When a child is admitted to the hospital,
pediatricians have the same concerns that families
have: make sure the child stays safe, comfortable,
and as emotionally secure as possible.
In my
childcare book
The Portable Pediatrician, I talk about
the emotional meaning of hospitalization for
children of each age group from Birth to Five. (It’s
in the “What If” section of each age-based chapter,
along with such challenges as parental divorce,
death of a pet, arrival of a new sibling, and so
on.) While I still stand by that advice, there have
been three big changes since then when it comes to
keeping children as safe and as comfortable as
possible:
1. A national shortage
of nurses, including pediatric nurses, may require
parents to step up their own role as caretaker to a
greater degree one would ever have expected.
2. Physician care in
the hospital is more likely to be directed by a “Hospitalist,”
a doctor employed specifically to care for
hospitalized children. Primary care physicians are
fading from the picture, and sometimes parents need
to be the link among three physician groups: primary
care doctor, hospitalists, and specialists (in such
fields as infectious disease, neurology,
cardiology.) This is especially crucial if
physicians disagree, and also at the time of
discharge, when follow-up instructions can be
crucial.
3. Over the last few
years, the study called MRI has become much more
available and more casually used. At the same time,
there are no governmental regulations or oversight
to make sure that safety is maintained. An ordinary
thoughtless action, such as bringing an IV pole into
the MRI suite, can cause disaster, even death;
parents need to be present and watchful to help
prevent such accidents.
My book What
You Don’t Know Can Kill You, discusses in
detail the implications of all of these changes, but
primarily for adults. Parents of hospitalized
children need a different take on these matters. I
hope that reading these, even casually, before a
planned or unplanned hospitalization, will tell you
what to prepare for.
So here is my advice for parents on each of these
topics, starting with the Nursing Shortage.
Nurses:
Missing in Action
We are in the midst of a critical nursing
shortage. Nurses are “aging out” -- half are 45 and
older. So there are fewer and fewer of them, which
means that they have to work longer and harder,
making it tough to recruit new nurses. And even if
there were lots of candidates, there is a
corresponding shortage of nurses qualified to teach
them.
This shortage, with its avalanche of increased
demands, is particularly hard on Pediatric Nurses,
who went into the profession in the first place
because they really like children, and who now
rarely may get a chance to interact with anything
that isn’t sounding an alarm.
The bottom line here is that when you assume a
nurse is going to be there, for whatever situation,
there just may not be a nurse available. You, the
parent/grandparent/other loving adult, must step in.
To do so, you need to be familiar with the contents
of the child’s room, the ward the room is in, and
solutions to common and to crisis situations.
Most especially, you need to bond with the
nursing and helping staff, making yourself useful
without being intrusive. If something needs to be
cleaned up, or fetched, or changed, see if it is
possible to do it yourself -- ask a staff member if
you’re not sure. If you think there is a problem,
present it as your concern, not as a foregone
conclusion that the staff person has erred. Once you
have a reputation for being positive, helpful, and
reliable, the staff will be even more responsive to
your requests.
The Constant
Grown Up
Someone competent, loving, and familiar should be
with the child
24/7, both at the bedside and accompanying
the child on any within-hospital trips.
When you stay overnight in the hospital, you need
to be both self-sufficient and vigilant.
Self-Sufficient: Try not to ask the staff
for help with your own needs. You must be
responsible for your own food, drink, and hygiene
products. A hospital overnight kit for the adult
should include
all your personal needs, a flashlight,
and a sleep mask and ear plugs. I also recommend a
shrill loud whistle to wear round your neck tucked
into your shirt, to use ONLY if there is a true
emergency and nobody comes to help.
Protect
against hospital-acquired infections:
Hospital-acquired germs can be very dangerous.
Hand-washing is crucial, and nurses tend to be more
fastidious than doctors about this. Nonetheless,
keep a rub-in hand cleanser at bedside: use it
yourself, and offer it to any professional or staff
member before they touch your child.
Since both children and hospitals tend to be
sticky, bring along a container of disposable
antibacterial/antiviral wipes, and frequently clean
off the surfaces that need it most -- TV remotes,
telephones (including your own cell), door knobs,
bed control buttons, toys and dolls.
Vigilant:
· Get to know your surroundings. Early on,
get used to where these are: the Nurses’ station,
the emergency exit, the source of drinkable water,
and the public or visitors’ bathroom (unless you can
use a private bathroom.) At the bedside, locate the
“call” button for the nurse, and vow to use it ONLY
in an emergency. Figure out how the bed buttons and
side rails work.
