Pediatric treatment model is a family affair

New tech role provides extra support

As part of its move toward family-centered care, St. Vincent’s hospital in Billings, MT, moved from the traditional nursing model that looks at only the patient to a family-centered model that includes mom, dad, and everyone else close to the child.

"It’s not just us telling them what is going on. We have a partnership that promotes family participation," says Martie Moore, RN, MAOM, quality improvement/pediatrics.

Since pediatrics must include the patient’s entire family — parents, siblings, grandparents, and sometimes extended family — the hospital wanted to make an environment as close to a normal routine as possible.

For instance, if a child routinely bathes at night after dinner, the hospital lets them continue the practice, rather than mandating morning baths.

A pleasant atmosphere and familiar routine are especially important to long-term patients, some of whom are there for a year or more, Moore says.

These are patients who live in rural communities that lack the specialized medical care the children need. For instance, a child who is on a ventilator, is dependent on technology, or requires 24-hour-a-day nursing care may stay in St. Vincent’s until arrangements can be made for them to be cared for in their communities.

Parents can sleep in day beds in the children’s rooms, but during the renovation for the shift to family-centered care, a private room was created for parents of critically ill patients who can sleep near the intensive care unit at no charge. This gives the parents privacy and a chance to rest while allowing them to remain near their child.

The nursing staff, and sometimes the physicians, meet with family members daily.

The hospital also combined its three traditional support roles — the unit clerks, housekeepers, and dietary assistants — into a pediatric technician that combines the three roles.

"One of the problems we identified was that housekeeping came in the mornings but never returned. When you have dirty diapers, you don’t have a very pleasant environment at the end of the day," Moore says.

Pediatric techs are assigned specifically to the pediatric unit and staff it for 12 hours a day.

When the pediatric tech positions were created, the hospital eliminated two full-time equivalent positions because duties were combined and some tasks, particularly unnecessary paperwork, were eliminated, Moore says.

The hospital has set up its own training program, with competency checks, for the pediatric technicians.

Lending a helping hand

Moore emphasizes that the pediatric techs are not used in traditional technician roles to help treat patients or assist with traditional nursing tasks. The number of licensed staff on the unit has not changed.

The hospital wanted to minimize the number of staff who provide hands-on care to the pediatric patients.

Instead, the pediatric techs assist with feeding the children and may play games with them or help them with an art project, Moore says.

In addition to performing their regular tasks, the pediatric techs offer weary parents a cup of coffee or offer to rock a distressed child while the parent takes a shower, Moore says.

"Having them assigned to the unit creates the understanding of what is happening here and makes them part of the team. They are more focused on the patients and have ownership and pride in what they are doing," she adds.