Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Katherine A. Hinderer, Senior Nurse Scientist at Connecticut Children’s

Transcript

Dr. Katherine A. Hinderer, Senior Nurse Scientist at Connecticut Children’s · Becker’s Healthcare -- Pediatric Leadership Podcast

0:00
This is Laura Dierda with the Beckley Healthcare
0:02
podcast. I'm thrilled today to be joined by
0:04
doctor Katie Hinderer, senior nurse scientist at the
0:06
Institute of Nursing Research and Evidence Based Practice,
0:09
as well as associate chair of nursing research
0:11
at the Connecticut Children's Research Institute. Doctor Hinder,
0:14
it's a pleasure to have you on the
0:15
podcast today. Thanks. I'm really excited to be
0:18
here.
0:19
Absolutely. And I'm looking forward to connecting with
0:21
you as well. I know we're gonna go
0:22
over some really important, information here about pediatric
0:25
mental health.
0:27
So this is going to be a podcast
0:29
that really
0:30
touches on so many different aspects of care
0:32
that are important to all communities. But before
0:35
we dive in, I'm wondering, can you tell
0:36
us a little bit more about yourself and
0:38
your career journey?
0:39
Sure.
0:41
So I am currently a nurse scientist in
0:44
a pediatric health center,
0:46
at Connecticut Children's, which is in Hartford, Connecticut.
0:49
I started out my career as a nurse
0:52
in actually adult health ICU
0:55
and worked at the bedside
0:57
for a while,
0:58
before I realized that there were other things
1:01
in my future. I was always really interested
1:03
in education and research.
1:05
So I, shifted gears and went and taught
1:09
at Salisbury University and their school of nursing
1:12
at Salisbury, Maryland for a while.
1:14
While I was there, I had the
1:17
unique opportunity to work with some of the
1:19
nurses at one of the local hospitals
1:22
in Salisbury, and
1:24
I really found myself enjoying that time connecting
1:27
with the clinical nurses,
1:29
talking to them about the real issues that
1:31
were going on at the bedside,
1:33
and just being able to spend time with
1:35
them and actually support them in research and
1:37
evidence based practice that they were interested in
1:40
doing.
1:42
So as a result, I ended up,
1:45
transitioning my career again
1:47
and,
1:49
was able to accept this position as a
1:51
nurse scientist at Connecticut Children's, and I've since
1:54
been able to grow in that role as
1:55
well.
1:57
I think I like to say one of
1:59
the best parts about my job is working
2:01
with clinical
2:02
teams and especially I love working with nurses,
2:05
of course,
2:07
to really support research questions that make a
2:10
difference,
2:11
in the care of children and their families
2:14
at the bedside.
2:15
So,
2:17
that's kind of what got me to where
2:18
I am now, and I really
2:21
love being a nurse and love working with
2:23
nurses and,
2:24
particularly love being able to do research
2:27
in the pediatric
2:28
world.
2:30
That's amazing to hear. And what a great
2:32
journey that you've had over time within the
2:34
clinical space as well as leadership and research
2:37
and more. It just really makes a big
2:38
difference on the type of care that we're
2:41
able to provide to, especially, pediatric patients.
2:44
Now I I know,
2:46
we we've recently,
2:48
done a lot of work around, some pediatric
2:50
mental health and behavioral health. And so I
2:52
was wondering if you could tell us a
2:53
little bit about that and, you know, what
2:55
really, you're seeing out there in the space.
2:57
What's, you know, top of mind is some
2:59
of the biggest challenges,
3:00
that you're encountering.
3:02
Absolutely.
3:04
So
3:04
we know that even before the COVID pandemic
3:07
started, pediatric mental health
3:10
was facing significant challenges in terms of not
3:13
having enough resources
3:15
to really
3:17
adequately care for kids and families of kids
3:19
that have
3:20
mental health and behavioral health concerns.
3:23
So leading up to the pandemic,
3:25
we already were resource poor in this area
3:28
as,
3:28
a country in general.
3:30
Once COVID hit, we started to see really
3:33
significant impacts in the mental health of of
3:36
everybody.
