Bringing a new culture to hospital care

Emotional support, nurse-patient relationships have changed the face of care at Lucile Packard Hospital

Kate Meyer wasn't given much time when her 13-year-old son, Clayton Hagy, was diagnosed in 2008 with biophenotypic leukemia. Clayton nearly blacked out in the school gym. Meyer took him to his pediatrician, expecting diabetes. But the diagnosis was dire.

On the way home from the doctor visit, Meyer received a call: Go directly to the emergency room at Lucile Packard Children's Hospital. The oncology team would meet them there, she recalled.

That day turned the family's world upside down. Clayton immediately received chemotherapy and was isolated in a special room where visitors dressed in gowns, masks and gloves so they wouldn't transmit infections. His immune system was wiped out by chemotherapy. It took a year, but he finally received a bone-marrow transplant, although it wasn't a perfect match, she said.

Meyer became keenly aware of the family's good fortune in coming to Packard Hospital, she said.

She had just started working for a place that brings information to Third World countries. "In many places, this (disease) is pretty much of a death sentence," she said.

Not only has the advanced medical care helped Clayton to battle the leukemia, the hospital has tried to meet his emotional and academic needs as well.

During the first 56 days of his initial hospitalization, he was introduced to Packard's Child Life program. The service offers art therapy, schooling and role-playing to prepare patients for difficult procedures. Clayton received tickets to San Jose Sharks and Warriors games, where children with compromised immune systems stay in special suites in the stadium, she said.

"When I went in for the transplant part of it, I got a dartboard with plastic tips. It was something to do. It felt good to throw something at the wall," said Clayton, now a 15-year-old high school sophomore.

"One of the most helpful things was the art therapist," he added.

Services for family members are available as well, to help them keep their emotions and mental health in balance.

"I used everything," Meyer said. She attended a parents' support group and received 15-minute massages to reduce stress, she said.

One of the most important elements of care for patients such as Clayton and their families is the relationship-based nursing program, according to Packard staff. Introduced in 2009, the program helps Clayton and other children develop a trusting relationship with nurses.

Prior to autumn 2009, nursing care at Packard was largely driven by a schedule of tasks such as administering medication, inserting tubes and checking lines, said Cathy Hedges, project coordinator for relationship-based nursing practice.

But now nurses spend five minutes on each shift in uninterrupted conversation at the patient's bedside. Sitting with the patient at eye level and making eye contact, the nurse asks specific questions to understand the patient's needs and concerns, she said.

"It's very rewarding and helps establish a relationship with the patient. Especially with Spanish-speaking families, it's tremendously helpful. Nurses learn how the mother thinks the baby is doing or can initiate a social-worker referral," she said.

When a new nurse comes on shift, he or she and the outgoing nurse go to the patient's bedside to see the patient together. They talk about what was learned about the patient during the previous shift and meet with the family, she said.

"It's a big change that's been positively received. Parents appreciate the tone," she said. Parents know which nurse will attend to their child from the start. Previously, it might be two hours before a new shift nurse would see the patient, she said.

Nursing team continuity, through on-and-off shift debriefings, also help identify issues early and improve patient safety, she said.

Hedges said she has seen a cultural transformation that has improved patient care and nurse satisfaction since she started at Stanford in 1984 and began at Packard when the hospital opened its doors in 1991.

"There's been a big shift. It's been fantastic to see the transformation in the past five or six years," she said.

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Like this comment
Posted by catkady12
a resident of Portola Valley
on May 30, 2011 at 7:55 pm

It's fantastic to see this positive shift in nursing! I know the nurses and educators work so hard to encourage nursing and patient care practices that can evolve to meet the hospital's needs. Good job CH and team!

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