Hopkins Nurse
News from the Johns Hopkins Hospital Department of Nursing, Johns Hopkins Bayview Medical Center, and Howard County General Hospital (a member of Johns Hopkins Medicine)

Songs for Healing

Ron Noecker '07 just released Healing Songs at Christmas

"Healing isn't separated by race or religion. The Christmas season is a time of love and caring for all people, no matter who you are," says Ron Noecker '07. He has just released Healing Songs at Christmas, an album dedicated to people living and working with cancer.

Noecker is a nurse at the Johns Hopkins Hospital in Weinberg 5D, an oncology unit with patients living with solid tumors, intractable pain, and constant reminders of their mortality. In his prior career, as a priest who would incorporate song into his homilies, Noecker gained an understanding of how music can help heal the human spirit. "There are some sentiments and feelings that can only be conveyed through music," he says. "Singing a little song can help patients get through some of the bad moments."

When a patient with retinal blastoma had one of those bad moments, Noecker sang to her a 4th century chant entitled "Of the Father's Love Begotten." Over the course of her hospitalization, she would often ask Noecker to sing to her-just "one more time." Though she died last November, Noecker has dedicated the song, the first recording on the Healing Songs album, to her.

"Singing at the bedside isn't the same as singing in an opera hall," says Noecker. "My music is intended to accompany contemplation on all the mysteries of life and death. It encourages people to think 'what is all this about?'" The album includes several traditional carols, a Spanish rendition of "Hail Mary," four pieces of Appalachian folk music by John Jacob Niles, and a touching version of "Auld Lang Syne" sung by Noecker and his 11-year-old niece.

In fact, says Noecker, the song "Auld Lang Syne" was instrumental in the production of this album. The inspiration for the project came just as he was completing his first year as a nurse, and Noecker did not have the funds to produce the CD himself. While working on New Year's Day, he set up his keyboard in the nurses' break room and was soon joined by nurses, doctors, and patients in singing the traditional "Auld Lang Syne." 

The unity and harmony of that moment later gave Noecker the courage to ask colleagues to support the production of Healing Songs through $100 sponsorships. "Every nurse or doctor I asked immediately said 'yes, of course!,'" says Noecker, who was seeking 50 sponsors and easily obtained more than 70. For each donation, the sponsor will receive 5 CDs and 10 additional CDs will be given to cancer patients discharged from The Johns Hopkins Hospital this holiday season.

To order Healing Songs at Christmas, visit www.HealingSongs2008.com or e-mail Ron Noecker at healingsongs@mac.com.

--Kelly Brooks-Staub

Bright Moments for Nursing on Hopkins Series

• The ABC series, Hopkins, was a ratings win for the network and portrayed heroic medicine, catastrophic disease, and miraculous technology. Many of you were glued to your TV each week to watch Hopkins from a different point of view. Nurses, while severely underrepresented, had some shining moments.
• Megan Quick, PICU, showed compassion to a beautiful infant undergoing cardioversion.
• Teresa DeVaughn, PICU, resuscitated a child and maintained a cardiac rhythm during transport to the ED. Hopkins also led to additional media coverage of Hopkins nurses.
• Rhonda Wyskiel, and Christine Gonzalez, MSN '07 WICU, appeared on the CBS Early Show.
• Megan Quick, PICU, traveled to New York City to be interviewed by ABC's Dr. Tim Johnson, health correspondent.
• Joan Diamond, Nurse Manager in Obstetrics, appeared in a WMAR special with other nurses.
• Deb Baker accel. '92, MSN '97, Director of Nursing for Surgery, did a live interview on WYPR.

The ABC series also increased interest among RNs in employment at Hopkins. During the series, job applications increased by 140 and web hits increased by 4,500, with 1,100 unique web visitors.

Magnet Drawn to Nursing-Again

Originally published in Inside Hopkins, July 24, 2008.

Karen Haller admits to holding her breath the past few months. So, when the vice president of nursing and patient care services received the long-awaited telephone call on July 16 that the hospital's Department of Nursing had once again attained the presti-gious Magnet Recognition status, she says her reaction was one of "relief!"

"We knew we were well prepared, had marshaled our resources to host an effective three-day site visit, and were supported by the Hospital as a whole," Haller says. "But it's not over until you receive the official word."

Led by Magnet coordina-tor Patty Dawson, MSN '03 and her team of Magnet ambassadors, the department's preparation paid off. The American Nurses Credentialing Center complimented the nursing department on its focus on retention, interdisciplinary teamwork, and creative roles such as wound care and patient safety nurses. Not only did the organization renew Hopkins' status for another four years, it had no recommendations for improvement to offer.

The credentialing center awards the Magnet stamp of approval to just five percent of the nation's roughly 7,570 hospitals based on their standards of excellence for nursing care, the 14 "forces of magnetism." In 2003, Hopkins became the first and only hospital in Maryland to receive the designa-tion for quality patient care and innovation in nursing practice.

"Nursing is a problem-oriented profession, so we are always asking, 'What's the patient's problem and how can we intervene?' or 'What's the unit's problem and how can we make the system function better?'" Haller comments. "We rarely ask, 'What's right around here?' Magnet allows us to think about what is right, good, excellent."

Hopkins nurses celebrate Magnet approval.

