National Nurses Week

Today marks the end of Children’s Hospital Boston’s celebration of National Nurses Week. In honor of the occasion here are some recent Thrive stories featuring our nursing community.

Children’s nurses teach in Cambodia. Since December 2009, a group of nurses, physicians and therapists from Children’s has dedicated themselves to setting up a “Sister PICU” (pediatric intensive care unit) program between Children’s and the National Pediatric Hospital (NPH) in Phnom Penh, Cambodia. Children’s nurses Maureen Hillier and Kim Cox talk about the weeks they spent training Cambodia nurses, 9,000 miles away from home, in Phnom Penh.

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Eva Gomez, MSN, RN

Life “inside the rails.” Eva Gomez, MSN, RN, is a nurse and staff development specialist at Children’s. In the following piece Eva explains how her recent heart surgery has renewed her appreciation for life and inspired her to be an even better care provider.

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Preparing for disaster. The recent devastating earthquake and tsunami in Japan forced many American families to think about their own disaster preparedness plans. But for families with children who have special medical needs, such preparation can mean the difference between life and death. John Murray, PhD, RN, Children’s director of Nursing Research in Surgical Programs and the Emergency Department, offers tips for parents and children with special medical needs on how they can make their own plans for dealing with disaster should it strike.

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Finally, here’s a piece written by Meaghan O’Keeffe, RN, who practices at Children’s Preoperative Clinic. She sees hundreds of patients every year, each with their own specific needs and backgrounds. It’s a demanding job, but Meaghan says the challenge and satisfaction associated with treating such a wide range of patients is exactly what she loves about nursing.

Zoe is a 14-year-old with scoliosis who needs surgery to correct the curvature of her spine. It’s an operation with a lengthy post-op recovery, but for a patient like Zoe, who also happens to have muscular dystrophy, the road to recovery is that much steeper. Because of her muscle weakness, she has problems with her lungs and often requires frequent hospitalizations. What would amount to a minor cold for most kids can easily send Zoe to the intensive care unit.

Every year we welcome over five thousand patients just like Zoe to Pre-Op clinic. Many of these patients have complex medical needs and are often forced to navigate a challenging maze of healthcare pathways to receive treatment. More often than not, our clinic is the place where all of these paths connect.

But our relationship with our patients starts well before they walk through our doors. A week before a child comes to the clinic, our nursing staff is already combing through their charts, searching for potential risk that could arise during general anesthesia. We review all types of medical documents, from single-page notes, to thousand-page documents. We identify issues, problem-solve and initiate conversation between physicians and nurse practitioners to ensure that each patient has a cohesive plan for their care.

By the time Zoe arrives at her Pre-Op Clinic appointment for anesthesia evaluation, we are ready for her. We have contacted her family to request they fax the most recent anti-seizure blood levels. We know that because she is in foster care, her case-worker needs to be available by phone to give anesthesia consent and we have received recommendations from all of her specialists which means that there is a firm plan in place for safe delivery of care.

It’s a lot of preparation work, but doing it early is important so by the time Zoe arrives we can focus on her. When her foster mom pushes Zoe’s wheelchair into my exam room, it’s all about Zoe. Zoe’s medical history is far longer than one would expect for a girl so young, but the face that sits across from me reflects none of that; all I see is a beautiful smile, beaming with youthful confidence. We confirm the upcoming procedure, discuss past surgeries and talk about any complications that may have arisen.  We talk about her seizures and her gastric reflux management, how they may affect the operation. Her foster mom, who has been with Zoe for many years, tells me about the terrible winter they have just gone through, with emergency room visits and a hospital admission for treatment of pneumonia. Zoe tells me about schoolwork and her favorite subject.

The whole time we’re talking, I’m assessing her case and formulating a plan. I can see that her skin tone is pink, that her breathing is unlabored.  She has a slight cough, but it appears to be upper airway congestion and I will rule out any wheeze, congestion, or decreased lung sounds when I examine her.

The collaborative nature of nursing is one of O’Keeffe’s favorite aspects of the job

I explain to mom and Zoe how and when to find out the specifics around the time of her surgery. I remind them of how long before the operation Zoe should stop eating solid foods and instruct her to take her anti-seizure meds on the morning of surgery. To make sure we’re all on the same page, I ask Zoe to repeat the instructions back to me to make sure she’s retained everything.

Nearing the end of the appointment, I have mom head back to the waiting room so that I can spend some time alone with Zoe.  I need to ask some confidential questions and I like to give patients the room to open up to me privately if they want.  I assess her airway, her heart, her lungs and her neurological status in my anesthesia-focused exam. I ask her if she has any questions or things she is wondering about before she meets with the anesthesiologist.  Turns out, she has two questions: What happens if she hiccups when she is sleeping during the surgery?  And is there any chance that the Jonas Brothers are going to be visiting the hospital while she is recovering?

Zoe is a fictional patient, but she embodies the essence of every patient I encounter here.  Each child I treat is unique, forcing me to think both critically and creatively, and allowing me to work with people and departments throughout the hospital. What I love most about the Pre-Op Clinic is that it enables me to practice in a way that reflects what I believe nursing truly is:  a collaborative medical profession which allows patients to receive the best and safest care possible. What I love most about being a nurse is that I am privileged to do this while having the opportunity to become part of, even if for a brief moment, the intimate lives of patients and their families.