V is for Volition

continued from page 1 child who is upset about a scary procedure in a novel environment, someone working to divert their attention may add another layer of stimulation, and also stress. In addition, not all procedural distress is due to the procedure itself, but to other factors not addressed by distraction, such as not being able to see what’s going on or from having body parts exposed. In such cases, the distraction is additional “noise.” Automatically providing distraction robs us of the opportunity to find out what is uniquely challenging to each patient and family at that time and to address those concerns appropriately.

Finally, the term “distraction” cheapens what we do as child life specialists. “Distraction” sounds like something that can be done by anyone with a bottle of bubbles or an iPad. Even a robot can “do distraction” (Beran, Ramirez-Serrano, Vanderkooi, & Kuhn, 2013). If we want our colleagues to respect our skills, we need to use language that accurately describes what we are capable of doing.

Using planned alternate focus employs the child’s active volition, therefore empowering the child. The power that comes from choosing how and when to be supported engenders mastery and ownership of the process of coping through a procedure. Some children may prefer to pay attention to the sequence and details of the event, and distraction would not serve them well. Others may want to attend elsewhere just during the hard parts, and some may prefer to fully engage in a different activity of their choice throughout the entire procedure. In each case, the child benefits from taking the lead in planning how to be supported.

• The influence of child life specialist run playrooms versus those staffed by volunteers/CLAs/and interns. What is the difference in the patient/child/sibling experience? How can this be measured?

• Research on how programs go about establishing procedure-free zones in their playrooms.

Planned alternate focus takes more time than choosing an appropriate distraction item, but even with as little time as it takes for medical staff to prepare, a child life specialist can assess the child’s knowledge and coping preferences for all or specific parts of the procedure, and what kind of diversional strategies they would prefer to use. With the luxury of time, extended psychological preparation and rehearsal of coping strategies are ideal.

The skill of a child life specialist isn’t in choosing the best distraction objects, but in the flexibility with which we can use our presence and degree to which we can engage and support the child in a way that empowers them as the patient. Planned alternate focus employs our skills and empowers the children and families in our care, helping them to gain mastery that will serve them well in future challenges.

References

Beran, T. N., Ramirez-Serrano, A., Vanderkooi, O. G., & Kuhn, S. (2013). Reducing children’s pain and distress towards flu vaccinations: A novel and effective application of humanoid robotics. Vaccine, 31(25), 2272-2277.