Presentation on theme: "Instructions for use of this template:"— Presentation transcript:
1 Instructions for use of this template: This PowerPoint was created by child life specialists on the Child Life Council’s Professional Resources Committee for use by professionals in the field.It may be used to educate multidisciplinary team members and students in your practice.You may use it “as is,” or you may customize it by adding graphics or photos, selecting only a subset of slides, or integrating some of the slides into your own presentation, as appropriate for your audience, please be sure to read over the comments listed at the bottom of each slide to know how to customize this for your institution.Please include the next slide (slide 2) in your presentation, either at the beginning, or end.A note about the photos: Consents for use of the photos for this powerpoint are on file with the CLC. You may use the photos along with this template “as is,” as well as for modified versions of this presentation that you create yourself. Please do not use the photos for other purposes beyond your presentation (i.e. websites, flyers, iPad apps, prep books, etc.)Please remove this slide (slide 1) prior to use.
2 Our Thanks to:The Child Life Council’s Professional Resources Committee, who provided a template to help in the creation of this presentation for our audience.
4 What is Child Life?Child life specialists address the psychosocial concerns that accompany health care experiences by promoting optimal child development and minimizing adverse effects. Using play and psychological preparation as primary tools, child life interventions facilitate coping and adjustment under circumstances that might otherwise be overwhelming.You may choose to add a picture of your Child Life Team to give a visual to your audience. Pictures of the playroom and other specific areas give a good visual and can add some local “color” to the presentation.
5 Certified Child Life Specialist Professional Standards of Practice Minimum bachelor’s degree or master’s degree* with specific coursework in human growth and development, family studies, psychology, and related fields*By 2022, all newly Certified Child Life Specialists will be required to hold a master’s degreeMinimum of 480 hour internshipNational Certification examinationProfessional development hours to maintain certificationAdherence to the code of ethics and standards established by the Child Life Council
6 PainProcedural pain is universal to all pediatric patients and needle stick pain is the most common source of pain in hospitalized children (Wong and Baker, 1988)Pain is subjectiveWong, D., Baker, C. (1988) Pain in children: comparison of assessment scales. Pediatric Nursing.14 (1): 9-17.
7 Gate Control Theory of Pain Experience of pain can be influenced by thoughts and emotionsIn order to help control the “gate” of pain, other tools can be utilized to distract/“trick” the skin or body to focus on additional sensations, such as cold or vibration, to minimize the sensation of the poke or painThe gate control theory of pain. (January 01, 1978). British Medical Journal, 2, 6137,
8 How Child Life Can Help Play Diagnosis education Preparation Support TherapeuticMedicalDiagnosis educationPreparationSupportProceduralEmotionalFamilyCoping Plans
9 Child Life’s Role in Pain Management Non-pharmacological pain managementGuided Imagery/RelaxationPositioning for ComfortEmotional SupportDistractionDeep BreathingOther pain management techniquesSucrose WaterLidocaine (injectable/topical)Vibration and coldFeel free to add information based on what common techniques your facility utilizes.
10 American Academy of Pediatrics “CCLSs are often directly involved in the utilization of nonpharmacologic pain management techniques and coaching or supporting patients and families before and/or during distressing medical procedures.”American Academy of PediatricsBrown, C., Ipsan, C., Lostocco, L., Vinocur, C. D., Chitkara, M. B., Percelay, J. M., Betts, J. M., ... Alexander, S. N. (January 01, 2014). Child life services. Pediatrics, 133, 5.)
