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One Voice

The hospital setting is a scary place. Kids are in an unfamiliar place with strange equipment. There are several people who sometimes do scary and painful things. Their routine is interrupted, and they often have very few choices about what happens to them. Is there anything we can do to help?

The purpose of the ONE VOICE campaign is to remind healthcare professionals to be considerate of the clinical environment that we expose children to during medical procedures. Each of the letters stands for one component of the environment that we need to remember.

  • O One voice should be heard during the procedure:

    • One person should be designated to do the speaking during a procedure. It can be the CLS, a nurse, the parent, child care partner etc.
    • Hearing more than one voice can be confusing and chaotic. Each person has to speak louder to become heard, which leads to an increased noise level. For example: imagine you're at a party and you have several people talking to you at the same time. How hard is it to concentrate on what one person is saying to you. Now imagine that you are three or four years old, you are having an IV started and everyone is talking to you at the same time.
    • Any additional conversation that needs to take place, needs to be kept at a very low volume (ie., having difficulty finding a vein, asking for assistance from another staff etc.)
    • It's OK for the parents to be a second voice of comfort to a child as long as it is not disruptive.

  • N Need for parental involvement:
    • Parents are the most important people in a child's world, they NEED to be present
    • Parents should be given a specific task/role during the procedure when appropriate ie., verbally console child, give child a hug etc.

  • E Educate the patient before the procedure about what is going to happen:
    • Utilize Child Life to provide teaching to patients of all ages.
    • If Child Life is not available to you, utilize simple, non-threatening words (hand out Considerations in Choosing Language).
    • They need to know what is expected of them i.e., "You need to hold your hand really still" "It's OK to cry or say OUCH, but you need to hold your hand still". Children really try to do their best. If they understand that holding their hand still will make it better for them, and will make it go faster, they will do their best.

  • V Validate a child with your words.
    • Target specific behaviors and always keep it in the positive. "You're doing such a good job holding still", "I like the way you're telling me you're angry", "It's not Ok to hit, but you can yell ouch".

  • O Offer the most comfortable, non-threatening position.
    • Utilize Positioning for Comfort holds. Laying down is the most threatening position to a child.
    • When you lay a child down, they automatically fight to sit up…let's take away one of the reasons they fight us, just because we can…and because it helps.

  • I Individualize your game plan.
    • Each child is different and each situation is different. Often the same child will react differently from one procedure to the next, even if it's the same procedure.
    • You will develop a certain style that is comfortable for you, just remember you may need to adapt it to best meet the needs of each of our patients.

  • C Choose appropriate distraction
    • Offer a child choices for distraction, bubbles, books, music, toys before you start the procedure.
    • Although we can't make the "ouch" not hurt (unless EMLA is used) there is almost always a point when a child wants and needs to be distracted.< /li >< /li >< /li >< /li >< /li >

  • E Eliminate unnecessary staff who are not actively involved with the procedure.
    • Make sure that only people who are actively involved in the procedure are in the room. If you think you may need an extra set of hands, have them wait outside the room and call them in if needed.
    • Even if all the people in the room are not going to be doing anything to the child, it is still very frightening. A 3-year-old may not believe that the extra people are not a threat to them.
    • An older child may feel very self-conscious. Kids always do their best to cope and to try to please adults. If they don't feel they are successful at coping, it may be especially embarrassing if there are a lot of people present.
    • We understand this is a teaching hospital and that students need to learn…there are ways of making it less threatening for our patients. Again, have extra people stand outside until perhaps maybe a more appropriate time to come in and observe, (after pt is sedated or when they are unable to see all the students observing). At times, it may be necessary to have only 1-2 students observe at a time.
    • No ONE person is in charge of kicking out extra people…our hope is that this will be a "self-regulated" practice.