Certified Child Life Specialists Research Articles

An examination of compassion fatigue risk in certified child life specialists

ABSTRACTCertified child life specialists (CCLSs) provide psychosocial interventions for children and families to manage potentially traumatic experiences in health care settings. Research on related professions indicates engaging in therapeutic relationships in high stress environments may place workers at risk for compassion fatigue. Results of an online survey using the Professional Quality of Life (ProQOL-5), completed by 154 CCLSs, showed that compassion fatigue risk in CCLSs was comparable to other helping professions. This risk was lower with peer support to debrief after patient fatality, and higher when working in intensive care and hematology/oncology units. Findings suggest need for compassion fatigue prevention, early identification, and support resources for CCLSs.

Mandatory Child Life Consultation and Its Impact on Pediatric MRI Workflow in an Academic Medical Center

Pediatric patients undergoing MRI often require general anesthesia, which may improve image quality but is associated with significant medical risk and economic cost. It has previously been shown that certified child life specialists using high-tech interventions (eg, MRI-compatible video goggles) significantly reduce the number of pediatric MRI patients who require sedation. Most imaging centers lack such technology, however, and it remains unclear whether simpler and less costly child life interventions may be equally effective in avoiding general anesthesia. The aim of this study was to assess the impact of requiring mandatory child life evaluation for all patients aged 5 to 18 years undergoing MRI before referral for general anesthesia. Inserting this simple step into the scheduling workflow significantly reduced the use of general anesthesia in this population: general anesthesia was required in 564 of 2,433 MRI cases during the 1-year baseline period compared with 484 of 2,526 cases during the 1-year intervention period (P < .01 by z test for proportions; absolute reduction, 4.0%; relative reduction, 14.8%). The authors estimate that instituting mandatory child life evaluation avoided the use of general anesthesia in approximately 102 patients during the intervention period. Further subgroup analysis revealed that avoidance of general anesthesia was highly significant in the 5- to 10-year-old age group, whereas those aged 11 to 18 years experienced only a trend toward modestly decreased use of general anesthesia. These results suggest that mandatory evaluation for standard child life interventions is a worthwhile step that can save many children from unnecessary exposure to the risks, cost, and inconvenience of general anesthesia.

A randomized controlled trial: child life services in pediatric imaging.

Children undergoing procedures in pediatric health care facilities and their families have been shown to benefit from psychosocial services and interventions such as those provided by a Certified Child Life Specialist (CCLS). The comprehensive impact of a CCLS in a pediatric imaging department is well recognized anecdotally but has not been examined in a prospective or randomized controlled fashion. We prospectively assessed the impact of a CCLS on parent satisfaction, staff satisfaction, child satisfaction, and parent and staff perceptions of child pain and distress in a pediatric imaging department. Eligible children between 1 and 12 years of age (n = 137) presenting to the pediatric imaging department for an imaging procedure were randomly assigned to an intervention or control arm. Those assigned to the intervention received the comprehensive services of a CCLS. The control group received standard of care, which did not include any child life services. Quantitative measures of satisfaction and perception of child pain and distress were assessed by parents and staff using a written 5-point Likert scale questionnaire after the imaging procedure. Children 4 and older were asked to answer 3 questions on a 3-point scale. Statistically significant differences between the intervention and control groups were found in 19 out of 24 measures. Parents in the intervention group indicated higher satisfaction and a lower perception of their child's pain and distress. Staff in the intervention group indicated greater child cooperation and a lower perception of the child's pain and distress. Children in the intervention group indicated a better overall experience and less fear than those in the control group. Child life specialists have a quantifiably positive impact on the care of children in imaging departments. Measures of parent satisfaction, staff satisfaction, child satisfaction, child pain and child distress are shown to be positively impacted by the services of a CCLS. These results have significant implications for hospitals striving to increase satisfaction, decrease costs and improve quality of care. In a health care landscape that is changing quickly and increasingly focused on the cost of care, future research should assess whether the core tenants of the child life profession support and contribute quantifiably to high-quality, cost-effective practices in health care.

