They're children, they're different (1980)

[Music] just tear tip is very carefully now most important thing for any nurse to realize when she comes on to a pediatric Ward is that children are different and that you can't treat them like adults right pediatric nursing and adult nursing are not the same thing at all and you're not just nursing the child you are nursing or looking after the whole family you can't isolate child from his family I [Applause] nor McCarthy can you come for report please can you come for report please [Applause] [Music] can I pass you this and if you could all look and see which group of patient you've got so that we're doing the report know which was which a child needs to identify with somebody particular if he's got his own nurse he feels important he feels somebody cares about him somebody belongs to him and obviously for a student nurse it's much easier for that nurse to come to terms with basic caring if it's with a small group of children the emotional support is as important as the continuity of physical care particularly in the children's wths and he's developed a viral menitis from the months it's fairly common we try to anticipate you should be able to anticipate everything that happens is going to happen to a child during his time with us good luck you won't you won't die thank thank you very much on top of him and tell him what it is what's going to happen to him in terms he understands encourage him to ask questions just observe him afterwards to see if he's taken it in if he's suddenly become very anxious go back and encourage him to talk about it and very often listen to the things that he says to the other children special special request bye to [Music] [Applause] you when a child arrives on the ward with his parents we greet them calling the child by name cuz I think that's important here we are AG next to a boy take both parents and child along to a bed making very clear that it can be their play area you know they can do what they like it's not just a place for going to bed b this is your base now what I'll do I'll give you this little thing that just tells you about visiting Etc and then at that point we have got a booklet on the ward that explains about who everybody is and gives a little map of the hospital give one of them to the parents to let them read t can just wander around and you can see where everything is and there's no need we won't do anything horrible to [Applause] him now it's free visiting to you your husband and his brothers and sisters yeah I let you unpack sort yourself out yeah and one of the nurses will come and have a chat with you and with tar in about qu an hour 20 minutes m is that all right yeah you're not in then usually leave the child and parents together just to get the feel of the w uh for about half an hour so they just get established after that time we come back and do what we consider our formal admission how are you where a nurse sits down with the parents and discuss the child his personality the sort of things he likes with regard to names for toilet food he intensely dislikes maybe allergic to it's important to find out the drinks he likes if it's child who's going to have an operation so that you don't give him something he intensely dislikes and start him off vomiting when he comes back you know things like that are important from the medical point of view as well he didn't had anything else to eat after you know yeah but he eats meat you know D no meat he doesn't eat meat yeah eat meat at home if it's something that her mother is worried about if you tell her her child is going to have an operation unexpectedly perhaps she just thought the child is coming in for some treatment if it's frightening news the Chan are the mother will forget at least 75% probably near to 90% of what you tell her so you have to go back repeat exactly the same thing in exactly the same way want go to never give an injection to a child no need to an adult you just have to tell the child the truth telling it what hurt most of the nurses have have met a child some point so they have a v idea of what a child is all about but I try to explain a child's world is different it's very much at this moment in time it's a day-to-day thing it's what's happening now they may talk about the future but they have no real understanding of the future as we know it and the child's world is very black and white there no Grays at all so one thing you're either for him or against him and something happening now is what's important it's no good saying in an hour you'll be better in in in hour you won't mind or when it's all over you'll forget about it you must actually look at what's going to happen and you know come to grips with it as something that's going that's happening right now be brave always telling the children the truth never promising them anything that isn't going to happen never blackmailing them because that is one of the favorite things people do to children if you do this or if you are a good boy I will give you that it's total honesty [Music] [Applause] right Mom you can put now good oh finished good mom get out you said oh no johs in there he coming in the tree johs in there he coming in the tree as a play lead in the hospital I think play is important because it has a link with their home environment and when they come into Hospital they're separated from um their home and their family and their friends and play can be very valuable because it can be reassuring bringing some normality to their life although they're in a rather strange and sometimes very frightening environment g e see see there well done that's quite good isn't it you hit them in the middle a w that is not allowed any play activities well I always feel the ward um is cold and the children themselves um are going to be I would say unhappy [Music] we have to um look at the child as a whole person not just looking at a child's leg or arm and we have to look after the child's emotional needs a situation has never Arisen where a doctor couldn't see a patient because of the chaos or an instruction the dror gave couldn't be passed to the nursing staff because it's organized car I think who's vegetarian two if we've got a child on the ward whose mother doesn't visit very frequently and when she is there can't provide any positive caring I usually try to allocate that child to the same nurse for more than one day every day that nurse is on duty he is the child that is allocated to her the nurse obviously would have more than one child to look after but I would recommend that she spends any spare time she's got with that child she's always aware of him she always tells him exactly what she is doing where she's going and unless it is something that must be done here and now she notices that that child is becoming miserable unhappy she drops she's doing even for a few