BY: SUSAN PASTOR ND, RN
Caring for a sick or injured child is very different from taking care of an adult. Well, obviously, right? It's easy to brush off that truism, but let me stop you right there. I am the chief nursing officer and senior leader of patient care operations at Dell Children's Medical Center of Central Texas, a Level I Pediatric Trauma Center serving 46 counties. The hospital opened in 2007 at its current location in Austin, Texas. We treat more than 67,000 sick and injured children every year during 137,607 inpatient and outpatient visits to the hospital, and I have gone on rounds and talked with thousands of these young patients and their families.
The care we provide at Dell Children's is tailored to consider the dynamics and expectations of the worried families who come to us for care. Even more importantly, I strive to ensure that our entire team focuses on the child from his or her point of view.
We have found that when a child arrives, he or she wants three things: Keep me safe. Heal me. Be nice to me. These expectations — mirrored by those of their families — drive the development of our processes.1
I'll show you what that means.
Pretend a 7-year-old Austin girl named Margie is out riding her bike and gets hit by a car. Unconscious, she is rushed to Dell Children's Medical Center, where she is examined, admitted and then admitted to the medical surgical unit.
Based on my conversations with many Margies, here's what we would learn about the hospital as she sees it.
Lesson 1
FIRST IMPRESSIONS ARE IMPORTANT
Margie would say one of the first things she remembers about the hospital is waking to strange sights and sounds. But when she looked around, she saw Winnie the Pooh at the end of a nurse's stethoscope. The nurse let Margie listen to her own heartbeat. Cool!
This illustrates a special difference between a children's hospital and an adult hospital. It is important that we work to make a child feel safe and cared for in surroundings that are friendly and familiar rather than scary. Few adults are frightened by the simple experiences of having someone take vital signs, nor are they generally distressed by waiting alone in an exam room. These routine events aren't so routine to a child. Simple things — a gentle cartoon character on the end of a stethoscope and an explanation from a friendly nurse — can make a world of difference.
Lesson 2
COMMUNICATE ON THE CHILD'S LEVEL.
A nurse came to take Margie's blood pressure and explained how the cuff that would wrap around her arm and puff up to give her arm "a special hug." Margie listens, then bravely holds out her arm for the procedure.
Using language that children can relate to when they are about to experience something new can ease the anxiety and allow for better compliance from the child.
Margie notices the nurse who never stops smiling. He tells her his name and he explains he is going to start an IV in her hand. He says there may be a quick pinch, but it won't hurt if she stays very still. She braces herself but the nurse is so quick that Margie feels him taping something to her arm almost before she knows it's over. And the smiling nurse makes a fuss and hands her a sticker for being so brave.
I feel good when our special patients get special attention. When I get an IV, I don't get a great sticker!
Lesson 3
THE HOSPITAL DESIGN HELPS TO CREATE A HEALING ENVIRONMENT.
Medical equipment and supplies are kid-sized. All patient rooms are private, so though Margie misses her family, her siblings can visit any time and her mom can spend the night with her, sleeping right nearby. The room is painted a pretty color and Margie can see bright colors in the hallway.
The hospital is full of surprises like a 10-foot, colorful guitar in the lobby and a huge, audiokinetic sculpture designed by American artist George Rhoads. The sculpture has colorful balls on wire tracks traveling through twists and turns; it is designed to demystify technology. More than 850 pieces of artwork decorate Dell Children's, some placed at a kid's eye level. A whole wall of dog pictures is a particular favorite.
One hallway features a large mosaic of the hospital founders St. Vincent de Paul, Louise de Marillac and Elizabeth Ann Seton who opened the Seton Infirmary in Austin in 1902. Elizabeth Ann Seton is the first American-born Catholic saint, and Seton Family of Hospitals is her namesake. It took Celia Berry, the artist, six months to complete the mosaic.
Hallways have many windows to let in the natural daylight, and all hospital floors have access to a big, four-story outdoor courtyard with grass, trees and a waterfall. Inside is a library where children can read or check out movies, and the hospital boasts a playroom outfitted with computers and games. The HEB Amphitheater located adjacent to the hospital's front lobby gives children a place to enjoy performances by local musicians and others.
