Video: Pediatric Intensive Care Nursing

Slide 1 - Introduction:

• Hi everyone, my name is Mallory. Very nice to meet you all. So my credentials, so I have PhD in Nursing. I just graduated las year, but I will talk all about that. I am a Nurse, and I am a Certified Pediatric Nurse as well as a Critical Care RN, so a Registered Nurse.

Slide 2 – High School Experience:

• So my journey, so I started you know in high school I would go through what I wanted to be/what I wanted to do. And initially I thought I wanted to be a lawyer. That really didn’t work, and I went elsewhere. I thought that since I liked to argue with people, but really I just realized that I liked to help people. So my high school experience was a little different. I actually went to an all-girls private school- so a very different experience.
• So the one thing I want to point out is the courses that really helped me to kind of shaped what I wanted to be and just for you guys to think about as you guys are kind of just going through these steps right now is I really found my love for helping people and kind of about the human body through biology and having to take anatomy and physiology courses. And then physics was something that was required in our high school, so I thought about taking that early. It was my junior when I finally settled on- oh maybe I want to do nursing, so it would be kind of helpful for me. It was a religion class that I took, that’s when I was like oh this could be a career path that I could be thinking about and that’s what really solidified that.
• In this picture, I just want to point out, I know a lot of times people are cramming down your throats like study, study, study. But you also have to think about your extracurricular too and things that make you happy and make your mental health happy. So I played basketball since I was little – so something that really helped me. When the time came to push and shove for college, it was kind of a question of do you want to play basketball in college or like where do you see yourself going in the future. And I had to make some tough decisions, and I decided to go with my future. And I ended up going to the University of Connecticut. I am from Connecticut, and the basketball players there are all 6’5, and I am all of maybe 5’7, so that wasn’t going to work. And for me though, there were programs at these universities that also have like intermural teams, so it was very helpful for me, and it was something that I was able to do to keep up my passion for sports and other extracurricular that some of these schools have and also keeping my studies at the forefront.

Slide 3 – Undergraduate Research:

• Then I went to UCONN. And it wasn’t until my sophomore year, so I started in 2010, but my sophomore year, I really started thinking about research. I was in the honors program. We were required to do a thesis. So we had to do an honors project of some sort. My research ended up being on premenstrual symptoms in women of color at the university. I am kind of understanding what kind of helped them or didn’t help them with their PMS symptoms. We gave them fish oil, just regular fish oil, to see if that helped with their pain or not, which it actually did. I was able to present that at some conferences. With that, I ended up applying for a grant. This is when it really solidified to me, hey this research stuff can be kind of cool. You can actually go to some really cool places. You think about research sometimes and you’re just like oh, I don’t know but it was really cool.

Slide 4 – New Orleans, Louisiana:

• I got to go to New Orleans, and present my research at the National Black Nurses Association Conference. And there, I made some really great connections, some really great friends, some people that I still talk to- to this day. And there are a lot of local chapters. I really haven’t gotten to the Philly chapter much, because I really just got to Philly about 8 months ago. But in Connecticut, at least, we have a local chapter that we sponsor middle school and high school students through a mentorship program and we do bring them to the national conferences. I think last year it was in Memphis. And it was really great because it is a great time to meet students of all levels who are interested in nursing. You don’t even have to be interested in nursing per say, but just interested in the medical field and be exposed to people who are also interested in this as well. And as Jess was saying, there are so many different avenues that you can take, so it’s just good to hear all of the different things.

Slide 5 – NICU Internship:

• So with that is trying out everything. So nursing is so broad. I didn’t know exactly what I wanted to do in nursing. I knew adults wasn’t my thing. So I realized that I wanted to do children. Initially, I thought I wanted to neonatal, so like the newborns, premature babies. So I had my summer internship, this was us in our summer internship program. I did the NICU. I loved it, but for me, it got a little- I guess monotonous is the word I would use. Very small babies- helping them, feeding them, helping them grow. I like the ICU environment because in the ICU, as far as patients, you get about 1 to 2, because they are so critically ill. But I wanted a little bit more. I wanted to look at like traumas and things like that. I was getting a little bit bored.

