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Pediatric Hospitalization, Obstacles And Opportunities For OT Practitioners Podcast

Pediatric Hospitalization, Obstacles And Opportunities For OT Practitioners Podcast
Laura Stimler, OTD, OTR/L, BCP, C/NDT, Dennis Cleary, MS, OTD, OTR/L
May 5, 2022

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Editor's note: This text-based course is a transcript of the Pediatric Hospitalization, Obstacles And Opportunities For OT Practitioners Podcast, presented by Laura Stimler, OTD, OTR/L, BCP, C/NDT,​ and Dennis Cleary, MS, OTD, OTR/L.

Learning Outcomes

  • After this course, participants will be able to:
    • Identify common reasons for admission to pediatric acute care settings.
    • Recognize risk factors for childhood occupational participation barriers in pediatric hospital settings.
    • List effective strategies to promote a culture of evidence-based practice in a pediatric hospital-based practice.

Podcast Discussion

Dennis: Hello, everyone, and welcome to the podcast. My name is Dennis Cleary. I am a senior researcher and occupational therapist at Cincinnati Children's Hospital Medical Center. I am pleased to be joined today by Dr.Laura Stimler, a faculty member at Spalding University in beautiful Louisville, Kentucky. How did I do at pronouncing Louisville?

Laura: Pretty good. 

Dennis: Thank you. We will discuss pediatric hospitalization, obstacles, and opportunities for OT practitioners. Could you tell us about your background and some of your expertise?

Laura: Thanks, Dennis. It is so nice to speak with you today. I always enjoy opportunities like this, so thank you to OccupationalTherapy.com for having me back. I have been working as an OT since about 2002, and I started in a pediatric skilled nursing facility called Home of the Innocents in Louisville, Kentucky. I fell in love with working with medically fragile children in a hospital-based setting. At that point in my life, I was ready for a change of scenery, and I decided to move to New York City after working for about a year. I loved the pediatric skilled nursing setting so much that I looked for a similar type of setting in New York City. I began work at the Elizabeth Seton Pediatric Center, which serves a similar medically fragile population. After working in that setting for about four years, I decided I wanted to switch gears and explore more critical care.

I learned about an available position at Memorial Sloan Kettering Cancer Center in Manhattan. I happened to be in the right place at the right time because they were looking to expand their pediatric oncology rehabilitation programming. Over about nine years, I was fortunate to work with incredible mentors like Claudine Campbell, McKenzie Pergolotti, and others who collaborated with many other disciplines to create a well-established pediatric program. During my tenure at Memorial Sloan Kettering, I fell in love with the pediatric acute care oncology population and medically fragile children in the pediatric intensive care unit.

Dennis: Great. Were these kids coming in for surgeries, or were they getting treatment? What kids did you see typically?

Laura: At Memorial Sloan Kettering, we had a specific unit that served children after surgery. They came after surgeries/planned admissions for close observation. It was also available for children with complicated medical conditions that needed more closely monitored. Over the years, the pediatric observation unit was transitioned to an actual pediatric intensive care unit. That transition was an exciting effort to be a part of and watch come to fruition. We started as a three-bed pediatric observation unit and then transitioned to a five to six-bed pediatric intensive care unit. At that point, we called it the "PU" and then transitioned it to the PICU. The hospital served children of all levels of critical needs. In the PICU, we kept children that required mechanical ventilation and more intensive treatments that previously we would have had to transfer to another hospital setting. 

Dennis: What was the span of kids' ages in this setting?

Laura: It is interesting. Specifically, we served children from four days old to young adults in the oncology unit. The four-day-old baby was diagnosed with a rare type of leukemia and blood-related issues. If a person is diagnosed with childhood cancer, the same medical team will often follow them for years into their survivorship. So, we would often see older adolescents and young adults. There was a vast range of ages.

Dennis: I see from your bio that you have some advanced degrees. Can you talk about what led you to get those more advanced degrees?