Collaborating for Family‐Centered Care: Integrating Child Life Specialists in the Prenatal Setting

<h2>Newborn Care Poster Presentation</h2><h3>Purpose for the Program</h3> Le Bonheur Fetal Center opened in September 2009 to provide comprehensive care for women who had received a prenatal diagnosis of a congenital anomaly. After a generic request for child life staff to supervise the children of expectant mothers during their mother's ultrasound examinations, the child life team saw the need for more specialized psychosocial services for the expectant family. A certified child life specialist with prior experience in program development was assigned to the fetal center to assess the needs and initiate services. <h3>Proposed Change</h3> To more closely examine the psychosocial care provided to this population and ways in which all the disciplines could be utilized to provide support as needed for each unique family. <h3>Implementation, Outcomes, and Evaluation</h3> We discuss collaboration that begins in the fetal center during obstetric visits, moves into labor and delivery at the nearby adult facility, and then follows with entry into the pediatric hospital. During this journey, families trust that all team members are working together to care for their child. To assist in the multiple transitions, child life specialists, in collaboration with nurses, aim to support the expectant family by providing preparation, emotional support, sibling preparation, parental coaching, and bereavement support when necessary. Success is totally reliant upon ongoing communication between all team members and the desire to always do what is best for that family in their unique situation. The literature reveals that a prenatal diagnosis results in anxiety, grief, and uncertainty for the entire family. Whether a prenatal diagnosis is relatively minor or a lethal anomaly, ongoing multidisciplinary collaboration allows for individualized care and best practice to be provided for this population. Case studies will illustrate this collaboration. <h3>Implications for Nursing Practice</h3> Though nurses and child life specialists have worked closely to develop the communication and collaboration needed to successfully meet the psychosocial care of these patients, all specialties can gain further understanding and respect for the need for psychosocial care in the medical treatment of any population. It should be encouraged to consider if all the disciplines within an institution are being used to their best potential in collaborative efforts to provide patient‐ and family‐centered care. Though high‐risk obstetrics is not a population found in every healthcare setting and child life specialists are not staffed in every institution, the lessons learned from collaboration and communication in patient‐ and family‐centered care can be benefited by all healthcare providers.

Retrospective Analysis of a Pediatric Vascular Access Program and Clinical Outcomes

BackgroundThe specialty of pediatric vascular access has grown rapidly during the past 5 years across the United States. The majority of children's hospitals have nurse-led vascular access teams that are providing comprehensive services, including the placement of peripherally inserted central catheters. A children's hospital in the southeastern United States conducted an Internal Review Board approved, retrospective analysis of 669 patients who had a peripherally inserted central catheter placed. ObjectiveThe objective was to have a better understanding of the program and clinical outcomes as well as identify areas for improvement. MethodsA data collection tool was developed to review the medical records of patients receiving a peripherally inserted central catheter from January 2009 through June 2011. Variables of interest included patient age, admitting diagnosis, intended therapy, procedure location, sedation type and usage, procedure success, insertion attempts, vessel selected, catheter size and type, catheter tip location, reason for discontinuation, and infection. The data was collected and analyzed by a nurse researcher from the University of South Florida. ResultsUsing the Modified Seldinger Technique and ultrasound, the team inserted a full line of polyurethane catheters, including computed tomography-injectable catheters, with an insertion success rate of 94%. We identified a significant reduction in our hospital's infection rate—from 9.12 per 1,000 catheter line days to 2.0 per 1,000 catheter line days—during the first year and a half of the program. The use of sedation and anesthesia was significantly reduced, with 49% of patients receiving an oral anxiolytic dose of midazolam and the integration of certified child life specialists into the procedure. ConclusionsPediatric vascular access is a rapidly growing specialty in nursing. Nurse-led vascular access teams have become commonplace in children's hospitals throughout the United States. Although the specialty has grown rapidly during the past 5 years, there is a need for data sharing to contribute to the knowledge base of pediatric vascular access.

