Child Life & Nursing: Practicing pediatric psychosocial support in Novy Jicin

 

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My recent visit to the Czech Republic, sponsored by the Klicek Foundation, included a return to the Mendelova Nursing School in Novy Jicin. This time, Maria Fernanda Busqueta Mendoza joined us from Mexico, and 50 students participated in our seminar, making it a great opportunity for global learning and a multicultural exchange of ideas. As you can see from the first photograph, the students were a lively bunch, and they eagerly participated in the highly interactive time we spent together. Jiri Kralovec served as our interpreter and his son, Jiri, touted  by Foto Video Magazine as this year’s hottest photographer on Instagram, documented our learning. Most of the photos below are his work.

Jiri and his wife, Marketa, started us off by sharing information about  the importance of play for hospitalized children and the history of their efforts to bring hospital play to the Czech Republic.  It has been a slow, uphill battle to change the hierarchal and disempowering bureaucracy of their medical system.  I followed with an introduction to the field of Child Life, the role of child life specialists in hospitals, and the possibilities for collaboration with nurses. I spoke about the role of play and community in the healing process, before moving on to some illustrative activities.

Sharing our own memories of play is one way to deepen our appreciation for the role of play in our lives and in the lives of children. I asked the class to think about their own childhood memories, using their five senses — what do they remember about their play environment? Did play occur inside or outdoors, or both? Were they playing alone, or with others? Did they play with toys, loose parts, or their imaginations? Are there sounds, smells, tastes or textures associated with their memories? What feelings are evoked in sharing them? The students paired up and took turns both sharing and listening to one another.

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Armed wth a deeper awareness of the value of play, the students were now ready to learn a bit about how to make procedures less frightening for children. I have always wanted to use role play as a way to demonstrate all the things that can go wrong during a procedure, and how minor changes can make things easier for medical staff, children, and caregivers. I took this opportunity and asked for volunteers. One young man played the patient. We instructed him to lie down and asked three others to pin him down to the table, much like medical personnel are likely to do when a child receives an IV. We demonstrated how the very act of being forced into a prone position increases one’s sense of vulnerability and loss of control.

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Add to that several adults talking at once, loudly over any protests you might make, telling you to stay still, not to cry, to be a big boy, not to look…. and you get the picture. Chaos, stress and shame accumulate to make for a disastrous experience for all.

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But there are some simple things that nurses can do, either alone or in partnership with play specialists, to change the outcomes of such procedures. It doesn’t mean that the child won’t cry, but it is more likely that the child won’t suffer emotional trauma, will return to baseline quicker, and the nurses can feel more successful and less like they are causing the child undue suffering.

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With these tips in mind, the students enacted a better case scenario, where the parent has a supportive role in positioning the child for comfort. The child is upright and held in a calming hug, rather than being restrained on the table. The child is given some choices, such as which hand to try first for the IV (the non dominant hand is preferable), and whether to watch the procedure or use a toy or book for distraction.

  • Electing one person to be the voice in the room,
  • encouraging the child to breathe deeply and slowly,
  • narrating each step of what the child will feel,
  • explaining how a tiny plastic catheter, not the IV needle, remains in the child’s hand to deliver medicine,
  • staying away from comparative or shaming statements,
  • and showing empathy

are all ways to provide psychosocial support, making the experience less traumatizing and painful for the child.  Accumulated painful and traumatic medical experiences can make children phobic and avoidant of medical care.

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We also spoke about non-pharmacological pain prevention and reduction. The interactive component of our lecture surely made our important information memorable. The action and laughter surely made more of an impression than a power point! We all reflected together about  how even adult patients can benefit from choices, information and empathy.

Back to the topic of play, we explored ways for the nurses to instill playful interactions into their communication with pediatric patients. Rapport building and distraction through the use of hand games is one way that they can put a child at ease. I demonstrated several hand games, and asked them to show me some of theirs as well.

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Our time with these wonderful students ended all too soon. We posed outside of the school for a photo with some of the Klicek Foundation hospital play specialists before heading to the historic square down the street. Around every corner of this country is a beautiful scene, no matter where you are!

