At the end of my first week of my internship, I find myself excited for the future but also frustrated with my present situation. To begin my internship in Child Life at Children’s Hospital Central California, I have to complete various steps so that I can even be at the site. After contacting my site supervisor, she was finally able to put me in touch with the correct person to complete my initial paperwork and qualifications to be interning. This woman schedules the clinical orientations for those interning at the hospital (for nursing and Child Life). After sending her proof of all of my immunizations and my TB test, I discovered that I needed to complete a few more things. Needless to say, after many trips to the health center at school, I will be cleared soon to attend an orientation.
However, after I found out last week that I cannot attend an orientation until the 19th (of February), I was quite upset. I feel frustrated as I wait to complete all of the necessary steps so that I can even be at my site. When I was at the hospital this week to turn in some papers, the woman in charge of orientation was quite firm and almost scolded me as she told me that until I had all of my immunizations completed and an updated TB test turned in, I was not even allowed to be talking to my site supervisor in any way or to be at the hospital. This was especially frustrating because she did not tell me I needed an updated TB test until after I had asked her. Therefore, after I had gone to the health center for the first time, I had to go back the very next day to get an updated test. Although I was taken aback by her harsh words, I quickly informed her that I have taken care of everything and I should be able to attend the soonest orientation.
In the end, although the initial stages of my internship have been frustrating, I am excited for what is to come. While at the hospital last week, my supervisor told me a little bit about the process of my internship and what areas of the hospital I will be involved in. I’m excited about eventually getting to work at my site and I’m eager to see what I have to share next week!
Week 2: Feb. 7 - 13
Week 3: Feb. 15-20
Yesterday I attended my facility orientation where we reviewed hospital rules, HIPPA laws, and the codes that are used at the hospital. This part was somewhat boring because I already knew about confidentiality. Some of the codes they use at the hospital are very serious and life threatening (health alarms, bomb threats, etc.) which definitely reminded me that being in the hospital environment can be a very serious thing. However, the orientation speaker said that a code pink (child abduction or kidnapping) usually doesn't even refer to patients. She said that most of the time, little (toddler) brother or sisters of a patient will become distracted by something and walk away from their parents who will then need help finding them. This reminded me that although children can be cute with their endless curiosity, sometimes they can be frustrating!
After attending my orientation, I met with my supervisor. She explained to me again that because the CL department in is a time of transition, I will need to be very flexible and patient. Next we went to the PICU and checked on a few of the children there without any parents or visitors. One boy had to get an x-ray taken. After my supervisor asked a nurse if he would need her, she said that 'no, he seems fine.' I noticed quickly that my supervisor was very persistent in her questions, continuing to ask different questions and in different ways.* I hope that I can be persistent and assertive regarding the care of my patients if I do go into this profession in the future. I know that I am not always as vocal as I should be in standing up for myself, so I hope I can learn this skill.* Even after talking to the nurse, my supervisor went to check on him and talk to his mom. He became very upset once the x-ray machine arrived. Because there wasn't much time, my supervisor could not calm the boy down enough to lay still so she had to hold him down so they could take it. Once we left the room, she explained to me that sometimes if there isn't time, her last resort is to help restrain a child instead of having the parent do it. She explained that the parent is already the 'bad guy' at home and she didn't want a parent to be in that situation while the patient was at the hospital. This resonated with me and definitely got me thinking about the parent-child relationship.
After that, we walked down to a room where a baby was barely waking up. My supervisor said that he didn't have many visitors and that he could really benefit from being held. After putting on the protective scrub smock, mask, and gloves, I sat down to hold him. It was a little tricky at first because he was hooked up to oxygen tubes and blood pressure wires, but then he settled down. It was funny because he didn't like the wires so he kept moving them, but then after awhile he fell asleep. Although it was a little alarming to have to wear so many things to protect myself from whatever he was sick with, it was fun to just hold him and talk to him for a few hours. He seemed like such a sweet little baby and it was sad for me to realize that his nurse was probably his only visitor. I fed him and then held him until he fell asleep.
Before I left my supervisor kept thanking me for being with the baby for such a long time. She told me that if she has spare time, it is one of the most rewarding things for her to just sit and hold a baby who needs to be loved on which I readily agreed with. I know that most days will not be as quiet and easy as yesterday was, but I'm ready and willing to keep learn and observing!
Week 4: Feb. 22-27
This was (finally) my first full week at my site. After arriving on Wednesday, I attended my first daily staff meeting. During these meetings, the Child Life specialists note which of their patients needs a volunteer and who can go to the playroom or the classroom. This is an important part of keeping each person in the CL department updated on all of the many patients that are at the hospital. The meeting moved quickly and I was easily confused by all of the medical and specific terms the women used. After the meeting, I was able to ask my supervisor questions about what happened and then we started rounds on her floors.
Just like I was last Friday, I was a little unsure about entering patients' rooms. My supervisor works so confidently and quickly, that I find myself easily confused by the terms and events that occur. After holding my questions for awhile, I slowly started asking about confusing aspects of the job. By asking questions and speaking up when something strange or confusing happened, I am quickly learning a lot of new things about Child Life and the hospital.
Also, like I mentioned in class yesterday, I have been doing a lot of walking! It may seem like a silly thing to note, but after two full days at my site, I realized that I need to get some better shoes! In order to cover all of the patients that are under her care, my supervisor has to walk over two floors and is constantly on the go. Because of this, I keep getting confused about where rooms are and where patients that we have visited are located! My supervisor is really understanding and helpful with this.
Sometimes I think I look a little lost because she'll smile and start explaining what just happened or where a certain room is. Because of our improving communication, I have been learning many new things, and my confidence has been growing. At the beginning of the week, I was overwhelmed and was questioning my intentions of going into CL but now I am excited and I am slowly building up my confidence. Also, because I am not considered an official intern in CL at the hospital, I am only supposed to observe. However, each time my supervisor asks me to do something small, my confidence builds and I get more excited!
Week 5: March 1-5
In my second full week at my internship, I am finding my confidence and my knowledge of Child Life growing in leaps and bounds. As I may have explained before, although I am completing the internship requirement for State, I am only considered a student at the hospital, and not an actual CL intern. At first I was a little frustrated that this limits what I am able to do at the hospital, but now I know that I am in the right position. After slowing becoming acclimated to the many aspects of the hospital and CL, I realize that having the position of a student who may only observe and may not get as "hands on" is okay. There is definitely a lot to learn and a lot to know about the profession. By asking more questions and keeping my ears open, I have finally learned the meaning of some crucial terms such as patients with NPO, RSV, contact/droplet (many patients have that), and 'appy's (appendicitis). Although I was a little overwhelmed at first, I am learning as I go and becoming more confident and comfortable.
Another large part of building my confidence depended on becoming familiar with the medical staff. It seems like every time I am at the hospital I meet someone new! As the nurses and various other medical professionals are becoming more familiar with my face, I have found it easier to work alongside my supervisor. A few times this week a few nurses even talked directly to me which may seem weird to mention, but because of the hierarchy of a hospital (surgeons, doctors, np's, nurses, specialists, and eventually CL specialists & etc.), it is very encouraging to me. I knew from job shadowing that dealing with attitudes from this hierarchy is a somewhat frustrating part of a CL specialists job, but each positive experience I have alleviates my doubts. Although some people obviously do not like the CL workers, one nurse initiated a conversation with me without even questioning my status as a student or waiting for my supervisor to join me. Patients and their parents also appreciate the work of the CL department and I am now very willing to be an advocate for CL programs and their many benefits.
Over time, as my supervisor notices my growing confidence and knowledge, she allows me to do more things and initiate more activities. This week I read more literature about CL, retrieved necessary toys and distraction tools, and was able to sit in on a procedural teaching lesson. Each new day brings more opportunities and drastically different experiences. On Wednesday I helped out in the classroom for a few hours, working on reading, math, and logic with some patients (yes, they do still have to go to school! -especially if they are at the hospital for an extended period). I have escorted patients to their rooms, ran to retrieve items from other departments, and have gone on rounds in other floors.
Also, each day I am asked to interact more with patients which is exciting because I get to develop my skills as a student and also because merely observing can be a little mundane. Next week I am going to be working with a different specialist and I am excited about the new opportunities. However, I do not know exactly what to expect because I will be in the oncology clinic, a department I have never visited. Needless to say, next week will definitely be interesting!
Week 6: March 7-13
A big thing my supervisor has been showing me is having to help patients who are emotionally reactive. When a child doesn't speak the same language, if they are delayed, or if they are fearful of adults then being at the hospital may be a scary experience. While it is easy for anyone to dismiss another person's fears by calling them "irrational," I feel that it is inappropriate to do so for children. In scary situations, children need to be allowed to express their fears. In tough situations, children need to be told that crying, screaming, and being afraid are natural and 'okay.'
