“No parent wants to see their child in pain”

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08/18/2020

Pmnweb

Advanced practice nurses at Riley work to dial down the pain for their young patients so they can put their energy toward healing.

By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

As a bedside nurse years ago, Stephanie Whittaker often felt her heartstrings pulled when a young patient was in pain.

She longed to be in a position to provide more effective pain management, so children could focus more on healing rather than hurting.

She went back to school to earn an advanced degree as a pediatric clinical nurse specialist with a focus on pediatric pain management and medical ethics. Today, she is an advanced practice nurse specializing in acute pain management at Riley Hospital for Children. It’s a role that suits her, giving her a sense of satisfaction just as she gives patients and their parents a sense of calm before and after surgery.

“The thing that compels me most is, I can’t change their diagnosis, and I can’t alter what happened, but what I can do is ease their suffering and their parents’ suffering. No parent wants to see their child in pain.”

Whittaker has been in her current role in Pediatric Anesthesia Acute Pain Service at Riley for eight years, pretty much as a solo act until the recent arrival of Heather Hollingsworth, also an advanced provider who completed her doctorate in nursing practice last year. Both are passionate about managing the pain that results from critical procedures done in the operating room.

“If you can help ease their pain, then children can be more active, can participate in therapies, relate better to family and friends and have some of that positivity that contributes to healing,” Whittaker said.

“I’m only one component,” she added. “The richest piece that I’m connected to are my physicians who place the epidural catheter infusion or peripheral nerve block. That’s the foundation. Without that piece, we’re limited in what we can achieve.”

Dr. Brian Egan, clinical director of anesthesiology, believes Whittaker is being too modest. In his opinion, the Riley team and patients are blessed to have her looking out for them.

“She is the glue, engine, oil, all of it for the pain team,” he said. “She interacts with patients and families, surgeons, nurse practitioners and nurses on the floor. She really is the touchpoint for the entire hospital.”

As advanced practice pain nurses, she and Hollingsworth work with patients in orthopedics, neurology, urology and cardiology to address post-operative pain, with the goal of getting kids home sooner and in better shape.

Scoliosis patients who undergo spinal fusions, for instance, used to stay in the hospital four or five days after surgery. It took that long to get them over the worst of the pain and up and moving. Now that time has been cut in half for otherwise healthy kids.

“SHE MAKES ME BETTER”

Whittaker is pleased to be able to share the accolades now with her colleague. “I am privileged and delighted to have a peer in Heather. She is perfectly fantastic. She makes me better.”

Hollingsworth has been with Riley for two years, joining the acute pain team in June. She previously worked at other children’s hospitals in the Midwest, but the pull of Riley was strong. Her sister was a Riley kid, and she knew someday she wanted to work here.

“When I was a little kid, this was just a wonderful place where kids went to get fixed,” she said.

Now she gets to be part of the miracle every day.

“We start out with kids going through some of the most painful procedures that anyone will experience, let alone a child,” Hollingsworth said. “And we follow them from the moment they come in for pre-op to the moment they leave. We get to be there to support them all the way. It’s a really gratifying experience.”

She and Whittaker work with patients undergoing procedures that are significant in post-operative pain, including chest wall deformity corrections, spinal fusions and other orthopedic surgeries.

Their goal is to manage the pain and the expectations for the patient and family, so that the child can focus their energy on healing.

“We try to help families and patients understand that pain has a purpose, especially post-operatively,” Whittaker said. “Its purpose is to protect you, to tell your body that you need to take it easy. If you felt no pain, you would be jumping around, endangering the tender work your surgeon just did.”

At the same time, she said, they don’t want that pain to become overwhelming because the body only has so much energy metabolically. Already it’s working hard to heal, she said.

“If you’re in so much pain that you’re not able to function, you’re going to be breathing shallowly, curled up in a little ball. If you’re not breathing well and thoroughly, you’re not oxygenating your body. If you can’t heal well, then comes suffering, and that’s harder.”