Slide 6 - NICU:

• So this is kind of a project that I made. Here you can see like a little baby hand, and then here is the blood pressure cuff- it’s so small, it is the size of a Band-Aid. But with that, it really helped me to figure out what I wanted to do. I wanted to stay in the ICU, but I wanted older kids that’s why I ended up in the pediatric ICU. So before I could get there, my senior year internship was actually (so this was in 2014) in the PICU, but I had also applied for a study abroad opportunity. And a lot of schools have these, and I really encourage you when you get in to college to consider these opportunities.

Slide 7 – Hong Kong, China:

• And your clinical experiences are embedded in them. So I got to go to Hong Kong, which was an amazing experience, because I would have never been exposed to this otherwise. So I went to the University of Hong Kong, and they have a school of nursing. So don’t worry they have everything in English, so that was actually very nice, because I don’t speak Chinese. And I got to go to the Chinese School of Medicine also, and they have a School of Eastern Medicine. So a lot of the medicine that we do is very different from the medicine they do. They have a lot of herbal remedies.

Slide 8 – Hong Kong, China (Photo):

• This is actually a picture of a figurine of some medical students back in like the early like 1800s when the plague was prevalent looking at mice that had the plague and trying to investigate what was going on in these mice.

Slide 9 – Hong Kong, China (Photo):

• This was an herbal medicine. And all these different medicines were used for various different things, such as certain diseases that we would use certain drugs; they would just use these herbal medicines in their place.

Slide 10 – Hong Kong, China (Photo):

• And here are some of the ways that they prepared them. They weighed everything out. That looks likes ginger root, so like something we don’t really use every day in medicine that they use pretty frequently.

Slide 11 – Hong Kong, China (Photo):

• In China, here is like an example of the way the pharmacist will prepare it for you. And you can actually go in and get one of these things and they’ll prepare it. You can drink it as teas. It can be eaten- various ways to take them. I don’t have a picture of it, but we also got to do cupping. I don’t know if you ever heard of that, but it’s like they take a cup and put it on your back. Then they light a fire, essentially, it makes a suction cup. And the whole idea is that it is reorganizing your Chi, your energy, to bring out any bad or pain that is at that area. It is very interesting.

Slide 12 – Pediatric Intensive Care Unit:

• So in the PICU I was SNIP, which is a student nurse intern – so I was a SNIP, and I had my final semester there, which was amazing and awesome. And then I was hired there as a RN that summer. I started in 2014, so that was at Connecticut Children’s Medical Center. The PICU that I am a part of, we are an 18 bed unit, so much smaller than CHOP, but we see children with all different types of diagnoses. There’s children with trauma, so car accidents, gunshot wounds as well as kids who get your regular illnesses like the flu and whatnot. Like I said the ratio is pretty small, it’s 1 to 2, because we have so many different things that we are doing. The PICU is a very technological advanced environment. I think all hospitals are at this point. If you like technology and you like problem solving and troubleshooting, which I found this out about myself, an ICU is a great place to start and kind of finish your career because as you can see here, you have to manage all these lines and all these pumps and know what’s going through. So you get really familiar with different medications, really familiar with your patient. You also have to remember, you know, at the end of this Christmas tree of stuff that is happening, there is a person at the other end of that. So you have to use your personal skills as well, as well as you technological skills and your analytical skills – that can be really useful in an ICU setting.
• The shifts we work are generally 12 hour shifts, they are 7 to 7. In the ICU, we are doing either every 1 hour or every 2 hour assessments of our patients – checking their vital signs, their mental status. Not all patients are awake and lively, some are sedated. We have to keep them sedated for their own comfort, because we do use a lot of machines that help them breathe. And you can imagine that if you had something like that, you may be inclined to potentially pull at it to get it way from you. So we do have to keep people pretty sedated. So the ICU is a relatively quietly environment. You don’t always hear the kids talking, playing. We don’t have a play room. You don’t hear that, but you hear different pumps and beeps of that sort, but it’s relatively quiet to other floors.

