No idea how that works
April 15, 2010 -- Two very good recent press reports illustrate how nursing innovations are saving lives in hospitals today, but they also show how far society has to go in understanding the value of what nurses do. Today, the Phoenix television station ABC-15 posted a short but helpful item on its web site describing a cooling blanket developed by nurses at Banner Baywood Heart Hospital which has been very effective in helping to increase patient survival and brain function. The very short piece manages to include good quotes from Lauren Woffinden, the nurse manager who was instrumental in developing the induced hypothermia protocols, and another nurse who provides additional explanation. But don't get too excited. A patient whose wife was recently saved by the treatment gushes: "Of course I'm not a doctor. I have no idea how that works, but whatever it did it saved her mind, her brain. She knew everybody, it's a miracle." Yes, thank goodness those physicians understand this stuff! Meanwhile, on April 10, the Courier-Express (DuBois, PA) ran a good, longer report by Katie Weidenboerner about the Nurture Rest, a positioning pillow for NICU babies that nurse Nicole Kovalyak of DuBois Regional Medical Center invented to promote rest, comfort, and better breathing, and thus better outcomes. Some elements of Kovalyak's pillow mimic the position of an infant on a mother's chest, but others actually simulate the womb for babies who have left it too soon. The ever-evolving device has been patented and has been in use at the hospital for years. But Kovalyak reports that interest from manufacturers has been slight, and we wonder if one factor is the profession of the person behind the pillow. Nurses' health care achievements greatly exceed society's understanding of them. But press reports like these two are a great way to close that gap.
Not a doctor
The report from the Phoenix ABC television affiliate is headlined "How a 'cooling blanket' is saving lives at Valley hospital." It tells the story of Deloris Rawson, whose husband Dennie awoke one recent night to find that his wife was having what turned out to be a heart attack and several small strokes. She was taken to Banner Baywood Heart Hospital, where she was close to death and "doctors and nurses...decided to use a cooling blanket treatment." See that? Physicians and nurses decided together--like a team!
And sure enough, the report notes that the "team" at the hospital has been "thrilled with the results of the Induced Hypothermia treatment." The piece explains:
Nurse and clinical manager Lauren Woffinden did her Master's project on induced hypothermia and she was instrumental in helping develop the protocols that are now saving lives like Deloris'. Nurse Candy Cross says they must act very quickly once the patient arrives at the hospital. "We're cooling down way below normal body temperature," said Cross. They cool the body from 37 to 32 degrees Celsius for 24 hours, slowing the blood flow and protecting the brain. "It decreases mortality and it improves neurologic function," said Cross. She says the hospital's heart attack survival rate has increased nearly 30 percent since starting the program.
Particularly for a short TV item, this is a good report on nursing innovation, doing a lot in a small space. Not only does the piece consult nurses for information about nursing work--not something we can take for granted--it also treats the nurses like the experts they are, credits them for the hypothermia initiative, and clearly states that it is saving lives. Cross provides useful hard data about the mechanism and results of the initiative, describing what it does in specific, non-emotional terms that are likely to inspire respect. And we learn that Woffinden has a master's degree. Nurses get graduate degrees in nursing!
The piece also says that the "snowbird couple is thanking God and technology" for the treatment that saved Deloris. But Dennie also seems to have someone else in mind:
Of course I'm not a doctor. I have no idea how that works, but whatever it did, it saved her mind, her brain. She knew everybody, it's a miracle.
It seems clear that nurses played a key role in developing this technology, and we suspect the ones who did the great majority of the work in performing the procedure. Yet the patient's grateful spouse seems to associate understanding of the treatment with physicians alone. We realize this is just one quote, and he may well have a greater understanding of the nurses' roles than the quote suggests. But it is sadly revealing.
Katie Weidenboerner's Courier-Express piece also does a very good job of crediting a nurse for nursing work, starting with the headline: "NICU nurse invents baby aid." We might quibble with the use of "aid," but headlines must be concise, and "invents" is strong. The report introduces Nicole Kovalyak, who has been "a registered nurse at the Neonatal Intensive Care Unit at DuBois Regional Medical Center for nine years." Kovalyak explains that despite many advances in health technology, "there hasn't been a whole lot to help position" vulnerable NICU infants. The piece describes the makeshift supports that the nurses construct to try to make NICU babies comfortable, well-meaning efforts that failed to meet the babies' needs at Kovalyak's hospital, at times leaving the babies sprawled on their backs. Surveying these efforts, Kovalyak was inspired to create something new. She drew a sketch, which her father turned into a "cardboard template." Based on that, her stepmother sewed a "pillow resembling a mother's chest."
