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Shelby Nickel Journal

Week 1

Introduction Because I want to continue with a career as a child life specialist, I want to have as many experiences during my practicum as possible. One goal I have by the end of my time here is to explain to at least one family the basics of child life and introduce them to what we have to offer. I think this will help the family become more educated about the field as well as help me learn the best way to explain child life. Another goal I have is to observe numerous treatments and distractions. By doing this, I feel I will be better prepared to participate in them on my own when the time comes. My last goal for my practicum is to build a relationship with at least one family to the point where they recognize me and are happy to see me when I come to the childs room. I feel I will reach all these goals by observing the child life specialists talking with families and seeing how they build relationships with them. Observing the child life specialists in the treatment room will also help me reach that goal. Three of my favorite activities to do with children are: sticker activities, Uno, and playing with toys they bring from home (I think this sometimes makes them more comfortable with the unfamiliar surroundings). May 20, 2013 I love the fact that I get to go to rounds every morning. I feel that it gives me a good blend of both medical and personal information about the children, which I think helps me interact better with them. It also gives me the opportunity to get to know the staff better and makes me feel like a part of the staff. Today I interacted the most with room 634. We started out coloring on coloring pages together. During this time I talked with him and asked him about things like his favorite color, movie, etc. Afterwards, we went down to the playroom where his family came to see him. While working with him, I learned that his asthma was not affecting him that much. He only coughed and wheezed more when he laughed, but it didnt seem to bother him. May 21, 2013 Today I went with Betsey to give room 638 a wagon ride around the hospital. Again, this was a situation that showed how child life positively affects a patients hospital experience. Before leaving the unit, the patient was not very happy, close to crying, and didnt want to do anything. The second we got on the elevator she was like a whole new personlaughing, smiling, and talking the whole time. During the ride we visited the gift shop, main lobby, mother and baby unit, and the fountain in the ambulatory care center. While working with the patient I noticed a lot of behavioral issues. She was either very happy or throwing a tantrum. This not only made things difficult for the nurses but also affected the family. She seemed to know exactly what to do to get what she wanted. I think I could have done more for here if I had the time. In my opinion, she might have benefited from not only taking her on wagon rides but also having somebody from

child life sit in her room and play with her. This would have given her the opportunity to play games as well as play with somebody other than her relatives. May 22, 2013 The highlight of my day was sitting with a three-year-old boy in room 639. His mother had to go to her car so I played with him for about half an hour. I was very glad to have the opportunity to play with the boy. While there, we played with a toy airplane that he brought from home. I noticed that having a child life presence greatly improved his mood during his mothers absence. Right after she left, he began crying, but as soon as I started playing with his airplane he began laughing and smiling. I think having his own toy from home really helped in comforting him while his mother was gone. I also think having someone sit with him that knew about developmentally appropriate activities for three-year-olds was good for him because I knew what types of activities he would like. I could not have done much more to comfort him considering how happy he was, so I think I successfully kept his attention. May 23, 2013 Thursday I observed Betsey helping with an IV start for a six-year-old boy in room 623. As a distraction she used a game on the iPad. Leading up to the procedure, the boy was very anxious, cried, and did not like having the EMLA cream on his hand. However Betsey found out he like Toy Story so she had him play a Toy Story game on the iPad. Because of playing this game during the procedure, he did not even notice the IV going in. This was my first opportunity to observe a procedure and it was very informative. I thought it was good to see the iPad used as distraction because it could be used in so many different ways and ages. I think it was also helpful to see what a successful distraction looked like so I can gain ideas about what works and what does not. However, I think it might have been even more helpful to see a few different distraction tools used on the same child. This would have showed me what to do in a situation where just one distraction tool is not successful. May 24, 2013 Today, I observed Tracy giving MRI education to an eleven-year-old boy in room 618. She used a combination of pictures, a model, and noises to describe what the experience would be like. This was my first time observing any education and I was happy to have the opportunity. The education seemed very successful to me and the boy was very relaxed throughout his MRI. I enjoyed watching Tracy work with him because she engaged his attention the whole time and was very interactive. He asked a lot of questions and made connection between the procedure and his previous knowledge. I believe much of this was a result of the child life specialists teaching.

