in your relationship with other staff.
Introduce staff as your friend when entering room (ex: "This is my friend Kristin. She's going to be one of your nurses today. She is going to help you feel so much better! I'm so glad she's here to help!)
Involve staff in patient birthday celebrations, prizes, get well posters, etc.
Recognize Nursing goals: work with them, not against them!
Find common ground with comfort positioning; recognize safety concerns
Be respectful of their work space and their time
Assist and be a team player!
"I thought it was awkward having so many people there with us in the room and so many people explaining the same thing." - Darlene, LPN
"I was adamant about NOT using Child Life for my procedures because I didn't think the children would be distracted and feel better ... they knew what was going on anyways. I didn't believe the distraction techniques and their upbeat personalities could help us or the kids." - Crystal, LPN
"When I first started working with Child Life, I didn't have a clear idea about their role in the ED. I thought they were there to play with the kids and give them toys and games to help keep them distracted. When I started working with them, I initially felt frustrated that they were trying to change my clinical practices. I was trained as an 'old school' nurse and my idea of starting an IV meant 2 nurses restraining a child and getting the IV in as quickly as possible. I was initially resistant to Child Life, as I felt that they were telling me that my ways were 'wrong.' That's not easy to hear, and change is always difficult."
Child Life on a Roll: More Child Life, please!
1 Activity Assistant (Monday-Friday coverage) whose primary focus was Waiting Room activities and supervising volunteers
2 "weekend" Child Life Specialists
36 hour positions: three 12 hour shifts (Fri-Sun or Sat-Mon)
ED weekend Child Life Specialists responsible for covering inpatient playroom on weekends (this took 10 hours of Child Life coverage from the ED every weekend!)
Appropriate referrals for Laceration Repairs and Orthopedic patients (conscious sedations)
Rarely referred for other procedures (blood draws/IV placement) or diagnosis teachings
Only referred for patients ages 4-10
"It's great having you guys and how you explain things before we get there and distract the kids to help us make things go faster and less stressful for the parents as well as the children." - Darlene, LPN
"I LOVE Child Life. I use them for all of my procedures (when available) and love having them. It helps the kids, parents, and makes my job a lot easier!" - Crystal, LPN
"Working with Child Life has reshaped my clinical practice in many ways. They have taught me that there are better approaches to patient care, and that each approach, each interaction, can be tailored for each specific child. I attended their in-service on child development, and it was so helpful to think about each age and developmental stage and how they might perceive the hospital experience. I feel like I have a whole new language with which I can communicate with my patients. They have made my job easier and more joyful, and most importantly they have helped us to minimize and sometimes even eliminate the trauma of undergoing hospital procedures for our patients." -Kristin, RN
"My experience with child life during my training in the ER changed the way I interact with each patient I come in contact with. I saw how their strategies and methodology can completely transform a child's experience during an otherwise very scary event. Not only do they soften the fear factor for the kids, they decrease parents anxiety, empowering them to feel more in control of an otherwise uncontrollable event. By doing this, they change the entire environment making procedures especially, more safe, and more time efficient for the patient and the staff. They improve the quality and efficiency of the care we provide. To have them in the UCC would greatly improve the level of care we service to our community, making us a more compassionate and efficient provider of healthcare to our children." - Tara, P.A.
Open Panel Discussion
Lauren Falduti, CCLS
Danielle Furio, CCLS
Heather Mahony, CCLS
Rebecca Fajardo Cabrera, LPN
Elina Fernandez, P.A.
David Lowe, M.D.
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