Another thing that I have had to deal with personally are my own hesitations I have while at the hospital. Sometimes being in a hospital can be a scary thing because of the various codes given over the intercom, language barriers, and the seriousness of medical problems all bring their own amounts of anxiety. Working in the medical field involves everything from life to death. Patients die, parents grieve, and their nurses and medical caregivers must cope with such losses. One example of a moment of anxiety occurred this week while I was walking down to a lower floor to meet up with the specialist I was observing. Before I reached the stairwell, I heard noises and lights going off in one unit. A 'code blue' was quickly called and as I continued to walk down the stairs, numerous doctors, specialists, and nurses ran up the stairs towards the patients' room. Sometimes it is hard to hear codes because it usually means that a patient has stopped breathing or has other life-threatening problems.
Other things include seeing an 8-month old child in the oncology clinic receiving a weekly chemotherapy treatment. One little 9-month old had SMA (small muscle atrophy) and the CL (Child Life) specialists were amazed he was still alive. Apparently SMA and CF (cystic fibrosis) patients usually die very young. Also, in DNR (do not resuscitate) meetings, parents must decide whether or not to keep their children on life support even after they code. I can't imagine having to decide whether or not to keep your loved one alive even after they cannot live without the support of machines. Seeing kids so young that are so sick or dying is sad and somewhat depressing. However, I really enjoy being involved in the emotional part of their healing process. I knew it might happen at one time and just last week, I heard a little girl tell her mom in a quiet voice that her friend was going home. Her mom commented, "Isn't that nice for him?" The girl replied, "but I want to go home! It would be more fun if it was me going home- not just him." I was glad that she had her mom to help her deal with her emotions, but sometimes it is the job of the CL specialist to help patients and families cope with overwhelming emotions. Sometimes parents become overwhelmed by the severity of their childs' situation and are not able to help their children adequately.
Therefore, at the same time that all of these things make me hesitant to enter into such an intense environment as a profession, they have fueled my desire to enter into the field of Child Life. If everyone felt anxious, overwhelmed, and scared by this intense profession, then children and their families will suffer. Sometimes I have to remind myself that while few things strongly scare me in a hospital, those same things, and many others scare children, which have harmful benefits in their healing process. I feel that I have a fitting personality and life experience to aid children and their families in their process of being hospital patients, some with light or serious health problems.
For instance, I am minoring in communicative disorders (deaf studies) so I know American Sign Language. A deaf patient was admitted a few weeks ago but not many people in the CL department know how to sign. (Actually only my supervisor and myself know ASL.) My supervisor had me talk with the patient and get to know her. When I went back a few days later, I was able to talk with her again, and I hung out with her a lot yesterday. Nurses and doctors are somewhat impatient with children sometimes (even without language barriers) so I was glad I could explain to her what was going on. Then on Friday, I was able to interpret for some CL workers, explaining the games we were playing and allowing them to carry on a conversation. At first I was really frustrated because I kept making mistakes, but then I slowly warmed up and started remembering things. She kept laughing at my mistakes so it was fun to joke with her and relate to her. When grown adults approached our signing as a strange thing, I began to realize how isolated she was. (It was a little strange when other patients became curious and stared at us signing though!) At times I felt badly for her because she was so isolated in a profoundly hearing environment, but then we became closer as we played games together. I was pleasantly surprised to have such a unique skill to share as a CL student, and I hope to see her next week and continue our friendship if she is still there. In the end, I have definitely learned that I cannot allow children to be treated passively so I am constantly feeling stronger about becoming an ally for them and becoming a Child Life specialist.
Week 7: March 15-20
One thing I have realized lately is how much I am learning. Every day is another new and entirely different day. CL specialists have to be flexible and work with a very tentative schedule. This week I observed in the oncology clinic again which is where cancer patients receive outpatient care. On Wednesday I was able to observe three LP procedures. During a lumbar procedure, the patient is sedated while spinal fluid is drawn (a chemo treatment is usually given too). For the two younger patients, the CLS used distraction and breathing tools to help calm the patients before their procedure. The CLS simply talked quietly to the older patient and held her hands. At first it was hard to watch such little children having this procedure, but I quickly saw the necessity of the CLS for each patient. She kept telling me that if a child is calm before a procedure, then they are able to stay calm during the procedure and then wake up calmly.
The ever-changing schedule in the oncology clinic allowed me to do many different things this week. She has also shown me different places in the hospital, telling me about the purpose of each area. We went to a tumor board where doctors discussed the history and diagnosis of a patient with germ cell tumors. It was really interesting to hear the medical process of treating patients. Also, I helped out in the playroom, working on puzzles with a patient. Another thing I enjoyed doing at the oncology clinic was making crafts with patients. We colored, cut, glued, and glittered. It is neat to be able to engage patients of different developmental stages in fun activities. The pace of the clinic is definitely different from a regular unit and we were able to talk a lot while waiting for patients. She explained the requirements and certification process CLS now have to go through to work in established hospitals. I'm really excited to hear how other established specialists got their start in the field of CL and was glad when the CLS shared her experience with me. We also talked about the role volunteers have at the hospital, helping patients when the CLS and medical staff cannot. Also, after talking to her about the clinic, I think that I may have a project to work on too! I'm excited to go back next week and put some longer hours in. Hopefully I can talk to my supervisor about visiting and observing in different areas of the hospital soon as well.
*To answer Lauren's question, I became interested in CL a few years ago. I met my current site supervisor through a mutual friend and talked her ear off about CL. I quickly realized that I wanted to go into CL instead of my original goal of nursing because my background and schooling fits the CL career far better than nursing. Although I sometimes wish I knew how to help patients medically, I know now that the role of the CLS is extremely helpful for patients. There are so many things children deal with at the hospital that can affect their physical situation that must be addressed too. Oops, I'm stepping off my CL soapbox now, but feel free to ask more questions!
Week 8: March 22-27
Once again, I experienced many new things at my site this week. On Wednesday I was in the oncology clinic again and was able to observe a few procedures with a Child Life Specialist (CLS). Every procedure is different, depending on the emotional state of the patient and their family. Some children are very quiet and calm, quiet and scared, or loudly scared, or loudly happy. One girl was very calm and excited to blow bubbles before she received her 'sleepy medicine'. Her dad held her while she became sedated, which seemed to make her and her parents more comfortable. The next patient was quiet and blew bubbles quickly as her mother talked for a long time with me. I think the mother may have needed someone to talk to calm herself down because she just kept talking without needing me to respond very often. Once again, the CLS I was observing told me that if we can calm patients (and their families) before a procedure, then they will wake up calmly and be more calm during procedures in the future. We talked again about a possible project and then I worked on some puzzles with some children. I also attended a long staff meeting on Wednesday. At this meeting, I simply observed and learned many new things. I learned some new things about how a Child Life program works together as a team, each fulfilling certain duties. I talked with my supervisor about my project and she gave me more direction for what I could work on. I hope to start working on my project soon both at my site and at home.
On Friday, I observed a different CLS in a unit I had only been in a few times before. She explained that she only works with patients who she receives referrals for. Apparently, getting referrals from nurses (& etc.) can be a big problem for specialists. Another thing she pointed out was a referral requesting toys to be brought for a patient. She explained that it is frustrating to receive that request because any professional in the hospital can take toys to a child. However, a CLS uses play and toys in various ways to address a range of problems or questions a patient may have and a more specific referral is more helpful.
I was also able to talk with this CLS about her background and education in CL. She explained that she attended a prestigious CL program for her master's degree and that she would be willing to talk more about further education goals with me. She encouraged me to become more educated in CL and to really start pursuing an internship position. Another exciting thing was when she offered to talk to the CL supervisor about possibly offering me a summer internship position. I wasn't even thinking I could do a CL internship without a degree (I'm graduating in the fall) so I found this news very exciting. I know at this point that I want to at least volunteer at the hospital once I complete my hours. Hours of volunteering are often required for internships but more than that, I really enjoy being with children at the hospital. And it wouldn't hurt to keep in contact with the CL program! In addition, I was very excited to hear that CL practicums are hard to find in California so my time at the hospital for my school internship will definitely help my resume! She also explained that I need to be more open to relocate for a position in CL because larger programs offer more training venues and larger cities typically employ more CLS at children's hospitals. I already knew some of the information she shared with me but I learned so much more. I'm excited to work with her again next week so I can continue learning about CL education, various CL programs, and becoming closer to completing some of my career objectives.