Shelby Nickel Journal

Week 2

May 28, 2013 Today I spent a good chunk of time going around the unit with Cindi Clawson while she read stories to the patients. It was very obvious that each child she read to was positively affected by her presence. The children were very engaged in her reading and answered questions throughout the stories. I really enjoyed this experience because it was a situation where one person associated with child life made multiple kids smile. I learned a lot from this experience about just how much reading a single story to a child can brighten his day. I also learned from observing Cindi how to adapt one book or activity to different age groups because she used childrens books effectively on patients as old as twelve. Overall, this was a great learning experience for me, not only for child life, but for childrens activities in general. May 29, 2013 One thing that stood out to me today was giving an eight-year-old a remote control car. When I went into his room he did not know what I was bringing and his face lit up when he saw the car. He gasped and said, Oh my gosh, my very own car! He seemed so overwhelmed with joy that it just put a smile on my face. This was an instance where child life was not necessarily used specifically, but just brining one toy meant the world that child. Because he has to be here for multiple days, I have tried to stay consistent with visiting him and learning what he likes. It seems that having a familiar face in his room once in a while has made him happier than if child life was not available for that. May 30, 2013 Today I sat in on a meeting with Tracy and Michaeleen. It was a nice experience to observe some of the inner workings and more business side of child life. I liked to see the different events in which child life is a part. However, after going to this meeting, I realized I definitely like working on the unit more than anything else. It was good to see the business side of things though, because thats equally as important as working with the patients. Relating more to child life, I observed Katie face painting on a sibling of a patient. This was one of my first interactions with a sibling at the hospital and therefore a rewarding one. The little girl appeared very bored in her sisters room until we arrived. Once she started getting her face painted she was laughing and smiling. This experience was the most rewarding so far because it was brand new for me. This was my first experience interacting with a sibling and I am very interested in siblings of hospitalized children. I hope to gain more experience with siblings before the end of my practicum. May 31, 2013 Today I spent a good part of my day helping at the Memorial Childrens Hospital tent at the Sunburst races Even though this didnt directly relate to child life, I enjoyed having the opportunity to do something off the unit while still supporting the childrens hospital.

The best part of helping at the booth was the numerous interactions with children. Even if it was just to give a child a Frisbee or pencil, it was worth it to see a smile on his or her face and talk to them for a few seconds. If in the future these children end up at the hospital, maybe their perception of it will be more positive than if they had not stopped to see us. A smile can make all the difference. June 1, 2013 This was my first experience both working with Tina and working on the weekend. There was not very much going on on the unit because so many families were with their children and several patients were discharged. The best part about today was that I got to work with Tina for the first time and experience how she interacts with patients. I observed a distraction for a one-year-old girl who was getting a blood draw. Tina was very good at talking calmly to her and attempting to calm her down with various toys. While Tina did a very good job at distracting the patient, I dont think anything more could have been done to keep her from crying. She insisted on watching what was going on and that only got her more worked up. Throughout this week I also looked at the pain management resources binder. It was very interesting to me to look at all the pain management techniques, but especially the non-pharmacological ones. I really like the comfort positions because unlike some medicinal pain management, any child can use them. Some children may be allergic to some medicines, but no child is allergic to comfort. A few of the comfort positions I most liked were back-to-chest, chest-to-chest, and the child sitting sideways on the parents lap. All of these encourage comforting hugs between parents and child, which in turn encourages calmness in the patient. Five Conditions I Learned ALL (acute lymphoblastic leukemia) Definition: rapidly growing cancer of the white blood cells Cause: blasts that are made by bone marrow are abnormal and cannot fight infections Treatment: chemotherapy, radiation therapy, or bone marrow/cord blood transplant Effect on patient/family: Because chemotherapy occurs for all patients with ALL, the patient and his or her family must deal with the patient being sick a lot and regular visits to the hospital. If the patient has a transplant, then there is a better chance for the cancer to go into remission and there would be fewer issues for the patient and family to worry about. Guillain-Barre Syndrome Definition: the bodys immune system attacks the nerves Cause: unknown, but is often preceded by an illness like a respiratory infection or the stomach flu Treatment: plasmapheresis (plasma is separated from blood cells and blood cells are put back in the body), intravenous immunoglobulin (blocks damaging antibodies)

