Alphabet 2.0 | T is for Telepresence: Utilizing Technology to Increase Socialization and Interactive Engagement Among Pediatric Patients on Isolation Precautions

Child life specialists often express concern about isolation in the hospital setting, but in truth, “isolation” could be referring to several different things. We might be referencing a patient being on isolation precautions as a result of infection control processes. We might be talking about how a patient is physically isolated from peers as a result of a diagnosis. Or we might be referring to the emotional isolation of a patient: the feeling that no one understands what they’re going through and that no one can reach them.

This last type, emotional isolation, often results from the first two, physical isolation and a lack of socialization opportunities. Due to infection prevention practices, patients on isolation precautions are typically restricted from socialization with peers and from participating in developmentally appropriate group activities. Socialization is a key component of mental and overall health. As Pizzignacco and Lima (2006) explain, “One of the coping strategies for children and adolescents with chronic disease is the search for social support from friends, family and professionals, as they consider this is one of the most significant ways to control stressors caused by the disease” (p. 575). Denny and colleagues (2013) found that children and adolescents with chronic health conditions are more likely to have emotional health concerns compared with their healthy counterparts. Koller, Nicholas, Goldie, Gearing, and Selkirk (2006) found that chronically ill children also shared more stories about loneliness, fear, and unpleasant emotions. Isolating ill children may exacerbate or intensify preexisting feelings of loneliness and alienation (Koller et al., 2006).

A patient driving the robot on an inpatient unit at Children’s
Mercy Kansas City.

One of the essential job functions of a child life specialist is to promote developmentally appropriate play and socialization opportunities in the hospital environment. At Children’s Mercy Kansas City, patient activity coordinators also have this essential job function. In December 2016, I partnered with the patient activity coordinator on my inpatient unit to address the emotional impact and lack of socialization opportunities that patients on isolation precautions were experiencing. We explored interventions aimed at combating this common barrier in order to optimize psychosocial and emotional health and development. In our exploration, we discovered telepresence resources from within our hospital’s telemedicine department that we hoped could enable expanded and exciting opportunities for developmentally appropriate activities and social interactions for our patients on isolation precautions.

Telepresence creates a sense of being in another environment. In particular, robotic telepresence offers the means to connect to a remote location via traditional telepresence with the added value of moving and actuating in that location (Kristoffersson, Coradeschi, & Loutfi, 2013). The telepresence device we used was a “robot” consisting of an iPad on a stand with wheels. This robot is controlled by a second iPad that allows the user to drive, (i.e., move forward, backward, turn, get taller and shorter), while also maintaining a live video (similar to FaceTime). The driver of the second iPad can see everything the robot sees, and wherever the robot is, people can see the face of the driver and communicate with them. Our institution began its telepresence robot journey by using the robot with individual patients, allowing the patient to “become” the robot, “ambulate” around the unit, socialize with staff, participate in unit playgroup, and attend special events. Equipped with live video and a microphone, the robot allows the patient to fully interact with staff, volunteers, and other patients, giving the patient opportunities to socialize and participate in activities that they otherwise would have missed. Patients have used the robot to tell jokes to staff, play Pictionary in the playroom, perform magic tricks for volunteers, attend the hospital’s first annual prom, and so much more! The use of telepresence robots has given our patients an ability to connect and engage in therapeutic group experiences previously hindered by isolation.

After the successful implementation of our telepresence robot program with individual patients, we identified the need for multiple patients on isolation to be able to socialize and engage with their peers and staff members simultaneously. To meet this need, we applied iPad video conferencing technology during various group socialization opportunities and events. 

To do this, each patient in isolation uses an iPad app to video conference to a single iPad that is utilized at the event or experience. This allows patients to not only participate in the activity, but also to socialize with peers who are present as well as other peers on isolation. Virtual group experiences have included playgroups, therapy dog visits, interactions with professional athletes, and other special events. Prior to the implementation of these virtual opportunities, patients in isolation were unable to participate in these group experiences or interact with other isolated patients at these events.

To assess patient satisfaction and to gather patient feedback on these telepresence experiences, we collected verbal comments from 13 patients (ages 4 to 19 years), who used the robot (16 times total) and used the iPads to video conference into group activities (15 times total). Patients unanimously expressed enjoyment of these experiences and satisfaction with the operation of the telepresence technology. Patient reported benefits included the ability to connect with peers, meeting patients with a similar diagnosis, engaging in age-appropriate group activities, and focusing on therapeutic interactions in a stressful environment. As one teen patient stated, “It was so nice to get out of my room! I mean… virtually.”

We acknowledge that nothing compares to being able to participate in an event or an experience in person. We have heard feedback that adds to our continued awareness of this. Patient statements include “I still wasn’t there” and “But I wish I could have gone.” However, being able to “attend” an event, or “leave their room” in some way is thought to be greatly impactful. A multidisciplinary team at our hospital is planning to conduct formal research and evaluate the best method to assess the impact of using this telepresence technology with patients.

We continue to utilize telepresence technology and we are focused on expanding these services to additional patient populations. Our institution has since obtained several more robots dedicated to promoting patients’ psychosocial engagement opportunities, allowing for additional patients to participate in telepresence experiences. We have added a very large touch screen computer monitor to one inpatient unit playroom. This monitor will be used to allow easier access for multiple patients to video conference in and engage in playgroups, teen groups, diagnosis teaching sessions, or even hospital-based school classes. The possibilities for utilizing the monitor are still under discussion and development.

Telepresence opportunities have also expanded from within our hospital environment into the outside community. Patients have been able to use the robot to attend their high school graduations, funerals of family members, and Sporting KC soccer games. Previously, patients who were admitted to the hospital would have missed these milestone experiences. Technology has allowed us to connect these patients in a whole new way!

In conjunction with our telemedicine department, we continue to make telepresence plans for the future. One thing is for sure: When a patient gets admitted to the hospital and is labeled “on isolation,” we no longer see this as a barrier, but as an opportunity for a new type of play and engagement. You should see patients’ faces when we ask, “Do you want to drive a robot?”

A volunteer accompanies two isolation patients virtually attending Children’s Mercy Kansas City’s first annual prom via iPad and robot.