Laura: While working in the pediatric acute care oncology setting, I decided to return for a clinical OT degree. I earned at Rocky Mountain University of Health Professions and focused on the pediatric science track. I was passionate about creating continuing education resources for OT practitioners during my capstone.

Dennis: You're in the right place for that (doing this podcast).

Laura: Exactly! During my capstone in 2014, only six articles included the role of occupational therapy in peds oncology. I wanted to contribute to the available literature to help therapists manage this specialized population. I can't say no to education opportunities.

I'm currently in the middle of my EdD program because of my research journey in academia. I wanted to personally strengthen my research skills and support the students in our doctoral program. I also love to support publications and continuing education efforts, specifically in peds oncology and general pediatric hospitalizations.

Dennis: Wonderful. I'm sure you're bringing those resources to the classroom, which I know your students appreciate. Can you discuss some of the most significant barriers to participation and occupations for children in the hospital besides missing school, which they probably like?

Laura: Children will experience many changes in routines and roles and have to adapt to a new environment. Looking at the Occupational Therapy Practice Framework and the long list of occupations, every single one can impact a hospitalized child. Hospitalization has a pretty global effect. Additionally, it can be overwhelming for everyone when you think about the lack of predictability in a hospital-based setting. Fear and pain are common issues and are frequently associated with many childhood conditions. There are also frequent care transitions between hospital units and caregiver separation. 

Dennis: Can you talk about what occupational therapy can offer children and their families to address these issues during hospitalization?

Laura: Sure. I always love to read the newly published Workforce & Salary Survey posted by AOTA. The trends are similar, but in 2019, 28% of OTs worked in a hospital-based setting. I believe this statistic was a combination of pediatric and adult hospitals, but hospitals are the most common work setting for OTs. According to the committee on hospital care, about five million children between the ages of birth to 17 are hospitalized annually. As OTs, we're well-positioned to have a significant impact and play a pretty dramatic role in the experience of a lot of families.

Common reasons for pediatric acute care hospitalizations are respiratory distress (including acute bronchiolitis, asthma, pneumonia), COVID, appendicitis, seizures, infections, dehydration, trauma, and other critical illnesses. Children with these conditions are at high risk for secondary issues. Secondary complications may include decreased strength, compromised cardiovascular and respiratory systems, psychosocial concerns, and emotional distress. As OTs, we play an essential role in preventing some of those secondary issues. Helping to support families and keeping children active and engaged as much as possible in a typical routine are crucial.

Dennis: Yeah. As you are getting your ED and already have a clinical doctorate in OT, you are interested in evidence. Can you discuss how we can incorporate evidence-based practice when working with these vulnerable children?

Laura: I've had experience working in departments that prioritize evidence-based practice, and I've also worked in other places that are more worried about meeting productivity demands. One easy strategy to build evidence into these fast-paced, complex, dynamic acute care settings is to facilitate an article discussion or a monthly journal club. Other activities are presenting in-services or building in time in the therapist's schedule for the OTs to attend educational events. These clinicians gain a more holistic understanding of services delivered in the hospital and know what is available.

In my experience, an institution prioritizes evidence building has a multi-layered impact and many benefits. First, of course, the children benefit, and outcomes are improved. It also enhances the morale of the program. As we observe others making it a priority to learn, it will make us want to do our best and practice the best evidence. The little steps can help create a high standard of care and develop a culture shift to a more evidence-based approach. It is essential to set the bar high.

Dennis: Yeah. Some organizations are dedicated to evidence-based practice and even allow some therapists to have part of their FTE devoted to that. Even some incentivize and reward research and add it as part of a paid role. 

We will be talking about students in a second, but they are a phenomenal resource, especially OTD Capstone students. I used to be a fieldwork and Capstone coordinator in a previous life. Fieldwork is where a student figures out how to be a therapist, and productivity is undoubtedly a part of that. There is more freedom within a capstone project to concentrate on some of those higher-level skills, which is more flexible. Do you see that at Spalding? I know you guys are transitioning to an OTD currently.

