After my 3 days at Montefiore, the lovely Katie had set me up with two day visits to different centres to visit the Child Life Specialists there and see how the different programmes work in these two very different hospitals!
Weill Cornell is a large and very splendid hospital in the Upper East Side in Manhatten with a 23 bedded PICU. Although I found the cots a bit alarming, it was a beautiful unit with some spectacular views!
On of the things I was particularly interested in here was the strong focus they have on preventing delirium in PICU patients, with those considered at risk being children who have had very severe illness, lots of sedation, lack of sleep and activity or prolonged hospital stay. They score all their patients twice daily, and use a tool kit to help those children. The tool kit is adapted for the child’s age but includes clock/calendar to help differentiate day and night, supplies to help stimulate the child in the day, headphones to reduce background noise, eye mask to promote day/night sleep cycle and a PICU diary project kit and parents are encouraged to make the bedside as familiar and comforting as possible. These are techniques we have been considering in Nottingham, so it was good to see them in established use and getting very positive feedback.
On talking to the ward manager, I also found that psycho-social needs of the family are taken into account, with all new families being seen by the ward manager and asked about how they are managing, are they sleeping etc. On the daily ward round, parents are also actively asked what involvement they have had in their child’s care that day and encouraged to be included and ask questions.
I asked about education for the new nurses to the unit and found that all new nurses get 14 weeks supernumerary, with the first 2 weeks spent in teaching with the rest shadowing. During the teaching, they get a session covering family centred care and also on Child Life Specialists. I was lucky enough to go and watch the lovely CLS who was hosting me for the day give the talk on the services which included a very adorable song from a little kid about big clocks and little clocks “You’ve got a big clock but I’ve got a little clock too” which was a great metaphor for how sometimes in our hurry to get all our jobs done on time we can forget to take the time to really see how the child is coping with the hospitalisation and with all the medical interventions.
I was also really impressed with the work the CLS did with siblings, not only spending time and doing prep with them but sending them cards to thank them for being such a good sibling and also providing parents with advice on how to recognise and cope with a sibling that might be struggling with their siblings illness and the absence of both the child and the parents. This is a very simple strategy but also very effective and really requires minimal resources to show the family that we are recognising the family as a whole unit, not just the sick child, and the effect a PICU admission can have on that family unit.
Elmhurst Hospital Center
Elmhurst is a very busy community hospital in Queens. It has a much smaller children’s hospital, with a 4 bedded PICU and a children’s ward. I was invited there to see the the Child Life Program as it was a much newer smaller one made a very interesting comparison to the larger more established programs at Montefiore and Weill Cornell. The CLS had come in around 2 years previously, prior to her the hospital had been without a CLS for several months and before that the program had much more of an art therapy focus than distraction and procedural preparation. The CLS I met had really revolutionised services and had sourced funding from several places, including for a play room and has now managed to get a second CLS on the team so they can cover ER as well as inpatients.
The PICU has relatively few ventilated patients as any longer term ones will get transferred out but I was told that the when they do have ventilated patients they try to do some multisensory work with them, providing music and lights. I was also given a fantastic demo of how they do procedural play with any of the patients requiring it using surgi dolls. These are great little soft stuffed dolls that come in a a variety of skin tones so the child can pick one that looks like them. They have blank faces and come with fabric pens so the kids can draw on a face and anything else they want. The CLS then gets out the medical equipment and does role play on the doll with it with the child and narrates the process to help them understand and normalise what will happen. She also encourages the children to feel confident and ask the nursing or medical staff questions and gives older children and parents notepads so they can write down any questions or concerns.
Thank you New York for a wonderful week!!