ONE VOICEONE VOICE

Developed byDeveloped by

Debbie Conklin, BS, CCLSDebbie Conklin, BS, CCLS

Certified Child Life SpecialistCertified Child Life Specialist

The Nebraska Medical CenterThe Nebraska Medical Center

One voice should be heard during the procedure.

Need for parental involvement.

Educate the patient before the procedure about what is going to happen.

Validate a child with your words.

Offer the patient the most comfortable, non-threatening position.

Individualize your game plan

Choose appropriate distraction to be used.

Eliminate unnecessary staff who are not actively involved with the procedure.

The hospital setting is a scary place. Kids are in a strange place with strange equipment. There are

strange people who sometimes do strange and painful things to kids.

Their routine is interrupted and they often have very few choices about

what happens to them. What can we do to help?

The purpose of the ONE VOICE campaign is to remind health care

professionals to be considerate of the clinical environment that we expose

children to during medical procedures.

Each of the letters of ONE VOICE stands for one component of the

environment that we need to remember.

OONE VOICENE VOICEOne voice should be heard during the procedure…

• One person should be designated to do the speaking during a procedure. It can be the child life specialist, a nurse, the parent, tech, etc.

• Hearing more than one voice can be confusing and chaotic; each person has to speak louder to become heard, which leads to an increased noise level. Imagine you’re in a meeting and several people are talking and trying to share ideas at the same time. Is it hard to concentrate? Imagine that you are three years old and having an IV started; everyone is talking to you at the same time. Can you imagine how difficult it is?

• Conversation that needs to take place regarding the procedure, needs to be kept at a very low volume. Examples of this conversation might be, “I’m having trouble finding a vein”, “The vein keeps rolling”, or asking for assistance from another staff member.

• It’s okay for the parents to be a second voice of comfort to a child as long as it not disruptive or negative in content.

OONNE VOICEE VOICE

Need for parental involvement…

• Parents are the most important people in a child’s world, they need to be present.

• Parents should be given a specific task or role during the procedure when appropriate. They can hold the child, comfort, or distract their child.

ONONEE VOICE VOICEEducate the patient before the procedure about what

is going to happen…

• Utilize child life specialist to provide teaching to patients of all ages.

• If child life is not available to you, utilize simple, non-threatening words (refer to Consideration in Choosing Language from “Psychosocial Care of Children in Hospitals: A Clinical Practice Manual From the ACCH Child Life Research Project).

• Children need to know what is expected of them as a patient. Saying things like, “You need to hold your hand really still” or “It’s Ok to cry or say OUCH, but you need to hold your hand still.” Children really try to do their best. If they understand that holding their hand still can make it better for them, and may make the procedure go faster, they will do their best.

ONE ONE VVOICEOICE

Validate a child with words…

• Target specific behaviors and always keep phrases positive; “You’re doing such a good job holding still” or “I know you are doing your best to hold still”.

• If a child becomes combative, redirect them by saying, “It’s not okay to hit, but you can yell ouch”.

ONE VONE VOOICEICE

Offer the most comfortable, non-threatening position...

• When you lay a young child down, they automatically struggle to sit up. Take away one of the reasons they struggle with healthcare staff; let them sit up. Why? Because we can, and it truly helps.

• Utilize “Positioning for Comfort” holds. Laying down is the most threatening position to many children. Allow them the choice of laying or sitting.

ONE VOONE VOIICECEIndividualize your game plan…

• Each child is different and each situation is different. What works for one child in a situation, may not work for another child.

• A child may react differently each time they have a procedure, even if it’s the same procedure.

• Each staff member will develop a certain style that is comfortable for them. Remember you may need to adapt your style or routine to best meet the needs of your patient.

ONE VOIONE VOICCEE

Choose appropriate distraction…

• Offer child choices for distraction; bubbles, books, music, toys before you start the procedure.

• Although we can’t always take the “ouch” away (always try to use topical numbing agents), there is almost always a point when a child wants and needs to be distracted.

• Children may be distracted, then need to watch what is happening for a time and that’s okay, attempt to distract them again.

ONE VOICONE VOICEEEliminate unnecessary staff who are not actively

involved in the procedure…

• Make sure that only people who are actively involved with the procedure are in the room. If a nurse or doctor feels they may need an “extra set of hands, just in case”, have the “extra hands” wait outside of the room until they are needed.

• Even if all the people in the room are not actually doing anything to the child, it may still frightening. A 3-yr-old may not believe that the extra people are not there to harm them.

• Older children may feel very self-conscious. Kids usually try to do their best to cope and please adults. If they don’t feel they are successful at coping, it may be especially embarrassing if there are a lot of people in the room.

• If there are students or staff that need to observe, there are still ways to make it less threatening for our patients. “Extra” people may stand outside of the room until there may be a more appropriate time to come in and observe (i.e.., after patient is sedated or when they are turned away and unable to see all the “extra people” observing.) At times, it may be necessary to have only 1-2 students observe a procedure. Our patients’ needs should always come first.

• Always get permission from the patient and/or parent before allowing students to observe.

• No ONE person is in charge of eliminating “extra” people…all staff are responsible.

Other things to remember…

Avoid… Avoid… • Comparing to other children:

Comparisons such as, “You should be able to do this, Johnny is younger than you, and he can do it”.

• Pitying:Children need supportive care, not gushing sympathy

• Talking down to children.Treat children appropriately for their age – physical appearance may be deceiving so make sure to know the age and developmental abilities of the patient.

• Saying “be a big kid”.Children will try to do their best. Focus on targeting a child’s specific behavior, i.e. “You are doing such a good job holding still”.

• Talking about children as if they are not there.Children hear and understand more than we think - misconceptions and fears may arise from fragments of information that are overheard and not explained.

Remember…Remember…• When preparing a child for a procedure, remember to include all

the senses in your description, i.e. smell, sight, touch: “The x-ray machine will not hurt, but it does make a ‘click’ sound”.

• Designate ONE VOICE to support a child• Get down on the child’s eye level.• Always introduce yourself to the patient and family.• Be honest.

Hiding the truth results in the child losing trust in hospital personnel. Don’t say it won’t hurt, unless it really won’t (and remember “hurt” can mean different things to different people).

• Give children only real choices.If the child can choose between juice and water to drink with their medication, great! However, the child has no choice about taking his medication, so do not offer one.

• Allow parents to be present.• Respect the child’s expression of emotions.

Crying and anger are normal - the child will feel and cope better if they are encouraged to express these emotions appropriately.