Parents can visit the Half-Pint Library to do research or ask a medical reference librarian for material about their child's condition and treatment, or they can visit the Safety Store to buy such items as car seats and bicycle helmets. As a Pediatric Level I Trauma Center, Dell Children's has a commitment to childhood injury prevention and to teaching safe behaviors.
Parents and others can pause in the beautiful Tom Maxwell Chapel, modeled after a chapel in France. The natural light streaming in creates a warm, soothing setting in which to pray or reflect.
We plan environments that create situations where both parent and child can comfort each other at times of stress. It is often more scary for the parent than the child when a parent has to leave a child alone for the night. Dell Children's is designed and decorated to create a calm, fun and familiar feeling for children so they can feel safe in the hospital environment.
Lesson 4
TRAINED PROFESSIONALS WHO ARE SKILLED IN WORKING WITH CHILDREN ARE KEY TO PROVIDING EXCELLENCE IN PATIENT CARE
At Dell Children's, the health care team is committed to addressing the physical, emotional, psychological, spiritual and family concerns that accompany a childhood illness or injury.
Hospital staff and parents know sick, frightened or uncomfortable young patients may not feel like eating on a regular schedule. At Dell Children's, Margie can call "room service" for nutritious, child-friendly food and snacks whenever she likes. The novelty alone tempts her appetite.
Margie's room has a care board — developed by staff nurses — hanging on the wall. Among its many items of information, the board shows the names of Margie's nurse and doctor, as well as a pain scale that allows Margie to point to a face to show the nurse how she is feeling: smiling, anxious, uncomfortable or crying.
The environment at Dell Children's enables staff to have a voice in the design of tools that make children's hospital experiences more pleasant and improve the provision of care.
When her doctor ordered a CT scan, Margie learned what to expect when a child life specialist came to tell her all about the scan machine and the sounds it makes. Then she used a special teaching doll to show Margie her how the procedure would go.
Child life specialists offer developmental and medical play designed to help children understand and cope with being in the hospital. They allow children to express their feelings through play, art and music therapy.
So let me repeat, at Dell Children's we tailor our services to reflect the truism, "caring for a sick or injured child is very different from taking care of an adult." Our team works hard to focus on our young patients from their point of view. Our mission reflects the work of our founders to bring health care to our region, with special concern for the poor and the most vulnerable. And the research is on our side.
A 2006 study published in the Journal of Pediatric Surgery examined pediatric injury case data gleaned from 2.5 million inpatient discharge records in 27 states.
The study showed in-hospital mortality, length of stay and hospital charges for children are all significantly higher when delivered in adult hospitals. The study's conclusion: "Younger and more seriously injured children have improved outcomes in children's hospitals."2
SUSAN PASTOR is chief nursing officer at Dell Children's Medical Center of Central Texas, Austin, Texas. She is an alumna of the Johnson & Johnson/Wharton Fellows Program in management for nurse executives at the University of Pennsylvania's Wharton School.
REFERENCES:
- Healthcare Performance Improvement, LLC, "Healing without Harm: Safety Behaviors for Error Prevention" (presentation, Dell Children's Medical Center, Austin, Texas, June 24, 2010).
- John C. Densmore et al., "Outcomes and Delivery of Care in Pediatric Injury," Journal of Pediatric Surgery 41, no. 1 (2006): 92-98.
Dell Children's Medical Center of Central Texas is a member of the Seton Family of Hospitals, the region's leading provider of comprehensive, advanced health care services. Seton is a member of Ascension Health.
Located in Austin, Texas, Dell Children's Medical Center was designated a Magnet facility in 2002, making it the second children's hospital in the nation to receive this distinction, and is accredited by the Joint Commission. Dell Children's also is the first hospital in the world to receive the LEED (Leadership in Energy & Environmental Design) Platinum designation, given by the U.S. Green Building Council.
Lesson 1
First impressions are important
Lesson 2
Communicate on the child's level
Lesson 3
The hospital design helps to create a healing environment
Lesson 4
Trained professionals who are skilled in working with children are key to providing excellence in patient care
Copyright © 2011 by the Catholic Health Association of the United States
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