Getting to know the critically ill patients they’re taking care of is hard enough for ICU doctors under normal circumstances. But it’s even worse during COVID-19.
Not only are there no visiting family members to give you information, “but the patients are all similar in terms of their medical issues, they’re all on a breathing machine, and many are lying on their bellies,” explained Brian Garibaldi, MD, associate professor of medicine and anesthesiology at Johns Hopkins Medicine and director of the isolation unit at Johns Hopkins Hospital in Baltimore, in a phone interview. “You might go for days without examining the front side of their body, so we’re not seeing their face. That makes establishing connections with patients a little more difficult.”
An Idea From the Chaplain
One day Garibaldi was talking to Elizabeth Tracey, a chaplain at the hospital who also is director of audio production at Johns Hopkins Medicine — someone very familiar with audio recordings. She had an idea: how about if she interviewed patients’ family members and made a recording of what they say? “I could edit it down to a few things families really want their doctors to know about their loved one,” she said. Garibaldi was immediately on board.
In a separate interview, Tracey — who also edits and appears on MedPage Today‘s TTHealthWatch podcast, said she had heard from a chaplain colleague who told her that a physician had said after an extubation of a terminal COVID-19 patient that “I realized I didn’t know anything about this person; I didn’t know if he had children, if he was married. I didn’t know anything.” So why not give the physicians and the rest of the healthcare team personal details — “Do they have a dog? Do they like to play poker? It’s all the things that make them human,” said Tracey.
Tracey said Garibaldi emphasized one thing: “The only way this is going to work is if it’s in the voice of the family member.” So Tracey began calling family members and saying, “Hey, I’m part of the team helping take care of your loved one … Under normal circumstances you’d be here in the ICU telling us your loved one’s story. The team would like to know your loved one better as a person; would you like to spend 15 to 20 minutes talking about them?”
So far, only one person has turned her down since Tracey began doing this in April, and that was because they didn’t like the sound of their recorded voice, Tracey said.
After getting the family member’s permission, she records the phone call and edits the comments down to 2 or 3 minutes; she estimated that she has completed 30 to 40 recordings so far. Currently, the recording is distributed to the medical staff by an administrator at the hospital, although she hopes to eventually get it added as a link in the patient’s electronic health record.
A Message to the Healthcare Team
Tracey also added a second component: the opportunity for the family member to send a recorded message directly to the patient. “I said, ‘if you were talking to your family member, what would you say? Talk to them directly.'”
“They say these things that are just unbelievable,” said Tracey. One mother recorded a message for her adult daughter, whose autistic child the mother was the custodian of. “She says, ‘I want you to know that everything is forgiven,'” said Tracey. “How can you have a more powerful example of love?” Those conversations also are edited down to 2 minutes and played for the patient.
The recordings for the medical staff are very helpful, said Garibaldi. “Just learning the simple things — What would they prefer to be called by if I met them in the grocery story? What hobbies do they like? What favorite music can we program on an iPad to keep them awake and stimulated during the day? Also, learning things like what that person has accomplished in their personal and professional life; it really puts things in perspective, to put their current illness in the context of where they’ve been, where they are, and where they might want to be going.”
Dale Needham, MD, professor of pulmonary and critical care medicine at Johns Hopkins, agreed. He noted that although the medical staff speaks with patients’ family members every day, “those conversations have to be efficient and focused, whereas Elizabeth has the luxury of spending more time, and distilling it into an audio file that we can listen to and understand and easily share.”
For example, Needham said, “we found out that one patient previously had worked at a Smithsonian museum, and we found out that one of our patients likes to tango. And we found out that one of our patients that we wouldn’t have expected — was a DJ” on the weekend, while he had a white-collar job at a law firm during the week.
“This can help us understand who the patient is, and as the sedation is lightened, it helps us interact with them in a more humanized way.” It’s also mutually beneficial because the families are aware that the staff knows a little about their loved one, he added.
“What a Gift She Gave Us”
Barbara Johnson, whose late sister was a COVID-19 patient at the hospital, agreed. “I thought it was an incredible opportunity, given that none of us could see my sister,” said Johnson, of Silver Spring, Maryland, who did a recording for her sister and one for the medical staff. (You can listen to the recordings in the player above; her recording for her sister Beverly is first, followed by the one for the healthcare team at 3:25.)
When she spoke with Tracey for the recording, Johnson said she was thinking about her sister, “What would I have said if I got to talk to her” the day she was intubated? “What a gift Elizabeth gave us.”