3:37
But we were really specifically focused in on
3:40
children and adolescents and even young adults that
3:43
were presenting to,
3:44
our medical center with different
3:47
mental and behavioral health concerns.
3:50
At the time,
3:51
we were fortunate enough to receive some funding
3:54
to
3:55
start looking at better ways to be able
3:58
to care for kids who are suffering from
4:01
mental health and behavioral health concerns.
4:04
So we initially wanted to look at how
4:08
can the nurse at the bedside
4:11
better
4:12
assess a child that comes into the emergency
4:15
department
4:16
and better be able to
4:18
tailor their care to make sure that the
4:20
needs of that child and their family are
4:22
being met,
4:24
to the the best of our ability.
4:26
Obviously, we don't want children to have to
4:29
come to the ER for mental health,
4:32
but sometimes this happens.
4:34
And at the time during the pandemic, we
4:36
were seeing a lot of kids coming in
4:38
with,
4:38
mental health chief complaints.
4:41
As nurses, we really wanted to look at
4:44
what we could do to improve the practice.
4:47
The great thing about the team that was
4:49
built at the time was that it was
4:52
really led by our
4:54
nurse manager of the emergency department
4:57
and also our senior director of,
5:00
emergency medicine. So we have a really nice
5:02
interprofessional team that approached
5:05
this care from a lot of different lenses.
5:08
We also,
5:10
were able to take this work and develop
5:12
a tool, which is what we kind of
5:14
came up with as a result of this
5:15
initial study. And the tool that we developed
5:18
is called the emergency behavioral health assessment tool.
5:21
The
5:22
nice thing about the emergency behavioral mental health
5:24
assessment tool, or as we lovingly call it,
5:26
the EBAT, is that it provides nurses
5:30
with a nursing assessment instrument
5:32
to help them,
5:35
sort of best categorize where the needs of
5:37
the child are at the time. And then
5:40
it also helps direct nurses
5:42
towards what kinds of nursing interventions we can
5:44
do to help support those children.
5:48
It also allows for our leadership team to
5:51
have a real time capture of what's going
5:54
on in the unit as far as the
5:56
children that have,
5:57
mental health concerns.
6:00
And it also allows us an opportunity to
6:03
help to make the case for resources we
6:04
might need for the kids. So for example,
6:07
if we have kids that need,
6:09
one to one observation and you need to
6:11
have staff there to be able to sit
6:13
with the children and and watch them,
6:16
this tool provides that kind of objective assessment
6:19
of that so that they can really do
6:21
those, get those things that they need.
6:24
Our, physician provider, who's doctor Steve Rogers,
6:27
likes to call it a vital science for
6:29
mental health. And it is kind of like
6:31
that, but I look at it as a
6:32
little more than that. In that, it's giving
6:34
our nurses tools to help quantify, you know,
6:37
what's going on with their patients and then
6:39
help guide them in their practice.
6:41
That's amazing. And, you know, really helpful to
6:44
understand impact of what a tool like this
6:46
can do in order to,
6:47
you know, deliver the right care and make
6:50
sure that the nurses have what they need
6:52
in order to,
6:53
direct the patients and get them into the
6:55
space that they need to get in, so
6:56
that, you know, they're able
6:58
to start whatever treatments they need or or,
7:01
you know, really
7:03
have that kind of, like, care that is
7:05
so important to them.
7:07
I'm curious, you know, in looking at this
7:09
tool,
7:10
how did you develop it? What was that
7:12
process like? And then,
7:13
are there any,
7:15
results that you can share with us from
7:17
how it's been working out so far?
7:19
Sure. So, the tool was really as I
7:22
said, it was actually the brainchild of our
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nurse leader at the time,
7:27
Ryan O'Donnell,
7:29
and also one of the clinical nurses who
7:31
was working primarily with this population.
7:33
And so
7:35
they kind of decided we need to do
7:37
this thing, and then this team sort of
7:39
organically came together. We just sort of started
7:41
plugging away at it during the pandemic.