But that was just the beginning, and the piece spends significant time on the development of what it refers to as both "Nurture Care" and the "Nurture Rest." The report says that the first "model" went into use in the DuBois hospital's NICU in 2007. There was a short instructional DVD, but otherwise the pillow appeared under a "cloud of secrecy," apparently to promote more honest reactions from the nurses and aid in improving the design. Kovalyak listened to her colleagues' comments, and "two years of suggestions and experiments led to about six reconstructions of the positioning device."
The article also explains in some detail what the Nurture Rest actually does and why. It draws on the growing awareness of the importance of kangaroo care, in which NICU nurses encourage parents to hold the vulnerable infants skin-to-skin on their chests (or, on ABC's Grey's Anatomy, in which surgeons simply hold the babies on their own chests). The Courier-Express report quotes Kovalyak:
"Studies of Kangaroo Care show it just does leaps and bounds for the baby. It calms them down, it lets them sleep, they eat better and grow faster. If they're on oxygen, they can decrease their oxygen faster," Kovalyak said. "It's just amazing what a natural response it is."
Kovalyak's pillow keeps babies' heads and necks straight so they can breathe properly, and there are "accessories" to adapt the pillow to different babies' needs.
"They usually grab onto the chest and they start to suck because that is a comfort mechanism for them," Kovalyak said. "You give them their binky and they start sucking--they go right to sleep. Usually their arm falls down around it like they're hugging the chest."
The piece also describes elements of Kovalyak's invention which suggest she is actually trying to simulate the womb itself, though that is not stated directly. The report says that soft fabric wraps around the baby and is attached to the pillow with Velcro, providing a "swaddle" effect. A "loose pouch" at the bottom of the pillow creates a boundary "similar to the one [the babies] had in the womb." Kovalyak explains that babies like to feel the kind of boundaries they had in utero, which makes them comfortable and helps them sleep, and that in turn allows them to grow. She says that the pillow also addresses the needs of the parents of the sick or premature child, noting that
we're going to try to ... record the mom's heartbeat and put it in the pillow that [the babies are] laying on. That way when mom and dad go home at night, mom'll think, I'm there through my heartbeat.
Of course, the babies might think that too, and this would seem to be a good way to provide an even more womb-like environment and help the infants thrive. All of these quotes from Kovalyak convey not only the virtues of the Nurture Rest, but a keen understanding of what vulnerable infants need, and suggest an advanced approach to NICU care, trying to simulate the womb in promising new ways. And as with the nurse quotes in the Phoenix report, most of these describe what the invention does in concrete, specific terms, rather than just saying it makes the babies "comfy" or "happy," which would permit readers to regard the pillow as part of the unskilled pillow-fluffing that nursing has traditionally been associated with.
The article closes with information about the Nurture Rest's prospects for more widespread use. Kovalyak reports that so far "manufacturers haven't been receptive to the idea," with most saying it "isn't something they've seen or made before." She suggests that is the point. The piece says that Kovalyak has a chance to get funding through Pepsi's Refresh Everything program, "which looks for people, businesses and non-profits with ideas that will have a positive impact and is giving away money to pay for those ideas." Kovalyak was in the running for the $250,000 awards that were to be given to the top two projects in the relevant category on May 1. The piece practically encourages readers to vote for her project, directing them to the web site and informing them of the voting deadline (sorry, voting is now closed), but the article also notes that the project was at that time ranked 115th out of 300 in the competition. Regardless, Kovalyak says that she is ready with several other ideas for her business, which is called Neonatal Loving Kare.
We hope that someone with the necessary resources will see the value in what Kovalyak has done. We can't say from this report why her ideas seem to have attracted less attention than they deserve, except that we doubt the manufacturers are actually uninterested because the Nurture Rest isn't something they've seen before. We do know that nurses' ideas are often discounted, at least until they are embraced by someone with more social esteem, such as physicians. Or maybe the Nurture Rest would benefit from a flashier name, like The Virtual Womb, or a more high-tech one, like the Neonatal Positioning Apparatus or the Neonatal Assistive Pillow, which could be shortened to NAP. Perhaps less emphasis on soft words like "nurture," "loving," and "kare" would help, however appropriate those might be to the product. (We assume the spelling of "kare" derives from the link to kangaroo care and/or from Kovalyak's surname.) In general, the use of emotional terminology does little to enhance respect for nurses or their work, since it may reinforce the stereotype that nursing is about unskilled emotional support, rather than advanced clinical care, which the Nurture Rest seems to be. The piece does not say whether any research has been done, but perhaps a study comparing babies who use the Nurture Rest to those who do not would be helpful, as it was in showing the value of the hypothermia program described in the Arizona article above.
Both of these press articles treat the nurses' innovations with respect, resisting the urge to sentimentalize or condescend to them, and both give readers a good sense of the value of the innovations. We thank those responsible.