Child Life in Action

in Dialysis Nutrition with Doreen Evans-Yorke, MA, CCLS

by Bea Wikander | May 29, 2018

lscottchildlifemedplay

Doreen Evans-Yorke, MA, CCLS, was first exposed to the child life profession while completing an undergraduate practicum at The Montreal Children’s Hospital, one of the first hospitals in North America with a child life program. The experience was transformative, and Doreen says child life chose her, rather than the other way around. 

Preparing food is a wholesome activity that involves precision, cooperation, patience, and sharing, and it provides a sense of control for children and teens who can’t regulate their mobility for long stretches of time.

Since that career-defining introduction to the child life profession, Doreen has lived in many countries and explored other careers, and she’s grateful now to be back where she started—working as a child life specialist at The Montreal Children’s Hospital. Doreen’s child life career spans more than thirty years, and certification was not yet in place when she first began practicing. After heeding the call to become a child life professional and gaining some work experience, Doreen spent some time away from clinical practice to raise her family and to live and work in Africa. After college, she had spent a year teaching English in Cameroon. Years later, she and her family went to Africa and stayed five years in Kenya and ten years in South Africa.

Child life was a foreign concept when Doreen lived in Africa, but she applied her child life education and skills whenever possible. In Kenya, she visited schools to talk about sickle cell disease, an area she was familiar with from her first stint at The Montreal Children’s Hospital. Her main work in Kenya was teaching university students who were preparing to become teachers at the secondary level. In South Africa, she taught in an American International school where her own children were students.  Although far removed from hospital practice, Doreen relied upon her experiences for a course she taught about exceptional students.

When Doreen returned to Canada after living in Africa, the child life profession had evolved and transformed. Although Doreen had always “felt the need for a more professional profile for child life,” becoming certified while re-adjusting to life in Canada was challenging. She never wavered in her commitment to the profession and became certified in 2010. She currently divides her time between dialysis patients and the emergency department at The Montreal Children’s Hospital, where she has worked for the past eleven years.

Doreen’s long career has allowed her to witness positive changes at The Montreal Children’s Hospital and in healthcare generally. The hospital is now part of a super hospital, with several institutions sharing a large campus, and the patient and family experience has been improved by the proximity of the children’s hospital to the adult hospital. Doreen recalls a car accident before the relocation and expansion, where a mother went to one hospital and her children to another. It was difficult for the father to visit both his wife and his children. With the new design, it is only a matter of minutes to get from one location to the other. Doreen has also seen the child life profession receive greater appreciation and respect from the healthcare team, and she works with many physicians and nurses who understand and value her work.

When not in the emergency department, Doreen works with dialysis patients, who range in age from seven to seventeen. They receive treatment three days a week, often for one to three years or more as they await kidney transplants. The dialysis unit has space for six patients, and Doreen currently sees four patients regularly. Her patients arrive at 8am to have their ports opened and tubes attached, after which they are then unable to leave their chairs until dialysis is complete, approximately six hours later. Doreen provides normalization by celebrating birthdays and holidays and establishing a routine.

Doreen devotes one day to arts and crafts and another to her unique cooking program. Doreen is especially passionate about her cooking program because “There’s so much negativity around food for children on dialysis.” The list of restricted foods can seem endless, especially to young patients. Bananas, potatoes, chocolate, and all salty foods are forbidden most of the time. Doreen asked one of her young patients what food she was most looking forward to after her scheduled kidney transplant. “An entire bag of chips!” was the girl’s gleeful response because she hadn’t been allowed more than one chip at a time before receiving her new kidney.

Child life specialists are known for their ability to find creative solutions and think on their feet. Doreen used these skills to set up a functional kitchen, find appropriate ingredients, and create interactive recipes that can be prepared in a microwave with oven conversion functionality. She consulted with the unit’s dietician and head nurse to determine the ingredients she could use with dialysis patients. Mindful of patients with additional dietary restrictions, Doreen became an expert on halal and kosher ingredients, particularly the marshmallows used for Rice Krispy treats.

Doreen’s scheduled time to cook with patients is sacrosanct. The hospital-based teachers understand that they can reschedule or make accommodations for a lesson or exam: food and camaraderie come first. To allow each patient to assist with adding ingredients and mixing, Doreen quickly does the math to figure out, for example, that four children can each add a half cup of flour if the recipe calls for two cups. She wheels her cooking cart from chair to chair, ensuring that each child has a chance to participate. Doreen admits it gets tricky when a recipe calls for two eggs, and four children are eager to crack them. The hard work is worth it because “It’s exhilarating and it’s so much fun to see them involved and the anticipation of tasting,” says Doreen.

After consulting with the medical team, Doreen realized that patients could cheat a little with restricted foods during dialysis because the machine cleans their blood of the salt and potassium that would normally be harmful. Chocolate is not usually allowed, but Doreen and her patients recently made oatmeal cookies with cranberries and chocolate chips, which they could safely eat during dialysis. She and her patients have made everything from zucchini chips to bannock, an Inuit flatbread. One of Doreen’s patients even asked for her recipes, so she could cook and bake for her family on the weekend.

Doreen’s patients are understandably enthusiastic about food, but the benefits of her program go beyond happy taste buds. Cooking is a wholesome activity that involves precision, cooperation, patience, and sharing. It provides a sense of control for children and teens who can’t regulate their mobility for long stretches of time. While Doreen is calculating how many cups or teaspoons each child can add and wheeling her cart from chair to chair, she’s also focused on the specific goals she’s developed for each child, such as sharing or trying new foods. To untrained eyes, her activities may seem like mere entertainment, but the crafts and cooking belie individualized developmental goals informed by continuous assessment.

Over the course of her child life career, Doreen has seen many positive changes in practice and perception, but she still sees room for progress and expansion. She would like the healthcare profession to “realize the professionalism and worth of child life and to provide the funds to have more people.” On a personal level, a passion for travel and a commitment to child life have been constants in Doreen’s life, and she hopes to have the opportunity to combine them. One of her professional goals is to do international child life work, perhaps disaster relief or mission-based. She is comfortable working in English, French, and Spanish so her linguistic skills would be a valuable contribution to international child life work. She’s particularly interested in bringing child life to developing countries and showing that “potential trauma related to medical care can be minimized through child life.” Wherever Doreen ends up, she will continue to make a difference in the lives of children and incorporate child life values into all aspects of her life.

See more Child Life in Action.
 

Child Life Profession