Patient Safety Heroes Save the Day

By Karen Haller, PhD, RN, FAAN
VP of Nursing and Patient Care Services, Johns Hopkins Hospital

Many at Hopkins know the story of Josie King, the 18-month old who died at our hospital from medical errors in 2001. Her parents experienced overwhelming sorrow and intense grief, but were also consumed with anger. Mrs. King has said that anger can do one of two things to you: "It can cause you to rot away or it can propel you forward."

In the years following Josie's death, Sorrel and Tony King moved forward and created the Josie King Foundation to unite healthcare providers and consumers, fund innovative safety programs, and create a culture of patient safety. The foundation funds an annual patient safety research award of $10,000 during Nurses Week; and hosts a luncheon for our patient safety heroes.

Who are patient safety heroes? They are individuals who have actively prevented harm to our patients. The literature calls them "positive deviants"-those among us who do the right thing and are agents for good. Nine individuals were identified by their nursing departments as having been a positive force to make healthcare safer. 

The Department of Gynecology recognized Sara Nakamoto-a first-year nurse-who discovered that a pre-mixed IV solution delivered to her unit had the incorrect medication label applied over another label. The IV bag actually contained the solution whose label was hidden, and was contraindicated for the patient. Nakamoto's patient had impaired renal function, and could have suffered significant complications had the drug been administered. For this individual patient, Nakamoto was a super hero!

Kelly Creighton was recognized by the Department of Medicine for her work on improving the safety of patients on monitors. Creighton determined that 27,000 alarms rang on her 15-bed intermediate care unit every 24 hours-that's one alarm every 3 seconds!  Creighton worked with her committee and the Hospital's clinical engineers to improve the situation, reducing "nuisance alarms" by 26%. Kelly literally took the noise out of the system, so that nurses could respond more quickly to patients in trouble.

For a complete list of this year's Patient Safety Heroes, go to www.josieking.org/blog/.

Intensive Foresight

Originally published in Dome, September 2008.

The nation's first ICU emerged at Johns Hopkins Bayview 50 years ago.

A half-century ago, the offer of $150 to participate in a potentially harrowing medical experiment at the old Baltimore City Hospital, now Johns Hopkins Bayview Medical Center, was something third-year medical student Chester Schmidt Jr. felt was too good to turn down-even if it meant being injected with a drug that briefly paralyzed his diaphragm. "That was a lot of money then," he recalls with a chuckle.

Schmidt, later the long-time director of psychiatry at Johns Hopkins Bayview, volunteered to let Peter Safar (1924-2003), then head of anesthesiology at City Hospital, use him as a guinea pig to test his new, groundbreaking methods for cardiopulmonary resuscitation. Such experiments, which subsequently earned Safar recognition as the "father of CPR," were among the astonishing innovations in critical care medicine that he initiated at City Hospital--including the opening in September 1958 of the country's first multi-disciplinary intensive care unit (ICU).

Since July, each of Johns Hopkins Bayview 's six ICUs--medical, surgical, coronary, neonatal, neuroscience and burn--individually has celebrated the 50th anniversary of their prototype's creation and their own unique contributions to that heritage. The celebration culminated on September 26th with a day-long symposium at Johns Hopkins Bayview, featuring lectures by some of the premiere physicians in critical care medicine from around the country.

Philip Zieve, former head of Johns Hopkins Bayview's department of medicine and chief of the center's medical staff, was an intern at City Hospital when the ICU was founded. He recalls Safar as an "aggressive and charismatic" leader of anesthesiology "who believed that there was an opportunity for better respiratory care if the patients could be hospitalized in a single unit with nurses trained to care for people with severely acute problems."

At the time, City Hospital was Baltimore's major polio center, but once the Salk vaccine virtually ended the threat of polio, Safar saw the opportunity to transform the hospital's four-bed ventilator unit into an ICU, Zieve says. It had round-the-clock staffing by an anesthesiologist, nurses and a surgeon, says Romergryko Geocadin, director of Johns Hopkins Bayview's neuroscience CCU, and became "the template for what the ICU today looks like."

The first ICU had just six beds, Zieve recalls. At today's 709-bed Johns Hopkins Bayview, one of every six beds is in an ICU, says [Jonathan] Sevransky [head of medical ICU]. Last fiscal year, 5,941 ICU patients were treated there.

Nurses in the ICU at Johns Hopkins Bayview Medical Center carry on 50-year legacy, begun when the nation's first ICU emerged at their hospital.

In the Hopkins Hospital's nine ICUs--neonatal, pediatric, cardiac surgical, surgical, medical, neuro critical care, coronary care, oncology and Weinberg--nearly 10,000 patients are treated annually, says Todd Dorman, vice chair for critical care. About 20 percent of the hospital's 1,017 beds are in ICUs, he adds.

Today, hundreds of nurses and dozens of physicians, respiratory therapists, pharmacists and support personnel work in the two hospitals' ICUs.

With people surviving longer with serious illnesses, "it's likely that hospitals will become more and more devoted to patients who need life support," Sevransky says. It is estimated that one percent of the country's gross domestic product already is being spent on ICU care, he notes.

"At the end of the day, after all the hoopla," says Geocadin, "if we can rekindle the zest of Peter Safar when he was at Johns Hopkins Bayview  creating all of this, it will inspire people." 

-Neil A. Grauer