Week 8/9: March 29-April 2 (spring break) I went to my site last week to get some more hours in and I am very glad I went. After a few weeks of learning new things, I was hoping to finally 'get my feet wet' and observe a procedure. Although I had observed an LP in the oncology clinic a few times, I wanted to observe something different and new. While observing a Child Life Specialist on one of the regular units, I was able to pre-op and then observe a few procedures. Both of the patients received PICC lines, which are more permanent IV's. With both patients, I was able to learn what PICC lines are, what they do, and how to relay that information to patients of different developmental stages. We had numerous communication problems with the first patient and I found it very frustrating to have to simply deal with his anxiety, without being able to explain what was happening. One passion I have is to use ASL and educate other people in sign language. However, it was highly frustrating when the mother of the patient (who only spoke Spanish), did not even teach her young child how to use Mexican Sign or any other form of signed language. Although my supervisor and I signed with the patient, we were aware of his limited understanding, confusion, and fear. However, while the first procedure was frustrating from the insurmountable language barrier, I was frustrated at the end of the second procedure for a different reason. I truly loved learning about the procedure, the sedation process, and how the medical staff work together to complete the procedure. Also, it was interesting to watch how a CLS works in tandem with medical staff, often without the request of help from the medical staff. Because the nurse administering the PICC line was relatively new at her position, my supervisor did small things to help alleviate tension in all of the people in the room, to aid the nurse, and to help the patient. With this second patient, a different ER doctor was monitoring the sedation and he started to play with the distraction toy my supervisor had used with the patient. Although I have experienced some harsh glances or unfriendly comments from medical staff before, I found it highly insulting when the doctor ridiculed the CL profession. In the middle of the room filled with the nurses, patient, CLS, and the patients' family, the doctor told me that I have been wasting my years at school getting my degree if I'm only going to play with toys when I'm done. I was pretty insulted and didn't know how to respond so I didn't really say anything. A few other specialists have mentioned their frustrations over this attitude and ignorance that many of the medical staff have. Toys are not always merely toys. For children who are patients in a hospital, toys provide distraction, entertainment, education from learning about medical terms and procedures, and they provide familiarity and a calming effect. Dramatic play also allows children to express feelings of fear, aggression, confusion, and contentment. I guess I didn't realize it, but I am now highly opinionated on the importance of toys and play for children in hospitals.
Furthermore, after talking with a few specialists, I think I have found my project! I am planning on organizing and outlining some medical play crafts and activities. Although the specialists have done some medical crafts in the past, there is no organized resource to pull prepared lessons from. I hope to work on this both at my site and off-site. By creating this resource, the staff in the playroom and the other CLS can quickly locate these useful distracting and educating tools for children. Crafts allow the patients to be distracted from their present circumstances, giving them control over completing the task at hand. Also, as patients maintain a certain amount of control over their project, a CLS can then teach them about the medical meaning of the craft as well as help them cope with their situation by guiding them in discussing their feelings.
Week 9: April 5-9
I spent this last Monday (the 5th) on our furlough day at my site. I'm glad I went in to get some extra hours because I experienced some new things. While in the oncology clinic, I was able to observe a bone marrow procedure (when they took a sample of bone marrow from a patients' back). Also, during the procedures I observed on Wednesday, the patients were calm while their parents were anxious. One of the sedating medications that the patients receive helps them to disassociate from their body during the procedure so they do not feel pain, while the other helps them to forget the entire process. While one medication causes quick and extreme drowsiness, the other medicine causes some patients to become 'talkers.' After talking to the Child Life Specialist, she told me that this medication can cause extreme behavior in patients. For example, if a patient has a relatively shy or quiet personality, then they talk a lot and have very dramatic reactions after they receive their medication when they are waking up. Very young school-age children talk about pretend boyfriends/girlfriends, how beautiful their nurses are, and the people in the room when they are recovering often have disfigured bodies. On Wednesday, one little boy looked at the CLS, said, 'Oh!', and moved back quickly. Apparently he saw that she had six heads and nineteen fingers. While all of this is very entertaining for the adults, it is helpful to understand the effects of the medications in order to explain their strange reactions to their parents. As a result, it is helpful to have an established relationship where children feel safe and comfortable before their procedures and medical experiences to ensure that they will be calm and peaceful during them and in the future. Oftentimes, to establish this comfortable relationship a CLS will play with a patient to gain their trust. As a result, on Wednesday, I played Monopoly with a patient for half an hour and then let another patient help us roll the dice and help us decide which properties to buy.
After learning a lot about the hospital, patients, and about oncology, I am excited to observe and interact in a few other areas of the hospital. On Friday, I went on rounds with my supervisor and responded to several referrals for patients. It was exciting to deliver items to patient rooms and interact with them on my own. Also, a girl came to job shadow my supervisor this afternoon. It was really rewarding being able to share what I have learned from her and teach her about different aspects of the hospital. I think that I haven't necessarily realized how much I have learned because of the time I am at the hospital every week. Also, I hope to work on my project this weekend. My project is to develop, organize, and write out medical play crafts. Patients benefit from this type of play because they learn about medicine, have interactions with the CL staff, and remain active and engaged (we try to make sure they are not bored or lonely). I am excited to start this project and to learn more about medical play.
Week 10: April 12-16
Week 11: April 19-23
This week was yet, another interesting week for me at my site. So far, I have definitely learned to be flexible and teachable in different experiences. One such instance arose when I arrived at my site this week. I was told that my supervisor had emergency surgery, she is recovering, and she will not be back until after the first week of May. This was frustrating news because I really need my supervisor's input on my project at this point. However, a few of the other specialists have offered their support and help in answering any questions and gathering any supplies that I need. My goal is to have my ideas printed out and ready to work on for when I return to my site next week. I am excited to work with the hospital supplies and equipment that I am utilizing in the activities I have planned.
I observed the same specialist that I was with last week. Her unit includes numerous CF patients and patients with breathing/lung problems. As a result, many of the patients are admitted to the hospital for a long time while they recover and recuperate from operations and procedures. The young boy I spent a lot of time with the previous week was still there and ready to hang out with me. We watched tv because he wasn't feeling very well and we tried to work on some of his homework. He seemed to be more discouraged and quiet in the morning, but he slowly began to smile more and he appeared to be happier the longer I was with him. In the afternoon, we took him to take a breathing test that measures his lung capacity. The specialist explained that these are very hard on a patients who have more aggressive symptoms of CF. I witnessed this first hand as the patient tried to perform well on the test. For healthy individuals, breathing into a tube for as long and hard as you can is not a very difficult task. However, for a CF individual, the mucus and built up stuff that is in their lungs makes it very hard for them to breathe, especially this way. The boy coughed very loudly and strongly for a few minutes after each time he took the test. He did it a few times because he wanted to do better. The specialist allowed him to cope with the test in his own way, offering support and encouragement after he was done with the test. It was fun to joke and play with him, teasing him and seeing him smile. I talked to him about the test when we were in his room, and he seemed to be more comfortable to talk there. Later in the afternoon we took a much older and healthier patient for the same test. He was able to breathe easily and performed well on the test because his lungs were so clear. The specialist also explained to me that they start talking patients of his age about transitioning to regular (adult) hospitals. It has been very interesting to meet children of different ages having very different health status's.
Another interesting thing I observed was with this same specialist. CF patients (among many others) are isolated and have various signs outside their rooms announcing the precautions taken to isolate and prevent infection. For instance, it is common practice to wear a gown, mask, and gloves when entering their rooms. However, we observed the breathing technician doing breathing treatments on two different patients at the same time. It was very frustrating to see her disobeying protocol and cross-contaminating the two patients. The specialist of this unit is very passionate, caring, and knowledgeable about her patients and their health problems. From her teaching and the conversations that she has with me, I have grown to feel very passionate about patient care of such ill and at-risk patients.
Moreover, it was very rewarding to work in the classroom and facilitate activities with patients this week. It was fun to interact and lead games with patients in the fun environment of the classroom. As many patients are not able to visit the classroom and playroom, it was very rewarding to interact with a few I had met in previous weeks in both of these fun places. We played bingo, gave out prizes, colored, and met the pet volunteer. Many of the young boys enjoyed petting the large dog, giving her commands, and then giving her treats. It was exciting to hear that a few patients I knew were being discharged because they were feeling so much better. Also, it was interesting to observe the specialist try to engage in medical play with a newly diagnosed patient with diabetes. As the young girl 'felt fine,' it was hard for her to suddenly see the need to have her finger poked often to measure her insulin levels. Although I am uncertain about when I will be able to graduate next school year, I am becoming more and more excited about applying for and participating in the internship required for certification. It seems a little silly to admit it, but I can feel myself getting closer and closer to an 'adult job' that I will eventually have after I have my degree and complete my internship. It's definitely exciting to look forward to a future that I hope to have in Child Life, one filled with many opportunities and experiences.
Week 12: April 26-30
This week I mainly observed in the playroom and patient units. Although I spent a few days in the classroom and a limited amount of time in the playroom, I had not spent an extended amount of time in the Child Life (CL) playroom. I enjoyed asking questions and learning about the playroom. The playroom has board games, toys, puzzles, a play kitchen, a medical play area, video games, puzzles, crafts, and movies that the patients can take back to their rooms. I helped to clean up and organize many different areas during slower times. Also, I played with a few patients and helped others with making crafts. The playroom assistant who was working that morning is very experienced and had a lot of knowledge to share with me. After one child engaged in unacceptable behavior, she handled the matter by taking care of the other children, and ignoring his crying tantrum. Later she explained that she was formerly a preschool teacher so she was used to tantrums, unsafe behavior, and how to notice antisocial communication. I also enjoyed the time I spent in the playroom because I was able to talk to a few volunteers. Volunteers definitely help the CL department function well and they are greatly appreciated.
