Are you comfortable caring for seriously ill children?

Many ED nurses are wary of caring for sick or injured children, but these patients have unique needs that every nurse must be prepared for, says Nancy Blake, RN, MN, CCRN, CNAA, director of critical care services at Children’s Medical Center in Los Angeles. Adverse outcomes may occur if pediatric education is allowed to fall by the wayside, she warns.

"The statistics across the country are that anywhere from 20%-30% of the ED visits are children — so all EDs see kids. But many adult nurses would rather not take care of pediatric patients because they don’t feel comfortable with it," she says. "Also, in rural areas, they may not have educational resources in the community."

Pediatrics patients are not just small adults, says Blake. "There are unique characteristics in children that are both physiological and psychosocial."

There are anatomical differences in children that could cause problems that wouldn’t necessarily be a problem with adults, says Blake. "For example, the airway in children is much smaller in diameter, and a small amount of mucus or swelling in the airway could cause a problem in an infant," she says.

Without effective inservices, problems such as poor airway management, multiple attempts to start intravenous lines, inadequate pain management, unnecessary transport to other facilities, and lack of emotional support for patients and families are bound to occur, says Ginger Young, RN, clinical educator for the ED at Children’s Medical Center Dallas. "Fear of the pediatric patient is often a big obstacle for those nurses used to the adult population," she says. "Lack of knowledge and the emotional component is also difficult."

If ED nurses are not effectively inserviced on the medications and equipment to use for pediatric patients, they could give incorrect dosages that could cause a sentinel event, warns Blake. "They also might not have the appropriately sized equipment for a child and have an untoward outcome because of inappropriate equipment," she says.

To ensure your ED provides appropriate care of pediatric patients, do the following:

  • Enroll in pediatric courses.

Blake recommends taking the Pediatric Advanced Life Support (PALS) class provided by the Dallas-based American Heart Association. (See resources below for more information.)

"This is a very good course to teach the basics of emergency resuscitation," she says. For the basics of pediatric emergency nursing, she recommends the Emergency Nursing Pediatric Certification (ENPC) course, given by the Des Plaines, IL-based Emergency Nurses Association. (See resource below for more information.) "It gives a basic overview of all pediatric emergencies, including pediatric trauma and child maltreatment."

If your hospital doesn’t offer this training, find out if a local pediatric facility does, recommends Blake. At Children’s Hospital Los Angeles, PALS classes are offered monthly, and ENPC classes are offered quarterly. "These classes are always full, and we offer the training to outside nurses," Blake says. "Many local hospitals actually send two to four of their nurses to every class, so within two years they can have their entire staff trained without offering it on site."

  • Take on-line courses.

If you can’t obtain funding for off-site education or a course is not available in your area, consider taking the on-line program Essentials in Critical Care Orientation, offered by the Aliso Viejo, CA-based American Association of Critical Care Nurses. (For more information, see resources, below.) "This has the basic pediatric content about developmental care in pediatrics and unique disease processes seen in pediatrics," says Blake.

  • Invite experts to give inservices.

Many transport teams who work with pediatric populations have education services available, says Young. "They will gladly come to an ED and provide inservices to the staff," she says.

If you have one or two nurses in your ED who have worked with the pediatric population, tap into their knowledge base by having them inservice the staff on problem areas, suggests Young. "Get a respiratory therapist to teach staff how to assess an airway and how to suction a pediatric patient," she advises.

  • Have nursing grand rounds.

At Children’s Medical Center Dallas, ED nurses were surveyed about the areas for which they wanted additional education. "We then compiled a list of the top 10 subjects," says Young.

Two or three nurses paired with an ancillary staff member such as a respiratory therapist, pharmacist, or social worker, and an attending physician. The group developed an inservice for topics such as trauma in the pediatric patient with a child abuse component, sepsis, and Kawasaki’s disease. "This also was an education for the staff who presented," she says.

Sources/Resources

For more information on pediatric education, contact:

  • Nancy Blake, RN, MN, CCRN, CNAA, Director of Critical Care Services, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop 74, Los Angeles, CA 90027. Telephone: (323) 669-2164. Fax: (323) 953-7987. E-mail: nblake@chla.usc.edu.
  • Ginger Young, RN, Clinical Educator, Emergency Center, Children’s Medical Center Dallas, 1935 Motor St., Dallas, TX 75235. Telephone: (214) 456-5686. E-mail: ginger.young@childrens.com.

The Pediatric Advanced Life Support (PALS) course provides information and strategies needed to recognize and prevent cardiopulmonary arrest in infants and children. For more information, contact:

  • American Heart Association, National Center, 7272 Greenville Ave., Dallas, TX 75231. Telephone: (877) 242-4277. E-mail: eccinfo@heart.org. Or to find a list of PALS courses in your area, go to www.americanheart.org. Click on "CPR & ECC" and "Find a Class Near You."

Emergency Nursing Pediatric Certification (EPNC) is a 16-hour course providing training in pediatric emergency nursing, including pediatric trauma and resuscitation. For more information, go to the Emergency Nurses Association web site (www.ena.org.) Click on "CATN II/ENPC/TNCC" and "ENPC." For a list of individuals to contact in your area, click on "Listing of ENPC contacts by state." Or contact:

  • ENA, Course Operations Department, 915 Lee St., Des Plaines, IL 60016-6569. Telephone: (800) 900-9659 or (847) 460-4120. Fax: (847) 460-4001. E-mail: jmika@ena.org.

Essentials in Critical Care Orientation is a web-based tool to teach nurses the basics of critical care. A site license for a one-year term costs $1,500 with additional fees for each end user. For more information, contact:

  • American Association of Critical Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109. Telephone: (800) 394-5995 ext. 8870 or (949) 362-2000. Fax: (949) 362-2021. E-mail: ecco@accn.org.