Regarding the recording for the medical staff, “I think that when you take away the family from a hospital room, it might be hard for doctors and nurses to relate to the individuals, and the fact that they wanted to was really quite powerful for me,” Johnson said. “I really wanted them to know what made her happy, and if she was there talking to them, what would she have told them? … I also wanted them to know — in case she woke up — that she was the kind of patient that would tell them what they wanted to hear. If she was not feeling well and wanted them to feel good about their job, she would say, ‘I’m doing great.’ So I wanted them to know, just read between the lines.”
Tracey has recruited several dozen additional volunteers — including chaplains and medical residents — to make the phone calls and edit the recordings. She also has expanded the service — which she calls “This Is My Story,” or TIMS — to include other patients in the hospital, since they also aren’t getting visitors during the pandemic. She said she hoped that other hospitals would adopt the practice.
Within the hospital, “there’s definitely a lot of enthusiasm from the medical units and also an enthusiastic response from pediatrics,” she said. “What parent wouldn’t want to record ‘Green Eggs and Ham’ for their kid?”
Sharon Tapp learned that a severe case of COVID-19 can threaten not only your life but also your sense of self. After a lifetime of good health, COVID transformed Tapp from a busy nurse case manager into a comatose ICU patient attached to a feeding tube and ventilator. Sharon fought for her life for 117 days. By the time she regained consciousness, her world had changed. “I was just like a newborn baby in a diaper,” she says. “I took care of everybody. Now, everybody wants to take care of me.”
At first, 60-year-old Tapp, who works at the VA Medical Affairs Center in Washington. D.C. lost her sense of taste. When she started suffering common COVID symptoms such as headache, chest pain, fever, and chills, she went to an urgent care clinic and was tested. Five days later the clinic informed Sharon that she had tested positive for COVID-19, and her boyfriend took her to their area hospital. After being admitted to the ICU, though, her condition became so serious that doctors transported her by helicopter to Johns Hopkins in Baltimore. There, physicians placed her in a medically induced coma and connected her to a ventilator.
Tapp survived the ventilator, pneumonia, and heart and lung failure before she rallied. Finally, she moved to an acute rehabilitation hospital, where she spent three weeks working to overcome the muscle breakdown and overall physical debility caused by the lengthy time she spent in a coma (she even had to learn how to swallow again).
Her recovery will be slow, as she is facing both physical and cognitive challenges, but Tapp is determinedly pursuing her speech, physical, and occupational therapy. She is using a rolling walker and a quad cane while regaining her sense of balance and building her strength to walk again. Sharon has a powerful goal in view: she is looking forward to her eventual return to the hospital (as a nurse). After all, nursing is part of who she is: “I like helping people. That’s just my nature. I really enjoy when they get better and I have something to do with it.”
For more on Sharon Tapp’s experience, see the story on the Today Show site.
The University of
Maryland School of Nursing (UMSON) recently received a $500,000
donation from alumna Mary Catherine Bunting, MS, CRNP, RN. Bunting received
her master’s degree from UMSON in 1972. Her donation will help the university
continue the work of UMSON’s Community
and Public Health Environmental Initiative (CPHEI) to provide health
oversight for children and families served by Baltimore City Early Head Start
(EHS) and other Head Start centers.
is a collaborative effort from the Maryland Family Network to improve overall
health and environmental health for EHS and Head Start center children from
birth through age 5, including programs that support mental, social, and
emotional development. The program was established in 2016 thanks to a $750,000
donation from Bunting.
Many UMSON students and faculty participate in CPHEI as part of the school’s ongoing service learning commitment, including Bachelor of Science in Nursing and RN-to-BSN program students, entry-into-nursing Clinical Nurse Leader master’s students, Community/Public Health Nursing master’s students, and Doctor of Nursing Practice students.
new funding will support continued efforts for CPHEI, which will include UMSON
students and faculty reviewing more than 1,000 child health records and
identifying children with chronic health conditions and those behind on
preventative care required under Maryland’s Medicaid program. They will also
provide direct care services including health screenings and home visits for
children with chronic conditions.
Laura Allen, MA, MS, RN, CPHEI program director, tells umaryland.edu, “CPHEI has brought much needed nursing services and environmental health oversight to a highly vulnerable population. If we weren’t there, there wouldn’t be as strong an emphasis on health, well-being, and how they relate to education. These families would be missing out on health screenings, health education, and general health literacy.”
Thanks to the new funding, CPHEI
has set a goal of helping all 47 of Baltimore’s Head Start centers become Eco-Healthy
Child Care-certified and to continuing its work of providing nursing services
in EHS centers.
To learn more about the
$500,000 donation given to the University of Maryland School of Nursing by
alumna Mary Catherine Bunting, visit here.