11 Guided ImageryGuided imagery induces an altered state of consciousness where a patient develops heightened focus on a particular idea for the purpose of relaxation and/or distraction.3 events associated with guided imagery:Absorption- patient totally involvedDisassociation- separate self from painSuggestibility- suggest scenes, patient can agree or disagreePatient must be in control to do guided imageryDisassociation- thinks of pleasant experience versus painSuggest- if favorite place the beach coach can suggest ‘can you feel the breeze?’Purpose: to bring pt to an altered stated that gives them control; brings them to a state that is not compatible with pain. Patient has to be in control to do guided imagery
12 Guided ImageryGuided imagery is most useful for longer procedures or for beside pain managementIt is most effective with older children who are able to use their imagination to follow the scriptGuided imagery is most useful for longer procedures, compared to procedures that are a shorter length of time, due to the amount of time to discuss the scene in great detail and utilize all senses.Feel free to discuss your favorite guided imagery script or provide in detail a description of the magic glove technique…Here is a link to the magic glove technique from the CLC https://www.childlife.org/files/MagicGlove.pdf
13 Positioning for Comfort Comfort positions allow for good control during a procedure while still allowing the child to receive comfort from the parentHelps the parent and child to feel more at ease and in controlSome positions, like laying on the back, can make children feel very vulnerableSparks, L. A., Setlik, J., & Luhman, J. (2007). Parental holding and positioning to decrease IV distress in young children: a randomized controlled trial. Journal of pediatric nursing, 22(6), doi: /j.pednSupine position is vulnerable for the child, as they are lying flatAllows the parent or caregiver to be involved
14 Positioning for Comfort: Advantages Fewer health care team members neededGreater immobility of the childClose physical contact with a caregiverCaregiver has an active role and can support the child in a positive wayCreates a sense of control for the childFewer People…nurse-wise are needed to complete the procedure. The parent holds the child in a comforting way.Child moves less when sitting up and hugging caregiver*Note: Child still cries, but studies demonstrate that child moves lessStephens, B. K, Barkey, M. E., & Hall, H. R (1999). Techniques to comfort children during stressful procedures. Advances in Mind-Body Medicine, 15,
15 Positioning for Comfort Children may still cry, but tend to display less stressCan be initiated as soon as a child has received some trunk and head control (3-5 months)Parents/caregivers should not be asked to hold down a child’s arms or legs; it is important to make sure parents feel comfortable with these positionsParents/caregivers can lie next to child on bed for procedures which require supine positionCompliment parents!Positions can always be adapted to meet the needs for each procedureAs previously mentioned, cry but tend not to move as much as lying supineComfort position can be used with infantsComfort position is like a big hug, not restraining flailing arms/legs – better to get an additional nurse if necessaryIf lying supine is preferred, it is another form of comfort position – child’s parent can lie on bed in comforting manner*Very important to ask parents initially what they prefer and feel comfortable doing!!! Must consider anxiety level of parents, size of patients/parents.
16 Examples of Positioning for Comfort IV /Blood Draw:Straddling lap of caregiverSide-SittingConsents for use of these photos for this powerpoint are on file with the CLC. Please do not use these photos for other purposes beyond this powerpoint. Can be adapted for what works best for the patients, caregiver, and staff
17 Examples of Positioning for Comfort IM injection in ThighLeg is bent over parent’s lap, keeping thigh muscle relaxedConsents for use of these photos for this powerpoint are on file with the CLC. Please do not use these photos for other purposes beyond this powerpoint. Can be adapted for what works best for the patients, caregiver, and staffLacey, C. M., Finkelstein, M., & Thygeson, M. V. (2008). The impact of positioning on fear during immunizations: Supine versus sitting up. Journal of Pediatric Nursing, 23,
18 Examples of Positioning for Comfort Port AccessSit forward-facing on parents lapParents can cross legs over child’s legs to prevent kickingConsents for use of these photos for this powerpoint are on file with the CLC. Please do not use these photos for other purposes beyond this powerpoint.
19 Examples of Positioning for Comfort NG DropHug parent during nasal aspirateChild can also be held on parents lap facing outward with parents arms and legs wrapped around the childConsents for use of these photos for this powerpoint are on file with the CLC. Please do not use these photos for other purposes beyond this powerpoint. Can additional details
20 Examples of Positioning for Comfort Urinary CatheterizationChild lies with head in parent’s lap on tableConsents for use of these photos for this powerpoint are on file with the CLC. Please do not use these photos for other purposes beyond this powerpoint. *I also point out is was the urinary catheterization procedure that allowed me to start using comfort positions, as parents really liked being involved in the procedure. They sit at the head of the bed either cross-legged or with each leg hanging off the bed and their child’s head sitting in the parent’s lap, with us providing something fun to distract. From a nursing standpoint, it also prevented the pt from moving his/her body upwards during the procedure, so both parties benefited. After doing it many times, the nurses became more open-minded to doing more comfort positions during other procedures.
