So needless to say, it's a constant battle to make sure all lines of communication remain open. Unfortunately, most children are going to associate scrubs with “yucky” medicine and getting poked, so it's no wonder their automatic response when we walk through the door is not typically pleasant.
The most immediate and effective de-escalation technique I've found thus far, is to literally hold both hands up and repeat "No ouchies!" until they calm down. Once that happens though, you've now entered into the no-ouchie contract, and so help you God if that trust is broken. They watch you diligently as you reach for your stethoscope, making sure there's no funny business.
After they realize no ouchies are intended, it is not uncommon for your patient to now willingly assist in your assessment by moving the stethoscope bell all around. Keep a watchful eye though, as you will end up listening to the bed, the chair, and almost always ending in their mouth. At that point, you just gotta roll with it and politely thank them for their help. At least they calmed down, right?
Though this may be true most of the time, believe it or not the "No ouchies" technique is not infallible (I know, I was shocked, too). One particularly inconsolable patient sticks out in my mind; a young boy who had just gotten a G-tube placed to help him gain weight. Imagine waking up from a very heavy nap one day and having a tube hanging from your belly that all the evil scrub-wearing people are trying to put stuff in. Needless to say, he was not a happy camper. In fact, he wouldn't let anyone go near it without all 4 extremities flailing about, along with an ear-piercing scream. It was horrible.
The day I was assigned to him, I found out it was time to start using the tube for feeds. I'm pretty sure I remember the hand off nurse chuckling “good luck” to me as she waved goodbye. Awesome. With other patients to care for, I worried how I would manage the additional time necessary to deal with the patient’s active resistance. So it was time to get creative… and time to ask for help. A vague memory from orientation popped into my head of a group of people trained specifically to help communicate with all types of kids. And so entered Child Life.
Within 10 minutes of just talking to him, our Child Life specialist had discovered my patient's idol and the trick to winning him over: Buzz Lightyear. She quickly returned with one of the biggest Buzz Lightyear stuffed toys I've ever seen, specially equipped with its own G-tube. She proceeded to explain to my patient, using his new favorite toy, how his own G-tube worked. How it would make him grow up to be big and strong, just like Buzz. He listened carefully, and slowly started to compare his tube with Buzz's.
The rest of the day, he was so happy and energetic he wouldn't stay in his room. He would walk around the floor, always dragging his surgery buddy Buzz with him. Sitting on different nurses' laps. Telling his story to anyone that would listen. About how he's going to grow up to be just like Buzz.
And since I have yet to see him back, I'd like to imagine he was right about that.
As you can tell from Marianna's latest post, the transition from student to professional often comes with unexpected challenges. We think she's doing a terrific job, don't you?