Laura: Absolutely. I am happy you brought that up and beat me to it. Please make room for OTD students in your practice. I'm speaking to the hospital-based therapists working in pediatric settings. I know things are more rigid now, especially with COVID and stricter isolation precautions, causing limited placement opportunities. At our university, we embrace community-based practice, and I am partnered with many students interested in rehab oncology specifically. It is challenging to establish partnerships with institutions that are National Cancer Institute-approved hospitals that are providing active cancer treatment because regulations are so strict right now. We have worked closely with our community-based partners to help build bridge programs to reach this specific population.

I think capstone students are a fantastic way to build evidence-based programs because the students are closely supported by faculty who have a research interest in that area. Another benefit of partnering with a capstone student is to forge a closer relationship with the university, as this can allow access to more resources like peer-review journals and databases. This collaboration can be fascinating.

Dennis: At Cincinnati Children's, we're doing our best to support as many capstone students as possible. I have two right now, as that's how much I care about this.

Laura: That's great.

Dennis: When we help students with research, the expectation is that they will be using evidence in their practice after they graduate. This next generation of therapists will be caring for me when I'm old, so I appreciate that. Can you talk about formal standards or guidelines that OT practitioners use to bring evidence-based practice to hospitals, specifically for psychosocial or other needs, especially for these sick kids?

Laura: Over the years, we've seen many guidelines emerge tailored to meet children and families where they are during different points of care. One example is the National Comprehensive Cancer Institute which offers helpful guidelines for phases of care requiring closer observation to assess and meet psychosocial needs. They specifically identify times when children and families might be more vulnerable to experiencing emotional distress after specific treatment and experiences in the hospital. The American Academy of Pediatrics Committee on Hospital Care also offers particular regulations and standards on interacting and utilizing specific disciplines in certain interprofessional collaborative efforts.

I like AOTA's recent publication on Addressing Acute Stress and Trauma, a decision guide they posted in response to COVID-19. If you look on AOTA's website and search different specialty topics in pediatric hospitalization, they offer many decision trees and information on navigating various complex issues.

Another thing that can be overwhelming about the acute care environment is the medical complexity, lab reports, and all the equipment involved (lines, tubes, etc.). Where do we start? I've also had unique experiences working in the oncology setting, where I have used nursing standards and activity parameters established outside the scope of OT. However, sometimes when those standards or guidelines are not well understood, people tend to be very conservative in what they do with patients. When we think about kids in the hospital, OTs must be confident and advocate on behalf of the kiddos we work with, especially those at risk for issues related to immobility. For example, I was part of a retrospective research study examining children admitted for stem cell transplantation and diagnosed with thrombocytopenia.

Dennis: I'm sure everyone knows what thrombocytopenia is, but would you describe that quickly?

Laura: Thrombocytopenia is a condition that occurs when individuals have low platelet counts putting them at high risk for bleeding. The actual definition of it or the level may be hospital or institution-specific. When children present with these specific blood levels, often a decision is made to hold therapy. Lack of mobility can be detrimental to kids in bed all day. We wanted to see if there were genuine associations between occupational therapy activities and the occurrence of adverse bleeding. We did not find an association between the two. My point is that it would be in the interest of our patients for us to all work together to create OT-specific guidelines and parameters to support what we can offer the kids.

Dennis: Do you find that nurses or physicians are open to that as they are very focused on keeping kids safe? Often, occupational therapy is the best part of their day, but I am biased.

Laura: I think it is essential to be "loud" with other professionals about how excellent our services are and all the good we can do. The potential is there if children engage as much as possible. In my experience, developing partnerships with those other people on the team, even simply learning their names and making an effort to interact, can be impactful and increase referrals. A physician may not fully understand what you're going to do with the child, but they trust that you're the expert in helping the child regain their functional abilities. We have to include the team in those types of decisions, but we have a better understanding of what a child can engage in based on lab values and so on.

Dennis: Great. Amid the COVID era, we are trying to work cohesively as a team. Anything we can do to make nurses' life easier will most likely be supported. I don't know if that's been your experience, but it's always been mine.