21 Emotional Support Comforting touch Encouraging words Developmentally appropriate medical explanationsReduces anxiety related to anticipatory painimpact of having hand to hold, someone to empathizepraise pt for doing well if doing well, encourage in helpful way if notexplaining steps helps to reduce anxiety related to anticipatory pain
22 Distraction/ Planned Alternative Focus Does not mean “Hey, look over here so you do not know what is happening!”Gives an alternative to focusing on painGives the patient a “job” and promotes sense of control over an appropriate aspect of the procedureGive age examples
23 Items useful for Distraction Toddler – bubbles, light spinner, cause and effect toys, toys with lights and sounds, sensory toys, etc.Preschool – bubbles, light spinner, toys with lights and sounds, young versions of i-spy books, ViewFinder and cartoon slides, stress ball, pinwheels, whistles, iPad games and activitiesSchool-age – i-spy books, iPad games and activities, conversation, music, singing, stress balls, pinwheels, whistles, etc.Adolescent – iPad games and activities, conversation, MadLibs, music, singing, hangman, Pictionary, stress balls, etc.Please know that these lists are not exhaustive, if you have a favorite distraction item, it might be helpful to list
24 Deep BreathingDeep breathing is a useful coping technique that can be used in the midst of painIt can be helpful for both chronic and acute painTools like whistles, bubbles, and pinwheels can encourage younger children to take bigger breathsVisuals, like birthday candles, can also be beneficial for younger children
25 Using Interventions Effectively Give parents and patients clear instructionsRationalize/describe techniques as being helpful or less threatening; ‘helping you hold still’ or ‘giving you a big hug’Involve the parents and include them in what is happeningDecreasing stress level of parentsParents are the experts of their childMake sure to thoroughly inform parents as to what is occurringProviding age-appropriate preparation to child prior to procedure taking placeUnderstanding that it can be stressful to parents, giving them a job (some role in distraction)
26 Additional Pain Management Techniques Cold SpraySucrose WaterPharmacological Numbing AgentsHeat and ColdSoothing ItemsCustomize this slide to include more information regarding additional pain management techniques available at your facility (such as JTip, ELMA, LMX, Buzzy, freezy spray, cold spray, SweetEase, pacifiers, hot or cold packs, etc).Encourage presenter to list other items mentioned or speak directly to the options available at your facility.Cold spray – aka freezy spray, often easy to useSucrose water – aka SweetEase or OraSweet – often effective for infantsPharmacological Numbing Agents – JTip, EMLA, LMX, Buzzy or other vibration devices, etc.Heat or Cold – ice or heat packs applied directly to or near the areaSoothing Items –pacifiers or teething rings
27 Bedside Pain Management Sometimes pain can be chronicSome tools that can be used in the procedure room can also be usedBubble blowingPlay with familiar toysRelaxationTeaching and rehearsing coping techniques can also be very beneficialIt is helpful for medical staff to realize that children often use play to help cope with pain. A child who is coping well with her chronic pain by playing a video game or watching a movie may still be experience pain, and may need continued pharmacological pain management along with distraction play
28 Developmental Level of Patient Possible Pain Management TechniqueInfantComfort positionEmotional supportSucrose waterToddlerDistraction/Planned alternative focusPre-schoolDeep breathingSchool-ageGuided imageryAdolescent
29 Remember Child Life can Help… Reduce patient and parental anxietyTeach techniques to facilitate copingOffer support during painful proceduresSet clear expectations
30 Child Life DepartmentInsert contact information/unit information