Effect on patient/family: This disorder can mentally affect the patient and possibly result in a long-term disability or paralysis. Because of this, the family may have to take on the responsibility of caring for the patient during his or her life. Ileus Definition: bowel obstruction because of the lack of peristalsis Cause: abdominal surgery, injury or trauma, infection, imbalance of electrolytes, muscle function disorders, use of certain drugs Treatment: If it is caused by surgery, it usually is fixed within a few days. Otherwise, it needs to be treated by adjustment of medication or replacing electrolytes. Other treatments include: diet limitation, NG tube, and IV fluids. Effect on patient/family: This condition affects both the patient and family because the patient will have to spend time in the hospital, which can be stressful. Definition: complication of an infection that occurs when chemicals used to fight infections cause inflammation in the body Cause: pneumonia, abdominal infection, kidney infection, blood infection Treatment: medications, therapy, surgery Effect on patient/family: An issue associated with sepsis is a weakened immune system, so the patient will be less likely to fight off other diseases and germs. Because of this, the family needs to be conscious of what germs they are bringing around the patient and be sure to stay clean when in the same environment. DKA (diabetic ketoacidosis) Definition: complication of diabetes that happens when the body produces high levels of ketones, develops when the body is unable to produce enough insulin Cause: triggered by an illness, problem with insulin therapy, or things such as stress, trauma, high fever, or surgery Treatment: fluid replacement, electrolyte replacement, insulin therapy Effect on patient/family: This condition can affect both the patient and family because everybody in the patients immediate environment will have to be more conscious of his or her diabetes and learn how to manage it in order to prevent future issues.

Sepsis

Shelby Nickel Journal

Week 3

June 3, 2013 Today was the by far the worst, but most unique experience Ive had while doing my practicum. I accompanied Tina and Betsey to the morgue to observe them doing hand molds on a six-year-old. This was my first experience with seeing a dead body in the hospital setting and it was very unpleasant but Im glad I got the experience. It was very interesting to see the process for making hand molds. It was educational as well, seeing as how I will most likely have to do them some time in the future. I think the hand mold process would have been easier for me to watch the first time if it had taken place on the unit not down in the morgue. However, despite the unsettling and sad circumstances, it was a good opportunity for me to learn something new about my future profession. I also went through the grief and bereavement folder of information and watched the Sesame Street video. I especially liked the video and how it portrayed the death of a loved one. I thought it did a fantastic job of gently teaching that when someone dies, they dont come back. This is something that many young children have a hard time understanding and this video did a good job of showing how to explain this to that age group. June 4, 2013 Much of my time in the afternoon today was spent in the playroom with a ten-yearold boy from room 628. We engaged in numerous activities over approximately a two-hour span of time. We played Hedbanz, cars, basketball, and kitchen. He was very active in all the activities and seemed to really enjoy the time spent out of his room. He has been by himself since he arrived here and has really enjoyed having volunteers and child life people interact with him. Playing with him today was one of the highlights of my practicum so far just because I know that child life greatly impacted his otherwise lonely and boring stay here at the hospital. If child life had not been present on this unit, he would most likely have been sitting by himself all weekend with very little interaction other than medical staff. Because of this, I think child life was key in giving him a positive hospital experience. June 5, 2013 Today I continued my ongoing interaction with the one-month-old in room 638 and her family. I have visited them several times throughout their stay here and have developed a relationship with both the mother and patient. The patient has come to recognize me and immediately calms down when I pick her up. Her mother has also become very comfortable with my presence and smiles and talks to me whenever I come in the room. I have noticed considerable change in the mothers comfort level since arriving at the hospital. She started out wanting and expecting somebody to sit with the baby whenever she left, even if the baby was asleep. Im guessing this was because of anxiety and discomfort about being in the hospital. However, she has gradually become more comfortable with leaving her child alone when leaves if the child is sleeping. The mother seems very eager to keep her baby near her and really seems to care about her wellbeing.

