PSYC 450 Week 4 Site Visit Journal 1 Example

Site Visit Journal 1: Watching a Child Life Specialist Prepare a Seven-Year-Old for Surgery Through Medical Play

Setting and Hours

I completed my first five observation hours on two Saturday mornings in the pediatric day surgery unit of a regional children's hospital, shadowing a certified child life specialist I will call Ms. Dana. The unit sees children for short procedures such as tonsillectomies, ear tubes and hernia repairs, most of whom go home the same day. Ms. Dana sees each child in the preoperative area, usually with only twenty to thirty minutes before the child goes back. Before each visit she checks the schedule, reads a short note from the nurse about the child's age and any past hospital experiences and decides which materials to bring. On my first morning she saw nine children, ranging from a toddler to a sixteen-year-old, and no two sessions looked the same.

The Preparation Session

The interaction I want to describe involved a seven-year-old I will call Lily, scheduled for ear tubes and removal of her adenoids. When Ms. Dana entered, Lily was hiding behind her mother's chair. Ms. Dana did not approach her directly. She sat on the floor, opened a bag and pulled out a cloth doll, a small hospital gown, an ID bracelet and a real anesthesia mask. She said, "This is Sam. Sam is having the same thing as you today. Can you help me get Sam ready?"

Lily watched for a minute and then came closer. Ms. Dana let her put the bracelet and gown on the doll. Next she opened a photo book showing the hallway, the operating room, the bed with its bright lights and the recovery room where Lily's mother would meet her. She explained that Lily would breathe through a mask that smelled a little funny and then fall into "a special sleep that doctors watch very carefully," and that she would not feel anything. Lily chose a strawberry scent to rub inside the mask. By the end, Lily placed the mask on Sam's face herself and told him, "It's just air. You'll be okay," using almost the same words Ms. Dana had used.

Connections to Course Material

Several course concepts appeared in those twenty minutes. Rollins et al. (2018) emphasize that young children may misunderstand medical events and that preparation should match their developmental level. Ms. Dana avoided words like "cut" and "put to sleep," which a seven-year-old might take literally, and she used concrete materials rather than explanations alone. The doll let Lily rehearse the experience from a position of control, which the textbook describes as one of play's central functions in health care. The Child Life Council (2011) describes the profession's role as reducing the negative effects of health care experiences through play, preparation and education, and this session was a clear example.

The research supports what I saw. Li et al. (2007) randomly assigned 203 children having day surgery to therapeutic play or to routine information. Children who received therapeutic play reported lower anxiety before and after surgery and showed fewer negative emotions at induction of anesthesia, although postoperative pain did not differ between groups. That last finding reminded me that preparation is not a substitute for good pain management.

Reflection

I was surprised by how much Ms. Dana accomplished by not hurrying. My instinct would have been to talk to Lily right away; instead she let the doll do the introducing. I also noticed how much Lily's mother relaxed once Lily started playing. I also felt uneasy at one point, when a resident came in mid-session to ask Lily's mother a question and Lily retreated behind the chair again; Ms. Dana simply waited and started over with the doll. For my next visit, I want to watch how Ms. Dana adapts preparation for older children and teenagers, who may find a doll babyish.

References

Child Life Council. (2011). The official documents of the Child Life Council.

Li, H. C. W., Lopez, V., & Lee, T. L. I. (2007). Effects of preoperative therapeutic play on outcomes of school-age children undergoing day surgery. Research in Nursing & Health, 30(3), 320-332. https://doi.org/10.1002/nur.20191

Rollins, J. H., Bolig, R., & Mahan, C. C. (Eds.). (2018). Meeting children's psychosocial needs across the health-care continuum (2nd ed.). PRO-ED.