The University of Maryland School of Nursing (UMSON) has launched its 13th dual admission program in partnership with the Community College of Baltimore County (CCBC). UMSON’s dual admission programs allow students to transition from earning an associate degree in nursing (ADN) to UMSON’s Bachelor of Science in Nursing (BSN) program.
Students from 13 community colleges around the state of Maryland can take part in the dual-admission program. Continuing to grow its dual admissions program is part of an effort by UMSON to increase the number of collaborative pathways toward earning a BSN in Maryland. Students at any of the 13 partner community colleges can apply to, be admitted to, and begin taking classes in UMSON’s BSN program while still working toward their ADN, saving them time in completing both degrees. Dual enrolled students also receive transfer credits from UMSON for the coursework they complete at a partner community college.
UMSON is also currently covering the cost of its BSN courses for students participating in the dual admission partnership while they are still enrolled in an ADN program. CCBC is one of the largest community colleges in the state, serving a wide geographic area across two campuses.
The dual admission program is aimed at increasing the number of qualified nursing candidates entering the field. The agreement is helping to further the mission of the Future of Nursing: Campaign for Action, an initiative of the Robert Wood Johnson Foundation and the AARP to transform health care through nursing. The campaign is based on a goal set by the Institute of Medicine to increase the number of nurses holding baccalaureate degrees to 80 percent by 2020.
To learn more about the University of Maryland School of Nursing’s latest dual admissions partnership to allow associate’s degree nursing students to earn their bachelor’s degrees in nursing, visit here.
The Johns Hopkins School of Nursing (JHSON) recently announced a new study track for students who want to train in nurse anesthesiology, which is currently one of the most lucrative roles in the field. A new program will launch in May 2020 as part of the advanced practice track of the Doctor of Nursing Practice (DNP) degree program.
Students who completed the 36-month course will earn a doctorate degree and be eligible to apply for certification as a register nurse anesthetist, also known as a CRNA. According to bizjournals.com, CRNA has been ranked among the top 10 “best jobs” by the U.S. News & World Report since 2016.
Nurse anesthetists have the highest overall earning potential among advanced practice nurses. JHSON’s new program is pending approval by the Council on Accreditation of Nurse Anesthesia Educational Programs. Applications are expected to open in August 2019 and registered nurses who hold a bachelor’s degree in nursing or an entry-level nursing master’s degree with one year of critical care experience will be eligible to apply.
Nursing students on the anesthesiology track will learn how to administer anesthesia and anesthesia-related services independently and as part of a team. they will train in real-world and simulated settings with peers fro the Hopkins School of Medicine. Through a partnership with the Hopkins department of anesthesiology and critical care medicine, nursing school students will be able to work with experienced anesthetists and anesthesiologists with multidisciplinary expertise. Students will administer over 600 anesthetics in a variety of settings and participate in more than 2,000 clinical hours in preparation for entering the CRNA workforce.
To learn more about the new advanced practice nurse anesthetist program being offered by the John’s Hopkins School of Nursing’s DNP program, visit here.
The University of Maryland Charles Regional Medical Center has received multiple accolades recently. For the 15th successive year, the medical center has earned the Workplace Excellence Seal of Approval Award from the Alliance for Workplace Excellence. UM Charles Regional Medical Center was also awarded the Health & Wellness Seal of Approval award, for the 13th successive year, and the Ecoleadership award for a second year.
“There is a lot to be said for the continued growth and development of our organization and our workforce,” said Stacey Cook, UM Charles Regional Medical Center vice president of human resources. “To be recognized again this year for the programs we offer that help our employees with work life balance, opportunities for development, wellness and a positive impact on the environment is amazing.”
The Alliance for Workplace Excellence (AWE) is a non-profit
based in Montgomery County, Maryland, dedicated to increasing workplace
excellence through education and recognition, in order to strengthen quality of
life and economic growth. They do so with several kinds of awards, including those
recently given to UM Charles Regional Medical Center. All recipients are
thoroughly assessed by an independent review panel.
Excellence award is given those with strong commitment to balance in leadership
and success throughout their workforce, where the Ecoleadership award is given
to employers leading the way for environmental sustainability within the
workplace. The Health & Wellness Seal of Approval is awarded to employers
who create and provide programs to better employees’ health and wellness.
These awards and successes are the result of UM Charles Regional Medical Center putting their employees and community first and foremost every day. “We are celebrating 80 years of service to the community this year and that would not be possible without our engaged and committed employees,” Cook added.
For more information about the UM Charles Regional Medical Center, click here.