You're a student nurse wearing unflattering scrubs, standing in front of a hospital bed, in a hospital, atop of which stands a screaming, naked, urine soaked, bald little 30 pound boy shaking his fists at the heavens, his infusion port hanging from his chest.
Now, is that what you were expecting? Yeah, me neither. And what lead to this strange turn of events? Most directly, the re-accessing of this little boy's port is what precipitated these hysterics. Indirectly, there are a number of different factors:
Factor 1: Lack of discipline at home and away. Dad was present during this entire thing. He was present when we gave the kid five chances to go the bathroom beforehand, which he alternately begged for then refused, presumably as a stall tactic. He was present when the boy started spitting on, swinging and kicking at the nurses. He was present earlier in the day when giving the boy 5ml of Tylenol became a 30 minute, all out battle of wills involving three grown adults holding him down and one nursing student (myself) shoving that syringe between clenched teeth to the back of his throat. Dad is also present every single day this kid eats nothing but Cheetos and apple juice, which is why at almost four years old he weighs only 15.1 kg. Dad, and we can assume mom, have neglected to set up a disciplinary system with this child. Children who aren't taught to mind before they get cancer, are not likely to suddenly mind once they do get cancer.
Factor 2: This kid was pissed. We just stuck a needle into his chest for goodness sake. I'd kick me.
Factor 3: The resident nurses, who are supposed to be experienced and seasoned, escalated the chaos of the child's environment by trying to yell over his screams. Apparently, the best way to calm a hysteric child is to scream back at him "what are you yelling about? You're going to be okay!!!!!" If this nursing student may make a suggestion to you, the seasoned nurse, it would be this: stop yelling! If your goal is to calm the child, why are you screaming at him? He can hear your regular tone, you know. I was holding his head and shoulder down (which was surprisingly difficult, considering his size) and his eyes went right to mine whenever I spoke, even though it was barely above a whisper and I was no closer to his ear than the shouters.
Factor 4: this kid was set up for a breakdown when we neglected explaining exactly what would be happening, what we expected from him, and what reward he would gain for going through it.
So, having evaluated all the areas where there was certain failure, let's rework this scenario so that next time we increase our chances of not ending up with a complete meltdown.
Here's how this should have went:
Step one: sit the child on the father's lap and repeat the following: "We need to give you a new port because this one doesn't work anymore. This is going to be a poke and it will hurt for a moment, but I know you are a very brave boy and you can do it. You can scream as loud as you want and you can cry as hard as you want, but what I need you to do is stay very still so that we only have to poke you once. We're going to hold you down to help you stay still. And when we're done, this is the bravery bead you're going to get to add to your string. Now, before we start, do you need to use the bathroom? Think about it for a second, because I'm not going to ask again." Don't ask him if he has any questions, don't let him have a drink from his sippy cup, nothing. Those are all stall tactics. The kid knows it, you know it, so don't cater to it.
Step two: hold him down and get that port in, keeping your voice soothing and quiet.
Step three: let the kid go, give him his promised reward and clean up your mess.
It's just not rocket science. And yes, there's no guarantee this strategy would yield any different results, but at the very least you did everything you could to promote harmony and success and prevent a very fragile and underweight child from burning more calories than he will probably consume in three days together.
No comments:
Post a Comment