Marie Coughlin, RNC, is the director of pediatrics at Radius Healthcare and Pediatric Center in Plymouth, Massachusetts. Radius Pediatric Center at Plymouth is a 62-bed skilled nursing facility that provides services for individuals with significant medical needs from infancy through age 22 and is one of only four long-term pediatric care programs in Massachusetts. In this interview, Coughlin describes her role as director and provides insight into the team dynamic that facilitates an integrated approach to enhancing the lives of the residents.
Q. What led you to work with children and young adults with complex medical conditions and severe developmental delays?
A. I have been working with children with special needs since I was thirteen years old. I used to perform in shows with other students from South Junior High in Brockton, Massachusetts, for medically challenged children at Lakeville Hospital (now closed). What impressed me the most was how happy the kids were despite how severe their physical limitations were. I came to think of them as "God's chosen children" and realized how fortunate I felt to be able to know them. Once I became a nurse, I wanted to work in this specialty and wouldn't dream of doing anything else.
Q. What drew you to your current position as director of pediatrics?
A. This is the first time a nurse has functioned as a pediatric director at the Radius Center. I accepted this opportunity because I knew I could bring improvements to an already outstanding program. My years of nursing experience based in special needs allow me to identify ways to develop existing services and to participate in the delivery of those services in a very personal and direct way. My heart is in nursing and I integrate that into my role every day. Naturally, I have to be able to see the big picture and handle budget issues, management of staff, outreach, and other managerial responsibilities, but my true passion is spending time with the kids and finding new ways to improve the quality of their lives.
Q. Can you describe some of the services you offer at Radius?
A. Many of our residents are affected by disabilities from birth and require alternative respiratory and feeding routes, such as tracheotomies or G-tubes. Others have suffered a traumatic event, for example, a brain injury. We provide long-term care and address the wide range of medical, educational, nutritional, and emotional needs of each individual.
This population is extremely underserved. It is common for placement to occur in a geriatric facility because of a lack of available services. We provide a far more encompassing environment. Referrals are only accepted for individuals aged 22 and under. Education is provided in our Pediatric Day School, which is certified by the department of education. And at age 23, a resident can transition to the Adult Services Program here at Radius or to another program such as Habilitation Assistance Corporation in North Plymouth or South Shore Collaborative in Hingham. Occasionally, our residents are able to move into a group home that is overseen by the Massachusetts Department of Mental Retardation.
We also offer a respite program for families. Sometimes there is illness in a family that interferes with taking care of a child, or family members may desire respite in order to take a vacation or attend an event such as a wedding. We always keep one bed open for such circumstances and the medical review team from the Massachusetts Department of Public Health approves all referrals.
"This population is extremely underserved. It is common for placement to occur in a geriatric facility because of a lack of available services." |
We also offer a Summer Camp that is a six-week program.
The most important thing to remember is that our facility is the client's home, and therefore all medical and educational programs and services are being delivered where the clients live. We strive to create a warm homelike atmosphere.
Q. The concept of a team approach seems central to the success of the Radius Pediatric Center. Could you explain how the staff members work together?
A. We divide the residents into groups of fifteen. Each group has one nurse and three certified nursing assistants. Our nurses not only provide direct care, but also function as educators and patient advocates. Experienced nurses mentor new hires and help them deal with the feelings of being overwhelmed that can come up frequently when first dealing with such a challenging population. To do this work, you need a great deal of patience and compassion and a willingness to be flexible.
We hold weekly nursing care plan meetings during which we focus on four residents at a time, and all of the various disciplines [involved in providing services] participate. Departments that are represented include speech therapy, dietary, physical and occupational therapy, as well as parents and guardians when they can attend. The resident's status is reviewed and new or ongoing medical issues are addressed. Goals are constantly updated and revised and measurable outcomes are evaluated.
The onsite availability of the various disciplines facilitates rapid adjustment in the plan of care for each individual when necessary.
Q. How is staff education provided?
A. Education is ongoing and includes seminars and in-services, both originating from within the facility as well as from outside sources. We conduct "lunch and learn" programs that provide brief but informative lessons. We are also developing a certification program for nursing assistants. We anticipate having it available by July 2008. Local nursing programs including Cape Cod Community College and Quincy College utilize our program for clinical rotations.
Q. What are some of the challenges and rewards you face in your current position?
A. Like the rest of the staff, I find the biggest challenge is not having enough time or space to accomplish all that I would like to do for our residents. I would love to develop a screened in play area since many of our kids are so sensitive to insect bites. The sun can also be very damaging due to some of the medications our clients take. As far as rewards, they are most often found in the little things. A good example is our upcoming Christmas Ride, which will allow groups of 10 residents at a time to travel by bus through several local towns to look at Christmas lights. There will be Christmas music playing, and this kind of event takes one staff member for each resident. We will provide this opportunity for two nights each week until every one of our kids is able to enjoy the experience. This is what we do - we help to make their lives as close to normal as possible - and many staff members volunteer during their free time to make this happen. They share my passion for helping to enhance the lives of those with special needs not only with the highest quality of medical care but also with a dose of good old-fashioned fun.
Kim Jordan, RN, is a freelance writer and a regular contributor to On Call.
