Nurses Plan Care for Young Patient
Cassidy Brown and her parents, Christine and Dan, back left, are surrounded by some of the many BWHers involved in her care, including, from left, Jackie Gagnon, RN, Maria Bentain-Melanson, RN, Matt Quin, RN, Nancy Minghella, RN, and, on right, Kerrin Daru, RN, and Luigi Nascimben, MD.
BWH nurses every day handle the complexities of care for patients post cardiac surgery, ensuring that care is meticulous, compassionate and driven by the specific needs of the individual patient and family. When the Cardiac Surgery ICU staff learned an 11-year-old girl needed surgery at BWH, they stepped up to the challenge of caring for one of the youngest post operative patients at the hospital.
The patient, Cassidy Brown, suffers from Kawasaki disease, for which she needed coronary bypass surgery—an operation that Children’s Hospital Boston does not perform because so few children ever need it.
In advance of Cassidy’s admission, nurses and other care providers worked closely with Children’s Hospital staff on everything from medication dosages to age specific growth and development issues to ensure the best care for their young patient.
Cassidy’s parents greatly appreciated the efforts of the entire team. “We knew everything two months out, what rooms she’d be staying in on both Shapiro 6 and 7 after surgery and what nurses would be taking care of her,” said her father, Dan Brown, who, along with his wife, Christine, was by Cassidy’s side throughout her stay at BWH. “We even saw nurses in a room across the hall learning about pediatric care. It was unbelievable. They were doing this just for us, just for our little girl.”
Nancy Minghella, BSN, RN, a cardiac surgery nurse at BWH for 20 years, was a member of the care team for Cassidy in the intensive care unit post-surgery. “This was a complete team effort,” she said. “I was a little nervous ahead of time, but felt well prepared to care for Cassidy.”
Nurse Educator Maria Bentain-Melanson, MSN, RN, CCRN, CSC, had developed guidelines and a care plan for Cassidy, as well as resources and education for staff caring for her. Though Cassidy did extremely well and had no complications, nurses were prepared for any possible situation.
“People were a little anxious because most are not used to doing this, so we wanted to be as prepared as we possibly could,” said Bentain-Melanson, adding that about eight to nine years ago, some Cardiac Surgery ICU staff cared for children on ventricular assist devices, before Children’s Hospital formed its own VAD program.
At the outset, nurses were concerned about the dosage of medications—in particular, pain medication. For adults, most medications are not weight-based, but potassium, magnesium, electrolytes—even the amount of joules needed for defibrillation—are based on a child’s weight.
BWH nursing staff collaborated with Toni Imprescia, RN, the Cardiac Surgery ICU nurse educator for Children’s, and Pharmacy staff to prepare algorithms and calculate the dosages ahead of time.
Performing advanced life support is also different on a child, so nurses were prepared with a code cart containing the proper medications and algorithms and attended a class on pediatric advanced life support, in the event it was needed.
“All of this information was available in a binder, and the emergency plan also was posted so that nurses would never have to go searching for something,” Bentain-Melanson said.
ICU and step-down nurses attended inservices based on Children’s Hospital’s care plan for age-specific development and alteration in growth and development of children ages 6 through 12. The complete care plan also addressed guidelines for pain management, hemodynamics, extubation protocol and socialization and family presence.
The ICU and Step-Down units collaborated in developing the plan of care that was based on the Children’s plan that Imprescia shared with Shapiro 7 nurses, modifying it to meet Cassidy’s needs in the step-down unit to ensure that nurses were ready to care for her. This provided a seamless transition from the ICU to step-down for Cassidy and her family. She even was placed in the same room on Shapiro 7 to help decrease any anxiety about being in a new environment.
Prior to the surgery, nurses attended a meeting of the entire multidisciplinary care team to discuss the care plan from admission to discharge.
Cassidy’s surgery went smoothly, and when she arrived in the ICU, nurses were equipped with a plan in case they had questions. Imprescia, who dropped by and checked in with BWH nurses during Cassidy’s admission to the ICU, remained on call, and Children’s shared the direct line to its ICU charge nurse.
“Our nursing teamdid an outstanding job in making the adjustments necessary to provide the specialized care Cassidy and her family needed. Everyone really went above and beyond to help give Cassidy a better chance at enjoying her youth,” said Matt Quin, BSN, RN, nurse manager of Shapiro 6.
“I loved caring for Cassidy,” Minghella said. “It was a great experience, and she was a pleasure to care for.”