Playing It Safe
Nurses take an active role in injury prevention by creating
programs that keep accidents from happening

By Nancy Deutsch, RN
November 1, 2004

Nurses who work in trauma centers commonly see children after motor vehicle accidents, horrific falls, or accidents around the home. What makes the job a little easier for some nurses is the opportunity to play a role in preventing accidents.

While nurses who take an active role in injury prevention may never know just how much impact they have, “if you plant the seed and save the life of one kid …,” it’s reward enough, says nurse Sally Jacko, RN, MPH, the trauma program manager at Harlem Hospital Center in New York.

When it comes to helping prevent injuries, Jacko wears more than one hat. She is also deputy director of the Injury Free Coalition for Kids, a position she’s held for a year and a half.

The Injury Free Coalition for Kids is a national organization that’s been existence since 1984. Founder Barbara Barlow, MD, who works in Harlem, felt that she saw too many children come in with preventable injuries. In fact, Harlem had twice the national injury rate. “I figured something could be done,” Barlow says.

At the beginning, “it was hard to get money from anyone. No one believed we could reduce injuries,” she says.

But Barlow persevered, and to prove her point, started keeping track of injury rates. This persuaded The Robert Wood Johnson Foundation to start funding the coalition, which it continues to do. The latest major contribution, given in 2001, was for $15 million to be spread over five years.

Funding from the coalition to support individual projects that now exist at the 40 Injury Free Coalition for Kids sites across the country is usually given for five years as well, at $50,000 annually. Hospitals that mentor other hospitals receive more. This donation is always double-matched — that is, the trauma center that receives the money must come up with twice that amount for injury prevention. Usually about half comes from the institution itself, in labor, materials, or money, and the rest comes from a variety of donors in the community.

The coalition doesn’t tell sites what to fund or how. That way “the folks are very inventive,” Barlow says.

Take, for example, the Injury Free Coalition for Kids site at Children’s Hospital and Health Center in San Diego, where Sue Cox, RN, MS, CEN, is coprincipal investigator. One of its projects has been to organize a baby safety shower, where the entire party centers on ways to keep children safe, including safety-issue bingo and a safety-related slide show.

The main goal, however, has been to cut down on the number of pedestrian-related accidents among children, something that is a problem in many communities, and an issue that was identified as a priority in Cox’s area. “We did a needs assessment,” says Cox, noting that too many children were coming in who had been hit by cars.

Cox, who has been involved with the Injury Free Coalition for Kids for about three years, says that the program kicked off with an educational campaign. Then environmental engineers were brought in to look at ways to manage traffic and modify the environment. For example, some traffic lights were changed so they’re more visible, and the timing of the lights was altered at some intersections to make it safer for pedestrians to cross.

In the neighborhood

The coalition also worked on creating a playground in a needy area. The premise is that if children have a safe area to play, they are less likely to play in the street. Community groups were rallied to help and came through with flying colors, Cox says. “We built the park in one day.”

To help increase safety in other areas where needs were noted, the group is working on creating a traveling safety trailer, which will be equipped with child safety items, such as car seats.

A knowledgeable staff member will go from neighborhood to neighborhood, educating the public and selling items on a sliding-scale basis to those with lower incomes, Cox says. Money from the Injury Free Coalition for Kids has helped make these changes possible, she notes. While other agencies often donate money, the Injury Free Coalition for Kids “plugs in the holes we can’t get from other organizations.”

But the Injury Free Coalition for Kids has provided more than that, Cox is quick to add. “Injury Free provides ideas,” she says. “It’s a think-tank type of group. You don’t have to reinvent the wheel.”

Those involved in the coalition share their ideas, which others can use in their own community, she says.

Pedestrian injuries were also a big problem in Philadelphia, where Marla Vanore, RN, MHA, is codirector of the Coalition site at The Children’s Hospital of Philadelphia.

The hospital has worked with the Injury Free Coalition for Kids since 1999, and it mentors two other Philadelphia hospitals.

Although she has been involved in various injury prevention endeavors, Vanore likes the Injury Free Coalition for Kids because “it’s a marriage between prevention and research. We need research on prevention to show it actually does something.”

Every site is encouraged to do research to find an area of need and to try to track how numbers of injuries change after a project is implemented, although that’s no small task, she notes. While the group has been fitting and distributing bicycle helmets, for example, and teaching children the rules of the road, it’s hard to measure compliance after children go home, or count accidents that could have — but don’t — happen. “All of these things are a real challenge to measure,” Vanore says.

While some children come in with bicycle-related injuries, pedestrian accidents in western Philadelphia are more pressing. “We see too many, and the injuries are severe,” Vanore says.

Safety messengers

It took a while to assess the needs of the community, Vanore says, and the group is just getting off the ground, but it has already developed a video aimed at educating children and their parents. While many other such videos have been made, most are aimed at children in suburban areas. The west Philadelphia area is urban and largely populated by African Americans, so local schoolchildren were solicited to develop and play in the video, called The Adventures of Hattie Mae and Thelma. It uses language that these particular families understand, Vanore says. They are now working on lesson plans to accompany the video and are creating a video for older children.

Their first assessment of the project will be to survey those who watch the video, to see if the messages are well-received.

It takes a long time to get the message out, and researching whether the injury rate is reduced will likely take time, Vanore adds. Furthermore, the video
“is not a Band-Aid. We are trying to be involved in the community and almost change the culture.”

Like the coalition site in San Diego, the Philadelphia group worked on putting in a playground — one of the first on a school lot, Vanore says. That was a job she particularly enjoyed, although her work is administrative. “I was building the playground,”Vanore says. The benefits were immediate: Within hours of its being built, the playground was filled with children.

In Denver, Theresa Rapstine, RN, BSN, administrative director of injury prevention at the Kiwanis Pediatric Trauma Institute, says it received its first grant from the coalition last November. “We’re one of the first to work specifically with rural communities,” she says.

Her group targeted a county that has the highest injury and death rate of children who are unrestrained in car seats.

They collected data on the community, which is made up mainly of migrant seasonal farm workers. The majority of people living there are Hispanic, Rapstine says.

The group is hiring a bilingual community liaison to run educational meetings in the community. Jacko says many of the nurses involved see tragedy on a day-to-day basis, as she does, and “often they feel they need to do something about it.”

The rewards are self-evident. “I see it makes a difference in the lives of the kids,” says Cox, who has been working in pediatric trauma for 25 years. While it’s hard to get exact numbers on accidents that could have happened but don’t, “I’ve seen a dramatic difference in the number of head injuries.”

Vanore’s bottom line: “We feel like we’re making a difference.”

Nancy Deutsch, RN, is a freelance writer.