Saturday, May 20, 2006

Treat me like a child

Treat Me Like a Child

I noticed a few things while working as a pediatric nurse. Kids get treated differently. They get treated, well, like kids. They aren’t expected to behave, to sit still for shots or take nasty medicine without, at least, making a face. We give all kinds of consideration to young patients. We take our time with them. Treatment rooms are pretty standard, so painful procedures get done elsewhere and the patient’s room remains a safe place. Newer children’s hospitals put in diversions, like Play Stations and toys and books. They come in bright colors and have a Child Life Specialist to explain all the scary things and to see what makes the child happy and more secure during their hospital stay.

Recently, I visited a friend (a grown-up) on the oncology floor. I expected the treatment there to be a little more patient-friendly than the average floor because in many ways cancer patients get treated like children; they’re both considered “innocent victims” of disease. But my friend was considered “a good patient.” She was sick, but not too sick. She didn’t complain a lot. She tried to be upbeat and cheerful and helpful when called upon by nurses and doctors to do things that weren’t pleasant. She told me that she didn’t see her nurse a lot and when she did, it wasn’t for very long. “I guess she’s busy taking care of her sicker patients.” One doctor who promised to come in and check on her every day, came by once during her two-week stay. She found out different things from different staff as they paraded through her room each day. She was scared because there didn’t seem to be “a Plan.” It was like fitting together the pieces of a puzzle. She needed the advice of friends who were nurses and doctors to put it together for her, because the staff certainly didn’t. In the end, the things that satisfied her she got because she opened her mouth and complained until something was done. Why does it have to be that way?

So here is my patient manifest. A list of requests, (okay, demands) for my caregivers, should I find myself ill.

Don’t expect me act like a grown-up. Grown-ups get scared too, but don’t like to show it, so it may come out in different ways. They may have denial or anger, or they may be overly cheerful and helpful. Expect that underneath, I am scared. If I act like a grouch and snap and generally act hateful, don’t take it personally. Treat me gently. Certainly, you should give up on the idea of me being “the good patient.”

Think about where I am in my life. Erikson’s stages of development don’t stop when someone reaches the age of majority. When’s the last time you put down “Integrity vs. Despair” on a care plan? People have real, developmental needs throughout their life span and they shouldn’t be ignored by health care providers because they’re adults.

Explain things to me like a child. Not condescending-but simply. Avoid big words and ask me questions to see if “I got it.” Part of assessing the patient is to see how much they know about their condition and don’t take that for granted. Medicine and hospitals are foreign concepts to anyone who hasn’t been ill. Most people know more about how to maintain their cars than their bodies. Part of your job is to communicate. Please don’t tell me, “He’s a real jerk, but an excellent doctor.” I don’t care how well you diagnose, treat, cut, or cure. If you can’t communicate effectively, you’re not doing your job well.

If I’m well enough, give me something to keep me busy. We all know if you keep a child occupied, they’ll stay out of your hair for a while. And I don’t mean the TV. I hate walking into a hospital room and having that TV blaring 24/7. It’s not just a babysitter for kids anymore. What happened to daily rounds by a volunteer with a cart full of books, newspapers and other diversions? And God forbid if every hospital room doesn’t become private soon. Yes, roommates can be a bother, but it can also give you someone to talk to and commiserate with. I used to work on a floor that still had one four-bed room. More often than not, the four would become fast friends and you wouldn’t have to answer a call bell all day.

Let me have control over something, even if it’s little. I hate to feel like I’m just another number on the pill-dispensing assembly line. If I want to take my aspirin with lunch, let me take it with lunch. So what? If it’s something that can’t be changed, take the time to explain why to me (see #3).

Have a plan and let me, or my family, in on it. Floors should have walking rounds, with all the members of the healthcare team. Everyone knows what’s going on and everyone gets on the same page. Do it at the same time everyday so that I and my family can know when you’re coming and get the answers we need. I need to have my family or a close friend with me when you talk to me. Just like a child, I get overwhelmed with too much information and may need a second set of ears to hear what you’re saying.

Treat me like an “innocent victim” regardless of whether I’m in the hospital for cancer or a drug overdose. Many, many people are hospitalized due to their own action. Does it really matter if it’s because of too many beers or too many cheeseburgers? This is called compassion and it’s usually not thought of until it’s missing. You would think that some patients would be above judgment, but once I overheard a doctor say, “We’re going to harvest HIS organs? Why, so another drug addict can get a liver?” Give me a break.

It sounds simple enough, but it’s rarely seen. There are some good excuses, I suppose: managed care, high patient to nurse ratios, staff burn-out and many other issues that are better saved for another time. Even so, if I should ever find myself in a hospital, save a bed for me in PICU, I want to be treated like a child.


dr peg said...

Great post, TC, excellent points.

I hope you'll submit this to Grand Rounds.

D.P. said...

Amen--great post!

Pine Baroness said...

As the mother of a medically fragile child, I have spent a lt of time in children's hospitals. I work in the cold world of advertising and I was flagergasted by how nice the nurses in the children's hospitals are. They would say "may I get you anything?" and they meant it!
I have never met such nice people in my life. It is amazing how they can be so nice when dealing with life and death issues in a child and other people can be so nasty when dealing with a $2.00 discount in an advertisement:-)

Mama Mia said...


ChrisAW said...

Yes! If only more professionals took the time to understand these points. Great post.

I am a Milliner's Dream, a woman of many "hats"... said...

Great post.

I recently did my peds rotation and posted about it. (In fact, I submitted it to Pediatric Grand Rounds.)

It's fun to read these experiences as well as what you do now.