This week I also attended my second staff meeting. The agenda mainly focused on expenditures and the rules/regulations concerning various purchases. It was interesting to learn about the guidelines that are in place regarding the decision making process of spending money from grants. A large corporation awarded a grant to the hospital to create a teen center. The money will allow the CL department to provide a multimedia center with games, gaming systems, and television monitors. Moreover, I was not initially very excited to attend the meeting but I feel that I learned a lot about the business side of CL.
I also spent some time in a patient unit. One child that I spent time with previously was still admitted so I spent time with him for awhile. We talked about a lot of different things, painted some crafts, and played with his fun little Cars toy. I asked him a lot of medical related questions but didn't press him for answers when he was hesitant. I really learned a lot about his medical condition, developmental stage, and his emotional level by talking about his medical condition. Although I have not observed too many procedures lately, I am still learning a lot of new things and about different aspects of the CL department.
Week 13: May 3-7
This week my supervisor was back from sick leave and I went with her on her units. While on her unit, we talked to various children regarding varying issues and concerns. One child was being admitted that day and needed to learn how to swallow the numerous pills she needed to continue healing at home. Although the patient was older, she was unable to swallow pills so we used M&M's to teach her how. First, we split a single M&M into four tiny parts and had her try to swallow one. Using various methods and with her mothers' support, the patient was able to slowly start swallowing the candies. We emphasized the necessity for the patient learn to swallow pills quickly so that they would not dissolve inside her mouth and start their time released action too soon. After awhile, she became more comfortable with smaller candies and eventually worked her way up to swallowing entire candies in one try. I found it encouraging to see her confidence rise from our efforts along with her mothers' positive support.
One thing that I learned last week was that certain organizations are in place to care for sick children when their parents are unable to. When a child has a difficult diagnosis with numerous scheduled medicines and treatments, parents can be overwhelmed and unable to care for their child. In that situation, medically trained individuals at these organizations will care for the child in their long-term housing facility. I was shocked to learn that one young patient at the hospital apparently lived at one of these facilities for a few years before returning to live with their family.
Week 14: May 11-14
This week was another unique week. I was with a different CLS on Wednesday in the PICU (Pediatric Intensive Care Unit) and learned many things from her as she has been in the field of Child Life for over 20 years. One of my first observations was how quiet the area was. Unlike what we see on tv shows, ICU's are not as rushed, hurried, or as loud as emergency rooms. Also, many patients in the PICU are hooked up to many monitors, medicines, and other machines that make a lot of unnatural noises (normally children do not have beeping beds or machines in their homes :). Because of the severity of the patients' health in the PICU, it is beneficial to speak in quiet and low voices because of this somewhat altered environment. We visited a few patients that previously had referrals and retrieved the items they needed (books, music, games, toys, and even stimulation toys for infants without any family/visitors). As in the other units of the hospital, I noticed that patients in the PICU also did not always have family or visitors. At the same time, other patients also had numerous family members just like on other floors. The CLS explained that while their hospital does not have a permanent and full-time position for a CLS in the PICU, many other hospitals do have one and also another in the ER, and that they have seen positive results from the presence of a CLS in each area.
I received a question from a classmate last week about "what I think is the biggest thing I learned at my site?"
My response: It's a little hard to narrow my answer down to one specific thing. Off the top of my head, I have to say that the biggest thing that I know now is that I definitely want to pursue a career in Child Life. I wasn't too scared or unsure of doing so before starting my practicum, but now I am very confident in my choice and excited to continue all the necessary steps to becoming a Child Life Specialist! Also, I now know firsthand how flexible and versatile a CLS must be to perform their job. Children have different needs, personalities, and fears and a CLS must be able to change their tactics and approach to meet those needs, connect with their personality, and to calm their fears.
However, after I found out last week that I cannot attend an orientation until the 19th (of February), I was quite upset. I feel frustrated as I wait to complete all of the necessary steps so that I can even be at my site. When I was at the hospital this week to turn in some papers, the woman in charge of orientation was quite firm and almost scolded me as she told me that until I had all of my immunizations completed and an updated TB test turned in, I was not even allowed to be talking to my site supervisor in any way or to be at the hospital. This was especially frustrating because she did not tell me I needed an updated TB test until after I had asked her. Therefore, after I had gone to the health center for the first time, I had to go back the very next day to get an updated test. Although I was taken aback by her harsh words, I quickly informed her that I have taken care of everything and I should be able to attend the soonest orientation.
In the end, although the initial stages of my internship have been frustrating, I am excited for what is to come. While at the hospital last week, my supervisor told me a little bit about the process of my internship and what areas of the hospital I will be involved in. I’m excited about eventually getting to work at my site and I’m eager to see what I have to share next week!
Week 2: Feb. 7 - 13
After getting all of my required information turned in, I am finally going to be able to attend my clinical orientation class this upcoming Friday. After some initial frustration, I am excited to jump in and learn a lot about Child Life (CL) at my site: Children's Hospital Central California (located in Madera).
This week, I was able to talk to my site supervisor about my learning objectives and I am excited to get to work! Previously I job shadowed a Child Life specialist who is actually now my site supervisor. While discussing my learning objectives, I realized that I will now be involved in many areas of the hospital that I have never visited before when I shadowed the CL specialist previously. This is exciting to me because I will be experiencing and learning so many new things.
Also, I learned what I will actually be doing while at my site. By doing some reading and research, I will be learning about Child Life, what the profession is, and what it entails in a children's hospital. I will also be learning about developmental stages of children and how they are present in the hospital. I'm excited about this because I will be able to apply some things I have learned in previous classes in a clinical setting. Also, I'm excited to begin my internship while I'm taking my theories class. I hope that I will be able to learn firsthand how each one of the 'grand theories' are evident in children. In addition, I will be observing and learning about what procedural teaching is and how to implement it in a hospital. I'm excited about explaining to children what IV's, Pic lines, and other things that may seem scary in a hospital are used for.
I will also be learning about play, distraction, and other tools to help children learn about and cope with their hospital experience. By observing other CL specialists, I hope to learn what tools to implement in similar situations in the future. After being able to help a CL specialist with implementing these strategies in my previous visits while job shadowing, I am excited to learn even more by observing from a clinical perspective.
One of the other things I will be doing is observing and implementing information I will be learning in the classroom and playroom. I am really excited about this because I was not able to visit these areas the previous times I was at the hospital. After talking to my supervisor, I think that this is probably where I will be doing the bulk of my work on a project for my site. I think that I might be working on developing play plans (a sort of schedule of lessons) for children of all ages and developmental stages. This should be an exciting and interesting process of integrating the concepts I will be learning in tangible ways.
After taking my orientation class next Friday, I hope to have new information to share about my experiences at the hospital. Although the orientation will mainly focus on hospital facility and employee standards, I am excited to get started and learn the basics about being a hospital employee so that I can jump into the field of Child Life.
This week, I was able to talk to my site supervisor about my learning objectives and I am excited to get to work! Previously I job shadowed a Child Life specialist who is actually now my site supervisor. While discussing my learning objectives, I realized that I will now be involved in many areas of the hospital that I have never visited before when I shadowed the CL specialist previously. This is exciting to me because I will be experiencing and learning so many new things.
Also, I learned what I will actually be doing while at my site. By doing some reading and research, I will be learning about Child Life, what the profession is, and what it entails in a children's hospital. I will also be learning about developmental stages of children and how they are present in the hospital. I'm excited about this because I will be able to apply some things I have learned in previous classes in a clinical setting. Also, I'm excited to begin my internship while I'm taking my theories class. I hope that I will be able to learn firsthand how each one of the 'grand theories' are evident in children. In addition, I will be observing and learning about what procedural teaching is and how to implement it in a hospital. I'm excited about explaining to children what IV's, Pic lines, and other things that may seem scary in a hospital are used for.
I will also be learning about play, distraction, and other tools to help children learn about and cope with their hospital experience. By observing other CL specialists, I hope to learn what tools to implement in similar situations in the future. After being able to help a CL specialist with implementing these strategies in my previous visits while job shadowing, I am excited to learn even more by observing from a clinical perspective.
One of the other things I will be doing is observing and implementing information I will be learning in the classroom and playroom. I am really excited about this because I was not able to visit these areas the previous times I was at the hospital. After talking to my supervisor, I think that this is probably where I will be doing the bulk of my work on a project for my site. I think that I might be working on developing play plans (a sort of schedule of lessons) for children of all ages and developmental stages. This should be an exciting and interesting process of integrating the concepts I will be learning in tangible ways.