Helping Children Say Goodbye to Loved Ones in Adult and Pediatric Intensive Care Units: Certified Child Life Specialist—Critical Care Nurse Partnership

Helping Children Say Goodbye to Loved Ones in Adult and Pediatric Intensive Care Units: Certified Child Life Specialist—Critical Care Nurse Partnership

The Importance of Child Life and Pain Management DuringVascular Access Procedures in Pediatrics

The author asks of the reader: Have you ever been called to start a peripheral intravenous (IV) catheter or place a peripherally inserted central catheter (PICC) in a child, and you wished someone else could do it? Performing vascular access procedures on children is considered by many one of the most stressful and difficult jobs. This article discusses the role of certified child life specialists (CCLSs) and some of the techniques used to assist children in coping with painful procedures as well as the necessity for proper assessment and pain management. The goal of this article is to eliminate the uncertainty of performing these procedures on pediatric patients. By making a few changes in your practice, one could dramatically increase successful outcomes and improve the overall quality of care provided to the patient.

Child Life Intervention During Angiocatheter Insertion in the Pediatric Emergency Department

Current literature is deficient regarding the scope of procedures for which certified child life specialist (CCLS) services are effective in the pediatric emergency department. The purpose of this study is to analyze the effect of CCLS intervention during routine peripheral venous angiocatheter insertion on child procedure-related distress. Eligible children were aged 2 to 16 years. Subjects were randomly assigned to CCLS intervention or standard care. The Observation Scale of Behavior Distress-revised (OSBD-r) [J Pediatr Psychol 12 (1987) 543] was recorded during the procedure. Secondary outcomes included child and parent State Trait Anxiety Inventories [Manual for the State-Trait Anxiety Inventory (1973) and Manual for the State-Trait Anxiety Inventory for Children (1973)] and an adapted parent customer satisfaction survey [Eval Program Plann 5 (1982) 233; Eval Program Plann 6 (1983) 299; and J Paediatr Child Health 31 (1995) 435]. Explanatory and intention-to-treat analyses were performed. One hundred forty-nine children completed the study. Although there was no statistical difference in mean total OSBD-r in the intention-to-treat analysis, the mean difference of 0.61 OSBD units (95% confidence interval, 0.04-1.19) in the anticipation phase in the 4- to 7-year age group was statistically significant. When the patients with only 1 insertion attempt were analyzed (n = 121), the total OSBD-r, anticipation, and preparation phase differences were statistically significant in the intention-to-treat analysis. In the explanatory analysis (n = 138), a mean significant difference in total OSBD-r score of 1.80 (95% confidence interval, 0.19-3.42) was found. There were no significant differences in child or parent anxiety or customer satisfaction between groups. CCLS intervention may reduce the behavioral stress associated with angiocatheter insertion, especially in children aged 4 to 7 years. These data further support the role of the CCLS as a patient and family advocate during routine procedures.

The role of a child life specialist in a pediatric radiology department.

Child life programming is predominantly developed in inpatient areas throughout major pediatric hospitals. However, the trend toward outpatient services has increased the need for facilities to develop child life positions to assist in the teaching demands of patients and families coming in for routine hospital visits. Since radiology is often the first experience for families, but not the last, it is essential to involve them in a positive experience. Imaging facilities serving pediatric patients are currently developing or considering child life programs. A certified child life specialist (CCLS) is committed to developing programming that enhances the child's understanding and involvement in their medical experience. This paper provides an outline of the responsibilities and areas of expertise of the CCLS in a pediatric radiology department. The reviewed program is based on, but not limited, to fluoroscopy.

What's in a name? Child life and the play lady legacy.

Child life specialists can now earn a nationally recognized credential as a "Certified Child Life Specialist" from the Child Life Certifying Commission. Yet, uncertainties linger about the nature of the child life specialist's identity, roles, and status among health care professionals. This article highlights the historical contexts within which a series of significant changes occurred in the profession's name. How Emma Plank and Thesi Bergmann, two pioneering authors in the field, influenced and were influenced by the play lady legacy is shown, and recommendations are made to find ways to honor the profession's past, while addressing the challenges of the 1990s.