Off the Charts

Peggy McDaniel, BSN, RN, an occasional contributor to this blog, works as a clinical liaison support manager of infusion, and is currently based in Brisbane, Australia.

Sitting in the dark movie theatre, I hear a familiar high–pitched “beep, beep, beep.” The sound brings me to full attention, away from the action on the big screen and back to my “date,” a blond and very handsome five-year-old boy sitting beside me. I see him mouth the words, “I can’t breathe,” but he makes no sound.

Children at playground, Brisbane, Australia, 1939/Wikimedia Commons

He’s not trying to be quiet for fellow moviegoers—he’s getting no air from his ventilator, as the alarm has indicated. Though his eyes are open wide and his nostrils flared with an oxygen-starved expression, his eyes still hold trust. He knows I can help him breathe, now—quickly, the Ambu bag is in my hand, squeezing breath into his immobile body, as I feel around in the dark for a disconnected vent circuit. (Of course, I had already silenced the alarm as quickly as possible, for the other kids and their parents in the theater during the lightly attended matinee.)

Such adventures out of the children’s hospital were a monthly occurrence. A child life therapist and a nurse would take medically fragile kids out into the community, usually with parents in attendance. These afternoons of fun gave the parents and kids hands-on experience before discharge.

And something unexpected nearly always happened. We taught parents how to attend to life-threatening emergencies that would become a daily challenge once they were home with their children. As parents acquired competence in caring for their kids, they realized that having a child with intense medical needs didn’t mean they couldn’t enjoy some of the things the community offered. We empowered the families to take on the challenge of returning to some kind of normalcy. Our hospital worked with a strong primary nursing model, so the hospital nurse also spent time with any nurses who would be caring for “our kids” at home after discharge. We often accompanied kids to school to meet the teachers and classrooms that would soon inherit them.

I did this work in the mid 1980s, and I often wonder how things are done today—especially since hospitals face budgetary challenges to an ever-greater degree. Currently I’m living in Australia and not working as a clinical nurse, but pediatric nursing is still my passion. Any stories about kids and health care from around the world attract my attention. Here in Australia, each state has tried to deal with ever-tightening budget constraints by making cuts to health care services. Most recently, all primary school nurses were removed from service in one state.

In 2010, AJN published my post on the insufficient numbers of school nurses in the U.S. It received some great comments. Given news I’ve been reading from the U.S. recently, it doesn’t sound like the school nursing situation has improved much. With the economy challenging everyone, from families to hospitals and schools, what would an investment in school nursing provide? Could more school and community-based nurses help identify at-risk kids with mental health issues, along with signs of abuse and neglect, while also providing potentially less critical needs such as hearing, immunization, and vision screenings? With so much talk from the U.S. about arming teachers with guns, might we first suggest some other types of “backup”—more nurses, social workers, and counsellors.

The medically complex kids are easy to spot, and although their care is challenging, it is obviously needed and simply cannot be ignored. But my thoughts also go to the kids who are not being fed regularly; ones who are seeing things at home that no adult, and especially no child, should witness; the ones seeking attention but not being seen, possibly until it’s too late. The needs of these kids are easy to miss, especially if no one is really looking.