Laura: Absolutely, we've got to work as a team. I find it's helpful to make an effort to see exactly how we can shift our day to support nurses and other allied health professionals. "Hey, what's on your agenda for today for this kiddo? How can I schedule my session with this child to make your day easier?

Dennis: Obviously, our aim is always to use a standardized assessment as much as possible, but sometimes there will be barriers to doing those. Do you have any recommendations on what we can do to get those in there? Or, what is the best practice for balancing standardized assessments with some of the productivity demands?

Laura: This has always been a frustration because it is time-consuming, and it does feel like there are so many barriers to using standardized assessments in acute care for children. Recently, more published screening tools have been age-appropriate for a broader scope of clients. Also, more focused assessments are available on different conditions and client factors, like delirium. For example, there is a broader scope of delirium assessments appropriate for OTs in an acute care setting. The Pediatric Quality of Life Inventory is an excellent screen with condition-specific modules. And it is appropriate to get other disciplines involved to meet a child's health-related quality of life needs.

Many new standardized assessments have been more appropriate for the acute care setting. So, I would recommend having a broad scope that addresses very young children through adolescence. The adolescent population in pediatric hospitals is often lost in the mix, and that's not an OT-specific issue but rather a healthcare system issue. Thus, it is essential to intentionally provide and utilize age-specific standardized assessments to meet the needs of very young children up through adolescents and young adults.

Dennis: Yeah. It is funny you say that. At least in academic settings, the most used book in our profession is Occupational Therapy for Children and Adolescents. It is now Case-Smith's Occupational Therapy for Children and Adolescents. Adolescents were added as we followed across the age range. We talked a little bit earlier about an interdisciplinary approach. What recommendations do you have to help facilitate good collaboration among teams? And in a pediatric hospital, what other types of members are you likely to see?

Laura: I have worked very closely with child life specialists. I think they have superpowers and a fantastic way of meeting children and families where they are. Child life specialists are terrific at providing age-appropriate and timely procedures or information about a medical condition that a child can understand. Within occupational therapy treatment, they can also be helpful when they partner with us from a motivational perspective. I think that child life and OT philosophies overlap and complement each other beautifully. It makes for a tremendously effective partnership to set a child up for a successful day and establish a routine.

We also have to partner with our nurses when time allows. Reach out to the nurse first thing in the morning of your day. You can also figure out which medications we need to schedule the OT sessions around during this collaboration. Medications can change daily, especially in the PICU setting. I think partnering with nursing to get a clear picture of the child's needs from a medication perspective is helpful.

I also love working with respiratory therapists, and I know they are now busier than ever. As far as the emerging early mobility programs in PICU and NICU settings, respiratory therapists play a critical role in bringing those programs to life.

We need to promote our unique value to other professions and help them understand what we can offer and how that differs between patients. For example, the needs of a young child admitted to the hospital for a stem cell transplantation will have very different needs and expectations than a child admitted to the hospital for spinal cord injury, near-drowning, or whatever it may be. We also need to let them know that we appreciate what they can offer.

Dennis: Yeah. What about physical therapists and speech-language pathologists? Do you want to talk about some of your experiences with the other members of the "tri-alliance?"

Laura: Absolutely. I did not mention them because it is a given that we work so closely together. I love our PT and SLP friends. In my experience in the PICU, I closely collaborated with physical therapists, especially in the early phases of mobilizing children after either complex procedures or accidents. It is a great way to be safe and effective the first couple of times that you work with a child who is in very critical condition. Of course, we always want to establish a consistent plan with other rehab providers.

Dennis: Did you do much when in New York with speech-language pathologists and dysphagia?

Laura: We did. When I worked in early intervention and skilled pediatric nursing in NY, our speech-language pathologist took the lead with swallowing. OT was on board to address the self-feeding component, but the speech-language pathologist also managed that. I know this is very different between hospitals. In my other acute care experiences, I worked with up to 30 occupational and physical therapists and only three SLPs. So, their primary focus was assessing swallowing and addressing those issues in that environment.

