Putting the YES back in AutoNOmy

Children learn autonomy by making their own choices and decisions about their day; what they will wear, what they will eat, or what they will play with outside. However, when a child is in the hospital, these choices often get overlooked or are non-existent. It is important for children to feel like they have a sense of control over their day, even if it’s in the slightest of ways.

If a child has to take medicine, there really is no choice. The medicine needs to be taken, right? Wrong. How would you like to take your medicine? Would you like to have the nurse or mommy squirt it in your mouth? Would you like to take it in a cup? Would you like to have a sip of sprite or apple juice afterwards? The list is endless. The medicine has to be taken, but the avenue to take the medicine can be a choice. A child is more likely to be receptive if they have even the smallest bit of control over the situation.

Where I’ve seen people (myself included) run into problems, is when you offer a choice when there isn’t an alternative. For instance, one time in surgery one of the anesthesiologists was trying to engage a 5-year-old girl in conversation before induction. The only masks we offer are pink – but they’re flavored differently (bubble gum, strawberry, and cherry). He holds a mask up and says “Look! Do you like pink?” To which the child promptly answered, “Nope.”

The anesthesiologist looks at me panicked and proceeds with, “Well…um…what’s your favorite color?” I then give him a look that says, “Um, where are you going with this? We only have pink.” He shrugs his shoulders and the child states, “PURPLE!” He fumbles in his drawer to find a piece that fits on the mask which is miraculously and luckily purple. He shows her quite amused with his quick thinking and she goes, “Yeah, but I want the whole thing to be purple because I don’t like pink.”

mask

This wouldn’t have been a problem if we didn’t offer the child a choice that she didn’t technically have. She needs to breathe in the medicine through this mask and whether or not she likes pink, we have to use it. Asking what flavor would have been a more appropriate question.

Same goes for when a nurse in surgery comes to pick up the patient from their Pre-Op room. We usually take the younger children back to surgery in a wagon but sometimes they can be pushed directly on their bed. This has made another choice for our patients to have control over during their hospitalization. However, when a nurse comes by and says, “You ready to go back to the spaceship room (what we call the OR for younger kids)?” and the child looks at her and says, “Not right now.”

I have had to redirect the question and the nurse will look at me and say “How’d you do that? I just asked them that and they said no.” The problem again was that that question had a “yes” or “no” answer and they chose no, which technically isn’t an option; they’re going back to the OR today whether they choose to or not. My redirection said, “It’s time to go back to the spaceship room. Would you like to ride in the wagon, walk, or ride on your bed?” To which the child then answered, “Ride in the wagon!” and eagerly hopped in the wagon.

wagon ride

Children still deserve the option to choose even if they are outside of their norm and in the hospital. While their options might be limited, it is still possible to give patients the autonomy that they need and desire.

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