June 6, 2013 Again today I interacted with the one-month-old in room 638 and her family. However, in addition to spending time with the patient and her mother, I also interacted some with the babys older sibling (around five years old). I have interacted with the sibling a few other times and each time she has been bored and seemed very excited to see me. Today when I walked in she noticed the stickers on my badge and clipboard and asked me if she could have some, so I did a sticker activity with her. When I came back later, she was having a blast arranging the stickers on the paper and kept thanking me for bringing the stickers. The mom also seemed very thankful to have me in the room and especially liked that I gave her a break to go get dinner. While she was gone I held the patient for about 45 minutes. Each time she cried I attempted to soothe her and she quieted down right away. After being with this family several days in a row, I really feel I have accomplished my initial goal of building a relationship with a family. All three family members (mother, sibling, and patient) seem to be happy and recognize me each time I walk in the room and are thankful for giving them breaks and talking with them. June 7, 2013 Today I spent a large amount of time with a ten-year-old boy in room 628. We played Pictureka and Uno for about an hour. He was very excited to play Pictureka because he had never played it before and ended up really liking the game. Somebody from Healthworks also came while I was in the room and we watched him do science experiments like film canister rockets and boogers made out of borax and glue. The patient highly enjoyed all of these activities and enthusiastically participated. I have interacted with this child daily for the whole week and have done numerous activities with him. This situation has taught me a hard part of a child life specialists job. Becoming attached to patients over a period of time makes it difficult when they are discharged because I want to be able to do activities with them. However, I understand that they cannot stay at the hospital forever and do not let it get to me when they have to leave. June 8, 2013 My favorite experience today was giving a birthday present to a two-year-old girl in room 626. It is her birthday tomorrow and Betsey and I thought she would really like it if we gave her something. I ended up giving her a choice between two Pillow Pets (a ladybug or a dog) from the birthday cabinet. This was my first experience with a birthday on the unit and I am so glad I got to be the one to give her the present. She was so excited to get a present and especially that she got to choose which Pillow Pet she wanted. Ever since she has gotten here, she has been very upset and cried when new people came into her room. When I walked in with the Pillow Pets, she was immediately happy and really liked that I was there. This was a perfect example of how child life can completely turn around a childs hospital experience just with a simple prize. I think she also liked that somebody was acknowledging her birthday even when she was in a strange place. It is little things like this that children remember and it is great that child life can be a part of that.

Shelby Nickel Journal

Week 4

June 10, 2013 Today I spent time with a nine-month-old boy while his parents went to get lunch. This was such an interesting experience for me because of the babys condition. He was here for failure to thrive so there was constantly a difference in what he looked like he should be able to do, and what he actually could do. Many times he would do something as little as wave or hold a bottle to feed himself and I would be completely surprised because he physically looked much younger than he actually was. His small size combined with his average developmental age made it very enjoyable to play with him because he looked like a little baby genius. Throughout my practicum experience, I have most enjoyed spending time with children around this age. Of course I love babies in general, but I feel like many times I can make more of a difference in their hospital experience than I do in older children. In general, many babies have a hard time entertaining themselves and want somebody with them in order to be happy. I have found in the many times I have interacted with babies that they have been extremely content when somebody stays in the room and plays with them rather than sitting by themselves. This is probably obvious to any person with knowledge about children and child development, but many people are uneducated when it comes to children and do not know things like this. My Story Probably the biggest influence on my decision to become a child life specialist has been having a younger sister with Down syndrome. There isnt one certain instance that sticks out in my mind as being the reason for my career choice. Being around Faith for seventeen years has given me the desire to not only work with children, but to work with children who have disadvantages or disabilities and that is exactly the population of children who end up in the hospital. Throughout Faiths life, she has been in the hospital multiple times and not had the opportunity to see a child life specialist. Specifically with her most recent hospital visit when she was about fourteen, she was very bored the whole time because she did not have much to entertain her. In this instance I believe she would have benefited greatly from the presence of child life. I think the most influential aspect on my career choice in regards to having her as a sister has been my daily interactions with her over the years. Helping her with schoolwork, playing with her, and just taking care of her in general have shown me how important it is for children to have somebody in their environment that understands childrens social, emotional, and cognitive development and developmentally appropriate activities that can be used with children. Since discovering how little many people understand about children, it has become a passion of mine to learn and utilize that information to help children in the hospital setting. June 11, 2013 Today I spent time with a non-verbal, severely delayed, fourteen-year-old boy. Although I did not do any activities with him, just having a friend sit in the room with him seemed to be all that he needed to relax. Whenever he was alone, he would cry constantly

