A Small Gesture of Kindness

Illustration by Janet Hamlin for AJN.

In our January Reflections column (free until March 1), “Just One More,” a nurse shares her memory of a family facing one of the most painful experiences imaginable—the death of a child.

In a situation like this, there is so little that can be done, and the usual gestures of expressing condolences or giving a pat on the hand feel inadequate and hollow.   

She writes:

“I knew that no words could lessen the unexpected heartbreak . . . But still, I wished there was something I could say, or do, that might make a small difference.”

Small gestures, lasting effects.

Most nurses can relate to such a situation. You may not be able to do anything to change a patient’s circumstances, and all you have left in your arsenal of care is a small gesture of kindness. […]

2022-02-11T09:39:23-05:00February 11th, 2022|Nursing, pediatrics, writing|0 Comments

Children’s Mental Health Crisis Reveals Holes in System

You don’t have to look far for evidence that the mental health of children and adolescents has been entering a crisis in recent years, one exacerbated by the unusual conditions imposed by Covid-19.

The June 18 Morbidity and Mortality Weekly Report (MMWR) from the CDC reported:

During February 21–March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls aged 12–17 years than during the same period in 2019; among boys aged 12–17 years, suspected suicide attempt ED visits increased 3.7%.

Photo by Yasser Chalid/Getty Images

As noted in a recent Washington Post story, “Emergency departments have meanwhile become a tattered safety net for adolescent mental health care.”

In this month’s AJN, Betsy Todd summarizes some of the current issues seen by school nurses and other health care professionals like nurse practitioners (NPs), who often feel overwhelmed by the intensity of the suffering and need they are now seeing in many children.

Systems pushed to their limits.

Todd notes that existing systems are proving woefully inadequate to the growing need, with wait times increasing to see child psychiatrists, therapists, and other experts, and pediatric hospitals in several states reporting “sharp increases in ED visits for […]

Who’s Going to Smile at My Baby? When the Pandemic Comes to the NICU

From the doorway, I watched the mother gently stroke her newborn’s forehead. “I love you,” she whispered. “I’ll be back soon.”

As a resource parent in the neonatal intensive care unit (NICU) at a large children’s hospital, I am privileged with the task of offering support to families. This was a typical stop in one of many patient rooms. As I gingerly entered the room, the mother glanced up at me, tears welling in her eyes as she scrambled to adjust her mask.

“I’m sorry,” she stammered. “I didn’t want to cry.” A tear rolled down her cheek.

“Not at all,” I replied. “I understand. It’s hard being a mom in the NICU, now more than ever.”

I invited her to share her feelings, hoping to offer some help or comfort. Wiping her cheek with her sleeve, she explained that the pandemic visiting rules had made it difficult to be at her baby’s bedside.

“I have other children, and I need to go home to watch them. The hospital rules say I am the only person allowed to take off their mask in her room, but she needs to see faces for her development. Who is going to smile at my baby when I’m not here?”

Speaking from personal experience.

2021-02-08T09:43:44-05:00February 8th, 2021|family experience, Nursing, Patients, pediatrics|0 Comments

Those Special Moments Nurses Sometimes Talk About

Before I became a nurse, I heard that nurses have special moments with their patients and families that they never forget, but I never truly understood what that meant.

My first neonatal code occurred about six months after I completed my orientation in the pediatric emergency department. I remember that shift being a particularly busy one. In the midst of the hustling and bustling of assessing and medicating patients and reevaluating and discharging them, I heard banging on the triage door and saw a mother and father wheeling in their baby carriage, frantically crying out that their baby Skye was blue in color.

By S.Hermann and F.Richter/Pixabay

I remember quickly removing her clothing and seeing how cyanotic she was, all while an electrocardiogram was being obtained and she was placed on the cardiac monitor. I recall hearing the doctors paging overhead for pediatric respiratory and anesthesiology to assist with resuscitation. Other team members included a CNA and a medical student who tried to relax the parents but were understandably not successful.

There were multiple unsuccessful attempts to obtain peripheral vascular access in Skye. I can still see the look of terror on Skye’s parents’ faces as the drill gun used to insert the intraosseous access whirled into baby Skye’s […]

2020-10-23T10:48:41-04:00October 23rd, 2020|family experience, Nursing, Patients, pediatrics|0 Comments

The Pediatric Illness PANDAS: Easy to Misdiagnose, Often Overlooked

What would you do if your young, previously healthy and happy child suddenly developed obsessive-compulsive disorder or symptoms of Tourette’s syndrome?

In “PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection,” authors Christine Pabst and Kim Subasic discuss an unusual pediatric illness that, although identified more than 20 years ago, is not well recognized by clinicians: PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection.

PANDAS is characterized by the sudden and dramatic onset of “psychiatric” symptoms such as the ones above, appearing during or shortly after infection with group A streptococcus.

Two factors make PANDAS difficult to diagnose.

  • First, it seems so obviously a psychiatric disorder that psychotropic or other psychiatric medications may be prescribed without further investigation.
  • Second, carrying group A streptococcus without signs of actual infection can also precipitate PANDAS, making it difficult to connect PANDAS symptoms with a previous medical illness.

[…]

2020-08-24T06:27:32-04:00August 24th, 2020|Nursing, pediatrics|0 Comments
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