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PSYCHOLOGICAL AND PSYCHIATRIC
SERVICES Every child who is admitted to Shriners Hospital can be expected to experience psychological distress and to demonstrate symptoms of that distress. The psychological, as well as the physical condition must be addressed from the time of admission of the patient in order to promote recovery. The acutely burned child's distress is both physical and psychological. Common reactions of children in this situation are fear, anxiety, acute stress disorder and, of course, expressions of pain. Issues of body image, social relations and self-concept will arise as the child progresses toward discharge from the acute care setting. It is not uncommon for the acutely burned child to have experienced great losses in addition to their injury; for example, children may have lost a parent, a sibling, their home or a beloved pet in the catastrophe that caused their own injuries. They must be told of such losses and assisted in grieving even while continuing to struggle with the discomfort of recovery and rehabilitation. The family of the burned child is also greatly impacted by the injury to the child. They are traumatized and grieving and feeling extreme guilt, usually irrational. They, too, can be expected to exhibit symptoms of trauma. They, too, are our 'patients', for we need them to be healthy assets to the recovery of the child. Shriners Burns Hospital has a staff of mental health experts who follow every child and family from the time of admission to eventual discharge from the Shriners system - i.e. through the acute admission, as outpatients during clinic visits, and through subsequent admissions until the child is 21 years old or no longer needs our services. There is no need to write a consult for these services for they are provided routinely for every patient. However, there is a need for the psychology-psychiatry team to hear of any observations made by other staff on an on-going basis.
Clinical Services We also have 1 or more psychology residents at any given time. A full-time school teacher provides schooling for every school-aged child as soon as they are able to participate, either at bedside or in the classroom on the 4th floor. Additionally, a professional counselor works mostly with clinical research, but will occasionally be involved clinically with a patient or family.
Resident's Role: If you observe indicators of abuse, tell us. You, and we, must report suspicious injuries and protect the child. You must order a long bone series x-ray and be sure that signs of abuse are documented in your notes and by photographs. If we contact DPRS, we ask you to complete the Physician's Report of Suspicious Injury form. If we report a suspicious injury, we must not discharge the child until DPRS gives the 'okay'.
Resident's Role: For both the patient and the patient's family, you are likely to see signs of emotional distress and behaviors that have the potential to escalate into a crisis situation. Symptoms of depression and anxiety (notably Acute Stress Disorder) are most common. Common signs of distress include, but are not limited to: tears, withdrawal, sleep disturbance, agitation, refusing treatment plan, yelling, grinding teeth, verbalization of hopelessness, denial of disfigurement, expressed fears, short temper, anger, hypervigilance (in general and in seeking information about child's care), nightmares, flashbacks. You should hunt for emotional distress in the same manner you would hunt for any anomaly in physical function. Note your observation to the patient or parent. Express your interest/concern through queries. If distress is present and you wonder if further intervention may help, call the assigned mental health professional or call x6718 and state the name of the child for whom you are concerned.
Clinical Research Resident's Role: Parents will likely ask you about the NIDRR studies, so be aware of the study, know that research protocols are available to you on the unit, and call for any questions or assistance in responding to parent or child queries/concerns: x6715 -or- x6718.
Resident's Role: As you spend a great amount of time with the patients and their families and are involved with the most painful of interventions, you can be most effective in assessing and treating the patient's pain. With the infant and children up to the age of 3, the patient's pain is assessed by the Observer Pain Scale with the primary caregiver being the reporter. Ask the parent to assess pain in each of these 4 environments: 1) when your child is lying or sitting and his/her wounds are fully dressed, how much pain do you imagine he/she is in?; 2) during the bath, how much pain do you believe your child is in?; 3) during dressing changes in the hospital room,........; 4) during the rehab. exercises, ......... Elicit from the parent what behaviors of the child contribute to his/her assessment, e.g. flailing of limbs, rigid extension of limbs, lack of cooing, developmentally regressed behavior, type of cry or whimper, lack of interest in toys, changes in indicators of symptomatic function (blood pressure, pulse, temperature), repetitive or stereotypic behavior. For the children 4-8 years of age or greater, the Faces of Pain Scale is utilized, and the patient is the reporter. Assess pain for the same 4 environments. Also, when addressing pain, a good habit is to inquire about quality and amount of sleep, especially nightmares, and level of itching.
And finally, we are always on call and serve a liaison service to you. If you have any hint of a concern or any question, please dial x6722 or ask the unit clerk to page us.
Next - Nursing Service Resident Orientation
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Staff: Clinical
Psychologist