After taking my orientation class next Friday, I hope to have new information to share about my experiences at the hospital. Although the orientation will mainly focus on hospital facility and employee standards, I am excited to get started and learn the basics about being a hospital employee so that I can jump into the field of Child Life.
Week 3: Feb. 15-20
Yesterday I attended my facility orientation where we reviewed hospital rules, HIPPA laws, and the codes that are used at the hospital. This part was somewhat boring because I already knew about confidentiality. Some of the codes they use at the hospital are very serious and life threatening (health alarms, bomb threats, etc.) which definitely reminded me that being in the hospital environment can be a very serious thing. However, the orientation speaker said that a code pink (child abduction or kidnapping) usually doesn't even refer to patients. She said that most of the time, little (toddler) brother or sisters of a patient will become distracted by something and walk away from their parents who will then need help finding them. This reminded me that although children can be cute with their endless curiosity, sometimes they can be frustrating!
After attending my orientation, I met with my supervisor. She explained to me again that because the CL department in is a time of transition, I will need to be very flexible and patient. Next we went to the PICU and checked on a few of the children there without any parents or visitors. One boy had to get an x-ray taken. After my supervisor asked a nurse if he would need her, she said that 'no, he seems fine.' I noticed quickly that my supervisor was very persistent in her questions, continuing to ask different questions and in different ways.* I hope that I can be persistent and assertive regarding the care of my patients if I do go into this profession in the future. I know that I am not always as vocal as I should be in standing up for myself, so I hope I can learn this skill.* Even after talking to the nurse, my supervisor went to check on him and talk to his mom. He became very upset once the x-ray machine arrived. Because there wasn't much time, my supervisor could not calm the boy down enough to lay still so she had to hold him down so they could take it. Once we left the room, she explained to me that sometimes if there isn't time, her last resort is to help restrain a child instead of having the parent do it. She explained that the parent is already the 'bad guy' at home and she didn't want a parent to be in that situation while the patient was at the hospital. This resonated with me and definitely got me thinking about the parent-child relationship.
After that, we walked down to a room where a baby was barely waking up. My supervisor said that he didn't have many visitors and that he could really benefit from being held. After putting on the protective scrub smock, mask, and gloves, I sat down to hold him. It was a little tricky at first because he was hooked up to oxygen tubes and blood pressure wires, but then he settled down. It was funny because he didn't like the wires so he kept moving them, but then after awhile he fell asleep. Although it was a little alarming to have to wear so many things to protect myself from whatever he was sick with, it was fun to just hold him and talk to him for a few hours. He seemed like such a sweet little baby and it was sad for me to realize that his nurse was probably his only visitor. I fed him and then held him until he fell asleep.
Before I left my supervisor kept thanking me for being with the baby for such a long time. She told me that if she has spare time, it is one of the most rewarding things for her to just sit and hold a baby who needs to be loved on which I readily agreed with. I know that most days will not be as quiet and easy as yesterday was, but I'm ready and willing to keep learn and observing!
Week 4: Feb. 22-27
This was (finally) my first full week at my site. After arriving on Wednesday, I attended my first daily staff meeting. During these meetings, the Child Life specialists note which of their patients needs a volunteer and who can go to the playroom or the classroom. This is an important part of keeping each person in the CL department updated on all of the many patients that are at the hospital. The meeting moved quickly and I was easily confused by all of the medical and specific terms the women used. After the meeting, I was able to ask my supervisor questions about what happened and then we started rounds on her floors.
Just like I was last Friday, I was a little unsure about entering patients' rooms. My supervisor works so confidently and quickly, that I find myself easily confused by the terms and events that occur. After holding my questions for awhile, I slowly started asking about confusing aspects of the job. By asking questions and speaking up when something strange or confusing happened, I am quickly learning a lot of new things about Child Life and the hospital.
Also, like I mentioned in class yesterday, I have been doing a lot of walking! It may seem like a silly thing to note, but after two full days at my site, I realized that I need to get some better shoes! In order to cover all of the patients that are under her care, my supervisor has to walk over two floors and is constantly on the go. Because of this, I keep getting confused about where rooms are and where patients that we have visited are located! My supervisor is really understanding and helpful with this.
Sometimes I think I look a little lost because she'll smile and start explaining what just happened or where a certain room is. Because of our improving communication, I have been learning many new things, and my confidence has been growing. At the beginning of the week, I was overwhelmed and was questioning my intentions of going into CL but now I am excited and I am slowly building up my confidence. Also, because I am not considered an official intern in CL at the hospital, I am only supposed to observe. However, each time my supervisor asks me to do something small, my confidence builds and I get more excited!
Week 5: March 1-5
In my second full week at my internship, I am finding my confidence and my knowledge of Child Life growing in leaps and bounds. As I may have explained before, although I am completing the internship requirement for State, I am only considered a student at the hospital, and not an actual CL intern. At first I was a little frustrated that this limits what I am able to do at the hospital, but now I know that I am in the right position. After slowing becoming acclimated to the many aspects of the hospital and CL, I realize that having the position of a student who may only observe and may not get as "hands on" is okay. There is definitely a lot to learn and a lot to know about the profession. By asking more questions and keeping my ears open, I have finally learned the meaning of some crucial terms such as patients with NPO, RSV, contact/droplet (many patients have that), and 'appy's (appendicitis). Although I was a little overwhelmed at first, I am learning as I go and becoming more confident and comfortable.
Another large part of building my confidence depended on becoming familiar with the medical staff. It seems like every time I am at the hospital I meet someone new! As the nurses and various other medical professionals are becoming more familiar with my face, I have found it easier to work alongside my supervisor. A few times this week a few nurses even talked directly to me which may seem weird to mention, but because of the hierarchy of a hospital (surgeons, doctors, np's, nurses, specialists, and eventually CL specialists & etc.), it is very encouraging to me. I knew from job shadowing that dealing with attitudes from this hierarchy is a somewhat frustrating part of a CL specialists job, but each positive experience I have alleviates my doubts. Although some people obviously do not like the CL workers, one nurse initiated a conversation with me without even questioning my status as a student or waiting for my supervisor to join me. Patients and their parents also appreciate the work of the CL department and I am now very willing to be an advocate for CL programs and their many benefits.
Over time, as my supervisor notices my growing confidence and knowledge, she allows me to do more things and initiate more activities. This week I read more literature about CL, retrieved necessary toys and distraction tools, and was able to sit in on a procedural teaching lesson. Each new day brings more opportunities and drastically different experiences. On Wednesday I helped out in the classroom for a few hours, working on reading, math, and logic with some patients (yes, they do still have to go to school! -especially if they are at the hospital for an extended period). I have escorted patients to their rooms, ran to retrieve items from other departments, and have gone on rounds in other floors.
Also, each day I am asked to interact more with patients which is exciting because I get to develop my skills as a student and also because merely observing can be a little mundane. Next week I am going to be working with a different specialist and I am excited about the new opportunities. However, I do not know exactly what to expect because I will be in the oncology clinic, a department I have never visited. Needless to say, next week will definitely be interesting!
Week 6: March 7-13
A big thing my supervisor has been showing me is having to help patients who are emotionally reactive. When a child doesn't speak the same language, if they are delayed, or if they are fearful of adults then being at the hospital may be a scary experience. While it is easy for anyone to dismiss another person's fears by calling them "irrational," I feel that it is inappropriate to do so for children. In scary situations, children need to be allowed to express their fears. In tough situations, children need to be told that crying, screaming, and being afraid are natural and 'okay.'
Another thing that I have had to deal with personally are my own hesitations I have while at the hospital. Sometimes being in a hospital can be a scary thing because of the various codes given over the intercom, language barriers, and the seriousness of medical problems all bring their own amounts of anxiety. Working in the medical field involves everything from life to death. Patients die, parents grieve, and their nurses and medical caregivers must cope with such losses. One example of a moment of anxiety occurred this week while I was walking down to a lower floor to meet up with the specialist I was observing. Before I reached the stairwell, I heard noises and lights going off in one unit. A 'code blue' was quickly called and as I continued to walk down the stairs, numerous doctors, specialists, and nurses ran up the stairs towards the patients' room. Sometimes it is hard to hear codes because it usually means that a patient has stopped breathing or has other life-threatening problems.
Other things include seeing an 8-month old child in the oncology clinic receiving a weekly chemotherapy treatment. One little 9-month old had SMA (small muscle atrophy) and the CL (Child Life) specialists were amazed he was still alive. Apparently SMA and CF (cystic fibrosis) patients usually die very young. Also, in DNR (do not resuscitate) meetings, parents must decide whether or not to keep their children on life support even after they code. I can't imagine having to decide whether or not to keep your loved one alive even after they cannot live without the support of machines. Seeing kids so young that are so sick or dying is sad and somewhat depressing. However, I really enjoy being involved in the emotional part of their healing process. I knew it might happen at one time and just last week, I heard a little girl tell her mom in a quiet voice that her friend was going home. Her mom commented, "Isn't that nice for him?" The girl replied, "but I want to go home! It would be more fun if it was me going home- not just him." I was glad that she had her mom to help her deal with her emotions, but sometimes it is the job of the CL specialist to help patients and families cope with overwhelming emotions. Sometimes parents become overwhelmed by the severity of their childs' situation and are not able to help their children adequately.