Dennis: It's good to have those friends, especially when working on feeding. There are some regional differences with dysphagia, even from hospital to hospital. Sometimes the OTs can take the lead or be close collaborators with that speech-language pathologist. With these young kiddos, positioning becomes essential for keeping people safe, so the more we can work together, the better outcomes we will see. Do you use the word kiddo? Is that pretty common?

Laura: I do, and I might have even typed it in my notes. I use it all the time.

Dennis: Do you call your own children kiddos?

Laura: Yes. I do.

Dennis: That's good. I like the word kiddo a lot as well. Any advice about negotiating solid relationships and partnerships with our PTs, SLPs, nursing, and social work friends?

Laura: I think avoiding unnecessary silly turf wars is one step. We need to develop partnerships with the other disciplines and families to keep the lines of communication open and increase the referral base. It is critical to be intentional with kids and families, developing therapeutic use of self. We can use this same approach with other disciplines. Each discipline has unique needs, and we may need to spend different amounts of time or interact during different times of the day.

Dennis: When you have a physician who refers to occupational therapy to keep a person "occupied," How do you respond educationally?

Laura: I gently nudge or offer, "It's more than just keeping someone busy." Then, I provide more specific information about the activities guided by occupational therapy that are unique and distinct from other professions. I always emphasize that our role is to teach children and families to be empowered, advocate on their behalf, and participate. It's not doing things for someone. It's encouraging them to do it independently. So, sometimes the individuals referring clients to us need a reminder that it's more than just keeping somebody busy.

Dennis: Yeah. However, I think sometimes a doctor is well-intentioned. The referral could be in our scope of practice, so if they're looking at restraint reduction or something significant, we have a vital role that we could play. I don't know if you've had any experiences with those types of situations?

Laura: Definitely. We need to help physicians, nurses, and nurse practitioners our focus when working with children and families. In New York, we were in a time of rapid development in the pediatric oncology program. One of the attending physicians was a huge supporter of rehab. I think he would have had rehab work with kids every day. He would often say, "Laura, you need to see these kids eight days a week for occupational therapy. We got to get them up!"

Before this cultural shift on the floor, the expectations were lower for these children. For example, a child admitted for a prolonged time typically need a wheelchair on the day of discharge. With the cultural shift of more rehab, the MD said, "These kids don't need wheelchairs to leave the unit anymore upon discharge." This result was eye-opening and exciting. We need to get these outcomes published to articulate the benefits of collaboration because we see these great things every day.

Dennis: Absolutely. Could you talk about COVID and how that's impacted pediatric hospitals? We have had many clients with COVID at Cincinnati Children's, but it seems to have gotten much worse with the most recent wave. Fortunately, the numbers have come down again, but can you talk about how that's impacted hospitals?

Laura: Sure. I'm back at Home of the Innocents in a per diem position and teaching full time. I was a PRN therapist during the thick of it. I think those things that we talked about during the beginning of our discussion, like social isolation and those common barriers, were escalated. Unfortunately, limited staff and support have compounded the already present issues. 

At this point, some of the restrictions are being lifted so that the weight can feel less heavy. However, I think we are not going to see some of the actual trauma that has occurred, and it's going to manifest in different ways for children hospitalized or even in school. The trauma that has happened during COVID, and continues now, will become more evident over the months to come. OTs in hospital-based settings will have a significant role now and in the near future in recognizing signs of acute stress and supporting families.

Dennis: AOTA has come out with some excellent resources.

Laura: They have. I believe I mentioned Addressing Acute Stress and Trauma: A Decision Guide For COVID-19 is available on their website, and they have a couple of others as well. There are some other good publications in adult literature. We are playing catch-up in pediatric research. Multi-system impairments from COVID are well documented. As practitioners, we want to be mindful of how COVID manifests differently in children, and the evidence is growing to help us understand what that even is. But I think there are some substantial resources available to help provide therapists with direction on what to keep a close eye on right now.

Dennis: Great. Those are in the handout from OccupationalTherapy.com. Can you talk about things that occupational therapists can do to help ease some of the burdens that families and kiddos experience during the transition of care from one setting to the next or from the hospital to home? 

