The therapeutic use of distraction is one of the most remarkable skills a critical care nurse can use when caring for paediatric patients. The emergency department can be an austere environment for any patient with its florescent lighting and vague antiseptic smell. Added to this the common association between the ED and some previously experienced trauma, it can be difficult to settle children into the setting and instil the sense of calm they often desperately need. Distraction is a well-validated method of reducing not only anxiety in the ED setting, but also procedural pain (Wente, 2013).
Given my own experience in the emergency environment, I understand clearly that the most comforting and familiar aspect of the ED environment are generally the people working there. However, for many children the association between the scrubs and the smell of industrially cleaned linen is just too strong to let them look beyond the uniform to the person trying desperately to reassure them. In my experience, this is the perfect time for distraction. By absorbing the child into something they do not associate with the scary hospital, you allow them to associate you with something else as well – something fun!
There are many excellent ways to include therapeutic distraction into your work with sick kids. Many departments have fabulous initiatives like clown doctors or play therapists – these work wonders, but take resources and perhaps more importantly, take time to locate. For this reason, I favour the quick and quirky use of guerrilla ‘distraction tools’. These tools can be colouring books or stuffed toys if you are lucky enough to have them handy – if these things aren’t always available in your ED, never fear, the perfect tool is often more ‘handy’ than you think.
The simple examination glove can be put to great use as a makeshift distraction tool that is always available, regardless of your situation. My favourite trick is to inflate the glove, tie off the end and use a permanent marker to create some kind of ‘character’ to entertain the patient. Given the limitations of the examination glove (i.e. the 5 fingers), there are certain shapes / characters that are more accessible than others.
While the fork arms of the t-rex may not be very child friendly, they can easily be substituted for straws (it just didn’t look as cool for demonstration purposes). The elephant is one of my favourite ‘go-to’ shapes, you just tie off the glove at the wrist and then tie the 4th finger to the 5th and the 2nd finger to the 3rd (making tiny little legs).
For the more advanced clinician (or regressed depending on your perspective), you may encounter some situations where gloves just don’t cut it. In these cases, the only barrier to getting a giggle is your imagination…
While I am not encouraging the reckless destruction of hospital consumables, gloves are in fact quite cheap, so don’t be afraid to give these a shot in your work with sick kids. Realistically, if you stuff it up they will probably laugh even more!
Reference:
Wente, S. J. K. (2013). Non-pharmacological pediatric pain management in emergency departments: a systematic review of the literature. Journal of Emergency Nursing; 39(2): 140-150.