13-YEAR-OLD WITH SCOLIOSIS

Acellyn “Acey” Roach is recovering from spinal fusion surgery performed four weeks ago at Riley. The 13-year-old was diagnosed with scoliosis in January, not long after her mom noticed that her back looked crooked while the teen tried on a fitted dress for a middle school dance.

“I told her to stand up straight, and she said she was,” Karen Maryfield said. “I tried to adjust her and realized something was not right.”

Acey had her pre-op workup done in March at Riley and was scheduled for surgery in April, but then COVID-19 hit. It wasn’t until July that she could have the surgery, and by then, the curvature in her spine (an S curve in her case) had gotten significantly worse, her mom said.

As mother and daughter sat out on a porch swing in their hometown of Linton, Indiana, on Monday evening, they talked about the anxieties they had going into the procedure and how the Riley team, including Hollingsworth, eased their fears.

“I was super nervous about how I was going to come out of surgery,” Acey said. “They really calmed me down; they put up with me and my pain.”

And they listened, her mom said.

“While she was at Riley, they realized she cannot tolerate pain medications very well,” Maryfield said of her daughter. “She was out of it. They called the pain team, and they acted immediately to adjust her meds.”

Acey did a complete 180 and soon was wide awake, eating and making jokes.

“They listened, and that was huge,” Maryfield said of the staff. “They were trying so hard to find what works best for her, and they do that for every kid.”

As members of the pediatric anesthesia department at Riley, Whittaker and Hollingsworth work closely with a team of six anesthesiologists who specialize in caring for kids undergoing these painful procedures. Together, they devise a plan specific to each patient. The plan follows the patient home, so parents can feel confident managing their kids’ care outside the hospital.

Acey is lucky. She takes only an ibuprofen now before she goes to school and says her back feels pretty good. Others require more intervention.

DIAL DOWN THE PAIN

It can be intimidating for parents to take their child home with a trick or treat bag full of medicine, Whittaker said.

“We try to get that very organized and in a grid schedule they can follow, so they can have confidence that they’re doing everything they can to help their kids.”

The goal with acute pain is to manage it aggressively enough so that children recover to a point where they don’t have lingering pain, which can develop into chronic pain, Whittaker said. Many children in the general surgery population who come in for multiple procedures related to bowel problems can development chronic pain.

“That makes it more important that the acute pain service team is on board early to work with the surgical team to get a strategic overview as to how we are going to manage this child’s pain,” she said. “The whole goal is to dial down that pain response so they can heal well, participate in therapies, get up and move and not develop that chronic pain.”

The team is careful to minimize the use of opioids in treatment.

“It’s not that opioids are evil, but they do have some unfortunate side effects and they carry with them the potential for misuse,” Whittaker said. “Everything we do is focused on using a specific medication targeted to a particular end point for pain so we’re able to minimize the amount of opioids, and we help the parents understand this so they can feel safe.”

IT TAKES A TEAM

Having Hollingsworth on board allows the pain team to provide a deeper level of service, Whittaker said, addressing the fear and angst surrounding what’s happening with kids and parents.

That requires a different level of care and commitment and an understanding of human emotions. Hollingsworth’s background in psychology helps advance that mission, helping patients and parents to not be afraid but to feel confident in the care being given.

In addition, the two work closely with physical therapists, child life specialists and the nurses on the floor.

“We couldn’t do anything to the level of success we have if we did not have that rich abundance of professionalism and caring from our floor nurses and their leadership,” Whittaker said.

The same goes for the other disciplines, Hollingsworth said.

“We can write meds and teach people how to plug them in, but child life going in and working on coping mechanisms, and physical therapy teaching them how to get up and how to maneuver, we can’t do all of that. If I could just carry a child life specialist around with me, I would do it. I would attach one to my hip.”

In the end, Whittaker said, she wants her patients to know that there is more right with them than wrong with them and her job is to give them the tools to be successful.

“You’re not broken, you’re recovering,” she tells them. “And here’s how we’re going to help you.”

Photos submitted and by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org