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How to Cope With Tragedy in the Pediatric ED


Dealing with daily human tragedies remains a hallmark of emergency nursing; and caring for children in the ED often requires nurses to take steps to prevent compassion fatigue and burnout while helping the patients as well as their parents. [caption id="attachment_47323" align="alignleft" width="200"]JQuinn_SNIP Janis Quinn, RN[/caption] "We have real emergencies every day," said Janis Quinn, MSN, APN, CPNP-AC, director of emergency services at Ann & Robert H. Lurie Children's Hospital of Chicago, a level 1 trauma center. "A wide variety of things can happen." Patients come in with injuries from auto accidents, falls, gunshot wounds, medical illnesses and child abuse. The majority of patients survive. Physicians admit to the ICU about 10% of the children treated in the Lurie ED, according to Quinn. "Every day we see serious [cases]," said Deb Potts, MSN, RN, CPEN, ED nurse manager at The Children's Hospital of Philadelphia. Emergency departments in the U.S. treated more than 25.5 million children in 2010, with 96% treated and released, according to a 2013 report, "Overview of Children in the Emergency Department, 2010," on the Agency for Health Care Research and Quality website. More children in large metropolitan areas were admitted than in smaller communities, according to the report. Common reasons for ED visits were injury and poisoning at 7.6 million and respiratory disorders at 6.8 million.

Parental support

[caption id="attachment_47324" align="alignleft" width="196"]DPotts_SNIP Deb Potts, RN[/caption] As with any pediatrics care, in addition to the patient, the nurse must tend to the emotional and educational needs of parents. Lurie and CHOP allow them to stay at the bedside during all procedures, including resuscitation. Clinicians work around the family members. "Family presence is written into everything we do here," Potts said. A chaplain or social worker at Lurie supports parents and other family members during a code or serious diagnosis. ED Chaplain Lavender Kelley helps notify friends or family and attends to the family members' immediate needs. Kelley also asks about what has helped them in past times of distress and taps into those resources, such as a community of broader support, religion or other beliefs. Being able to help save lives and change patient outcomes keeps nurses in the pediatric ED. "This is the best job ever," Quinn said. "You get to be present during some of the most difficult times in a family's life, and if you can make it a little easier for that family, what greater purpose is there?"

Coping with serious cases

Nurses cope in different ways. Hospitals encourage healthy options. "There is tragedy in this profession," Quinn said. "You cope, because we are at a good place. The majority of patients get better." Lurie's chaplains and social workers support staff who have witnessed tragedies. Kelley rounds with the clinical team and makes an effort to touch base with staff members, who she develops relationships with from the time of hire. Kelley might recommend art therapy or other creative outlets, such as yoga, exercise, meditation apps or professional counseling, if needed. "People who work in hospitals are innately compassionate and want to make a difference in people's lives," Kelley said. "A lot of work with staff is helping them connect back that this means something more than a job. This is who I am." Lurie's Resiliency Education and Crisis Help Team provides additional debriefing. For extremely distressing events, such as a death or child abuse, the REACH team holds an initial opportunity for clinicians to talk about what happened, followed by a more formal debriefing a couple of days later. "It's helpful to talk about it," Quinn said. "In the short term, [nurses] have to keep working." Talking about the cases helps nurses express their emotions. "The greatest thing we do is hot debriefing," Potts said. "Anyone on the team can initiate the hot debrief. We pull everyone together." CHOP tries to conduct the debriefing as soon as possible after an event, such as a serious trauma, a new diagnoses or a death. The debriefing gives everyone a chance to talk about feelings. Anyone can facilitate, but usually it is the physician or social worker. CHOP offers employees a program to support health and wellness, and encourages healthy behaviors. CHOP also has an employee assistance program. Additionally, Potts said the nurses support each other. "Every nurse needs to know what they need to refill their tank," Potts said. "You need to know how you are going to replenish yourself and come back the next day." Debra Anscombe Wood is a freelance writer based in Florida.