Therefore, at the same time that all of these things make me hesitant to enter into such an intense environment as a profession, they have fueled my desire to enter into the field of Child Life. If everyone felt anxious, overwhelmed, and scared by this intense profession, then children and their families will suffer. Sometimes I have to remind myself that while few things strongly scare me in a hospital, those same things, and many others scare children, which have harmful benefits in their healing process. I feel that I have a fitting personality and life experience to aid children and their families in their process of being hospital patients, some with light or serious health problems.
For instance, I am minoring in communicative disorders (deaf studies) so I know American Sign Language. A deaf patient was admitted a few weeks ago but not many people in the CL department know how to sign. (Actually only my supervisor and myself know ASL.) My supervisor had me talk with the patient and get to know her. When I went back a few days later, I was able to talk with her again, and I hung out with her a lot yesterday. Nurses and doctors are somewhat impatient with children sometimes (even without language barriers) so I was glad I could explain to her what was going on. Then on Friday, I was able to interpret for some CL workers, explaining the games we were playing and allowing them to carry on a conversation. At first I was really frustrated because I kept making mistakes, but then I slowly warmed up and started remembering things. She kept laughing at my mistakes so it was fun to joke with her and relate to her. When grown adults approached our signing as a strange thing, I began to realize how isolated she was. (It was a little strange when other patients became curious and stared at us signing though!) At times I felt badly for her because she was so isolated in a profoundly hearing environment, but then we became closer as we played games together. I was pleasantly surprised to have such a unique skill to share as a CL student, and I hope to see her next week and continue our friendship if she is still there. In the end, I have definitely learned that I cannot allow children to be treated passively so I am constantly feeling stronger about becoming an ally for them and becoming a Child Life specialist.
Week 7: March 15-20
One thing I have realized lately is how much I am learning. Every day is another new and entirely different day. CL specialists have to be flexible and work with a very tentative schedule. This week I observed in the oncology clinic again which is where cancer patients receive outpatient care. On Wednesday I was able to observe three LP procedures. During a lumbar procedure, the patient is sedated while spinal fluid is drawn (a chemo treatment is usually given too). For the two younger patients, the CLS used distraction and breathing tools to help calm the patients before their procedure. The CLS simply talked quietly to the older patient and held her hands. At first it was hard to watch such little children having this procedure, but I quickly saw the necessity of the CLS for each patient. She kept telling me that if a child is calm before a procedure, then they are able to stay calm during the procedure and then wake up calmly.
The ever-changing schedule in the oncology clinic allowed me to do many different things this week. She has also shown me different places in the hospital, telling me about the purpose of each area. We went to a tumor board where doctors discussed the history and diagnosis of a patient with germ cell tumors. It was really interesting to hear the medical process of treating patients. Also, I helped out in the playroom, working on puzzles with a patient. Another thing I enjoyed doing at the oncology clinic was making crafts with patients. We colored, cut, glued, and glittered. It is neat to be able to engage patients of different developmental stages in fun activities. The pace of the clinic is definitely different from a regular unit and we were able to talk a lot while waiting for patients. She explained the requirements and certification process CLS now have to go through to work in established hospitals. I'm really excited to hear how other established specialists got their start in the field of CL and was glad when the CLS shared her experience with me. We also talked about the role volunteers have at the hospital, helping patients when the CLS and medical staff cannot. Also, after talking to her about the clinic, I think that I may have a project to work on too! I'm excited to go back next week and put some longer hours in. Hopefully I can talk to my supervisor about visiting and observing in different areas of the hospital soon as well.
*To answer Lauren's question, I became interested in CL a few years ago. I met my current site supervisor through a mutual friend and talked her ear off about CL. I quickly realized that I wanted to go into CL instead of my original goal of nursing because my background and schooling fits the CL career far better than nursing. Although I sometimes wish I knew how to help patients medically, I know now that the role of the CLS is extremely helpful for patients. There are so many things children deal with at the hospital that can affect their physical situation that must be addressed too. Oops, I'm stepping off my CL soapbox now, but feel free to ask more questions!
Week 8: March 22-27
Once again, I experienced many new things at my site this week. On Wednesday I was in the oncology clinic again and was able to observe a few procedures with a Child Life Specialist (CLS). Every procedure is different, depending on the emotional state of the patient and their family. Some children are very quiet and calm, quiet and scared, or loudly scared, or loudly happy. One girl was very calm and excited to blow bubbles before she received her 'sleepy medicine'. Her dad held her while she became sedated, which seemed to make her and her parents more comfortable. The next patient was quiet and blew bubbles quickly as her mother talked for a long time with me. I think the mother may have needed someone to talk to calm herself down because she just kept talking without needing me to respond very often. Once again, the CLS I was observing told me that if we can calm patients (and their families) before a procedure, then they will wake up calmly and be more calm during procedures in the future. We talked again about a possible project and then I worked on some puzzles with some children. I also attended a long staff meeting on Wednesday. At this meeting, I simply observed and learned many new things. I learned some new things about how a Child Life program works together as a team, each fulfilling certain duties. I talked with my supervisor about my project and she gave me more direction for what I could work on. I hope to start working on my project soon both at my site and at home.
On Friday, I observed a different CLS in a unit I had only been in a few times before. She explained that she only works with patients who she receives referrals for. Apparently, getting referrals from nurses (& etc.) can be a big problem for specialists. Another thing she pointed out was a referral requesting toys to be brought for a patient. She explained that it is frustrating to receive that request because any professional in the hospital can take toys to a child. However, a CLS uses play and toys in various ways to address a range of problems or questions a patient may have and a more specific referral is more helpful.
I was also able to talk with this CLS about her background and education in CL. She explained that she attended a prestigious CL program for her master's degree and that she would be willing to talk more about further education goals with me. She encouraged me to become more educated in CL and to really start pursuing an internship position. Another exciting thing was when she offered to talk to the CL supervisor about possibly offering me a summer internship position. I wasn't even thinking I could do a CL internship without a degree (I'm graduating in the fall) so I found this news very exciting. I know at this point that I want to at least volunteer at the hospital once I complete my hours. Hours of volunteering are often required for internships but more than that, I really enjoy being with children at the hospital. And it wouldn't hurt to keep in contact with the CL program! In addition, I was very excited to hear that CL practicums are hard to find in California so my time at the hospital for my school internship will definitely help my resume! She also explained that I need to be more open to relocate for a position in CL because larger programs offer more training venues and larger cities typically employ more CLS at children's hospitals. I already knew some of the information she shared with me but I learned so much more. I'm excited to work with her again next week so I can continue learning about CL education, various CL programs, and becoming closer to completing some of my career objectives.
Week 8/9: March 29-April 2 (spring break) I went to my site last week to get some more hours in and I am very glad I went. After a few weeks of learning new things, I was hoping to finally 'get my feet wet' and observe a procedure. Although I had observed an LP in the oncology clinic a few times, I wanted to observe something different and new. While observing a Child Life Specialist on one of the regular units, I was able to pre-op and then observe a few procedures. Both of the patients received PICC lines, which are more permanent IV's. With both patients, I was able to learn what PICC lines are, what they do, and how to relay that information to patients of different developmental stages. We had numerous communication problems with the first patient and I found it very frustrating to have to simply deal with his anxiety, without being able to explain what was happening. One passion I have is to use ASL and educate other people in sign language. However, it was highly frustrating when the mother of the patient (who only spoke Spanish), did not even teach her young child how to use Mexican Sign or any other form of signed language. Although my supervisor and I signed with the patient, we were aware of his limited understanding, confusion, and fear. However, while the first procedure was frustrating from the insurmountable language barrier, I was frustrated at the end of the second procedure for a different reason. I truly loved learning about the procedure, the sedation process, and how the medical staff work together to complete the procedure. Also, it was interesting to watch how a CLS works in tandem with medical staff, often without the request of help from the medical staff. Because the nurse administering the PICC line was relatively new at her position, my supervisor did small things to help alleviate tension in all of the people in the room, to aid the nurse, and to help the patient. With this second patient, a different ER doctor was monitoring the sedation and he started to play with the distraction toy my supervisor had used with the patient. Although I have experienced some harsh glances or unfriendly comments from medical staff before, I found it highly insulting when the doctor ridiculed the CL profession. In the middle of the room filled with the nurses, patient, CLS, and the patients' family, the doctor told me that I have been wasting my years at school getting my degree if I'm only going to play with toys when I'm done. I was pretty insulted and didn't know how to respond so I didn't really say anything. A few other specialists have mentioned their frustrations over this attitude and ignorance that many of the medical staff have. Toys are not always merely toys. For children who are patients in a hospital, toys provide distraction, entertainment, education from learning about medical terms and procedures, and they provide familiarity and a calming effect. Dramatic play also allows children to express feelings of fear, aggression, confusion, and contentment. I guess I didn't realize it, but I am now highly opinionated on the importance of toys and play for children in hospitals.
