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The problem with ‘Being Brave’

Sophie (5 years old) screamed in pain and tried desperately to get away. She couldn’t move! Someone was holding her down! She began to perspire and tried frantically to make them stop. Everyone was talking loudly and sternly at her.

‘BE BRAVE!’ ‘Come on! Stop this now. It doesn’t even hurt!’
‘If you don’t stop moving, we will have to do it again!’ ‘BE BRAVE!’
‘I thought you were a big girl! I didn’t realise you were a baby!’

This scenario is something I see daily in my nursing practice. We (nurses, doctors and parents) all want to provide medical care for the child with the least amount of protesting. So we send the child messages regularly that it is not OK to cry or be unhappy with what we are doing.

We do this by telling them to be brave- in other words, if you are scared, don’t be. That is unacceptable behaviour.

We do this by telling them it won’t hurt- in other words, if it does hurt, you aren’t really feeling that.

Sometimes, we even avoid telling them what will be happening because we want to avoid hearing their cries.

The reality is children do get upset. Children do feel pain. Children feel fear when they don’t know what is happening to them. Asking them to deny this is asking them to deny their feelings for the sake of our own discomfort.

Our patients will feel better able to cope with traumatic experiences when we adequately prepare them with 100% honesty and include them in decision making where possible. For example, when I know a child is going to be getting a needle, I begin the process by applying numbing gel. While I put it on, I begin to explain the process to the child. My explanation will slightly differ depending on the child’s age but it will sound something like this…

‘Sophie, I am putting this gel on your hands and elbows because the Doctor would like to give you a needle…

This gel usually takes away SOME of the pain. You will still feel the needle but it will hopefully be a lot less painful…

This gel takes 30 minutes to work so you have time to think about what I’ve said. I will come back to answer any questions you might have. We can also talk about what you can do to help us make the pain even less.’

Usually, as soon as I have mentioned ‘needle’, the child cries, turns away from me or becomes apprehensive. This is usually the time that I hear the parent say ‘Be Brave’ or ‘Look at the nurse when she is speaking to you!’ This is a great indication that they understand what is going to happen! I welcome these feelings and encourage the display of emotion. It helps them to work through their fear and come to terms with it more quickly.

It is very therapeutic for a person to be allowed to express their feelings as raw as they are and often results in a more relaxed patient- something else that helps reduce pain! To acknowledge their fear, I empathetically say:

‘Are you feeling scared? I understand that. It is scary getting a needle and it’s ok to cry about it if you need to. Just remember your Mum/Dad and I will be here to help you. We don’t want it to hurt either.’

Being brave does not change anything for the child. It doesn’t make the procedure any less painful or any less stressful. Telling them to be brave does not help them. It risks denying them the chance to fully express themselves and naturally make peace with their situation. Instead, we can use this experience to build trust with our patients by acknowledging their feelings and being a reassuring & calming presence.

If you are stuck on some ideas on how to help your patient through their emotions during a procedure, try these out for size:

‘I can see it is really hurting you.’
‘Thank you for holding still.’
‘Thank you for letting us do this. I see it hurts.’

Until next time…

Note: To learn more about listening to a child and what it can do for them on an emotional and psychological level, read these wonderful articles by Hand in Hand Parenting:

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