The awe inspiring thing about technology is that it continues to advance, evolve, it is infinite. The miracle of technology is that it gives us time…and more chances to get things right. The chance to do something one last time, the opportunity to try something for the first time….perhaps, if we’re really lucky—technology will afford someone a chance to live for a lifetime. Technology is our “physical” safety net…but it can also be the very thing that impedes on all other aspects of life– our inner compass, the ability to ascertain what we really want versus what everyone around us wants, how we perceive ourselves, how we make meaning of our experiences, how we grieve, how we reintegrate into the world, and how we continue to develop as healthy individuals throughout the lifespan. While we continue to learn more and more about all the latest and greatest innovations in healthcare, nurses must remain the “constant” that serves as the reminder to all disciplines that though technology can often yield more time or a better quality of life for people—those ends cannot be achieved without a holistic approach to care and recovery of the complexly ill human being.
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In my next article I will discuss the evolution of a new device that was designed for use in a wide variety of pediatric populations of patients with heart failure as a bridge to transplant, bridge to recovery, or bridge to decision. My reasoning for writing about pediatric patients is twofold. First–I had some harrowing experiences caring for adolescent patients implanted with LVADs as a bridge and I didn’t have the first clue of how to take care of “the adolescent.” I had the technology down, what to watch for, how to do the dressing changes, what the numbers on the portable monitor meant etc—but the developmental stage of the patients threw me for a loop and quite frankly I resented not being able to get any guidance or in service to help me provide the best care for them. The unit I worked on was for adults. I was trained to recover adults. Second, technology has caught up to the pediatric populations with respect to circulatory assistive devices and it’s time nurses discuss what could and should be done to ensure our nursing skills “grow with” this technology so we are providing “all around and all inclusive” holistic care of the pediatric patient and their family. Failing to take the “pause before play” approach encourages tunnel vision within nurses—the tendency to focus too much on technology and not enough on high touch, high thinking, or theory application and development.
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There are numerous issues to contemplate with the adult who has been implanted with a circulatory device, there are even more to consider with a child or adolescent. For instance, principles of family centered care, fostering the achievement of developmental milestones and tasks depending on the age of the child, as well as facilitating the grieving process of both patient and family at their own levels of understanding—just to name a few. How on earth do I make a care plan that includes those big things? That’s scary stuff, and the lack of experience left me feeling inept and ill equipped to provide the best nursing care I could. There was a barrier between me and my patients. I mean, how do I communicate with an adolescent without unintentionally isolating them or hurting their feelings? Yes, I thought about these things, and I was troubled by them all the time. I looked at the kids like glass, afraid to do or say anything that would upset or frighten them. I did not want to break any glass. So I did my best, but I’m pretty sure I did better at the technology and the routine nursing stuff versus anything else.
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Children and adolescent LVAD patients are better served in facilities that have units designed specifically for their unique needs. Parents could provide better support to each other throughout the process, children and adolescents would also have instant access to see and support each other throughout their journeys—ie: the “wow I’m not the only one with a pump in my heart” aha moment. Can you imagine how that one single revelation could positively impact the recovery and self confidence of an adolescent? Reading stuff on the internet and consulting my old nursing books just wasn’t helping me put the pieces together. Concerned, but hopeful, I had submitted suggestions to my manager that would assist not just myself to overcome these knowledge deficits and insecurities, but would raise awareness to all the staff that an LVAD isn’t just an LVAD. I had suggested we purchase some pediatric nursing textbooks for reference, and developing an in service accompanied by some core competencies for the staff. I also suggested consulting the local children’s hospital to inquire about having some of their nurses and child life specialists guest speak to educate us, provide valuable insights, or perhaps demonstrate communication techniques and care plan ideas. Again, I was greeted with an “are you crazy” expression from my then manager and the suggestions were rejected. Big surprise. BUT! Now…there are blogs. So, maybe this perspective will help someone somewhere out there who is in the same shoes I used to be….
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Next up: The Berlin Heart EXCOR Ventricular Assist Device, the first widespread North American Study– and its implications for nursing……