Slide 13 – My PhD Journey:

• And then so my PhD journey, so the following year after I started in the PICU, so in 2015, I had a lot of questions, and I was wondering why do we do things this way. At the time we were getting children who had scoliosis. And you guys may be familiar with having to go through checks with the school nurse. But we had children who were going through surgery to realign their back. We had them coming to the PICU after surgery for recovery. And I couldn’t figure out why some kids did really, really well after surgery but other kids had excruciating pain and they had to stay with us for a very long amount of time. And I was trying to figure out whether there was something inherent in these children that made them more susceptible to this pain as opposed to the other children, and I couldn’t figure out why so you know what I was like I need to get a PhD so I can answer these questions and try to solve all the world’s problems, right – that’s what you think you are going to do.
• So I got my PhD, and in the middle of that, in the summer of 2016, I ended up going to the National Institutes of Health, the Nursing Research Institute. There’s about 22 institutes within NIH. And you probably heard a lot about them right now with everything going on with COVID. But there is one dedicated solely to the Nursing Research Institute, and they have a Summer Genetics Institute that is 4 weeks long, so for a whole month, I had to move down to Maryland right outside of D.C., and we learned hands-on experiences, getting genetics research training and looking at translational science from that bench to bedside that Paulette had talked about.
• In this picture here, I am working, and I don’t know if any of you are familiar with the book The Immortal Life of Henrietta Lacks – any of you heard of that? So Henrietta Lacks was this woman. This was about in the 50s or so, I believe. She had a cervical cancer. And being a black woman at that time, there was a lot of racial inequalities going on at that time. And they used her cells, they weren’t really treating her, she thought she was getting treatment, but they used her cells (collected them) because they were like this miraculous cancer that just kept spreading and spreading and spreading. And it was creating these cell lines and they couldn’t figure out how fast it was spreading. Henrietta ended up dying, but they kept these cells for years, it was the cell lines that they kept for years, because it just spread so quickly. So finally, years later, the family heard and found out, because these cells had been used to find cures for certain cancers and certain treatments. And the family never even knew that their mom was involved in these discoveries. So at the NIH, we were able to use these HELA cells, Henrietta Lacks cells, and it was just an amazing experience that you are able to use something that was not done for such good but is now making really big advances in the medical sciences.

Slide 14 – My Postdoc Journey:

• So my Postdoc Journey, so I just came to CHOP in 2019 to work on some more research, because everything is more fun with more research. So I came to CHOP, and my big question that I wanted to answer now is similar to those with the spinal fusion surgeries, was to know – why do some children after being in the PICU end up doing well but others don’t. And they end up having really bad physical symptoms, and they are kind of worse off than when they came in. And sometimes kids don’t return to normal. So I really wanted to figure out why that was.

Slide 15 – Twitter:

• Preparing this presentation, I came across this tweet. This is an older person. She was 19. This came up just the other day around Corona stuff. But she said “We aren’t talking enough about what surviving the ICU looks like. It is not a victory. When I woke up in the ICU I was 19 years old. I was in diapers. I could not lift my legs because the blankets were too heavy. I had tubes in my face and chest, a catheter, a femoral line (which is a type of IV, but it is a bigger IV). Everything hurt. I was confused and scared. It took weeks to be able to simply walk again”.
• So this is kind of what I am researching now. It is what is that experience after ICU. We are able to save people, which is actually really great, but we have to make sure that we maintain their function after they leave from the ICU, which we do a really good job of doing for the most part but there are some people (for some reason or another) don’t have such a good experience. So I really want to figure out who those people are and how can we help those people.
• That’s the end of my presentation.