Laura: Yes. I would also love your perspective on this, as I know you have much experience in care transitions. Easing the burdens of changes in care is a great place to position students to build programming. A family may need to continue to bring the child to that same hospital for medical reasons, so there might be benefits in keeping all of their care in the same system. Conversely, there may be significant benefits to moving their care to a community-based setting. One being the child and family may be more comfortable. However, this is loosening the ties with the hospital-based environment that has been a security blanket for children with chronic or critical issues, so it needs to be a team decision.

Students can create inspiring programs and fill some gaps in those transitions. A formal liaison between hospital-based and school-based practice and the family can be beneficial. Kids can be part of so many different communities like sports, which can be overwhelming for families.

Dennis: You're right. Students are phenomenal at that. They do an excellent job specifically with creating programs and compiling resources. Those can be printed out or included in their medical records as they're leaving. At Cincinnati Children's, we're fortunate within our department that we have vocational rehabilitation counselors that deal with these types of transition issues. They are experts at knowing what resources are out there, specifically looking at developmental disabilities and vocational rehabilitation and then working with the school districts to support them until their immune systems are back to the point that they can return to school.

People love Costco because it's the right level of product that you need for what you want to do. There are not ten different lawnmowers, but only one. They have done the work to figure out what lawnmowers most people need. In the same way, a student can curate all the information to help families instead of letting them blindly research things on Google.

Laura: Absolutely. I would love to share one example of an idea one of our students brought to life during her capstone experience. She worked in an outpatient setting at a pediatric rehabilitation hospital, and the focus of her capstone was to maximize leisure participation for children after being discharged. She had an interest in learning about trauma-informed care. She created an interactive app for children and families to use when they were discharged from the hospital for the project. Within this interactive map, she made a key that gave families information. For example, was the site accessible? The place was appropriate for what ages? Were there times of the day when the area was less busy for immunocompromised children? Was there a private space for families? It was incredible to see her bring these ideas to create an interactive website where families could click on different places around the community. 

Dennis: Awesome. I just think students add so much to most of what we do. Any other ideas in terms of capstones that might be able to do to help you in your everyday practice?

Laura: I had another student very interested in pediatric oncology, but this was last year when it was tough to work with children actively. So, this student, a dance instructor, created adaptive dance classes. For example, she tailored a dance class appropriate for preschoolers who were not strong enough to stand at the edge of their beds. The adapted dance program was designed for these children to participate in a choreographed routine, sitting at the edge of their bed with supervision. I am always blown away by the students' ideas.

Dennis: Absolutely. That's the fun part of teaching and part of what I miss. I have an affiliation with the University of Cincinnati but no real strong teaching responsibilities other than these capstone students we had during COVID. One of them was responsible for our return to work PPE curriculum for young adults with intellectual developmental disabilities via some videos and supports to help them understand the necessity of it and how to don and doff it. (As a side note, I will say "don and doff" at least once for every podcast. Three jaw chuck will be the other OT phrase I will throw out.)

Do you have any advice for someone who is looking to change careers?

Laura: My number one recommendation would be to establish a mentor. Find someone in the field that can offer you resources and advice. A student may live in an area that does not have available positions in a pediatric hospital-based setting. I usually recommend that they try to get one foot in the door in a PRN pediatric position elsewhere to work on their pediatric-specific skills. It might be part-time in a school-based setting or early intervention. And then the other foot in the door working with an adult acute care. So, combining their experience in pediatrics, and then even if it's working with adults in a medically complex setting, can help them gain an appreciation for and the confidence to work with children eventually in medically complex environments.

Also, I think there are many AOTA fellowship programs in pediatrics, which are exciting. And I'm jealous that these were not an option many years ago when I graduated. But a couple of examples include Boston Children's Hospital, Children's Hospital of Philadelphia, and Cincinnati Children's Hospital Medical Center, just to name a few.

Dennis Cleary: I've heard that's a good one.

