My First Experiences of Child Nursing Emergencies

#HelloMyNameIs Alice and I am currently in my 2nd year of studying Children’s Nursing. When I was thinking about what I should write, in my first ever blog entry, one topic kept circulating around my mind – experiencing resuscitations and emergency situations for the first time as student nurses.

I remember being terrified before my first placement because I had trained my brain into believing I would be looking after sick babies and children all the time. I was scared because I didn’t know how I would react emotionally and physically. How wrong I was!

I want to completely reassure all of you who are reading, that being nervous is so normal, it’s a good thing. As compassionate and caring nurses and people, nerves show we really do care, and will want to do the best for our patients. I am going to show you an extract of my portfolio, showing you my reflections from my first ever crash call (which happened in second year), and then my reflections following another which happened a few weeks later. I feel this is the best way to reassure you and give you an insight into things that student nurses really do get to be a part of, and how I did much better in the situations then I thought I was doing. I have included my mentor comments for you to read because I want you to see this, I was shocked that I got positive feedback from staff because I didn’t feel I had done very well. It is a little on the long side, but I urge you to read it all to see how my outlook changed, and I hope you will pay attention to how it is normal to feel out of your depth when you experience something for the first time, because we are learning, we don’t have the knowledge to perform any better. But what makes us good student nurses, and health practitioners, is the ability to always reflect, learn what went well and not so well in every situation you find yourself in – and to ALWAYS ask for help when unsure!

Reflection 1

I was doing a twilight shift which finished at 10:30pm. About 30mins before the end my mentor (a sister) was asked to help the ward as a patient’s saturations kept dipping. I was asked to go and observe and help.
When I arrived, it I was told a chest infection and thick secretions were the problem. So, I assisted the nurses with repositioning and suctioning. It became apparent that the oxygen saturations were not improving like we wanted so doctors and the physiotherapists were called. A few minutes later the consultant arrived listened to her chest and shouted for someone to phone for anaesthetics. Just after this had happened the patient started to fit, and her breathing almost stopped. A crash call was made, and I suddenly found myself in a very scary and intense situation.
The patient was in a ward bay full of other patients who became distressed as you would expect which added to the emotion in the room.
I stayed as long as I could to be on standby in case they needed any help, but I was going to miss the last train.
When I left the hospital I was overcome with emotion and had a little cry because I had never seen a child get so poorly so quickly and because I had absolutely no idea what happened to her after I left.

The next day I asked to speak to the Sister and I had a good chat with her. She made me feel like what I was feeling was the right emotions, and that she would be worried if someone in the caring industry didn’t feel how I did. Just before I went home, I managed to catch my mentor (Deputy Sister) long enough to have a proper debrief as she was with me when it happened. She explained what I saw and the reasons why the staff were doing different things, and then told me what happened to the patient when I had to leave to come home. She said that I had done well which surprised me because I didn’t realise I had done anything other than watch. Things I had done subconsciously without realising had been noticed by the other nurses. She said she was impressed that I asked to stay with the patient when the nurses were going to other patients before she had the arrest and before anyone had realised that she was unwell- I had recognised without realising that she was vulnerable. She was also impressed that I did things to make the medical team more efficient, I cleared the bed space, turned on the light, ran to find oxygen.

This gave me a huge sense of relief because I felt so upset by it all was because I thought I had no idea what to do and was helpless. I am so relieved that the patient had pulled through and is being cared for in a more specialist environment. I have discovered throughout my training that the first time I see something I have a larger emotional response to it then I would rather like. however, after I have seen a resus once, and understand what happens, I feel I will be better at understanding what is happening in the future.

Comments from Mentor – Alice has shown great professional maturity following this incident. it has made me realise as a qualified nurse how emergencies can affect students when they are new to these situations. the debrief following this situation has enabled Alice and myself to examine our own practice effecting how we will respond in future emergencies.

Reflection 2

I was working with my mentor doing bloods when the crash bell went. She left and then came back telling me that someone was having a seizure. It was a little girl who had a febrile convulsion in the ED and once up on our unit had several more. My mentor was happy that other staff were dealing with it. I asked if I could go and observe because I haven’t seen a child have a seizure before, my mentor agreed. When I arrived, the child was still seizing, and she was frothing at the mouth. The nurses started suctioning her and did an emergency bleep to get medical teams to come and assist. It became clear that this seizure needed some careful management and the child was moved into a more appropriate place where medications and equipment were freely available. The child kept on seizing despite receiving lots of anti-seizure drugs, and so anaesthetics were called. They made the decision to intubate to protect her airways. As this was happening, I decided I wanted to get more hands on, I helped by writing down the medications that had been given and scribing on the wall, tidying up as the space was getting messy and cluttered-to make it easier for the medical team. I also noticed that the mother wasn’t coping very well. She had been at her daughter’s bedside the whole time and had witnessed the emergency taking place. I decided that I would try and reassure her by offering her support and trying to explain what was going on. I explained what they were trying to achieve out of intubating, and why they needed to cannulate lots of different areas, as well as who the different people were (their job roles). I think this really helped mum as there was someone who she could ask questions to that wasn’t directly involved in the intubation.

The child then went down for a head CT scan and I accompanied the medical staff. The CT scan was clear, after liaising with a tertiary hospital she was taken to the HDU bed on the paediatric ward to be extubated and monitored.

I wanted to reflect on this because this was such a different experience to my first resus situation. I felt like I knew what I could do to help the situation and knew my limitations in terms of what I could and couldn’t do. I felt proud of myself and happy because I felt I had made a real contribution, I wasn’t sad or emotional about what I had seen like I was the first time. I felt rewarded. I believe this was in part, because she made such a quick recovery. My role in supporting the mum was beneficial, and I know through speaking to staff afterwards that me taking the time to reassure her made her feel supported and included in her child’s treatment, even if she was just watching from the door frame.

Comments from Mentor – Alice was involved in the stabilisation of a child with a prolonged seizure who required intubation. She was able to make valid contributions to the clinical process of intubation and stabilisation, appropriate to her level of practice, and learnt from this process. Alice took it upon herself to provide emotional support to the parent of the unwell child, she was kind and comforting and was able to keep the parent updated throughout episode of care. I was extremely impressed that Alice had the confidence to feel able to provide this support.

(Side note- you will always be supported by the nurses and doctors on your placement and will never be asked to perform in emergency situations if you don’t want to. Your mentors and buddies have been students too and are really understanding. Our university is always fabulous at focussing on maintaining student satisfaction and mental health, you can always talk to your placement tutors, your university tutor- or anyone else who you trust!)

I hope you can see how my two resuscitation experiences had taught me so much. And that these learning experiences may be hard when you are in them, but they help to shape who you start to become as a nurse, learning vital skills that will enable to be the amazing child nurse you are already becoming!

Author: Alice Beal, Year 2 Student

(Details anonymised in order to protect patient confidentiality)

Disclaimer: This blog contains personal opinions of students only and does not necessarily represent the views of the Children’s Nursing team, School of Health Sciences or the University of Surrey.

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