Caring for sick children
Published at: 22 Nov 2019
The Child and Adolescent Unit (CAU) at GV Health treats some of the community’s youngest and most vulnerable patients.
The 12-bed ward, according to Acting Nurse Unit Manager Paula Holland, often expands due to demand with several services also operating throughout the entire Paediatrics Department.
The department uses a family-based approach to care.
Clinical Director of Paediatrics Dan Garrick said the service was currently experiencing an increase in demand.
“We get a lot of referrals to Paediatrics Outpatients,” he said.
“The service is currently operating at capacity and we’re actively looking to expand that.”
Dr Garrick said, as a result, nurses often took on extra workloads.
Ms Holland highlighted the fact there were several services and special clinics that operated out of the CAU.
“We do have an ears, nose and throat specialist and a general specialist that travel from Melbourne,” she said, in addition to the dedicated team at GV Health.
Other services include a Refugee Clinic, a Feeding Clinic, Palliative Care and a dedicated social worker.
Dr Garrick said they also interfaced with the Child and Adolescent Mental Health Service for children who needed that level of extra care.
“We also develop programs and initiatives for special clinics for children with complex emotional and behavioural problems and developmental disorders,” he said.
Dr Garrick said the department also supported the University of Melbourne’s Department of Rural Health’s medical students studying to become general practitioners.
“They come into the unit for an intensive three-week block,” he said.
“That program has become well-recognised for the training of students.”
Dr Garrick highlighted the fact that the department was also incredibly multi-cultural when it came to patient demographics.
“We do need to be culturally sensitive and appropriate,” he said and added they had fantastic support from phone interpreters.
GV Health was the first Victorian health service to join a national consortium of Foetal Alcohol Spectrum Disorder Clinics in Australia last year.
The clinic was established in conjunction with the PATCHES Paediatrics Group in Western Australia.
Clinical Director of Paediatrics Dan Garrick said the focus of the clinic involved diagnosing FASD – a complex condition resulting from mothers consuming alcohol while pregnant.
GV Health FASD Clinic Manager Kim Cowen explained why diagnosis could be challenging.
“Assessing for FASD is quite an involved process requiring multiple assessments with different clinicians,” she said.
“Without a dedicated clinic, it can be really hard to piece together all the assessments needed for a diagnosis.
“It is great that we can now offer this service to families locally and help link them in with the ongoing supports that these kids need.”
Dr Garrick said the clinic used a multidisciplinary model.
‘‘That works well and it’s necessary. It is made up of neuro-psychologists, speech pathologists, occupational therapists, paediatricians, and a coordinator who works across all those disciplines putting it together,’’ he said.
‘‘Having all these specialists available in a one-stop clinic format makes assessment much smoother for families who previously would have had to travel to Melbourne and attend multiple appointments.’’
Paediatric Liaison and Accident and Emergency
Paediatric Liaison Nurse Beck Brisbane ensures the smooth transition of young patients from the Emergency Department to the Child and Adolescent Unit at GV Health.
Ms Brisbane said this involved spending time between the two departments, liaising with ED staff and patients.
“We’ll have a weekly meeting with all the care team,” she said.
The role also included making improvements in the transfer of young patients from ED to the CAU, ensuring continuity of care.
“A lot of nurses come in with qualifications in adult general nursing,” she said.
“Children are a whole different dynamic, though.”
Ms Brisbane said her role included supporting ED nurses with child and adolescent patients, ensuring they felt comfortable treating their patient.
Clinical Director of Paediatrics Dan Garrick said the role was crucial as 35 per cent of presentations to GV Health’s ED were children.
“The Emergency Department is also getting busier and a lot of GPs are relying on us to help,” he said.
Ms Brisbane said ED could be quite a daunting place for children and their parents which was why her role was important.
“They’re mixed in with adults … we do have special rooms for them, but it can be daunting,” she said.
“Even coming into the kids’ ward can be daunting for some people.”
“The safety limits of children are different than adults,” Dr Garrick said.
“They can become highly stressed (in that environment).”
GV Health’s Child Life Therapist Helen Hindson assists with the stress and discomfort of sick children and their families in the Child and Adolescent Unit.
Ms Hindson joined the role this year after working as a primary school teacher and recently completing a course in psychological science.
Ms Hindson spoke passionately about her role when first appointed and said it was fantastic providing the young patients with activities to distract them during their tough time in hospital.