7:44
Fortunately or not fortunately,
7:46
because things were escalating so quickly with pediatric
7:49
mental health at that time, that enabled us
7:51
to be able to really
7:52
hone in and focus on this project and
7:54
get it done relatively quickly.
7:57
I think some of the things and the
7:59
good outcomes that we've seen from this tool
8:01
are that,
8:03
it gives us a
8:05
sort of ongoing
8:06
ability to assess patients where they are at
8:09
the very
8:10
moment of care that you're with them. So,
8:12
for example,
8:13
when kids typically present to the emergency department
8:17
or any patient presents the emergency department,
8:20
they get a one time sort of assessment
8:22
that gives the overall sort of level of
8:25
acuity of the patient.
8:27
But that is a static measure and it
8:29
doesn't change.
8:31
And we know with a lot of health
8:32
conditions, but particularly with kids in mental health,
8:36
that their condition can change a lot over
8:38
the course of time that they're, you know,
8:40
maybe being seen in the emergency department.
8:42
So this tool allows us that flexibility to
8:45
be able to continue to reassess the patient
8:47
and say, okay, well now, you know, their
8:49
acuity is a little bit lower. So maybe
8:51
they don't need the intense interventions that we
8:54
were doing a little bit earlier. Or maybe
8:56
now their acuity is is going up and
8:58
they're, you know, getting upset or other things
9:00
are happening. So we need to kind of
9:01
intervene a little bit more with those kids.
9:04
And the other thing that we found in
9:05
our own,
9:07
practice was that we were able to significantly
9:10
reduce the amount of
9:12
restraint use and the amount of,
9:15
other types
9:16
of restraint devices
9:17
on the kids who were in the mental
9:19
health area. So what it did, I think,
9:21
was allowed us to
9:23
identify
9:24
better ways to help kids who were struggling
9:27
with mental health.
9:29
And it allowed us more opportunity to be
9:32
able to provide that one on one observation
9:34
and allowed us to really back away from
9:37
the use of,
9:38
as many restraints,
9:40
in the patients, which is always some like,
9:42
a goal. We don't want to ever have
9:44
to do that. And sometimes for safety, that's
9:47
something that we have to do. But I
9:48
think that that, to me, has been one
9:50
of the most amazing outcomes of this project
9:53
is that we were really able to significantly
9:55
drop that number.
9:57
That's amazing to hear. And, you know, what
9:59
a significant,
10:01
action to be able to take. And like
10:02
you said, reducing that number of children in
10:05
restraints,
10:05
I I can imagine that makes a really
10:07
big difference for those patients and their families
10:09
as they're going through their care journeys with
10:11
you.
10:12
I am curious, you know, for other clinicians
10:14
out there in hospitals or or systems that
10:17
are experiencing
10:18
similar challenges to what you have described at
10:20
the beginning of our conversation,
10:22
what can they do to develop something similar
10:24
or or really,
10:26
be able to start moving in this direction
10:27
of being able to,
10:29
understand patients better and then, you know, have
10:32
a a a tool of their own that
10:34
they can assess in real time?
10:37
So I think there were
10:39
many things that we did as an organization
10:41
at Connecticut Children's to better support pediatric mental
10:44
health
10:45
that happened along with the development of the
10:47
tool. As I said, with this tool, we
10:50
were able to quantify getting more resources that
10:53
were tailored towards mental health. So we were
10:56
able to hire
10:58
more individuals
10:59
who could sit with the patients. We were
11:01
able to hire more nurses with specialized training.
11:04
We were able to bring in some different
11:06
training programs for our teams, which really, I
11:08
think, helped. So I think as organizations are
11:11
looking at this,
11:12
always focusing on, you know, what are the
11:15
real resources you need and then trying to
11:17
get get those resources. I think that this
11:20
allowed our nursing leadership team to have the
11:23
data to support the need for some of
11:26
those things that they were able to to
11:28
get.
11:29
We are currently working
11:31
now. We have some new funding, which is
11:34
from the Heilbronner
11:36
Scholar
11:37
Award from Rockefeller University.
