- A physician’s learning of the Touchpoints approach helps nurture parent-child relationships
As a family physician working in a maternity clinic in Comox, Dr Theresa Wilson observes families interacting with each other and sometimes witnesses the frustrations related to adapting to a child’s development. This is an experience not unfamiliar to her during some of her visits with families with young children.
“All parents want to do well by their child, and all parents have strengths,” says Dr Wilson, who credits Touchpoints for her understanding that relationships are the foundation for development.
Dr Wilson first learned about Touchpoints and attended the initial training when it was brought to the Comox Valley by the Pathways to Healing Partnership and a public health nursing coordinator.
Touchpoints is a framework that guides practitioners to intentionally build on relationships between physicians and parents and their families, and between parents and their young children.
Dr Wilson explains that using the Touchpoints guiding principles is a culturally responsive approach to care as it can help practitioners recognize and understand the differences of patients before and during a visit –meeting patients where they are at. Physicians can use the child’s behavior to learn more about where the family is at, and how they are coping with a new developmental change or challenge. The Touchpoints principles also helps physicians observe interactions for strengths.
“You’re doing what you’re doing, just better. We are genuinely changing how we see people by becoming more self-aware,” says Dr Wilson.
Physicians can shift conversations between parents and children from what is not working to what is working well. Through reflection and practice, physicians work alongside families during predictable periods of disorganization or regression as a child learns or acquires a new skill or milestone.
“I can help parents to see that it’s okay that their child's development fluctuates when the child is working on a learning a new skill,” says Dr Wilson. “I can help normalize the ups-and-down.”
Strengthening the parent-child relationship
Dr Wilson recalls a time when she was with a patient who had just delivered her child. The patient’s partner had rushed into the patient room, missing the birth by eight minutes. Recognizing that the father was disappointed, Dr Wilson was able to help reframe the experience.
“I had seen the baby turn its head to look at the father when he came into the room,” shares Dr Wilson. “So I pointed that out to the father, who hadn’t seen it. I was able to use the language of the baby and narrate its behavior.”
By focusing on the positive aspects of the situation, Dr Wilson transformed how the interaction was remembered by the family.
Reducing physician burnout
By using the Touchpoints approach with patients, doctors can help reduce their own stress and feelings of burnout.
Before a patient visit, Dr Wilson reviews the area of development, looking for what might be seen or expected during the visit and reflecting on potential Touchpoints assumptions and guidelines. With that preparation, she feels grounded and ready for difficult issues that may come up during the interaction.
“My patients have commented about how they appreciate the extra time I’m spending with them, but that’s not the case,” says Dr Wilson. “My visit times have not changed.”
Supported by the Physician Engagement Society of Comox and Courtney, which is funded by the Facility Engagement Initiative, the interactive training is offered to doctors through the Comox Valley Child Development Association (CVCDA). For more information, contact the CVCDA.
Watch the video below to learn more about Touchpoints from a panel of multidisciplinary health practitioners in BC.
The webinar is presented by the Shared Care Committee –one of four Joint Collaborative Committees that represent a partnership of Doctors of BC and BC Government– and the CVCDA.
Any hospital’s Emergency Department (ED) has seen life-threatening drama and life-saving results – often it is preparation that makes the difference. Dr Matt Carere, an ED doctor at the Victoria General Hospital knows well the importance of being prepared.
During the past year or so, he along with Dr Donovan MacDonald, an emergency medicine resident doing a Fellowship in simulation training, with the support of ED Department Heads Drs Paul Collela and Gavin Jones, and help from the South Island Medical Staff Association's Facility Engagement Initiative funding have brought “in situ simulation” training to the hospital’s ED.
This training allows ED staff and relevant specialties to work, learn and reinforce their skills together in their clinical environment. It also helps identify hazards and deficiencies within clinical systems, the environment and the health team. This is unlike the traditional simulation training conducted at teaching hospitals.
From simulation to real life
A recent in situ simulation helped save the life of a two-week old newborn. Dr Carere, “there is nothing more daunting than having a two-week old premature baby in profound shock and peri-arrest come in. And nothing more satisfying than being able to work in the most efficient way possible to save her because we had just run a simulation a week previously that yielded a number of critical changes to our approach.”
Over the last year, one to two simulations were held each month, involving not only Emergency Department physicians, but also Pediatric Intensive Care docs, PICU and NICU nurses, pediatricians, hematopathologists, anesthesiologists, adult intensivists, respiratory therapists, ECG and lab technicians, as well as more than 40 different emergency department nurses.
Dr Carere notes, “getting them to come in and give us their input on how we can improve our practices in the ED is invaluable. This doesn’t happen without complete buy in from everyone. In fact, we have a group of nurses who volunteer for these nursing education days. They’re getting examined under a microscope by us and they are all for it.”
“There is nothing more daunting than having a two-week old premature baby in profound shock and peri-arrest come in. And nothing more satisfying than being able to work in the most efficient way possible to save her because we had just run a simulation a week previously that yielded a number of critical changes to our approach.
Each scenario is attended by a clinical nurse educator to summarize the scenario and lessons learned to ensure any insights or needed actions are given to all ED staff. The group also film each simulation so that those not able to attend on the day can still learn from the experience. Dr Carere states, “It’s humbling because I’m in these rooms with all these talented doctors and nurses and every time I personally am learning so much.”
Due to COVID, some practices have been made more complicated. With in situ simulations, even the smallest barriers can be revealed to have a huge impact. For example, a recent simulation involved a cardiac arrest with a suspected COVID patient. One doctor discovered administering CPR in full PPE with glasses, googles and face mask left him unable to see as his glasses continually fogged up.
The South Island Medical Staff Association's FEI funding funding has been inestimable in allowing this work to happen. Feedback has been universally positive from staff to the hospital administration. Dr Carere is working to help make in situ simulation become a natural part of the hospital’s culture.