Laura: You've heard many great things about that one, right?

Dennis: I have.

Laura: Maybe you can tell us a couple of things.

Dennis: Cincinnati Children's Hospital Medical Center (CCHMC) is terrific, as are other pediatric hospitals, like Nationwide Children's Hospital. There are many great children's hospitals in Ohio, so we're very fortunate. A large percent of your time at CCHMC treatment, and then 25% of the time is devoted to research. Typically with pediatric hospitals, there is some affiliation with a university. Due to this, many therapists also get some practice teaching. Any ideas on how to find a mentor?

Laura: I picked up the phone and called a couple of places, especially when I was new to pediatric oncology. I told them I wanted to share ideas with someone working with a similar population.

Dennis: AOTA is a great resource. If you go to the national conference, it is a great way to meet people. The key is to be the last in line, not the first, when you want to talk to a speaker. They can't run, but they'll try. I am just kidding. Don't do anything creepy. However, I think the AOTA conference is an excellent way to meet some of our national experts. Often, we put these people on pedestals, but most OTs are kind, warm, exceptional human beings. AOTA is an excellent way to meet mentors who may be able to refer you to some clinicians in your area.

Laura: I was going to say I've enjoyed creating a pediatric critical care elective course for our students at Spalding. For students, we have a specialty topics course where students can choose a couple of areas that they're interested in depending on faculty availability and expertise. We involve guest speakers from other universities, hospitals, and other institutions. So, I would encourage students to reach out to guest speakers introduced within your courses on topics of interest. Don't be afraid to follow up via email with additional questions.

Dennis: Great. I have great ideas for other people. Do you invite clinicians to attend any of your courses for their own learning? For example, you could offer continuing education in the evenings.

Laura: I love that idea.

Dennis: Anything we can do to cement the academic and the clinical aspect of our profession is essential. We all get along typically and like each other, so anything we do to facilitate that relationship would be great. Do you have any other recommendations for people as they're entering pediatric practice to help navigate the complexities of the acute care setting?

Laura: I think just being intentional with balancing the operational demands of hospital-based practice and remaining true to the occupational roots of OT practice. This is a tough thing to do but prioritize the main occupations of children like play. Make that a priority in the hospital and have fun. I know it can be an overwhelming place to make that a priority but always keep that at the forefront. Find meaningful, enjoyable things for the kids and families.

An AOTA-published acute care textbook is fantastic with some great survival tips. Additionally, keep practice guidelines accessible and current. These can also be practice guidelines from other professional organizations, standards published by other institutions, or department-specific. Staying organized is also crucial.

Dennis: Can I give a practice guideline tip?

Laura: Please.

Dennis: They publish practice guidelines in AJOT, and when there is an update to a policy, this is updated in AJOT as well. This is a little tip for those playing along at home.

Laura: Definitely.

Dennis: It's hard to believe it's been almost an hour. Can you give some final advice for practitioners interested in working in pediatric hospitals or wanting to make the world a better place for kids?

Laura: Occupational therapists focus on the big picture and maintain human connections. We use a holistic, top-down approach rather than getting hung up on the skill-specific issues often emphasized in acute care. I also think using therapeutic use of self is everything. It is essential to remain mindful and intentional with your interactions with both clients and colleagues. It takes all of us to support the kids and families in their fragile states. We could be working with a patient on their lowest day, and it is vital to remain positive and hopeful.

Dennis: Someone once said that it's important what we do, but patients rarely remember what we do, but they remember how they felt. What are the things that we can do to help them? As you said, we may have to support kids when they are in pain or having a rough day. What is crucial is that we uphold their dignity and support them. Hopefully, tomorrow's going to be a better day for them.

Laura: Absolutely.

Dennis: Dr. Laura Stimler, from Spalding University in Louisville, Kentucky, the time has flown. Thanks so much for your time, and I hope you have a great day.

Laura: Thank you so much, Dennis. I really enjoyed our discussion. 


Please refer to the outline and handout.


