Since 2023, Lauren Demarest has served in the role of lead nurse/nurse coordinator for our Pediatric Intestinal Rehabilitation and Care Clinic at Ochsner Children's. This is a multidisciplinary clinic that provides care to children who have had major abdominal surgeries and bowel resections, usually soon after birth, leading to short bowel syndrome, which necessitates IV nutrition (=Total Parenteral Nutrition/TPN) delivered via a Central Venous Line (CVL) for survival, growth, and hydration for the next many months to years. Additionally, these children often have gastrostomy tubes (=G-tubes) to enable delivery of feeds directly into the intestines.

After spending many months in the neonatal ICUs, these children transition care to our outpatient Multidisciplinary Intestinal Rehabilitation and Care Clinic on discharge home. As one may expect, the role of the Intestinal Rehabilitation (IR) nurse is critical to the success of this program and the management of children as outpatients needs expertise, time, dedication, and patience - Lauren has proven, time and again, that she has an abundance of these attributes to serve the many needs of these children and their families. We take care of about 20 children on PN and another 25 who have been successfully weaned off. In the clinic, she provides exquisite hands-on care with great skill, especially around the CVL. The list of life-threatening complications that can arise in such patients is long - CVL occlusions, CVL infections, liver disease, to name a few. Lauren is the first to receive patient calls, and she is always prompt in directing the families in the right direction or seeking advice from the MD. The care of these children requires hours of time devoted to care coordination between physicians, care teams, and home care companies, nursing facilities, pharmacies, and PN delivery companies - Lauren is always on top of these tasks.

Families call her with a high level of trust and have on many occasions commented on how lucky our clinic is to have such a talented and dedicated nurse and that the level of efficiency of the clinic has improved since Lauren joined. I often hear her talk to families, both in person and on the phone, with a calm demeanor and take time to listen, reassure, and explain each step and recommendation, and ensure that the family understands the situation. This level of care makes a difference in the family's level of comfort and trust in the care team. The journey on PN is a long one, many years to decades for patients and families, with many setbacks, emotional ups and downs, and Lauren has always been a pillar of support to these families. I have seen her beam with joy and celebrate with families when we finally achieve our major goal - getting the child off IV nutrition and getting the CVL out, and she has devised a 'PN graduation ceremony' which we perform in clinic once a child's CVL comes out! She has on many occasions advocated for patients and their families, for example, the PN graduation ceremony, providing free CVL vests to prevent dislodgement of the CVL, arranging free accommodation a night before for families travelling from many hours away. She often takes time out of her busy outpatient schedule to go see our patients and their families when they are admitted inpatient. Seeing a familiar face brings priceless joy to families and gives them comfort in a stressful situation. She is an admirable and well-liked team worker within the division of Pediatric Gastroenterology, Hepatology, and Nutrition, and over the years, I have seen fellow nurses, senior nursing managers, and MDs recognize her work ethic and leadership skills.

One of many instances comes to my mind that demonstrates a good head on her shoulders, and an example of going beyond her duties under difficult circumstances during one of our clinic days, as soon as she lay eyes on the patient, Lauren thought that one of our 10 month old, PN dependent patients, who was here for a clinic scheduled appointment, did not look right, not as playful as we are used to seeing him and fussier than usual. A temperature measurement revealed a fever of 102 F, which in a young child with a CVL in place is an emergency since they are generally septic. It is important to remember that bacteria in the bloodstream multiply and double in numbers approximately every 20 minutes, and time is of the essence, and any delays can be the difference between a floor admission and a stable child vs PICU admission on vasopressors.

After collecting all the vital signs, Lauren skipped her usual initial assessment, which in this infant would have involved assessment of the CVL site, CVL dressing, G-tube site, ostomy site, and then questions about general health, feeds, medication review, parental concerns on many occasions, lab draw via CVL, and a dressing change - saving valuable time. After informing the mother that she was going to come get me to look at the infant, she walked over to my office with a calm sense of urgency and informed me that I should come see the febrile infant, who should go to the ED across the street. Her assessment was spot on. The infant looked like he was septic, but the mother, who lives about 4 hours away, broke down into tears when we informed her that the child would need to go to the ED for further management and would likely need to be admitted. She was certainly not prepared for this, and it triggered a sense of panic in the mother.

Lauren went beyond her normal call of duty in calmly reassuring her and explaining to her the rationale of this decision and the next steps again, and that it was in the child's best interest. While we arranged for an emergent ED transfer, she stayed at mom's side, consoling her and providing emotional support and reassuring her throughout the process. The mother regained her composure spectacularly and thanked us for all the compassionate care that was provided, mostly by Lauren. Lauren then walked them over to our pediatric ED and only left after a proper handoff. Lauren's conduct was beyond impressive. Many parents have expressed their desire to nominate Lauren for the DAISY Award for the exceptional care that she provides to their kids in and out of the clinic, which helps dramatically decrease the burden off the parents' shoulders. They appreciate her kindness and the sense that they are truly seen and heard. She has received shout-outs on social media, for example, from the short bowel syndrome family support groups. I wholeheartedly agree with these families that Lauren has impressed us tremendously with her level of dedication in a clinic where compassion, skill, and resilience are essential - she is a rightful nominee for consideration for this prestigious award. She exudes talent and compassion for children with chronic medical conditions.