Accidental death....

I heard about this one case from one of my classmates, who also works in an ED. This is an incredibly sad story. For privacy purposes some of these elements have changed.

A family of a 2 year old were in the living room. Mom was on an elliptical machine, Dad was nearby on the computer, and their 2 year old was on the couch. Child manages to get off the couch, but in the process falls into the elliptical, which was still being used by Mom, and gets crushed. Mom immediately stops, gets off, and then calls 9-1-1.

Child ends up dying.

I cannot imagine what it must be like to lose a child. I can't even fathom how someone must feel who had unintentionally caused their child's death. My sincerest condolences to this family.

This is a fear I have, working in the ED. I have fully admitted I"m not a fan of paediatric nursing, however I am coming around and learning to step up to the challenge. The idea of having to work on a child who was severely injured makes me sick to my stomach. I can't imagine how the staff felt that day, and how they could go back to working on the sore throats, injured hands, etc that we generally get in Emerg.

Blows my mind.

Where are the parents?

I haven't been posting recently due to a swampload of work with both Nursing, the part time job, and my thesis work.

This week I had the opportunity to observe in the paediatric Emergency Department at the local children's hospital. Although paediatrics isn't my thing, I am more and more convinced that ER nursing is where I could fit. I like the system that is set up at this particular ER, for both adult and paediatrics (I even had the opportunity to observe in the Adult Emerg in the resuscitation room)

Today I was shown how lack of parenting is effecting the treatment of children, and how nurses sometimes have to be firm to get the point across.

This one child and his parents came into triage today. Apparently the child had had a series of respiratory infections, which eventually spread into a fairly serious case of otitis media; a fancy way of saying an ear infection. Anyway, the parents had taken him to the urgent care center here in town about 4 days ago, had been given the diagnosis, and had been given a prescription for the medication to treat it. The parents filled the prescription, and had also been giving the child some children's analgesics for the pain. Here is where the problem lies. The child is a fussy child, and the only child of the parents. He's 4 years old, and doesn't like hospitals. This is totally understandable for a sick child who maybe associates doctors or nurses with needles and pain. What got me was that because he was a fussy child at home, he had refused to take the prescription medication. Again, totally understandable, because he's a fussy child. Which brings me to the crux of this rant: The parents did not make him take the medication. Here is a child of 4 dictating what he can and cannot get medically! What sense does this make? What type of parents are these that don't even give medication needed to benefit the child? Who are the parents here? I would be more able to understand if they had some cultural or religious views on this particular medication and could not administer it for that reason, but to not give a child medication that he needs because the CHILD DID NOT FEEL LIKE TAKING IT? Come on!

So now the child has a worse ear infection, is in more pain, and the parents are at children's emergency because the ear was now leaking purulent drainage. Surprise surprise that the ear infection got worse. I had a hard time observing this because the child did NOT want his temperature taken as well, and the parents were trying to reason the kid into doing it. OK after teaching the kid what we're going to do, sometimes the parents need to take control of the child and do something for his/her benefit. Again, the parents did not step up. I was really tempted to hold his arm down to help the triage nurse, but alas, it is not my role to do that, it was the parents.

What happend? Why aren't parents stepping up to the plate? Don't they know that by their intent to not "hurt" or cause the child any discomfort, they are actually making the child worse?

I'm glad the ER nurse sat down with the parents after this and discussed the situation. I just hope they have learned a lesson from this. I sure have.

waaaaaaaaaaa

This week was a challenging week in paediatrics. Although I am starting to get the hang of things on the floor and feel that I would be able to take more responsibility and more patients, I am also coming to the realization that paediatrics is not for me. The reason I say this is not because I do not like children, it’s because there are some circumstances for which paediatrics will be incredibly difficult. First, I think I like kids too much to see them in pain, and to see how much the parents are worried and scared for their child. Second, as much as kids can tell you a lot, a baby is unable to tell you what kind of pain they are in, and what is wrong with them, which makes working with them incredibly frustrating because you want to help but do not know how.

I found myself out of my element. I hate when kids cry. I mean, I really hate it. The reason I hate it that much is because of the uselessness I feel when working with them; I don’t know what is wrong with them, and I feel terrible that I cannot help them out. I also get incredibly frustrated because after some prolonged crying I feel as though nothing I have done has helped.

This week I had the opportunity to work with two little girls, one 3 years old, and one 23 months. The 3 year old had an undiagnosed mass midline and left lateral of her neck inferior to her hyoid bone. She was admitted because she had a fever, and a possible urinary tract infection along with the mass. Her foster mother had roomed in since Saturday with her, and had only left to go to the bathroom, and to have a shower (while the girl was with her foster father). The 23 month old had gotten caught in a conveyor at a dairy farm, and had a severe friction burn on her left lower arm. This friction burn required skin grafts, and unfortunately the first graft didn’t take- she had to have a second graft completed. This resulted in her having multiple dressings on her left arm, right arm, and left leg. Both girls had IVs as well as antibiotics to hang, which I feel more confident about giving.