Stimler, L., and Cleary, D. (2022). Pediatric hospitalization, obstacles, and opportunities for OT practitioners podcast. OccupationalTherapy.com, Article 5505. Available at www.occupationaltherapy.com

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laura stimler

Laura Stimler, OTD, OTR/L, BCP, C/NDT

Laura Stimler is an occupational therapist and Assistant Professor in the Auerbach School of Occupational Therapy at Spalding University. She holds advanced certifications including AOTA Board Certification in Pediatrics, USC/WPS Sensory Integration and Administration of Sensory Integration Praxis Test, and Pediatric Neuro-Developmental Treatment. Prior to teaching, Laura specialized in acute care rehabilitation oncology at Memorial Sloan Kettering Cancer Center in New York City. Her areas of teaching include pediatrics, acute care, oncology, and fundamentals of OT.

dennis cleary

Dennis Cleary, MS, OTD, OTR/L

Dr. Dennis Cleary has over 25 years of experience as an occupational therapist.  Dennis’ clinical practice has been primarily with children and adults with intellectual disabilities to encourage their full participation in all aspects of life at home, work, and in the community. He has had faculty positions at The Ohio State University and Indiana University. As a researcher, he has been on teams that have received over seven million dollars in grants from state and federal agencies, including a National Institutes of Health multisite trial of the Vocational Fit Assessment, an age-appropriate transition assessment, which he co-created. He has numerous publications and national and international presentations. Dennis is passionate about increasing the role of Occupational Therapy in transition-age service with the goal of improving outcomes and quality of life for all. 


Related Courses

Pediatric Hospitalization, Obstacles And Opportunities For OT Practitioners Podcast
Presented by Laura Stimler, OTD, OTR/L, BCP, C/NDT, Dennis Cleary, MS, OTD, OTR/L
Course: #5567Level: Introductory1 Hour
Participation barriers that children and families face during pediatric hospital admissions will be explored during this podcast. Opportunities for occupational therapy practitioners will be discussed to ease the burden of prolonged hospital stays. This course is part of the Continued Learning Podcast series.

Adolescent Eating Disorders And Occupational Therapy Podcast
Presented by Lindy L. Weaver, PhD, OTR/L, Dennis Cleary, MS, OTD, OTR/L
Course: #5629Level: Intermediate1 Hour
Common eating disorders that occur among adolescents, their functional impacts, and ways occupational therapy practitioners can support young people and their families experiencing eating disorders will be explored in this course. This course is part of the Continued Learning Podcast series.

Occupational Therapy's Role In Opioid Recovery Podcast
Presented by Monica Robinson, OTD, MS, OT/L, BCMH, FAOTA, Dennis Cleary, MS, OTD, OTR/L
Course: #5671Level: Intermediate1 Hour
Opioid-use disorder is a national population health crisis affecting those of all ages. Understanding the demographic, socioeconomic, psychosocial, and substance use characteristics of different groups of opioid users allows OT practitioners to tailor interventions. OT practitioners can provide interventions across the life span supporting a return to meaningful occupations, roles, and routines. This is part of the Continued Learning Podcast series.

What’s Culture Got To Do With It? OT Practice With Pediatric Clients From Diverse Communities Podcast
Presented by Cristina Reyes Smith, OTD, OTR/L, Dennis Cleary, MS, OTD, OTR/L
Course: #5690Level: Introductory1 Hour
The meaning in occupational engagement is rooted in the client's cultural heritage. Occupational therapy practitioners must be aware of and sensitive to any client's culture, but it is especially important for pediatric practitioners at this formative stage of life. This is part of the Continued Learning Podcast series.

Psychosocial Considerations in the Pediatric Acute Care Hospital Setting
Presented by Laura Stimler, OTD, OTR/L, BCP, C/NDT
Course: #5184Level: Introductory1 Hour
This presentation will explore psychosocial issues children and their families experience during acute hospital admissions. Trends and reasons for hospitalizations will be described. Evidence-based occupational therapy evaluation and treatment interventions to address the psychosocial needs of children admitted to the hospital will be described.

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