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Restoring my Soul: Recipe for Self Care in The Czech Republic

 

 

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We all need time to restore our energy and feed our spirits. It is not an easy task during the workaday world of most of our lives. For anyone in the service professions, self care is a necessity, not an option. As a professor teaching Child Life graduate students, my calendar revolves around the academic year, and by the time the end of May rolls around, I am usually quite exhausted and spent. An invitation to teach in the Czech Republic came at a very good moment for me  – after graduation and at a beautiful time of year.

Recipe Ingredients:

Knowing what to expect

The recipe for filling my well was a simple one, but I could not have done it without the friendship and nurturing of the Kralovec family. Marketa graciously and painstakingly created a hand written and illustrated book telling the tale of all we would be doing together in the next two weeks. The guide was especially helpful in letting me know what to expect, as we traversed the country and visited Poland and Austria.

A Warm Welcome

But the whirlwind began with a gentle, warm welcome back to Malejovice, the home of the Kralovec family and the Klicek Foundation Hospice. My third excursion from New York City to the Czech Republic felt like returning to the home of my soul. Marketka, their daughter and a highly skilled artist, documented my arrival by depicting the short emotional distance between our two homes. What’s an ocean anyway when like minds and hearts connect?

Bright and cozy bed linens and wild flowers from their garden greeted me in the guest room. The sounds of the birds sifted in with a gentle breeze through the open window.

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Wonderful Home Cooked Meals

Each meal was prepared from local ingredients and cooked with love. The eggs from their chickens (rescued from terrible conditions in a chicken mill), fresh herbs from their garden, homemade soup, duck with dumplings and sauerkraut, fresh bread and danishes, black tea and local beer…….. my palate fairly exploded from the goodness of it all. The family would not allow me to wash a plate or rise for a napkin. The nurturing wasn’t just about the food, but the care with which they served it.

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Four Legged and Winged Friends

Animals are therapy, and a wide variety of animals inhabit the pastures surrounding the 100 year old schoolhouse. Each morning began with a chorus of birds at about 4 AM, followed by the harsh and comical braying of Donkey (his name is Donkey) at 7 AM. The sheep served as the snooze alarm, sounding off a few moments after Donkey. Mollie the dog was the night time alarm system,  and the chickens cooed and clucked whenever we approached them. The cats draped themselves over windowsills and plant boxes and moseyed up and down the driveway throughout the day.

 

Nature

Nature is what grounds us and reminds us of the cycle of life, our smallness, and the beauty of creation. The surrounding forests of Malejovice, the wild flowers and rolling hills and pastures, the lush ponds and hidden villages of the country………  all served to quiet my gerbil wheel mind.

Solitude

I get plenty of time alone teaching online from my apartment, but there is something different about being alone with nature in wide open space. Nothing to distract me from the sun, breeze, scents and light.

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Wonderful People

Solitude is always best when you return from your walk to a household filled with joy, love, laughter, and music. The time spent with these people, and all the people we met on our travels, energized me and acted as a balm to my tired soul. Thank you. Thank you. Thank you – and these words will never be enough to convey my gratitude.

Instructions:

Repeat whenever able.

 

Palliative Care: the Art of Companionship

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Photo by Ludvik Hradilek

Jiri  and Marketa Kralovec have been serving families facing illness and loss for many years. Their work through the Klicek Foundation in the Czech Republic has brought palliative care to parents and children who in their most difficult hours, crave witnessing and gentle care as a family unit. Below is a statement of their philosophy, their humanity threading through it like gold.  Continue reading

Deconstructing Walls

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Earlier this week, I blogged about teaching play techniques to students and professionals in the Czech Republic. I find myself still processing everything I saw and heard while in this beautiful country, and I am reluctant to leave it all behind, even as I prepare for my next journey abroad which is rapidly approaching in a few weeks.

“What one thing really stuck with you?” a friend asked me yesterday. It was hard to pick one thing, as so much is still reverberating. And the words to describe what I experienced are flitting just out of reach somewhere in my jet lagged brain.

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Czech countryside

I keep coming back to our three-hour road trip to the nursing school in Nový Jičin. Jiri is driving, and I ride shot-gun, the windshield framing the Czech countryside that slips by us, leaving swaths of  wild poppies, rich green pastures and elven forests and  in our wake. But it’s not the view that resonates with me. Continue reading