It’s 8 a.m. The nurses are moving efficiently around the sunny unit, preparing feeding tubes, suctioning trachs, taking vitals and talking softly to the patients they’re preparing for the day.
It looks and sounds like any unit in any excellent acute care hospital—but it’s the 14-bed Brain Injury Unit of The Hospital at The Children’s Institute of Pittsburgh, one of the country’s premier pediatric rehabilitation hospitals.
Today the busy unit is at capacity. Patients include, for example, a toddler who was hit by a truck… a teen recovering from meningitis… an infant injured in a home accident… and a pre-teen recovering from surgery for a brain infection.
When the young patients arrive, many are essentially comatose, unable even to respond or sit up. “We want to get them started on therapies as soon as possible — ideally within 24 hours of admission — so the physicians and nurses constantly evaluate their readiness,” says Nurse Emily Hutchins, RN, BS. “The therapists here are great about adapting goals and approaches so the kids can start benefiting almost immediately.”
All day long, the unit buzzes with activity. The nurses work closely with their care team colleagues: physicians (hospitalists, intensivists and pediatric physical and rehabilitation medicine specialists); therapists (physical, occupational, speech/language, respiratory and recreation); psychologists and psychiatrists; nutritionists; teachers and more.
Occasionally, a Crisis
At every moment, the nurses are assessing the condition of each child. Especially in newly admitted patients, who are still very ill, there can occasionally be a crisis: a seizure, for example, or a thalamic storm — life-threatening instability in the part of the nervous system that controls vital functions.
And, as on any brain injury unit, behavior issues arise: the young patients can show agitation, aggression, oppositional behavior and impulsiveness. Nurse Sharon Connelly, RN, BSN, CRRN (Certified Registered Rehabilitation Nurse) says, “Our job is to make sure that the patient stays safe, to try to change whatever aspect of the environment is overstimulating —and to help the family understand that this is not the child acting out; this is a result of the brain injury.”
Working with families to help them come to grips with the changes brought by illness or injury is always a major aspect of pediatric rehab nursing. Chief Nursing Officer Beverly G. Farinelli, RN, BSN, MHA says, “Suddenly the little everyday things families took for granted become enormous goals and milestones — saying a word, moving a hand, sitting up.
“The nurses are with the parents and other family members more than anyone else is, so it’s our job to help them adapt to the new realities — and to realize that progress will take time and patience. We’re always realistic and honest — and we help them see possibilities instead of just disabilities.”
With great medical and nursing care and therapies, and plenty of love from their families, the young patients move toward realizing their potential, often achieving even far more than expected.
“The kids are so brave and so loving, and the parents are amazing,” says Sharon Connelly, a rehab nurse for 24 years. “We have the great privilege of working with them long enough that we really get to know them on their journey. And together we sometimes see miracles.”
Maryanne Henderson, DO, Chief Medical Officer of The Hospital at The Children’s Institute, says, “Rehabilitation medicine always requires a team approach — but I think that sometimes, because nurses aren’t physicians or therapists, their importance to the team can be overlooked. The reality is that in many ways they’re the most important members of the team; they’re with the patients and families much more than anyone else — and our rehabilitation nurses are first-rate.”
It’s 11 p.m. Therapies are over for the day. The children have been bathed and positioned for a night’s rest. Visitors have left. The unit is quiet; lights are low. And, quietly and efficiently, the pediatric rehab nurses go about their work — making sure the young patients will be ready for the next day of their journey.
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