Focus on Caring for Critically Ill Children

More than 5.7 million people are admitted to an intensive care unit (ICU) for acute and emergency care each year in the United States, according to the Society for Critical Care Medicine. Although specific statistics on admission to the pediatric ICU (PICU) are not available, PICUs around the country provide specialized critical care and ongoing treatments for hundreds of thousands of children every year.

Most children end up in the PICU because of complex or chronic conditions, ranging from severe infections to brain injury or multiple organ failure.  The care needs of these children differ from those of adults in obvious ways—such as the need for special, smaller-sized equipment—and in less obvious ways—such as the need to reduce noise pollution in the PICU so that children can rest and recover. Research also suggests that, after leaving the hospital, many of these children experience ongoing psychological issues, such as post-traumatic stress or anxiety.

Identifying and understanding these needs and helping families cope with the short- and long-term changes that result are top priorities of NICHD’s Pediatric Trauma and Critical Illness Branch (PTCIB). The branch was created in 2013 to provide a focal point for pediatric critical care research. It recently published a strategic plan to help guide its activities and grow its research portfolio.
Tammara Jenkins is a key player in critical care research and practice, both in PTCIB and at the NIH Clinical Center in Bethesda, MD. Jenkins is a Pediatric Critical Care Advanced Practice Registered Nurse and a board-certified Pediatric Clinical Nurse Specialist. She also directs PTCIB’s research portfolio on ethical, translational, and applied research in pediatric critical care. She is passionate about understanding and addressing the acute care needs of children and families. We recently had a chance to ask her about her and the origins of her interest in pediatric critical care medicine.

Q: What is your main role in the PTCIB?

Ms. Jenkins: My main role is to look out for the unique needs of children and their families who experience critical illness or injury. When a child comes to the PICU because of a life-threatening illness or injury, the child’s condition can deteriorate rapidly. New technology allows us to save more patient lives than ever before. But we are only starting to learn what happens after the child survives, when the child and family must cope with lingering effects related to the injury or the life-saving treatments. We need more research in this area to help these children and families.

Q: You have been at NIH since 1994, working first at the NIH Clinical Center as a Pediatric Critical Care Clinical Nurse Specialist in the PICU. What led you to NICHD? 

Ms. Jenkins: Rather than treating one patient at a time, I wanted to affect change for children across the country and around the world. At NICHD, I have an opportunity to combine my passion for clinical work with research on best practices and effective treatments.

In my role here, my colleague, Dr. Robert Tamburro, and I oversee the Collaborative Pediatric Critical Care Research Network, which includes seven large PICUs across the country and a data coordinating center. The network aims to reduce morbidity and mortality in pediatric critical illness and injury and to provide a framework for expanding scientific research on pediatric critical care practice. Through my work with this network, I can help inform practice that directly impacts the critical care of children. I feel I can truly make a difference in this understudied field.

Q: What are some of the gaps you see in current pediatric critical care?

Ms. Jenkins: We really need to know more about how families function and cope after a child’s illness. How has a child’s ability to walk or talk or breathe—basic functions—changed since leaving intensive care treatment? Some people can function despite a disability, while others are physically or emotionally devastated. If we are going to preserve and improve family life after critical illness, we need to know what factors contribute to this difference.

Q: Have you maintained some of your responsibilities at the Clinical Center?

Ms. Jenkins: Yes, I continue to serve on its Ethics Committee and to address issues related to critical care treatment, specifically end-of-life care and comfort. I feel that it is extremely important to include parents and children in decisions about treatment, especially when it comes to removing or limiting life-supporting therapies. I’m also trying to incorporate more Family-Centered Care, the belief that when you care for a child, you care for the whole family, into NIH practice. Years ago, during the redesign of the Clinical Center, I led the effort to make the PICU more “family-friendly” by including beds for parents to stay overnight with their child so they can be there throughout their stay. I know how important it is to keep the family together as much as possible.

I also wear a few other hats at NIH. During the summer months, I oversee medical and nursing care at Camp Fantastic, a camp for children with cancer, sponsored by the Pediatric Oncology Branch of the National Cancer Institute. We never turn a child away from camp; if they want to go, we will do whatever it takes to make it happen safely. We had one child who came straight from the hospital to camp, but still was sick enough that she needed to stay in the infirmary with a nurse and a doctor. She was going to miss out on the experience of sharing a cabin with her counselors and the other little girls, so we arranged a sleepover with her cabin-mates and counselors in the infirmary, and they had a late-night party there. It might not have been the full experience, but at least they were together.

Q: How did you get interested in this field of work?

Ms. Jenkins: I always knew I wanted to do something in the medical field. As a teen, I worked as a candy striper, volunteering at a local children’s hospital. I was captivated by how much the nursing staff engaged and helped patients. After graduating from the nursing program at California State University, Long Beach, I decided to purse my master’s degree in pediatric critical care nursing at the University of Pennsylvania. During my graduate program, I had the unique opportunity to begin a clinical rotation in the Adult & Pediatric ICU at the NIH Clinical Center, and for me it was the best of both worlds. I could pursue academics and work directly with patients. I learn something every day. I love the interaction with people and the chance to make a difference in the lives of children and their families. That’s where I get my motivation and energy.

Originally Posted: August 4, 2017


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