I looked forward to the challenge of working with these two girls, as I had yet to work with anyone in paediatrics under the age of 11. They also seemed to have interesting medical cases, and their moms both were present, which made getting to know the girls a lot easier. The challenge for me, however, was when the 23 month old’s mom left. To give some backstory, this little girl had cried the entire beginning of the shift, a full 5 hours. At first, I thought the crying was because she was tired; her mom stated she hadn’t had a nap all day. We had gotten her to sleep for a bit, but because of protocols we had to check vitals every 5-10 minutes after giving morphine, so it ended up waking her up. Finally, at 8pm, we were able to get her to sleep. By this time I was exhausted; as you know I had spent earlier in the day with my brother for his knee surgery, and in total I was on my 18^th hour of a 20 hour hospital day.

I dreaded going back and working with her the following day, as I knew the 23 month old girl would cry when she saw me. To my dismay she did, and also the 3 year old, generally a delight to work with, was acting up and crying too. Not only did I have 1 inconsolable crier, I now had two. Luckily, mom of the 3 year old took care of most of the crying, and helped out when I needed to do assessments. In the end, I spent over an hour and a half working with the 23-month-old, trying to console her after her mom left. I think she was finally comforted after she realized that I was not going to leave her alone.

I felt so helpless! Stop crying! Please stop! I think that I’ll have to black out for the first 5 years of my future children’s life, and let the hubby deal with it. I just can’t stand the crying.

Wowzers

This week presented a challenge that I have never experienced before. As I was trying to get air out of one of my teenage patient’s IV line, I brought up the subject of his previous hospitalization- he had been hit by a car. Sensing that our rapport could handle some light teasing, I joking said “So, did you jump in front of it or something?” and he said yes. First, this made me think ‘oh crap now what am I going to say’. But luckily, my nursing-mode kicked in (apparently I have one!) and I firstly apologized for making that joke, and second asked him his thought process surrounding the incident. Apparently something inside him had told him to do it, and although he knew it was wrong, he still placed himself in front of the car. I asked him if he heard specific voices, which he denied. I also asked him if he had talked to someone or told someone that he had jumped in front of the car. He said that he hadn’t, that this was the first time he had ever said anything to anyone, and that “all they knew is that I got hit by a car”. I was saying that perhaps he should talk to someone, and was about to ask him questions about his risk for suicide now, when his dad arrived. This was ultimately a conversation shifter, as we never continued this conversation after Dad arrived. Unfortunately, I did not see my patient’s face when his Dad came in, or I would be better able to tell how the arrival of his Dad had affected him.

Once this admission happened and I had introduced myself to Dad, I left the room knowing I had to say something to the nurse that was supervising me. I pulled her aside and told her what my concerns were; that my patient was probably being discharged today yet he had mentioned these self-harmful things. I noted that this needed to be addressed somehow, and asked what we should do next. The staff nurse then told me that I needed to chart this, and that when the team came down to view his x-ray they needed to be told of the conversation, so they could decide about future treatment. I also told my clinical instructor, who helped me organize my thoughts and my observations about the interaction so I could chart it properly and effectively.

After charting this, I went back to visit my patient to chat and to spend time with him and his Dad. When Dad went to go get a drink downstairs, I seized my opportunity, played videogames with my patient, and tried to further develop our therapeutic relationship. I got more information out of him; his parents had divorced when he was young, and now his father was remarried and living in another town about 1.5hours away. He didn’t get to see his Dad much, but when he did, he enjoyed it a lot. He also mentioned that he and Mom moved around a lot. When asked where he had lived, he mentioned that he and his mom had lived in New Jersey, and that one day he was travelling into New York City when he saw the plane hit the World Trade Center. This struck me as odd: Two serious admissions in one day? Yet some of his facts checked out. I wondered, however, if his story was true, and how much of his comments were done in a self-attention manner. Overall though, these comments led to a picture of boy with some serious psychological assessment needed.

Before I entered nursing I thought I had a pretty open minded view on mental health; that it was an important aspect of health and that sometimes it needs medical attention, just like an infection or a chronic cough. I never truly realized, though, how much sometimes people need help to cope with life. I also forget that sometimes people don't want to admit that there is a problem. At first the above patient's mom was VERY upset with the idea that her son needed some sort of psychological consult. I don't blame her. This is sort of saying that something about her son's mental health is not necessarily ok, and bringing in that stereotype that her son was 'crazy'. Even though I can openly say that he needs someone to talk to to work out these issues, I'm somewhat of a hypocrite because I would feel weird to talk to someone if I was in a similar situation. I'd probably even think it was unnecessary, and make myself feel stupid for seeking help. Although I am currently working towards changing that within myself, I can have a better appreciation of the hesitancy some people feel about going to a mental health professional.