How did you come to specialise in paediatrics?
I have always wanted to be a nurse, specifically taking care of children. That’s why I chose specifically to take Children’s Nursing BSC (Hons) degree. For me, I was always going to work with children, but throughout my career I have had a variety of experience caring for adults too.
In dealing with complex cases, what approach do you take with children to help them understand what they are going through?
It really all depends on the child, their personality, their age, and their cognitive and mental ability – which may have been affected by traumatic injury. Quite often they will have special needs, which calls for routine and exploring different ways in which the child is best able to express their feelings.
For all children it’s about finding a way that they are comfortable communicating with you. For younger children I will often use pictures. The child can relate to different images and use them to explain how they feel. Using imagery, we can build what is known as a ‘communication passport’. In the passport there will be pictures to represent what the child likes and dislikes, and how they communicate.
This also works incredibly well for children of all ages who are unable to express themselves through words. It’s a good way for others to get to know the child and understand how best to communicate with them to help them through their rehabilitation journey.
It’s obviously a very scary time for children who have experienced serious injury, so putting them at ease is vital. With younger children I tend to get them involved in some kind of play or activity such as colouring or drawing, and talk to them while they are engaged in an enjoyable activity.
With older children such as teenagers, it’s important not to treat them like a child, for example, talking to them, not about them when discussing their treatment. I try and include them as much as possible in any decisions about their treatment and make them feel like an adult by giving them a chance to say what they want.
In what ways are you able to provide emotional and practical support to the families?
Talk to them. In my previous role as a paediatric HDU/ITU Nurse, I dealt with many parents who were understandably distressed. I would try my best to calm them down. Sometimes that would mean simply giving them the facts. For example, some parents were anxious about surgery overrunning, but often they would only have been told the surgery time which wouldn’t include the anaesthetics and recovery times.
Letting them know it’s ok to feel this way and listening is a huge part of providing emotional support. Being confident in offering practical advice and support really helps instil confidence in the parent too – that this is normal, that everything will be fine.
Being able to reassure parents while ensuring they understand the facts is key. A cup of tea also goes a long way!
Is there a particular case/patient throughout your career that has really made an impact on you and why?
We had a 16 year old come in for spinal surgery, which resulted in complications and meant the child had to stay in hospital a lot longer than expected.
Due to the nature of the injury, he was left with paraplegia and recovery after surgery meant continuously lying on an orthopaedic bed in the spinal cord injury unit. This was very difficult for him and he experienced low mood and stress.
Over 2 months I built up a great nurse-patient relationship with him. I would always take time out of my day to go and see him and try and keep him occupied and entertained with games of UNO and other activities to lift his mood, and try and help him stay positive.
I reassured him that there was always a chance he could start walking again. Motivation is a huge factor in rehabilitation and recovery, and I would encourage him to put in the work on his rehabilitation and do what they’re telling you to do while you’re here. I would tell him by doing this you will get back on your feet. I’d make sure I motivated him every time I was on shift, accompanying him to his physio sessions and supporting in any way I could. When he left hospital, he was able to walk with the assistance of crutches.
Following his discharge, the MDT responsible for his ongoing care let me know that his mobility was vastly improving, and he had started to take part in activities he’s previously enjoyed, such as basketball. They also passed a message on from him to tell me thank you. It means a lot because you know you’ve been an integral part of their rehabilitation and recovery.
Can you tell me a bit more about your experience of managing large teams of clinicians, what did it involve?
I was Ward Sister for 3 years, managing a team of nurses and HCA’s and managing patient care. This included ensuring the safety of patients and being responsible for making decisions in response to rapidly changing circumstances, for example, if a patient’s health started deteriorating it would be immediately escalated to me to decide on their care. I would lead MDT meetings with a variety of medical professionals including consultants, anaesthetists, speech and language therapists, occupational therapists, dieticians, social workers, psychologists, and others, to discuss all cases: inpatient care, discharge and arrivals for the following week.
Why the change from nursing to case management?
For me the one thing I know is that I always wanted to work with children. I went straight from studying children’s nursing to an orthopaedic hospital. Because of my education and experience specialising in children’s health and complex injuries, case management and working in the Young People & Children’s Services team at HCML was a good fit. Here I am still working with children – and adults – that have complex orthopaedic injuries, acquired brain injuries, neurological trauma, persistent pain and more. I am able to make a real, positive impact on children’s lives following injury, helping them throughout their whole rehabilitation journey, rather than just at the acute stage, stepping away from purely bedside care.
What are the key skills from nursing that will help you with case management?
My clinical knowledge. Having worked in an orthopaedic hospital, I have the skills and experience to support the many rehabilitation clients who have orthopaedic injuries. That, and my experience and love of working with children to help them to feel better.
What are the three top qualities you think a case manager should have?
- Communication – you need to communicate effectively with clients for yours and their benefits.
- Assessment technique – a good assessment requires certain skills to get the relevant information from the client to understand how best to support them.
- Commitment – as a case manager, you will sometimes be managing a client’s case for years. You have to be committed to helping and doing the very best for your clients.
What attracted you to HCML?
I was looking for jobs working with children, and although I wanted to move away from the acute care side of things, I still wanted it to be nursing related. I came across HCML and read up on the company. The case management role seemed interesting in the way it links to nursing. A lot of things about HCML appealed to me including being able to keep my NMC registration that I worked hard for.
You’ll be used to dealing with extremely personal and difficult situations as a nurse, what do you do inside or outside of work to manage stress and remain resilient?
When I’m finished with day – especially when I worked in a hospital – I would try to shut off from the workday. It’s hard walking away at the end of the day from people that you are helping, but handing over to the next shift and trusting the experience of others to manage is important.
Talking to friends in a similar role is really helpful. Chatting through and making sense of difficult situations can help, especially if it’s someone in a similar field who will no doubt have experienced the things you have been faced with and what you’re feeling themselves at some point.