and appeared miserable. As soon as I sat down next to him, he stopped crying and stared at me for the half an hour that I sat there. I did not even have to talk to him (although I did some) because all he cared about was knowing that he was not alone. I could tell he very much enjoyed having me sit with him because his eyes lit up when I talked and he seemed to relax a lot more than when he was by himself. He even attempted to smile a few times while I was talking. After having this experience, I realized that sometimes patients who are non-verbal tell you more with their body language than children who can vocalize their feelings. I was very glad to have this experience today and I hope to do something like it again before my practicum is finished. June 12, 2013 Today I spent a little bit of time with a five-year-old boy in room 637. He has been very irritable and miserable for the whole week he has been here, but today he was super happy and really glad that I brought stuff in the room for him to do. He has had the VECTA machine in his room for the past couple days and he wanted it again today so I took it in and he immediately smiled and thanked me for bringing it. It was great to see a distraction tool being used for pleasure rather than to help with a procedure. Im glad that something like the VECTA has multiple uses and it doesnt just have to be associated with pain and procedures. I like having the opportunity to have a variety of experiences with one tool or technique and this instance was the perfect time for that. June 13, 2013 Today was a busy day and I had the opportunity for a wide variety of experiences. I held a one-month-old and also had the opportunity to observe and be a part of distractions for a G-tube placing, NG-tube placing, and wound care. This has probably been one of the busiest days I have seen while doing my practicum and I really like that I have had to do so much today. I feel like today has been one of the best learning days I have had so far. I have also interacted with the most patients today than any other day I have been here. Each experience today has showed me just how much child lifes presence can affect a childs hospital stay. Every patient benefited from having child life in the room and was much calmer than if we had not been there. I cannot be thankful enough to have had the opportunity to do this practicum and gain all of the knowledge I have about the child life profession. June 14, 2013 I had my first experience today with watching an EEG take place. This was a great experience and the three-year-old girl seemed to handle it very well. Prior to the testing taking place, Becky and I went into the room to educate the girl on what was going to happen. She really liked when Becky let her use the swabs on Becky and she was not anxious at all. Once her testing started, Margaret and I sat with her and soothed her. She became so calm that she fell asleep. I was so glad to see that her medical procedure turned out so good for her and that she handled it well.

Shelby Nickel Journal

Week 5

June 17, 2013 Today I felt like a real asset to the child life department. I started out the day by providing orientation to the unit for Sandy, the new practicum student. Doing this really made me feel like I had valuable information that would help others filling the same position as me. Because I am very close to finishing my practicum, I felt I could provide Sandy with not only information about the unit, but also child life related knowledge about the patients. In addition to orienting Sandy, I also gave orientation to a group of about eight new volunteers, which made me feel trusted and like I had even more responsibility. I very much enjoyed passing on my knowledge of pediatrics to newcomers and demonstrating what child life can do in the lives of patients. June 18, 2013 Today was a brand new experience as I was in the pediatric hemotology/oncology clinic for the whole morning. Throughout my practicum I had not spent much time in the clinic, and never while shadowing a child life specialist. It was such a great experience to observe how Becky interacted with the chronic patients. Not only was it fun for me to have this experience, it was also very educational from a child life perspective to see interaction between a child life specialist and a patient who had met several times before. It was very different than interactions between one-time inpatients and child life specialists. I observed that there tended to be stronger bonds between the individuals when they knew each other previously and this made the interactions in the clinic more in-depth and personal than on the unit. I can see why there was such a desire to have a child life specialist in the clinic. June 19, 2013 This was my last day of my practicum and it was somewhat saddening to realize I would not be interacting with these children every day like I had for the past month. The main activity I did today was helping at the Memorial Childrens Hospital booth at the Four Winds Invitational. While at this event, I spent time putting small casts on childrens fingers. Even though this was not child life related in the hospital setting, it was great to show healthy children some of what happens in the hospital and show them that it is not all scary. Many of the children enjoyed getting the casts so much that they wanted multiple. I thought this was a very enjoyable way to end my last day at the hospital.