SickKids is a large children’s hospital in the centre of Toronto, all centred around a rather impressive atrium with fountains and bright yellow lifts that you can watch going up and down, transfixing several children!
There is a PICU and a CICU which run alongside each other but are separate. The PICU is 24 bedded with average census of 17, although when I arrived they only had 2 patients which was the lowest anyone could ever remember – apparently I bring the calm with me as Montefiore and Boston were also oddly quiet when I visited! Not sure what else I bring though as much to everyone’s surprise, on my first day there was also a ‘Code Purple’ – the code for armed/hostage situation which put the whole hospital on lock down for 3 hours. Fortunately it turned out to be just precautionary after reports of someone in a mask acting oddly on the nearby university campus.
SickKids is also showing some very impressive family centred care (FCC) practice on their PICU. The clinical nurse specialists (CNS) created a family satisfaction questionnaire, adapted from a validated tool, which has a FCC basis. This has allowed them to identify areas for improvement and also to track their progress. One thing that came up was that families did not feel like they were getting a proper orientation to the unit so they started an intervention to teach the nursing staff about the importance of a good orientation and of consistency of care for families. They also, as part of their Family Centred Care Committee created a detailed orientation pack and are working on a project to create a video orientation that could be played in the family waiting room. The committee involves the CNS, Child Life, Social Worker and bedside nurses and meets monthly to discuss issues and work on projects such as the orientation project and are currently trying to get a parent advisor on board. They also have put together strategies to support complex/long staying families including assigning them a care team and hold a weekly continuity of care meeting with that child’s MDT to discuss their care and support needs.
This practice is translated into the education that the new nurses receive. SickKids PICU does not take new grads but new nurses to the unit get a comprehensive 3 month induction into the unit combining teaching days and time shadowing their preceptors. Included in this are 3 hours of teaching on FCC and a session from the SW on families in crisis, which I participated in (observing wasn’t an option here – everyone has to join in!). This was a fantastic session discussing what it means to be in crisis, how a family gets to crisis point and different ways of communicating with families to either help them out of crisis or to stop them reaching it. Some really interesting points came out of it, particularly how subjective it is for each family and how expecting each family to cope in the same way is incredibly unhelpful – he gave the great analogy that if you drop two people in the middle of a lake and one swims to shore but the other starts drowning, shouting at the drowning person to swim more efficiently is not going to save them, they need help – if a family could cope, they would cope, if they can’t they need support. There were also some interesting points on the dangers of labelling families as ‘difficult’ and how to reduce this kind of judgement.
This whole FCC ethos and education seems to have been embraced by the bedside nurses and I was incredibly impressed when I shadowed for a early shift one day, in particular the nurse I was following was wonderful and gave the family lots of support and positive reinforcement. Talking to the charge nurse as well, I found that family dynamics was always discussed in hand over and the senior team will touch base with the family every day to see how they are getting on. They also try keep elements of the child’s daily routine where possible and encourage the families to stay involved in cares and if an intubated child is stable they encourage the parents to have cuddles. All this is also supported by the CLS (who gave an amazing talk on her work with siblings at the PICU world congress which had half the room getting a bit emotional) who promotes a child friendly environment on the unit with the help of her friend Hermin – the hand puppet made with a google eyed ring! This may sound like a very simple idea but has proved incredibly effective, Hermin helps the kids take deep breaths when they are stressed or in pain by eating the bubbles they blow, promotes positive touch by gently eating fluff off kids and find that kids tell Hermin what is bothering them or going on with them a lot more easily than they would tell to the adults face. She has been encouraging all the staff to have a Hermin and carry one with them as a sign for the children that they are child friendly. Hermin has an Instagram account and I promised to send back some pictures of Hermin on my travels, so here he is enjoying a sunset (sort of).