11:39
And we're actually working to do some further
11:42
validation testing of our tool.
11:45
Over the course of the next year, we're
11:47
gonna be doing a study that's gonna look
11:49
at
11:50
the tool itself. We're gonna be doing some
11:52
different types of statistical tests to see,
11:55
how well the tool is performing.
11:58
And we hope to really be able to
11:59
have a nice final product at the end
12:01
of the year that we can share with
12:03
other institutions.
12:06
This to me is really exciting because there
12:08
really aren't a lot of tools out there
12:10
that are like what we're we're offering,
12:12
in our tool. And I think it's gonna
12:15
provide
12:15
a nice way
12:17
to, you know, say this is a good
12:19
tool. It's reliable. It's valid. And it's something
12:21
that can be used in other institutions as
12:24
well.
12:25
As a scientist,
12:26
nobody ever likes to create their own measures
12:29
and especially the homegrown measure thing isn't always
12:31
the best approach,
12:33
even though sometimes people have to do that.
12:35
But I think the work that we're gonna
12:36
be doing this year is even more exciting
12:38
because we're gonna be really
12:41
trying to further support and make the best
12:43
tool possible so that other institutions across the
12:47
country can use
12:48
this tool to support their own nursing practice.
12:52
I love that. Thank you so much for
12:54
digging a little bit deeper there and explaining
12:56
just everything that goes into developing a program
12:58
and tool, that's transformative
13:00
for those youth mental health patients.
13:03
Before we wrap up here, I wanted to
13:05
get your,
13:06
your thoughts on what's next. Where do you
13:08
see the space of youth mental health headed
13:11
and especially
13:12
how are things changing at Connecticut Children's?
13:16
Of course.
13:17
So as a a nurse, I'm always a
13:19
nurse first, and then also as a scientist,
13:22
my dream is that, you know, we don't
13:24
have to treat as many children in the
13:26
emergency department with, mental health concerns.
13:30
I hope that in the future, the research
13:32
we're doing and research that others are doing
13:34
are gonna help
13:36
to, you know, decrease the need for kids
13:38
to come to the emergency department when they're
13:40
having mental health
13:42
concerns. And I'm hoping that, you know, we'll
13:44
be able to strengthen our community based resources
13:48
so that kids can get the care they
13:49
need in their own communities, in their own
13:51
homes.
13:52
That's kind of my dream for where youth
13:54
mental health is gonna go. It's probably gonna
13:57
take a lifetime to finish that work, but,
14:00
that's kind of what I think. At Connecticut
14:02
Children's, I think we're continuing to really focus
14:05
on a lot of different aspects of youth
14:06
mental health. We've recently opened a suicide prevention
14:10
center. We have a lot of other work
14:12
being done in the mental health space, both
14:14
in the emergency department,
14:16
and also on our inpatient side of care
14:19
as well,
14:20
and partnering with other institutions and organizations across
14:24
the state to really help promote,
14:26
youth mental health.
14:28
I'm hoping that, you know, as a nurse
14:30
scientist,
14:31
my impact on this research would be just
14:34
to really improve the practice and the care
14:37
that these kids receive.
14:39
Because a lot of times, you know, kids
14:41
can be very marginalized that have mental health
14:44
conditions. Actually, anybody that has a mental health
14:46
condition can be marginalized.
14:48
A lot of people don't understand,
14:50
mental health conditions or have empathy for folks
14:52
that have mental health conditions.
14:54
And I'm hoping that through the work that
14:56
we're doing, we're just gonna help improve the
14:58
care of those kids so that they can
15:00
get, to where they need to be, so
15:02
they can try to really
15:04
get towards mental wellness,
15:06
and to a place where they, you know,
15:07
will be able to continue to function and
15:09
live in their schools and their communities and
15:10
and not have to visit us in the
15:13
ER.
15:14
I love that. Doctor Hinder, thank you so
15:16
much for joining us on the podcast today.
15:17
This has been such a fun conversation, really
15:20
inspiring and informative, and I look forward to
15:22
connecting with you again soon. Thank you so
15:24
much. It was great being here too.