Furthermore, after talking with a few specialists, I think I have found my project! I am planning on organizing and outlining some medical play crafts and activities. Although the specialists have done some medical crafts in the past, there is no organized resource to pull prepared lessons from. I hope to work on this both at my site and off-site. By creating this resource, the staff in the playroom and the other CLS can quickly locate these useful distracting and educating tools for children. Crafts allow the patients to be distracted from their present circumstances, giving them control over completing the task at hand. Also, as patients maintain a certain amount of control over their project, a CLS can then teach them about the medical meaning of the craft as well as help them cope with their situation by guiding them in discussing their feelings.
Week 9: April 5-9
I spent this last Monday (the 5th) on our furlough day at my site. I'm glad I went in to get some extra hours because I experienced some new things. While in the oncology clinic, I was able to observe a bone marrow procedure (when they took a sample of bone marrow from a patients' back). Also, during the procedures I observed on Wednesday, the patients were calm while their parents were anxious. One of the sedating medications that the patients receive helps them to disassociate from their body during the procedure so they do not feel pain, while the other helps them to forget the entire process. While one medication causes quick and extreme drowsiness, the other medicine causes some patients to become 'talkers.' After talking to the Child Life Specialist, she told me that this medication can cause extreme behavior in patients. For example, if a patient has a relatively shy or quiet personality, then they talk a lot and have very dramatic reactions after they receive their medication when they are waking up. Very young school-age children talk about pretend boyfriends/girlfriends, how beautiful their nurses are, and the people in the room when they are recovering often have disfigured bodies. On Wednesday, one little boy looked at the CLS, said, 'Oh!', and moved back quickly. Apparently he saw that she had six heads and nineteen fingers. While all of this is very entertaining for the adults, it is helpful to understand the effects of the medications in order to explain their strange reactions to their parents. As a result, it is helpful to have an established relationship where children feel safe and comfortable before their procedures and medical experiences to ensure that they will be calm and peaceful during them and in the future. Oftentimes, to establish this comfortable relationship a CLS will play with a patient to gain their trust. As a result, on Wednesday, I played Monopoly with a patient for half an hour and then let another patient help us roll the dice and help us decide which properties to buy.
After learning a lot about the hospital, patients, and about oncology, I am excited to observe and interact in a few other areas of the hospital. On Friday, I went on rounds with my supervisor and responded to several referrals for patients. It was exciting to deliver items to patient rooms and interact with them on my own. Also, a girl came to job shadow my supervisor this afternoon. It was really rewarding being able to share what I have learned from her and teach her about different aspects of the hospital. I think that I haven't necessarily realized how much I have learned because of the time I am at the hospital every week. Also, I hope to work on my project this weekend. My project is to develop, organize, and write out medical play crafts. Patients benefit from this type of play because they learn about medicine, have interactions with the CL staff, and remain active and engaged (we try to make sure they are not bored or lonely). I am excited to start this project and to learn more about medical play.
Week 10: April 12-16
One of the specialists talked to the department head about giving me a summer internship. I knew that it was only a small possibility, but I appreciate her initiative and motivation to help me further my career in CL. Although I will not be able to do a summer internship at the hospital, I am already researching which hospitals have internship programs that I will be eligible for after graduating in the fall. I may try to visit a few programs over the summer and I hope to work on applications too. As I continue researching CL, I am more certain that I am in the right career and I realize the need to relocate to complete an internship. Although this is not ideal, I am excited to have my goals slowly becoming more of a reality! Also, I am continuously more grateful for this practicum opportunity that I am completing currently. I am also grateful to achieve this experience with a title superior of simply being a volunteer. While practicums in CL are very rare in California, I am almost done with one and I will have completed an impressive amount of hours on-site! I only mention this to provide encouragement for you in my class. I hope it is encouraging to know that these hours of hard work I am (and you are) committing right now are definitely going to pay off in the future.
This week was definitely different and interesting. I observed teaching and medical play for diabetes. Apparently many oncology patients are diagnosed with diabetes during their hospital stay and it is important to familiarize them with their new situation. The girl we were working with was very uncooperative and didn't want our help because she was still in denial about her diagnosis. It was frustrating to work with, but understandable because like she said, she didn't even feel sick. I was also able to observe charting, which is the process of writing about the services a CLS provides for each patient. Also, I am now observing a different specialist and it's pretty exciting. She has been working in the field of CL many years (just like the previous CLS I observed) and she has a lot to teach me. This new CLS works primarily with children with CF (cystic fibrosis) and other breathing problems or disorders. Before we even went to her unit, she talked with me for awhile, having me read some information and then explaining the genetics, symptoms, and triggers CF patients have. It was really interesting to have her explain so many new things that I had heard before but did not really understand. At one point, she apologized for bombarding me with information and I joked back that she was excited to have me with her. After doing rounds of the unit, where she continued to talk with me, she had me sit with a young male patient. She wanted me to see the breathing treatments and vest therapies that CF patients undergo each day at the hospital. I think I might have a hard time dealing with CF because of the rigorous schedule of pills, meals, and treatments these patients undergo (they constantly need to eat because they don't digest food or gain weight very well). It was fun getting to know this little boy and keeping him company while he had his vest treatment. Later on, due to many factors, I almost passed out in the treatment room as I was observing an infant have an LP. I was really frustrated with myself because I felt that it reflected badly on my capabilities as a CLS. However, many people were really supportive and assured me that it happens to a lot of people, even when you're doing something you've done a million times before. Although my confidence was shaken, I was glad for the opportunity to observe what I was able to before I had to step out of the room.
Later that day, I was able to do rounds of the unit again. The CLS explained to me the poor survival rates for people with CF and pointed out many patients with deceased siblings from the disease. I then spent more time with the patient I was with during the morning. When I first went into his room, he was crying quietly because he missed his family. Because of the time I spent with him in the morning, I was able to help him process and cope with his feelings. Explaining that it's okay to feel lonely, we talked about his mom and his family. I asked him what he liked to do with his mom and tried to give him things to look forward to doing when she visited next. Sometimes I felt a little surprised with the questions I thought of, but was pleased when he relaxed after awhile and was able to work on a puzzle with me. During the long time that I was with him, he had various treatments and I asked him questions about different things. I didn't want to leave because of our growing bond so I told him I would try to visit him then next time I came. I have to say that after days like this one, it is easy to realize the fulfillment I can receive from doing this as a career. Although days can be harder because of being tired or from stress in my personal life, helping kids is definitely a rewarding and fun thing to do!
This week was definitely different and interesting. I observed teaching and medical play for diabetes. Apparently many oncology patients are diagnosed with diabetes during their hospital stay and it is important to familiarize them with their new situation. The girl we were working with was very uncooperative and didn't want our help because she was still in denial about her diagnosis. It was frustrating to work with, but understandable because like she said, she didn't even feel sick. I was also able to observe charting, which is the process of writing about the services a CLS provides for each patient. Also, I am now observing a different specialist and it's pretty exciting. She has been working in the field of CL many years (just like the previous CLS I observed) and she has a lot to teach me. This new CLS works primarily with children with CF (cystic fibrosis) and other breathing problems or disorders. Before we even went to her unit, she talked with me for awhile, having me read some information and then explaining the genetics, symptoms, and triggers CF patients have. It was really interesting to have her explain so many new things that I had heard before but did not really understand. At one point, she apologized for bombarding me with information and I joked back that she was excited to have me with her. After doing rounds of the unit, where she continued to talk with me, she had me sit with a young male patient. She wanted me to see the breathing treatments and vest therapies that CF patients undergo each day at the hospital. I think I might have a hard time dealing with CF because of the rigorous schedule of pills, meals, and treatments these patients undergo (they constantly need to eat because they don't digest food or gain weight very well). It was fun getting to know this little boy and keeping him company while he had his vest treatment. Later on, due to many factors, I almost passed out in the treatment room as I was observing an infant have an LP. I was really frustrated with myself because I felt that it reflected badly on my capabilities as a CLS. However, many people were really supportive and assured me that it happens to a lot of people, even when you're doing something you've done a million times before. Although my confidence was shaken, I was glad for the opportunity to observe what I was able to before I had to step out of the room.