“For the little ones they might come down to the play room … I’ll do some art and craft activities,” she said.
Ms Hindson said her favourite part of the job was bringing a smile to the kids’ faces and diverting their attention away from their hospital stay.
Being able to support the parents who visit the ward is also another vital part of her job.
“The focus is all on the kids … you forget this is potentially traumatic for the parents as well.”
Clinical Director of Paediatrics Dan Garrick said the Child Life Therapist role was not only important for the distraction of painful procedures and being in hospital, but also provided sensory stimulation for patients.
Home and Community Services
Children with high medical needs receive regular visits from GV Health’s Paediatric Home and Community Services.
Child and Adolescent Unit Acting Nursing Unit Manager Paula Holland said the program involved visiting schools and homes to provide care.
“We often provide post-acute care after surgery,” she said.
“We provide extra support for complex kids.”
Ms Holland said the service helped to ease parental anxieties around their child’s treatment and allowed them to get on with their day-to-day activities.
“It also normalises things for the child…getting seen in their home environment,” she said.
Clinical Director of Paediatrics Dan Garrick said the Paediatric Department was looking to further develop this service into a Hospital in the Home service in the future.
“It allows you to do more medical care in the home, like giving intravenous antibiotics or changing complex dressings,” Ms Holland said.
Special Care Nursery
The GV Health Special Care Nursery has eight beds and supports babies born from 32 weeks and 1500g, according to Clinical Care Coordinator Cindy Batey.
“For anyone that gives birth here (prior to 32 weeks or if underweight), we always stabilise the baby for transfer and we get them to an appropriate location as soon as possible,” she said.
Located in GV Health’s Maternity Unit, the Special Care Nursery operates at Level 4 out of five levels in Victoria, according to Clinical Director of Paediatrics Dan Garrick.
“That means there is a high level of skillsets required,” he said.
Ms Batey and Dr Garrick said the Child and Adolescent Unit and the Maternity Unit worked closely together.
“We do rotate nurses that work across both units,” Ms Batey said.
She said it was an exciting time for the nursery with staff currently working on a project with The Royal Women’s Hospital.
“Babies born prior to 30 weeks require extra eye screenings which we don’t have the equipment for,” she said.
“We’ve been negotiating with the team from The Royal Women’s (Hospital) to support us so we can get the babies back here sooner.”
Dr Garrick said the project would involve a team from The Royal Women’s Hospital visiting GV Health to conduct the tests.
Ms Batey said it was incredibly important to support families through their journey, given they were not dealing with just one patient.
“We have to have a different approach … we need to provide family-centred care,” she said.
Diabetes Care Project
GV Health established a Diabetes Care Project – a multidisciplinary clinic which sees diabetes educators support families of a child living with diabetes.
Clinical Director of Paediatrics Dan Garrick said the educators also supported schools as part of the program.
“A lot of children are on insulin pumps these days,” he said.
Dr Garrick said the project was developed with best practice guidelines from Australia and internationally.
He said it involved the educators spending time teaching families and teaching staff what to do when it comes to caring for children living with diabetes.
Victorian Paediatric Rehabilitation Service
GV Health operates a satellite site of the statewide Victorian Paediatric Rehabilitation Service.
“We have been doing this for some years,” Clinical Director of Paediatrics Dan Garrick said.
“It is for children with significant medical and physical conditions that require rehabilitation.”
Dr Garrick said the services included a Botox clinic which required highly skilled staff members.
He said Botox helped with the relief of joint movement and said treatment depended on the individual.
“Usually they’ll come to outpatients then come onto the ward and have the procedure,” he said.
Acting Nurse Unit Manager Ms Holland said the service was highly sought after with patients travelling all the way from Albury to receive treatment.
“We cover the entire Hume region,” she said.
“A lot of these families would have normally needed to take a whole day out to travel to Melbourne for the treatment.”
Paediatric Integrated Cancer Service
Children undergoing chemotherapy treatment can receive it on GV Health’s Children’s Ward.
The Paediatric Integrated Cancer Service runs every Friday at the Child and Adolescent Unit.
“If they meet the requirements, they can have their treatment here,” Acting Nurse Unit Manager Paula Holland said.
“We have four nurses who are trained in chemotherapy.”
The service means that children can have the treatment in a brighter and more colourful environment as well as eliminating the need for many families to travel to Melbourne to receive treatment.