Friday, April 5, 2013

Tips for Pediatric Providers

In my 3 short months at CPS, I have learned from residents with terrible bedside manner how to make pediatric patients (children) have a bad experience in clinic. Here is how not to do that:

  • Of most importance, please come prepared and read the patient's chart before asking questions that are already in the chart (in nursing we call this pre-labing and we do it for all of our patients).
  • State your name several times and make it clear who you are: attending, resident, nurse, nursing student, physical therapist, social worker, etc.
  • Please ask the people in the room how they are related to the children. Don't make assumptions about who the people are (they teach this in nursing school, do they not go over this in medical school?).
  • Please play with the child when doing your assessments. Help him/her not be scared of the tools. e.g. when doing reflexes, it can be kind of funny so you say "Want to see a trick, it won't hurt".
  • Ask parents to hold the child in a way that is easiest for you to do your assesments (or for nurses to give shots).
  • Don't repeat "You just don't want to cooperate with us today!" He/She is a sick child in a clinic that is boring, no fun, and you're a stranger. The children are not out to get you. Instead say something like "It must be really hard to be here with lots of strangers poking at you." Take a moment to center yourself and the energey in the room and then start again. Move onto something else and then come back to it.
  • Please explain everything that you are doing outloud, "I am going to wave these boards back and forth to measure her/his ability to see objects at varying distances."
  • Be creative with your assessments as one doctor did, "Let's see if there are any dinosaurs in your ears" when using an otoscope.
  • When I come to the hospital to inquire about the patient's status and as the nurse on the acute care floor do not know if the injuries were accidental or non-accidental, that worries me because then you are not looking for signs of abuse.
  • State your name!
  • When you do your assessment, please give your report/results "Her/His nose look clean." or as one doctor said "no monsters in your nose".
  • Use a doll, teddy bear, self, parent, sibling to demonstrate your assessment or procedure when possible. "Let's see if daddy has monsters in his ears" or "Let's see if teddy bear has a rash on her back" and let the child demonstrate the assessment on the doll, if possible, "Do you want to check your dolly's feet for a rash. Does dolly have a rash?"
  • Give lots of positive feedback for wanted behavior, "Thank you for showing me the rash on your foot. High five!" Stickers, singing, dancing, and stamps also work well.
  • Have parents repeat back the instructions for medications.
  • Ask for both parents to be in the room if they are present to the appointment, if possible.
  • Ask parents how they think they are managing the child's condition.
  • State your name!
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