Later that day, I was able to do rounds of the unit again. The CLS explained to me the poor survival rates for people with CF and pointed out many patients with deceased siblings from the disease. I then spent more time with the patient I was with during the morning. When I first went into his room, he was crying quietly because he missed his family. Because of the time I spent with him in the morning, I was able to help him process and cope with his feelings. Explaining that it's okay to feel lonely, we talked about his mom and his family. I asked him what he liked to do with his mom and tried to give him things to look forward to doing when she visited next. Sometimes I felt a little surprised with the questions I thought of, but was pleased when he relaxed after awhile and was able to work on a puzzle with me. During the long time that I was with him, he had various treatments and I asked him questions about different things. I didn't want to leave because of our growing bond so I told him I would try to visit him then next time I came. I have to say that after days like this one, it is easy to realize the fulfillment I can receive from doing this as a career. Although days can be harder because of being tired or from stress in my personal life, helping kids is definitely a rewarding and fun thing to do!
Week 11: April 19-23
This week was yet, another interesting week for me at my site. So far, I have definitely learned to be flexible and teachable in different experiences. One such instance arose when I arrived at my site this week. I was told that my supervisor had emergency surgery, she is recovering, and she will not be back until after the first week of May. This was frustrating news because I really need my supervisor's input on my project at this point. However, a few of the other specialists have offered their support and help in answering any questions and gathering any supplies that I need. My goal is to have my ideas printed out and ready to work on for when I return to my site next week. I am excited to work with the hospital supplies and equipment that I am utilizing in the activities I have planned.
I observed the same specialist that I was with last week. Her unit includes numerous CF patients and patients with breathing/lung problems. As a result, many of the patients are admitted to the hospital for a long time while they recover and recuperate from operations and procedures. The young boy I spent a lot of time with the previous week was still there and ready to hang out with me. We watched tv because he wasn't feeling very well and we tried to work on some of his homework. He seemed to be more discouraged and quiet in the morning, but he slowly began to smile more and he appeared to be happier the longer I was with him. In the afternoon, we took him to take a breathing test that measures his lung capacity. The specialist explained that these are very hard on a patients who have more aggressive symptoms of CF. I witnessed this first hand as the patient tried to perform well on the test. For healthy individuals, breathing into a tube for as long and hard as you can is not a very difficult task. However, for a CF individual, the mucus and built up stuff that is in their lungs makes it very hard for them to breathe, especially this way. The boy coughed very loudly and strongly for a few minutes after each time he took the test. He did it a few times because he wanted to do better. The specialist allowed him to cope with the test in his own way, offering support and encouragement after he was done with the test. It was fun to joke and play with him, teasing him and seeing him smile. I talked to him about the test when we were in his room, and he seemed to be more comfortable to talk there. Later in the afternoon we took a much older and healthier patient for the same test. He was able to breathe easily and performed well on the test because his lungs were so clear. The specialist also explained to me that they start talking patients of his age about transitioning to regular (adult) hospitals. It has been very interesting to meet children of different ages having very different health status's.
Another interesting thing I observed was with this same specialist. CF patients (among many others) are isolated and have various signs outside their rooms announcing the precautions taken to isolate and prevent infection. For instance, it is common practice to wear a gown, mask, and gloves when entering their rooms. However, we observed the breathing technician doing breathing treatments on two different patients at the same time. It was very frustrating to see her disobeying protocol and cross-contaminating the two patients. The specialist of this unit is very passionate, caring, and knowledgeable about her patients and their health problems. From her teaching and the conversations that she has with me, I have grown to feel very passionate about patient care of such ill and at-risk patients.
Moreover, it was very rewarding to work in the classroom and facilitate activities with patients this week. It was fun to interact and lead games with patients in the fun environment of the classroom. As many patients are not able to visit the classroom and playroom, it was very rewarding to interact with a few I had met in previous weeks in both of these fun places. We played bingo, gave out prizes, colored, and met the pet volunteer. Many of the young boys enjoyed petting the large dog, giving her commands, and then giving her treats. It was exciting to hear that a few patients I knew were being discharged because they were feeling so much better. Also, it was interesting to observe the specialist try to engage in medical play with a newly diagnosed patient with diabetes. As the young girl 'felt fine,' it was hard for her to suddenly see the need to have her finger poked often to measure her insulin levels. Although I am uncertain about when I will be able to graduate next school year, I am becoming more and more excited about applying for and participating in the internship required for certification. It seems a little silly to admit it, but I can feel myself getting closer and closer to an 'adult job' that I will eventually have after I have my degree and complete my internship. It's definitely exciting to look forward to a future that I hope to have in Child Life, one filled with many opportunities and experiences.
Week 12: April 26-30
This week I mainly observed in the playroom and patient units. Although I spent a few days in the classroom and a limited amount of time in the playroom, I had not spent an extended amount of time in the Child Life (CL) playroom. I enjoyed asking questions and learning about the playroom. The playroom has board games, toys, puzzles, a play kitchen, a medical play area, video games, puzzles, crafts, and movies that the patients can take back to their rooms. I helped to clean up and organize many different areas during slower times. Also, I played with a few patients and helped others with making crafts. The playroom assistant who was working that morning is very experienced and had a lot of knowledge to share with me. After one child engaged in unacceptable behavior, she handled the matter by taking care of the other children, and ignoring his crying tantrum. Later she explained that she was formerly a preschool teacher so she was used to tantrums, unsafe behavior, and how to notice antisocial communication. I also enjoyed the time I spent in the playroom because I was able to talk to a few volunteers. Volunteers definitely help the CL department function well and they are greatly appreciated.
This week I also attended my second staff meeting. The agenda mainly focused on expenditures and the rules/regulations concerning various purchases. It was interesting to learn about the guidelines that are in place regarding the decision making process of spending money from grants. A large corporation awarded a grant to the hospital to create a teen center. The money will allow the CL department to provide a multimedia center with games, gaming systems, and television monitors. Moreover, I was not initially very excited to attend the meeting but I feel that I learned a lot about the business side of CL.
I also spent some time in a patient unit. One child that I spent time with previously was still admitted so I spent time with him for awhile. We talked about a lot of different things, painted some crafts, and played with his fun little Cars toy. I asked him a lot of medical related questions but didn't press him for answers when he was hesitant. I really learned a lot about his medical condition, developmental stage, and his emotional level by talking about his medical condition. Although I have not observed too many procedures lately, I am still learning a lot of new things and about different aspects of the CL department.
Week 13: May 3-7
This week my supervisor was back from sick leave and I went with her on her units. While on her unit, we talked to various children regarding varying issues and concerns. One child was being admitted that day and needed to learn how to swallow the numerous pills she needed to continue healing at home. Although the patient was older, she was unable to swallow pills so we used M&M's to teach her how. First, we split a single M&M into four tiny parts and had her try to swallow one. Using various methods and with her mothers' support, the patient was able to slowly start swallowing the candies. We emphasized the necessity for the patient learn to swallow pills quickly so that they would not dissolve inside her mouth and start their time released action too soon. After awhile, she became more comfortable with smaller candies and eventually worked her way up to swallowing entire candies in one try. I found it encouraging to see her confidence rise from our efforts along with her mothers' positive support.
One thing that I learned last week was that certain organizations are in place to care for sick children when their parents are unable to. When a child has a difficult diagnosis with numerous scheduled medicines and treatments, parents can be overwhelmed and unable to care for their child. In that situation, medically trained individuals at these organizations will care for the child in their long-term housing facility. I was shocked to learn that one young patient at the hospital apparently lived at one of these facilities for a few years before returning to live with their family.
Week 14: May 11-14
This week was another unique week. I was with a different CLS on Wednesday in the PICU (Pediatric Intensive Care Unit) and learned many things from her as she has been in the field of Child Life for over 20 years. One of my first observations was how quiet the area was. Unlike what we see on tv shows, ICU's are not as rushed, hurried, or as loud as emergency rooms. Also, many patients in the PICU are hooked up to many monitors, medicines, and other machines that make a lot of unnatural noises (normally children do not have beeping beds or machines in their homes :). Because of the severity of the patients' health in the PICU, it is beneficial to speak in quiet and low voices because of this somewhat altered environment. We visited a few patients that previously had referrals and retrieved the items they needed (books, music, games, toys, and even stimulation toys for infants without any family/visitors). As in the other units of the hospital, I noticed that patients in the PICU also did not always have family or visitors. At the same time, other patients also had numerous family members just like on other floors. The CLS explained that while their hospital does not have a permanent and full-time position for a CLS in the PICU, many other hospitals do have one and also another in the ER, and that they have seen positive results from the presence of a CLS in each area.
I received a question from a classmate last week about "what I think is the biggest thing I learned at my site?"
My response: It's a little hard to narrow my answer down to one specific thing. Off the top of my head, I have to say that the biggest thing that I know now is that I definitely want to pursue a career in Child Life. I wasn't too scared or unsure of doing so before starting my practicum, but now I am very confident in my choice and excited to continue all the necessary steps to becoming a Child Life Specialist! Also, I now know firsthand how flexible and versatile a CLS must be to perform their job. Children have different needs, personalities, and fears and a CLS must be able to change their tactics and approach to meet those needs, connect with their personality, and to calm their fears.
