Nursing Role In the Prosthetic Clinic Team
JOY WINDORSKI, RN
The clinic team should be thought of as a puzzle. Each team member represents a piece that has its own shape. The pieces (team members) fit their services together in a way that creates a complete picture of care for the child. Nursing does not have it's own puzzle piece. Nursing should be pictured as the border that surrounds the puzzle and in a certain respect holds the picture together. Nursing interfaces with every other piece of the puzzle as an advocate for the child and family (Fig. 1 ).
The nursing role within the Prosthetic Team at Gillette Children's Hospital is one of patient support and education, coordination of team activities, liaison between the team and patient/family, and resource person for the patient/ family in locating services. This role serves children with limb loss and their families by encouraging them to utilize the skills and talents of other team members.
Traditional Nursing Role
The nursing role by itself holds a traditional focus including needs assessment, patient/family education, and assisting families in locating services that will benefit them. The nurse is additionally trained in assessment skills that can help identify problems with non-compliance, inadequate home care, and inappropriate or insufficient planning to meet the child's needs.
Prosthetic Nursing Role
Nursing objectives specific to pediatric prosthetics are tied closely to those of other team members. When objectives are met, the patient/family will:
- Mourn limb loss appropriately.
- Learn proper use and care of the residual limb and prosthesis.
- Achieve maximum independence through prosthetic use, adaptive equip ment, or retraining of skills.
- Establish a positive self-image.
- Set realistic life goals. At Gillette Children's Hospital, the nurse plays a central role on the Prosthetic Team. A recent qualitative survey of 37 families cared for by our team indicated that 92% felt the nursing role was very important to their child's care (Table 1 ). The survey additionally monitored some individual nursing services available to our families and found that 76% rated a preclinic visit with the nurse as important, and 81% noted the ability to call the clinic nurse between visits as important to them (Table 2 ).
Specific Prosthetic Services
Many services have been developed and/or actively supported by nursing in response to patient needs within our clinic. These include variations of concepts that educate and support children and families. These services were also rated in importance to families on our qualitative survey (Table 2 ).
A. Family Introductions
Individual introductions between families were highly rated on the survey. These introductions are often most effectively done by nursing, who has a feel for individual family needs. This is a service that is "routinely" offered to new families, or in special circumstances such as surgery or a change in prosthetic design. The most common need met through these introductions is with parents who are trying to anticipate experiences their child will face as a teen or young adult.
B. Clinic Scrapbook
Our clinic scrapbook was started in 1984. Families like to contribute. It gives them a sense of belonging as well as an opportunity to receive positive feedback on their child's accomplishments. It creates a sense of hopefulness to see the achievements of others in the book. Additionally, the book is effective use of time spent in the waiting room.
C. Prosthetically Fitted Dolls
Prosthetically fitted dolls joined our team in 1989. They are based on a concept of self acceptance. The team has found them useful in evaluating children's activities of daily living as well as levels of acceptance of their own limb loss. The dolls are made to order upon parent request by a local seamstress. The prosthetic limb for each doll is made by our prosthetic technician and attached to the doll with Velcro.
D. Family Resource Center
Gillette Children's Hospital has a Family Resource Center located within the clinic waiting room. It is open during clinic hours, and gives access to books, magazines, audio visuals, and information about community services and events. The information it contains is monitored by nursing and other team members, and distributed by volunteers.
E. Play Group
Our clinic currently offers an upper limb play group monthly, in coordination with an upper limb prosthetic clinic day. The group has access to a recreation therapy specialist, and is supported by nursing, occupational therapy, and family services. It provides a setting where staff can observe developmental skills and problems with prosthetic use. It also acts as a spontaneous support group for the children and parents.
F. Annual Picnic
Every year the Prosthetic Team hosts a clinic picnic. Personal invitations are sent to each child and family. This is a team sponsored and hospital supported event. Each team member makes a personal investment, even if only to bring ice or buy the mustard. There is a statement of commitment and caring towards our families. The picnic includes a canoe event supervised by an outdoor adventure group, which is both fun and educational for the children. The picnic, once again, provides an informal support group setting.
G. Informational Programs
Two formal surveys have been done at Gillette Children's Hospital Prosthetic Clinic in the past six years, to evaluate the need for structured support groups. The results indicated that parents need support for initial reactions to limb loss, and later have interest mainly in occasional information or education sessions. This year our team offered an informational program on the same day as the picnic (Fig. 2 ). Educational items available to the families in clinic were displayed. Individual team members spoke on a variety of topics including: Prosthetic fabrication, emotional transitions, and a look at prosthetics in another culture. Day care for younger children was provided by hospital volunteer services. The program was planned for the morning of the picnic day to encourage family attendance. Responses were positive, and parents willingly gave feedback for planning next year's program.
Nursing plays an important role as an advocate for the child with limb loss, and can assist the child and family in utilizing the expertise of other team members. Nursing can identify a wide variety of needs that may affect the outcome of long term treatment plans for individuals. "Pulling the puzzle together" can open communication and build a trust relationship between families and the Prosthetic Team.
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Gillette Children's Hospital, 200 East University Avenue, St. Paul, Minnesota 55101