We’re celebrating International Nurses Day (May 12th) with a true, personal story about nursing. As a middle child in a family of ten children, Dr. Coyne reflects on the impact her childhood has had on her career in children’s nursing.
Written by Imelda Coyne, PhD, BSc (Hons), HDip N (Hons), RSCN, RGN, RNT, FTCD, FEANS
Most of my career has been about promoting the importance of listening to and seeking children’s views in matters that affect their lives. On reflection, I think that my nursing career and research were influenced somewhat by my childhood and my nursing experiences.
Growing up as a middle child in a family of ten children meant that it was often difficult to have one’s view heard. All of my siblings were strong, opinionated characters whereas I was quite shy and reserved. It was challenging to find my place in this large family and to have my views heard, never mind respected. Having a voice was further challenged by my education in a private boarding school managed by nuns from a religious order. The nuns preferred children to be seen and not heard and were keen on discipline and rules. Likewise, the hospital where I did my nurse education in children’s nursing was a strictly controlled hierarchy managed by nuns. My schooling and nurse education were similar disempowering environments in the 1980’s. It was frustrating to not have a voice, and to lack autonomy and decision-making. Similarly, at this time, there was not a culture of seeking children’s views nor of involving them and often children had to undergo procedures with minimal preparation or information.
I always wanted to be a children’s nurse but witnessing children’s pain and suffering was very hard. Things like the sight of blood made me feel really squeamish so I thought a few times that nursing might not be the career for me. I remember one time being in a room with other student nurses watching a nurse tutor demonstrate how to bathe a baby. When the tutor told us that the baby had a serious heart problem, I felt my legs going wobbly and I slumped to the ground. When I came around I was in the ward kitchen surrounded by the concerned faces of my peers. The tutor quizzed me about whether I had my breakfast and my general health. I was reluctant to admit that it was not a case of a missed breakfast, instead it was because I felt so upset over the fact that a baby only a few weeks old had a major heart defect and would require life-threatening surgery. On another occasion I was assisting a senior nurse and doctor to perform a lumbar puncture on a small toddler (who was very distressed) and when I saw the long needle I felt weak and had to excuse myself. I found it upsetting that children had to often undergo painful and distressing procedures. However, I persisted and became a children’s nurse as that was always my end-goal.
After qualifying as a children’s nurses, I gained experience in neonatal, gastrointestinal and cardiac intensive care units for about fifteen years. As I moved up nursing grades, I found myself doing more administration than I preferred. Being with the children and families was the most enjoyable aspect of my job so I felt increasingly sad that promotion meant less ‘hands on’ clinical practice. Then a colleague advised me to change to nurse education as there I could influence the next generation of nurses and demonstrate care at the bedside. I was so pleased when I got my first teaching job in the nursing school in Great Ormond Street Hospital as it combined teaching with clinical practice. Nowadays there are more opportunities for nurses who want to remain ‘by the bedside’ such as, advanced and clinical nurse specialist roles which is really important as they can make a significant contribution to nursing care quality.
Although I have encountered many challenges I have maintained my focus which is about making a difference to children’s lives. At times when some jobs have been difficult, my passion for children’s rights and well-being has sustained me and kept me pushing ahead in my career. Despite all the challenges, I was delighted to become the first children’s nurse from Ireland to obtain a nursing doctorate in 2003. At that time most PhD in nursing focused on education or management topics whilst my PhD was based on clinical nursing research. I was fortunate to be mentored by an inspirational nurse, Professor Sarah Cowley, from King’s College University of London. My PhD was titled, A grounded theory of disrupted lives: children, parents, and nurses in the children’s ward. While I was researching this topic, I became even more aware of how ‘silent’ or ‘invisible’ the child’s contribution was to communication interactions and pursued this further in my postdoctoral work.
Since then, I have held several academic posts in the university sector and collaborated with many inspiring children’s nurses and nurse academics. In my current post as Professor of Children’s Nursing and Co-Director of the Trinity Research in Childhood Centre I lead a team in the delivery of high quality teaching, clinical practice, and research. I believe in supporting and encouraging nurses to do higher level studies and to take a research-based approach to patient care. I have helped many undergraduate nurses to publish work in peer-reviewed journals. Through chairing the Irish Undergraduate Awards nursing committee, I have helped undergraduates to receive awards for excellent essays. They are the future leaders who can make a real difference to children and families health and wellbeing.
Although I have published widely on the necessity to involve children in their care and treatment, it has not always been easy or straightforward. I remember one paper in particular because it was challenging to get it published (rejected by two journals). I was reporting research on children and young people’s experiences of participation in communication and decision making in a hospital setting and the paper was eventually published in the Journal of Clinical Nursing. So when this paper was chosen by the editor as the best research paper in 2011, I was surprised and delighted in equal measure. This led to the dissemination of my research across the world in leading health service journals and websites (e.g. Health Service Journal, Hospitalist News, Medical News Today, MediLexicon UK, MSN Health USA, Med India), nursing and medical organisations worldwide, UK and USA government committees (e.g. Associate Parliamentary Health Group UK, The Office of Minority Health), websites (Medline Plus, Healthfinder) and radio and TV websites ( ABC network, CBS radio network, Fox network, WorldNow network and Raycom Media Network).
I continue to promote child-centered care through my teaching, research and academic positions, ensuring that children are central to the development of interventions and research when it concerns their lives by presenting my research in academic and non-academic forums. For example, we developed an intervention to prepare adolescents for transition to adult health care services which was successful because adolescents and young adults with chronic conditions actively participated in every stage of the research. Young people were key to the design, style, wording of the information and website www.SteppingUp.ie. They co-produced videos of themselves speaking about their transition experiences which were hosted on the website. A International hockey player for Ireland, a young man with diabetes launched the intervention. The website won the best hospital project award in 2014 which was all due to the young people’s efforts and guidance. It is important that we find creative ways to engage children and young people and consequently I was excited to collaborate with the Oxford Public and Patient Involvement (PPI) Advisory Group, UK on a theatre play ‘People Are Messy’ which explains how children and young people can help with identifying research priorities and designing clinical research.
My current research focuses on nurse-led interventions to support adolescents and young people’s transition to adult healthcare services. As children increasingly survive with long-term conditions, they need support and guidance on how to develop self-care skills. My research has revealed how children hold a marginalized role in communication interactions and decision-making in healthcare encounters. We must find creative ways to enable and promote children’s ways of expressing their views and experiences. In one study, we used a simple technique where we asked hospitalized children if they had three wishes, what would they wish for. For most children, their wishes were about their communication interactions with healthcare professionals. They wanted to be informed, allowed time to ask questions express their views, and be listened to. This helped reduce their fears and anxieties. As one child said ‘My one big wish is that nurses and doctors would explain things better to children.
If I had one big wish, it would be that adults give children time to voice their needs and preferences, listen to what they have to say, and if adults cannot accommodate their preferences explain why they cannot do so. I am grateful that I have had the opportunity to work with children as they have taught me a lot about compassion, love and caring.
Dr. Imelda Coyne is the co-editor of Being Participatory: Researching with Children and Young People (Springer, 2018).