minutes and goes back when you haven't finished it some people could say that's a bad thing because the nurse gets emotionally involved with the child I think it balances out for the child it's a good thing and that's what we're there for rhubarb pie and custard are simina and jam the children's world oh it's very happy and very friendly I think that was the first thing that hit me they most of them were dressed um even the children in the tractions they were dressed and it didn't see it seemed more like a play school to be honest it didn't seem like a hospital that I thought it was going to be whenever I've come in Nick's always been playing with somebody now are you when are you going home you think tomorrow put one there I don't know if this particular W being a children's Ward is different from any other Ward but for a 6y old Etc I think it's a great Advantage having somebody you know a great deal more friendly than they used to be in the nurses and um the free and easy attitude about this visiting that you can visit the children basically any time which I think is very good I believe that the best person to look after a child is his mother or father if he's filling that role and the best best place to look after the child of at home so therefore I think it's our duty to maintain as much of that home atmosphere in hospital as we can while trying as nurses therefore professionals to get the child home as quickly as possible as safely as possible so from the w point of view then it just automatically follows the parents must have free visiting they must be able to participate in everything that happens to their child unless it would endanger the child there are very few procedures in fact I can't think of any one that a mother or father couldn't be present the W so the mother or father should be present if they can and particularly on the under fives if either mother or father could stay at night so provide facilities for them to stay I know it may seem the wrong way around but I often think by relaxing the parents very often first you very often get through to the child through the parents and that way the child feels the child relaxes it's relaxing the muscle all the time it's the movement that makes it ache sometime so you wouldn't be able to move it while it's in traction okay it's very easy pick out the priorities no matter how busy or confusing it looks to an outsider so I like people to feel that they can come to the W whenever they want to for the children really so they feel happy they feel at home people are relaxed people coming into the ward aren't antagonized by somebody saying you shouldn't be here at this time the children pick up people's moods very very quickly and if doctors March in or nurses March up to a child in a very aggressive way the child just backs away from them won't communicate with them and gets very frightened and very often takes it personally think it's something they've done and that's why I try and keep it fore an easy atmosphere because everything that happens in the W affects the children it affects their parents people can come and go Su themselves I try to keep it that way hello Sarah with Wendy when the accident happened and it's just possible that he feels a bit still feels a bit guilty I don't know but definitely the mother is laughing and smiling much less now that she did a week ago and I don't know if something's cooking if there's something that we're doing that she's not happy about or if it's just the strain of visiting hospital every day for long periods that's telling I don't know what it is Terrence Moone is 9 years old left irritable hip he's still on traction Mr conu came to see him today is very happy with him there isn't any SP left now but said to keep him on traction until Saturday and then to take him off Nicholas Hall is 10 today he went down at right or toxi he absolutely fought having a PO stop when he came back but at 6 we finally persuaded him and he had one 5 Mig very small amount really anyway he's tolerating small amounts of water his mom was with him she has been since he came back tar Ali the seven went down for a left her me came back at 4: his parents have been with him ever since he came back he's fine he's on small amounts of water now I think it's very important that children should be admitted to Children's Wards adult Wards are not very satisfactory for children they may see things that upset them the whole Ward is not geared for their care and it is more important that they should be in an atmosphere that is suitable for them I think there is a possibility of for teenagers of having some Choice uh but uh young children should always be with young children on on a proper children's for if there's one Golden Rule I should like to think that it is that the children are not our children but the parents' children and we need to involve the parents in the care and treatment of children in hospital as much as possible play is very necessary in an art patient Department It's usually the first place that a child comes to in hospital this is one of the most important things for hospitals to real realiz that a play area can be set up anywhere you just need a large cardboard box and good equipment and preferably somebody who can be there with it and that's all you need so he can hear you that's right stay with me m go down there there's a hello hello how are you I'm fine have a good journey down yes we did it's a bit tired yes I'm sure it is she looks tired she ready for bed tired yeah oh be glad to put her down actually yes well I can show you her bed in a minute are you going to be living with in with her um yes I am all well if you'd like to come to cubicle just down here on the left you a bed to me parents are you have the child you have the parents they're not they're not separate they are they are together and um we're not just treating the child we we well we're involving the parents in the treatment of the child so I suppose in that way we are cre trying to create an environment that's near a homik by getting the parents to stay there probably just the clock actually cuz I can feel the motor still going I feel that the parents should be there as much as possible it doesn't worry me it doesn't prevent me doing my work in fact it helps you've just got to write in that column what she's actually doing at those times I see and then symptoms if she's been having any of those strange attacks and just write n down there if she's seems quite well now [Music] and this is exactly what they did since they could no longer tow that gum drop without wheels they left him by himself in a field we tried to create an environment that is like somewhere that's familiar to them not really to home cuz that isn't completely possible we can make the place a little bit homely but more like a nursery school or like their Ordinary Day School