Jennifer Eazell

CCMC Practicum
23 October 2017
Journal #6:
17-year-old male patient:
This week, I worked with a 17-year-old male patient who was hospitalized for chronic
pain. With awareness of the adolescent’s need for privacy and independence, I made sure to
knock and ask permission if I could enter his room before simply walking. Upon entering his
room, I noticed he was lying down on his side watching a TV show on his tablet. I introduced
myself and explained why I was there. I asked what show he was watching (he said Hawaii 5-0),
and if I could hang out and watch it with him. He agreed. He seemed to be fairly quiet, but of
complete awareness and developmentally appropriate understanding as seen by his
conversational mannerisms, such as appropriate responses to basic questions and later through
his thorough responses to questions regarding the show. According to Thompson (2009),
adolescents are in the formal operational stage of cognitive development in which one’s
cognitive understanding and subsequently one’s play are more abstracted. He appeared to have
an understanding of abstract thought as seen by his reactions and hypothesizing of the TV show.
For example, when discussing what he thought would happen next after the episode ended, he
said he said that he thought that it was going to come out that “the brother did get involved with
some bad guys and he’s going to end up getting killed”. Given the context of the show and his
age, I was not alarmed by his choice of words (specifically the word “killed”). I was careful to
keep it in mind and was cautious in case he talked about killing/death more frequently, which he
didn’t. He didn’t appear to have any fixations or needs that were beyond my help as a Child Life
Student in that regard.
At one point during the interaction, I mentioned that it was 2pm so group was starting. I
acknowledged his need for independence while still being aware of his need for socialization. I
gave him a choice: he could either finish the episode (with the awareness that there was only
about 15 minutes left) and then go to group, or pause the episode and go to group now. He
decided he wanted to finish the episode and then go, which I felt was a good deal because it
helped to establish rapport and trust with me by not blatantly telling him what to do as well as
the fact that it got him to go to group that day which is good for his socialization.
8-year-old female patient:
This week, I also worked with an 8-year-old female patient with Medulloblastoma of the
cerebellum. Upon entering the room, I noticed she was quiet and working on a craft. I asked if I
could hang out with her and see what she was doing. She showed me rather than telling me what
she was doing by taking out all the tools and previous projects that she had completed. She had
little beads that she was turning into little designs by putting them together on a template and
spraying them with water. According to Thompson (2009) and Piaget, at age 8 one should be in
the concrete operational stage of development. The patient clearly demonstrated her “thinking is
more orderly, more structured, and more logical” as seen in her ability to complete her detailed
bead activity independently and with such apparent ease (Thompson, 2009, p. 141). Through this
interaction, I also noticed that, developmentally speaking, her language skill ability and
understanding appear to be age-appropriate as demonstrated through her answering my questions
with quiet one or two word answers or by showing me, but that she was simply choosing not to
talk. Her communicative withdrawal could likely be her form of coping with the traumas of
hospitalization and lack of socialization.
Another developmental consideration I noticed from our interaction was her physical
development, specifically her fine motor skill development. She appeared to have age-
appropriate fine motor skills as seen by her precision and skill at creating her little designs with
the placement of each tiny bead into the little template. According to Piaget, fine motor skills are
developed up to age 7, which she clearly demonstrated so there are no apparent delays in
physical motor skills in that regard. Additionally, Erikson’s stage of industry vs. inferiority is
demonstrated by her desire to create and complete little projects like the one’s she did with the
beads. When she finished her design, she had a visible yet subtle happiness as demonstrated by
her smile likely due to her feelings of accomplishment as supported by Erikson’s theories.

Unfamiliar Medical Terms Defined:

 Medulloblastoma
o Medulloblastoma is a cancerous tumor—also called cerebellar primitive
neuroectodermal tumor (PNET)—that starts in the region of the brain at the base
of the skull, called the posterior fossa (St. Jude’s, 2017).

 Cellulitis
 o Cellulitis is a common, potentially serious bacterial skin infection. Cellulitis
appears as a swollen, red area of skin that feels hot and tender. It can spread
rapidly to other parts of the body. Cellulitis isn't usually spread from person to
person (Mayo Clinic, 2015).
Goals:
 My goals for this coming week are to continue building my confidence talking to patients
and families by working on my introductions as well as some go-to questions to help
stimulate conversation/connection. Also, I hope to gain more observational experience
with procedures (specifically, sutures since it is something that I haven’t seen yet).
Another goal I have is to work on more specific patient-based activity plans that can help
provide a more defined and detailed experience.

Self-Reflection:
This past week went well I think. I think there were naturally highs and lows associated
with being a student. Some moments I felt confident and felt as if I was gaining ground, while
other moments I felt nervous and underprepared mentally. However, this week I felt far more
highs than lows, which is a plus! I feel like I’m making progress. Some of the highs I
experienced were in my patient/family interactions. One in particular that comes to mind is with
a grandma and a patient. I feel like I was a good equal parts listener and helper, which is my goal.
I listened to grandma’s needs of making some phone calls and helped provide moments for her to
step out and get her bearings. Also, I helped a 4-year-old child go from sad and quiet when I first
entered to active and talkative through play. Those moments felt good and out way the bad for
sure. One of the lows from this week as discussed above was during a one on one interaction
with a 15-year-old male patient. I felt myself struggling to find the right words and could feel
mom and his closed off personalities. I found myself trying but struggling to find the words to
“get in” with him. I tried video games, but he was uninterested. I tried suggesting board games
but he was putting off a vibe like he just wanted me to leave so I ended up telling him maybe we
can try another time when you’re feeling up to it.

References:

Thompson, R.H. Md. (2009). The Handbook of Child Life: A Guide to Pediatric Psychosocial Care. Springfield, IL:
Charles C. Thomas.

https://www.g-w.com/pdf/sampchap/9781590708132_ch04.pdf

Medulloblastoma info retrieved from https://www.stjude.org/disease/medulloblastoma.html

Cellulitis info retrieved from https://www.mayoclinic.org/diseases-conditions/cellulitis/basics/definition/con-

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