Can art be of help in a Paediatric ICU?
How to manage the emotional impact of being hospitalised in an ICU on a child and his or her family?
A few months ago, we began a process of work with a group of nurses from the Paediatric Intensive Care Unit of the Nuestra Señora La Candelaria Hospital in Tenerife.. Our aim is to help them shape their own intuition: children who are hospitalised in a paediatric ICU and their families suffer from stress and anxiety during their stay in hospital.
Despite the heterogeneity of the ailments and of the relatives, there is one constant that is repeated: unfortunately, the lack of resources in the hospital (there are no child psychologists and the few psychologists there are are saturated and only assist in extremely serious cases such as an accident with serious consequences, a very incapacitating illness, etc.) pushes the nursing staff to take charge of the emotional situation of the patients and their relatives.
We chat with Quique Chinea Navarro, one of the members of the nursing team that forms part of the group - together with Severiano Torres Negrín, Liliana Quintero Sánchez, Ruyman Miranda Morales and Laura León Remedios - of Comitentes (We call Comitentes a group of citizens who, with the help of mediation - carried out in this case by ZEMOS98 - organise themselves in order to formulate a commission that will be “translated” and produced by an artist and which aims to help solve the problem they have.).
“A few years ago we realised that we needed something to help us manage the emotional impact of being hospitalised for these children and their families. But we didn't want to do a typical brochure. We want something more creative,” explains Quique. Their current goal is to document those everyday situations in which both patients and families are under emotional stress, in order to identify which are the most common and see what kind of artistic process can best address the challenges involved. They are also looking for bibliographical references and other professionals with whom to organise a working conference in autumn to share experiences and compare methods.
The work of the nursing staff in the Paediatric Intensive Care Unit of the Nuestra Señora la Candelaria Hospital in Tenerife goes far beyond a mere task strictly related to nursing: without specialised knowledge, they work as psychologists for hospitalised children and their families, as teachers who teach them about body and health care, as clowns who entertain and make children laugh when they are having a hard time.. Sometimes they even act as fathers, mothers or friends in their absence.
Unfortunately, the crisis or the evolution of medical institutions has not been able to prioritise resources to ensure that qualified and specialised people take on these tasks. So we are faced with a group of people who, as the ones who spend the most time with patients and families, play a crucial role in the physical and mental care of hospitalised people. “We always try to put ourselves in the place of the families and children. As soon as we come into contact with them, our work begins. Obviously the priority is the patient's health and the techniques we have to put them through. But from the very first minute we are trying to make them feel comfortable. The paediatric ICU is a hostile environment for a normal citizen and part of our job is to make it friendlier,” adds Quique Chinea.
It is not always easy: “As is normal, there are many situations in which our work encounters obstacles. There are families who are very collaborative and understand that we are there to help. But there are other times when nerves or stress make parents ask us about almost everything we do to the children. And sometimes there is no time to explain it properly because the urgency and priority is to carry out a certain technique”.”
On other occasions the situation is even more serious: single mothers or families who do not have extra help to care for their other children have to be absent and leave hospitalised children unaccompanied. In these cases, the emotional bond between nurses and children becomes even more essential: “I think we all have our tricks and we try to connect with the children. Sometimes, for those of us who have children, it can be easier to empathise with parents and connect with younger children. But in general, I think we all make an effort to minimise the stress and anxiety of being there. The problem is that there is no single approach: ”You make your own manual. You know that if it's a child of 4 or 5 years old, you can talk about the Canine Patrol. And if it's a teenager, we ask them about Fortnite“.
In the Paediatric ICU, children from 10 days old to 16 years old generally (sometimes even up to 18 years old) are cared for, so the range of strategies to gain the trust of families and children is quite wide. The hospital itself, at the request of nursing staff and other professionals, has been trying to create a friendlier environment: “In our case, we have stickers of little animals on the ceiling, our uniforms are not those of the rest of the hospital but have children's motifs, the electrodes of the little ones have kittens or puppies, among others”. But, as Quique explains, there are times when only the imagination and inventiveness of the nursing staff is capable of coping with a stressful situation: “For children with respiratory problems who have to wear a mask, we make up a story in which they are the protagonists and we tell them they are a superhero or an astronaut who is about to carry out a very important mission”.
In the end, it is a question of persuasion in which children and/or families have to be convinced of the importance of undergoing the necessary techniques for their health care. What happens is that resistance is not always overcome.
“There are times when parents choose to portray us as the bad guys, telling the child that if they don't listen to us we will end up poking them or that we are going to get angry. Even if they mean well, that is a mistake. We are there to help them and they need to see us as an ally, not an enemy. Other times it is the parents themselves who are the most resistant. And that's when you discover the importance of everything a relative can bring ”from home‘: ’There have been nights when, work permitting, we can spend hours chatting with a relative.
«In the end, they tell you about their lives, they unburden themselves, they release tensions”, says Chinea. The work has, therefore, a psychological component: “You can be worse at pricking or channelling a line but, in the end, what the parents are going to perceive is the closeness in the way you treat them. In that sense, it is no different from any other profession where you are in contact with other people: a taxi driver or a waiter also deals with these issues. Nursing practice is a reflection of what happens in society. That is why Chinea believes there is an essential issue at work: ”Being a caring nurse is vocational. You can learn but you have to like dealing with children and people“.
Concomitentes is a project that seeks to generate a space for mediation between a group of people representing civil society and one or more artists.. Art must be at the service not only of itself, but also of the social or professional needs of people who do not usually have contact with these disciplines and their practices. In the case of the Paediatric ICU, as in many hospitals and health centres, the question is: How to alleviate the stress and anxiety that these spaces cause by default and by their own dynamics? Is it possible to help nursing staff, paediatricians and other professionals, through an artistic process and the creation of a cultural product that serve as tools for the emotional care of patients and their families?
