Budget cuts bring benefits to children’s hospital
When the word came from administration at Columbus (OH) Children’s Hospital to merge the child developmental services and volunteer departments, staff wondered how they could serve patients and families effectively with less than half their original work force. But two years later, the 4.5 FTEs have implemented creative ideas that resulted in an expanded focus on children and their families, says Jane Jarboe, PhD, director of family and volunteer services.
"While downsizing is always stressful and painful, the department now has a much broader function and perspective," says Jarboe, who was hired to make the integration a reality.
"The specialists now share their expertise throughout the organization and have become skilled at supervising and delegating to volunteers." Child life specialists are charged with helping children cope with intrusive procedures by engaging them in diversionary and recreational activities as well as providing normal play activities during hospitalization.
For example, before the merger, the child life specialists were assigned to a specific unit where they spent the majority of their shift interacting with the children directly. "They were more integrated with the staff. They attended patient care meetings, they helped children cope during procedures, and directed activities in the play room," Jarboe says. Volunteers were involved in some of the child life activities, but they did not report directly to the specialists.
But in the new role, specialists are called coordinators and are responsible for child life and volunteer programs by actively recruiting, interviewing, and training volunteers whom they supervise in family-focused activities throughout the hospital. "Volunteers are enjoying the new opportunities to interact with children," Jarboe notes.
"Now, child life specialists are consultants and educators for more than 600 volunteers, enabling them to see to the needs of families throughout the entire hospital, rather than just one inpatient unit," Jarboe says. "This also frees the specialist to do more education of the staff and more hands-on intervention with the children."
Another unexpected benefit of directing a volunteer pool was that coordinators don’t wait for a department to ask for their services. "We assess their needs and work to establish programs there," Jarboe says.
For example, the outpatient area traditionally was not equipped with a play room. But with the shift to outpatient services, children often spend long hours in hemodialysis or infusion therapy. "Volunteers are a welcome relief for parents," she says.
Jarboe shared with Patient-Focused Care other innovations resulting from the merger:
• Reading and waiting program.
Volunteers read materials on health, safety, and hygiene to children who are waiting for clinic appointments. "They read stories and then talk about the concepts," Jarboe says. "It provides important information and also role models literacy." Volunteers also help children and families apply for library cards with applications kept on hand.
• Adopt a playroom.
With less than five coordinators to staff the nine inpatient playrooms, volunteers are a crucial presence there as well. Outside corporate groups come in weekly and do a specific activity with the children, then remain to close the playroom and wash all the toys.
• Video station.
Patients and families can select videos (which were donated to the hospital) and take them back to their rooms to watch. The concept of the station was designed by a coordinator and staffed by teen volunteers. Another volunteer also created a computerized check-out program.
• Family visitor role.
Volunteers visit families to talk about available programs and facilities such as the library, play room, and pastoral care.
• Special visits.
For children whose parents are unable to visit frequently, or those in isolation, or who face lengthy hospitalization, volunteers and coordinators note on a "Children to Be Seen" list. "Everyone contributes to the list, and volunteers check the list when they have a spare moment," Jarboe says.
Kits help staff, parents, and kids cope
But the innovation Jarboe is proudest of is the development and implementation of "Coping Kits," a tool kit to teach professional and family caregivers how to help children cope during medical procedures. The kit contains items such as pinwheels, magic wands, bubbles, pop-up books, and slinkies that encourage children to refocus their attention on the toy, rather than the treatment, says its creator Donna Trentel. In addition to toys, the kit features a laminated coping card with quick tips on how to provide emotional support.
"The impetus for its development was the realization that we could not be there for all treatments all the time," Trentel says. "As child life specialists, we had long used this approach to help children decrease anxiety and fear and to help them gain emotional control, but the toys weren’t doing the patient any good if they were locked away in our cupboard."
After first testing the kit concept on the burn unit, Trentel then received a small grant to package 40 others for distribution throughout the hospital.
The kit debuted during Children and Health Care week in March, followed by inservices for inpatient and outpatient staff.
"Basically, we stressed that taking a few minutes to help a child prepare and cope with a procedure would help them do their job easier, and more efficiently not to mention making it easier for the patient," says Trentel.
Other important points of the inservice are captured in brief as reminders on the coping cards:
• Make sure the patient is interested in the object, but keep in mind the age and developmental level of the child.
• Use a limited number of toys at one time too many distraction objects may be confusing.
• Allow the patient to have the object for a few minutes before the medical procedure.
• Engage the patient with the object during the procedure, or if this is not possible, have the object in sight and use it for the child. For example, blow bubbles.
• Give lots of praise for even a small success such as keeping still for a short period of time.
The cards also explain how caregivers can use music, touch, and breathing to relax and soothe patients of all ages.
By learning and using these techniques, parents not only learn how to help their child feel more in control of the hospital experience, but it also prepares them for coping strategies they can use at home after discharge, says Jarboe.
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