· Remember that wards become darker at
night. Make sure you can make your way around with
your flashlight. Figure out what you are going to
sleep on well before night falls, and get acquainted
with that piece of furniture -- and make sure it
doesn’t obstruct the path to the child’s bed.
· Ask the nurse to give you a basic
explanation of each of the “Lines” placed for your
child. Lines are tubes: to deliver oxygen, fluids,
medication, blood, liquid feedings; to collect for
the lab or to evacuate stomach contents, urine,
drainage, pus, air pockets. Each line should be
clearly identified, so that the fluid or medication
doesn’t go into the wrong tube -- food into a vein,
for instance. Ask how the lines are labeled or
identified to be “foolproof” in this way.
And then, of course,
keep a watchful eye when any substance is injected
into a “Line.” If you think someone is about to make
an error, speak up at once, but try to be vigilant,
not offensive. “I’m sorry to interrupt, but I
thought that that is the arterial line, and they
said nothing should be put into it.”
If a change is made in
lines -- if one is going to be removed or added --
make sure you understand why, and what it is for. If
the person doing the procedure is one you don’t
know, or is clearly a subordinate to the main doctor
involved, make sure that the supervising physician
has ordered the change.
Monitor your
child:
Make friends with the Monitors.
Monitors are computers that receive and interpret
the signals your child’s body is sending out. These
signals are delivered as numbers via a “lead” placed
on or in the body, transmitted by a wire to the
machine. Most commonly, monitors measure heart and
breathing rate, blood pressure (how hard the heart
needs to work), and the blood’s supply of oxygen.
Other monitors measure more special signals: the
pressure of the spinal fluid, for instance.
The Settings on a monitor determine at what point
the number value of each particular “vital sign”
gets too high or too low, at which point the monitor
should alarm. A heart rate over 150, say, or oxygen
saturation under 90. These settings vary from
individual to individual, depending on age and
condition.
Well that’s all fine and good, but it doesn’t
take childhood behavior into account. You may
notice, and be alarmed, that when a monitor alarm
goes off like a cat with its tail stepped on, it
very often doesn’t get an instant full team
response. Almost always, that’s because nurses, no
matter how busy, know which children are in a
precarious situation and which are not.
What if Timmy starts tantruming about the tapioca
pudding and his heart rate goes up to 180? Or Nancy,
also inflamed by the mere concept of tapioca, holds
her breath until she turns blue and her oxygen
drops, for thirty seconds, to 78? Or angelic little
Franklin doesn’t like the itchy monitor leads on his
chest and finger and in the space of fourteen
seconds takes them all off and tries to eat them? Or
chubby little Poppy sweats so much all her leads
come unstuck?
But it can work the other way, too. Monitors
can’t monitor everything -- how a child is feeling,
or talking, or behaving, or whether he looks as if
he is going to throw up. They also can’t announce
that even though the numbers are within the range of
the settings, there is a sinister trend: say that
over an hour the Oxygen Saturation falls from 100 to
93. Clearly, there is something wrong, but the alarm
doesn’t go off. To spot the trend, somebody’s got to
be watching the child. That’s what nurses used to
do, back in the day -- they would get to know their
small patients and be alert to such changes. Now
it’s up to YOU.
So keep your eyes open, and if you think your
child’s condition is changing for the worse, press
the Call Button. If no one comes, get out there in
the corridor and snag the next nurse you see. Worse
case scenario, blow that whistle.
Finally: yes, it’s nice to bring treats for the
nurses. But even better, bring them real help, a
positive attitude that assumes that they know what
they are doing and have your child’s best interests
at heart. A note of praise to the nurse, with a copy
to the supervisor and the head of the hospital, goes
a lot farther than chocolates. If you really want to
bring a treat, fresh fruit is appreciated even more
than processed sweets by most nursing staffs.
When you get home from the hospital, it’s always
appreciated if you can drop a note to your
pediatrician to report on your stay, and any
comments on the care your child received.
Copyright ©
2007 Laura Nathanson
Author:
Dr. Laura Nathanson is the author of
What You Don't Know Can Kill You
(Published by Collins; May
2007; $15.95US/$19.95CAN; 978-0-06-114582-7) and
The Portable Pediatrician (Collins, 2002), as well as
several other books. She has practiced pediatrics
for more than thirty years, is board certified in
pediatrics and peri-neonatology, and has been
consistently listed in
The Best Doctors in
America.
For more information, please visit
www.lauranathansonmd.com
