Pediatric Psychologists Help to Protect Resilience of Children and Families During Inpatient Admissions

By Monica Agoston, PhD, ABPP and Naadira C. Upshaw, PsyD 
Atlanta Behavioral Health Advocates

Bouncing back from a hospitalization is extremely difficult for families. Often providers within a hospital setting do not see the lasting effects on families after they leave the inpatient environment.  Protecting a child and family’s resilience is critical in promoting healing in the context of stress secondary to a hospitalization, as well as in facilitating effective community, home, and school re-integration. Regardless of the reason for a child’s hospitalization (whether for acute/chronic illness or injury), the often unexpected and arduous nature of an admission has the potential to significantly impact a child’s and/or family’s emotional health during admission and beyond discharge. Protecting resilience is especially important for families who experience repeated admissions throughout a child’s life. For these families, stress of repeated admissions becomes chronic and can begin having a significant negative impact on physical health.
As pediatric psychologists, we often work with medical teams to advocate for supporting key areas of resiliency during an admission. We utilize a framework that incorporates understanding of how a child’s medical concerns impact other areas of functioning (e.g., emotional, social, familial, academic, or behavioral). An imperative and often understated aspect of our job is to help medical teams foster environments that are conducive to promoting resiliency and healing with the goal of buffering the deleterious impact of a hospital admission.
An approach developed in the NICU for developmental care¹ outlines areas of resiliency that are applicable for patients of any age: a healing environment, protected sleep, pain and stress management, activities of daily living, and family collaborative care.  Pediatric psychologists have a unique opportunity to provide advocacy within a pediatric medical setting to promote resiliency for our patients and their families.

A healing environment for families is crucial in promoting resilience and supporting a child’s recovery from an acute/chronic illness or injury. To facilitate this, we educate nursing staff on trying to keep the lights off as much as possible during the night and naptime, keeping lights on and blinds open during the day to encourage wakefulness, keeping noise to a minimum, and providing children with developmentally appropriate toys to engage them in play and distraction. We also educate families on ways they can support a calm, soothing environment for their children during hospitalization and after discharge. Families often welcome a chance to take ownership of an area of their child’s health during an admission in which many aspects of their child’s care may feel out of their control.

Protected sleep is one of the most important elements for healing and one of the most difficult to achieve in a hospital environment. As pediatric psychologists, we often collaborate with Child Life to set daily schedules, including a regular bed times and wake up times.  We also educate nursing staff on the importance of sleep and brainstorm together ways to modify care that may reduce the number of interruptions during nighttime hours. We encourage limiting the amount of vitals taken at night if possible, as well as grouping medication administration with vitals. The use of electronics is an area in which we try to tread carefully. While these devices can be helpful for distraction and coping during the daytime, we strongly encourage limiting their availability and access at night. For children with difficulty initiating sleep (which can occur for a variety of reasons, e.g., pain, discomfort in an unfamiliar environment), we often encourage teams to consider the use of medications if the team feels like it is medically appropriate.

Advocating for appropriate pain and stress management for children is also imperative, particularly at a time when awareness of the dangers of opioids has been brought to national attention and the use of opioid medications has been significantly restricted. Teaching patients non-pharmacological pain and stress management strategies like deep breathing, imagery, and distraction help improve a child’s overall well-being, gives them a sense of control over their pain and stress, and often helps them more fully engage in physical and occupational therapies.  We frequently push for a functional assessment of a child’s pain while also recognizing pain numbers are a critical aspect of a nurse’s care requirements. Families are also encouraged to advocate for appropriate pain management, such as providing numbing cream or cold spray to children before a blood draw. Mothers are also encouraged to breastfeed babies during a needle stick. Our goal is to educate families and nursing staff on the importance of using pain management techniques during any procedure, no matter how small.

Engaging in activities of daily living often speeds up healing in the hospital environment. Pediatric psychologists frequently co-treat patients with physical and occupational therapists to support use of coping skills while achieving difficult milestones, such as brushing teeth or getting out of bed for the first time after surgery. Teaching children coping skills to manage difficult tasks enables them to meet milestones more quickly and may lead to a shorter hospital stay.

Finally, collaboration and engagement with families is essential to ensure families understand the plan of care and that they continue to be able to support their child’s needs after discharge.  We consistently encourage self-care for families with the goal of improving their ability to take care of their children. As pediatric psychologists, we often develop strong rapport with family members and they often bring up issues they would not normally bring up with the medical team. We have the opportunity to act as liaisons with teams for concerns brought up about a child’s care, which can be incorporated into a more effective care plan.
In summary, pediatric psychologists have a unique opportunity to advocate for the protection of these core areas (a healing environment, protected sleep, pain and stress management, activities of daily living, and family collaborative care) to promote resiliency during a very stressful experience for children and families. What other areas would you like to have advocated for in pediatric medical settings? Talk to us in the comments!


Reference:

1. Coughlin, M., Gibbins, S., & Hoath, S. (2009). Core measures for developmentally supportive care in neonatal intensive care units: Theory, precedence and practice. Journal of Advanced Nursing, 65, 2239-2248.