Nursing Clinicals (12-1-2007)

One of the clinical experiences we were assigned was to spend 4 hours in a daycare to observe the “normal” growth and development of toddlers and preschoolers. I and two classmates went to the facility right on time with positive thoughts, prepared with paper, pen and clipboard, stethescope and miniatrue blood pressure cuffs. Shouldn’t be too bad, right? Ugh…it was awful! The environment was loud, chaotic, and the way the children were handled was just ridiculous. I understand that words are important but this was PC gone completeley overboard. I can’t remember the last time I felt so glad to leave a place. How blessed I am to have never had to shop for daycares.  This facility is reputed to be a very good one, so I can’t imagine the state of the others. I don’t know how parents do it, honestly. In any case we were asked to write a journal explaining our feelings about the experience so here it is:

My first impressions as we entered the facility were that the staff was slightly overwhelmed. They are cautious in following laws regarding how many children each adult may supervise but even within those parameters they seemed more stressed than I would have expected. While each of the caregivers seemed to enjoy what she did, I only saw one woman who did not express (verbally and non-verbally) that she was anxious to get the day done and go home. I found that somewhat troubling. If I were a parent I would hope that my child would be with people who wanted to be with them and truly enjoyed their job. To be fair my visit was during the last half of the day which may have contributed to the fatigue and lack of patience.

        I began my observation with the preschoolers who were playing well together in one area. One of the children was sitting nearby at a table eating his snack after all the others had gone to play. When he was finished he called to the caregiver, “Miss Emily, can I be excused?” she did not hear him. He shouted three more times before my fellow classmate got her attention for him and she allowed him to get up from the table to wash his hands and join the group. This was when I first took note of the very high level of noise in the environment and how it affected the children as well as the caregivers.

            I moved on to where some toddlers were playing with puzzles on the floor. In this section to add to the already distracting sounds was a radio playing music. I didn’t have to spend much time here before my head began to throb and the noise level began to affect my ability to concentrate. I noticed one child right away who was pacing back and forth with her fingers in her ears. I asked the caregiver about the girl, and as I suspected she told me she had Autism. I was very surprised to see an Autistic child in such an environment. Admittedly, I don’t know great deal about the condition but from what I do know I would think her senses might be overloaded in a much calmer environment than this one and it disturbed me greatly to see her plugging her ears and pacing the way she did. The staff simply ignored her for the most part, allowing her to roam between the different ages and classes. For the remainder of my time there she barely responded to anyone and spent much of her time blocking out the noise with her fingers.

        I was truly caught off guard by some of the policies of the facility and the verbiage the staff used. For example, I witnessed two children grab the same puzzle at the same time. As toddlers they are not keen on sharing so they each pulled it in their own direction. When little Alex let go of it, the girl got bumped with it. She immediately began to cry and ran to the caregiver Miss Emily, who held her on her lap hugging and patting her while she cried for what seemed like at least five minutes. Miss Emily, while rocking the girl, looked at Alex and pointed her finger at him. Sternly she said, “You hurt my friend and that makes me sad!” Alex, who is three years old, just looked at her with big sad eyes. He looked utterly shocked. It seemed clear to me that he had no idea what had happened to the girl or why Miss Emily was upset with him. As another staff member walked by Miss Emily said to her, “Can you please remove Alex from the circle? He is not using his gentle touch.” Alex was promptly picked up and plopped down in a corner of the play area that was not occupied. He was left there, completely ignored by staff for more than ten minutes. He showed no signs of emotion regarding the incident, only boredom rolling around on the floor. Miss Emily talked to us shortly after about her class and the ages of the children in her care as well as the hygiene policies they have. She casually mentioned that as we had already observed she unfortunately had a couple of “violent” children in her group. She then looked in Alex’s general direction. He was lying on the floor very near us at the time and certainly was within earshot of our conversation. He was eventually allowed to get up from his spot because I asked Miss Emily if I could listen to his heart rate. Had I not intervened I do not know how long he would have been ignored. I do not see the value in the disciplinary action that was taken if he was never talked to about the infraction, and he is unable to learn from it. The only redeeming value is that it removed a potentially “violent” child from the rest of the children. I was also very uncomfortable to see a child labeled so negatively and at such a young age.

            Later when I went back to watch the preschoolers I was again surprised by the behavior of the staff. I noticed that this caregiver did not tell the children not to do things; instead she would ask if they had permission to do them. For example, one boy was reaching for something inside a box on the top of a shelf. The caregiver did not ask him to stop, she did not redirect him elsewhere, she simply asked him “Jordan, did I say you could do that?” He looked at her with a bewildered expression and meekly pulled his hand away. I understand the desire to stay away from negative words and judgmental remarks, however the words used here with such small children seemed confusing at best. What is little Jordan to do? Must he stop before each action and carefully consider whether or not he was specifically told he is allowed to do it? This seems discouraging to me as well as inappropriate. I think some children would stop trying to explore and learn new things in response and just stay content to do what they already know is safe and acceptable.

        I saw this same caregiver react in a manner I found to be unsettling just a short time later. She asked her students to line up with their coats on to go play outside. She instructed them to stand in line with their hands on the shoulders of the person in front of them and wait. One girl apparently poked the boy in front of her and he began to cry for the caregiver. She responded quickly and sharply by leaning into the four year old girl’s face and saying, “Stop harassing my friend! I don’t like it!” The girl responded much like Alex did. She looked puzzled and her eyes were big with surprise. I am really not sure how effective it is to tell a four year old not to harass a classmate, but I was certainly surprised and a little sad to see harassment come to preschool.

        Overall, I was very uncomfortable with the experience. I left feeling very sad for the children lost in the commotion of the environment, the children being scolded with words they don’t understand, the children being labeled as violent at three years old because they picked up the wrong toy at the wrong time. I also sympathize with the caregivers who I am sure are doing what they are trained to do and trying to care for the children while navigating the system they are in. Having had four children of my own, I was not in great need of observing these children to understand the stages of growth and development. I was considering however, people who may be experiencing this for the first time, and I feel the experience for them might be an unfair depiction of “normal”. I recognize that many children are placed in daycare settings, but this environment is anything but normal. There is no quiet time for the children when they need it, there is no solitary break from the large group of their peers, the children have no choice over the activities they wish to be involved in, they are simply herded from one to the next whether they are ready or not, there isn’t even an opportunity to receive any individual attention from an adult. In short we were sent to view an abnormal environment to find normal behaviors.

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