In September, Children’s Hospital Boston is launching
the public phase of Cause for Wonder, our comprehensive fundraising
campaign. Running from 2000 to 2005, the Cause for Wonder
campaign is generating unprecedented support for the hospital’s
vital mission on behalf of pediatric patients. It offers meaningful
opportunities for donors to help in new and exciting ways.
The wonder each child inspires in the staff at Children’s,
and the awe the institution’s scientists and world-class
clinicians evoke in grateful family members, are the spirit
of this ambitious campaign. Charitable gifts to the Cause
for Wonder campaign create new opportunities to care for more
children who need the best that medical science can provide,
and will accelerate the translation of laboratory research
into novel treatments for diseases. Campaign contributions
will also help Children’s train tomorrow’s pediatric
leaders and bring care and services to children in our urban
You can't ignore a child in pain. You just want to fix it,"
says Joan O'Brien, RN, clinical educator on the Hematology/Oncology
Unit at Children's Hospital Boston. O'Brien has seen more than enough
pain in children with sickle cell anemia, a genetic blood disorder
affecting red blood cells' ability to carry oxygen that afflicts
one in 600 African-American babies (and a few of Caribbean and Mediterranean
descent). Normal red blood cells—smooth, round and flexible—can
move easily through blood vessels. By contrast, sickled cells are
stiff, sticky, C-shaped and tend to cluster, causing painful blockages
that can lead to organ damage or even stroke.
Sixteen-year-old Jessica Villegas, a Children's patient since birth,
knows only too well how intense these sickle cell episodes can be.
For years the pain has brought her to the hospital's Emergency Department
(ED) every three or four months.
"Jessica's pain is severe and difficult to manage, and it's
important to get it under control right away," says O'Brien,
who knows Jessica from many years of hospitalizations on the Hematology/Oncology
floor. "The ED is often the first stop for sickle cell patients
in pain, but residents and interns rotating through may never have
seen a sickle cell crisis before," she explains. "Understandably,
they're unsure about administering the high doses of medication
this kind of pain demands." Patient-controlled analgesic (PCA)
pumps are an effective way to administer pain medication, but because
they require careful monitoring and patient education they are not
standard emergency room treatment. Patients are connected to PCAs
once they're admitted to the floor, often hours later.
Two years ago, after Jessica suffered a delay in admission, O'Brien
began to wonder if there was a better way to serve these patients.
With support from Children's new Center for Innovation and Clinical
Scholarship in Pediatric Nursing (CICSPN), in collaboration with
several other departments, she spearheaded a change. Her initiative
shows how quickly a good idea can transform patient care.
The CICSPN was established to bring the best clinical practice,
education and scholarship to nursing at Children's. It focuses on
three critical areas: developing and testing new care practices,
creating an environment that supports clinically based nursing research,
and fostering collaborative ventures between academic and clinical
settings. The Center also is addressing pediatric nurse training
and concerns about the nationwide nursing shortage by actively recruiting
and retaining high-level pediatric nurses. "Children's is prepared
to play a critical role in determining what pediatric nurses need
to know, how they are trained and the way they practice," says
Eileen Sporing, MSN, RN, senior vice president for Patient Care
Operations. "We're positioned to advance the excellence of
the nursing profession at Children's Hospital Boston and throughout
In the fall of 2001, the Center awarded O'Brien an eight-week sabbatical.
Freed from her day-to-day duties, she conducted a literature search
to find the current best practice in pain management. Together with
Pain Services and the Hematology and Emergency Departments, she
created guidelines for ED physicians treating sickle cell crises.
O'Brien also taught the ED nursing staff how to administer the PCA
pump, produced an instructional video and designed an evaluation
program to get feedback directly from parents in the emergency room.
Her efforts paid off. A year later, evaluations show that ED waiting
time and pain levels have been reduced.
Appropriately, Jessica Villegas was one of the first to benefit.
"It used to be so frustrating to watch her wait hours to get
relief," says Lourdes Santiago, Jessica's mother. "The
next time we brought Jessica to the ED, they hooked her up to the
PCA pump right away and she was admitted to the floor with her medication
already infusing. Joan's persistence made a huge difference, because
faster treatment means Jessica can go home sooner."
This moment of triumph for one patient family has a wider significance
in improved care for hundreds of patients at the hospital—and
beyond. Last fall, O'Brien presented her story at the 2002 Association
of Pediatric Oncology national conference. And recently, the ED
staff celebrated another achievement when they treated a young sickle
cell patient with a PCA pump so promptly and successfully that they
completely eliminated the inpatient stay. -KK
Your gift to the Center for Innovation and Clinical
Scholarship in Pediatric Nursing will fund nursing sabbaticals,
clinical research and other critical initiatives. To learn more
about how you can help, please contact Cindy Zilch at the
Children's Hospital Trust, (617) 355-2416 or email@example.com