you're better than I [Music] am again can I have another gu see right let's try I don't like to busy Fe do I [Music] right I'm going to touch your skin with a needle right done most adults they know what's going to happen they're frightened because they know children are frightened because of what they imagin going to happen they don't really know [Applause] did you have a drink of C children don't talk about their fears in the same way as adults um but when they're playing when they're playing their little doctors and nurses games they they talk about operations and death and um a little girl came to me the other day and sort of said I know what they do when they take your tonsils out they rip them out and we had a long chat about taking tonsils out and how she wouldn't know anything about it and how it's not they're not really ripped out but um I mean she wanted to be told that she wanted someone to talk to her about it you listen to them telling each other horror stories it's very interesting about what's going to happen to them and I think it's important for the nurse to listen to these things and to try and straighten them out and talk to them it's all right can you find it I [Applause] think and then Tommy should we listen to her back as well yeah and back oh that's it can you can you listen there I think is this I think that's a spare one that was Elizabeth's one how is she is she getting better yeah you can wear that one all right thank you when children come into Hospital frequently you've obviously got a very different situation because you do want to maintain the normal education of the child therefore it's important that a contact is made with the school and the syllabus is kept to in some way or other I think what the hospital teacher always does is to try and maintain a normal situation for the child that's obviously very important for the child uh educationally and socially Miss will it be all right if I got down a care please yes would you pick me up in 10 minutes time please I should think I can manage that one for you okay a quick pee into your ears doesn't hurt Jamie doesn't just promise just a quick peek okay we promise you won't hurt you count it to 10 and you'll H be over very still you say one two three don't take his Ted Victoria [Music] four 5 6 7 8 9 and 10 there you are wasn't that quick oh you guys can we look at your throat now come on yourth you say ah ah spatula please ah oh yes say ah oh okay okay right you just say ah go on try shout Jamie say ah try that again one more time you look look up put your head say ah good boy oh that's good yes great there's only one I want to ask about and that's um po Clark dnv yes is it dnv the liaison Health visitor goes on Ward rounds and notes every child that's admitted to hospital and feeds that information back to the own the child's own health visitor um mainly so that she can do an early visit when the child's discharged from hospital she can also provide us with a lot of information about the child's home environment so it won't get any it was she's been back and she's got herment and I showed her how to put it in she came back yesterday she came back yesterday to CH but she had been having FL and fful at home no she had but it hadn't done anything good for it wonder if she was going put it in properly well I don't think she was putting it in properly but I showed her and I told her it was better to get someone else to hold baby's head you've been here before haven't you I think we take out shares in this joint yeah you po me bed [Music] [Applause] yeah that's a good come on do you want to stay I'll stay yes yes M me stay with you Alice nice it it is most important that the children feel relaxed when they're in hospital this is as important as their medical treatment and and if they're in the right environment and feel relaxed and happy then they are much more likely to make a quicker recovery when I admit a child now I make sure I know exactly what it eats and drinks what it drinks out of which is so important to try make the mother feel relaxed is another important thing so that you get out of her all the strange little things like the food I mean any vegetables none at all none at all Alice uh except chips and potato roast potatoes and cold boiled potatoes not H and chips it's the same with the little things that they have their little cuddly bits and pieces I mean some of them have the most strange sort of odd bits of Mother's nties and things that get ferly brought out of shopping bags [Applause] it's much easier to get the child to do what you want if you have the parents there and or the brothers and sisters you don't have to have special rooms for mothers to sleep in we do put up camp beds in the ward and we can always find space for mothers or fathers to sleep there's usually beds we can borrow from somewhere for them we never have to refuse a parent a bit Coke what Coke a Coke how about a milkshake I thank you come on then let's have a nice big b from you John how you do it that's it come on in mate [Music] [Music] the ward atmosphere should be as relaxed as possible and one tries to treat them as near as possible to the way the mothers treat them at home the child should never be made to feel that he or she has to stay in bed or that they have to get up and about in the daytime in the end it comes down to this pediatric nursing is a very different thing from adult nursing and when one's caring for a child and's not caring for that child only but the whole family and children should not be isolated from their family Alice weed is a three-year-old girl was admitted this evening she is a little girl who has Wheezy attacks she's had several admissions here before um she's had one dose of sbal V the nebulizer and she's a lot better and she's on a mock sill and she's drinking fairly well um her pulse and respirations are a little bit elevated if you could record them hourly overnight and her her temperature is normal but if you could record that 4 hourly mother is living in with with her she's going to sleep in a bed beside her in the ward we'd like a um an MSU from Alice in the morning if possible she's got a a sheep skin rug there which she always carries around with her so cuddly um Toby Ford was admitted at um 6:30 this evening he's a 5-year-old boy he ran into another child at school and banged his head and um was s to possibly be knocked out he hasn't got a fracture he vomited a lot of times he hasn't vomited since submission and his observations are all quite normal um so he can have clear fluids and if you could do hourly neurological observations on him please he seems to settled down quite well Wayne Langley is 14 months old he came in on the 21st with an upper respiratory tract infection and pyrexia and he's had these infections off and on for several weeks um mother also pointed out that he than