I have been amazed at all of the attention that Music Therapy has been receiving ever since it became part of Rep. Giffords rehabilitation plan. This story was posted today on the Children's Memorial website, and it features a video of our PICU Music Therapist (and a good friend of mine). Check it out!
http://tinyurl.com/4oc5vo8
Thursday, March 10, 2011
Update on my Dad
I have so many musical moments floating around in my head that I am hoping to write about at some point, but for now, they are on hold. 3 weeks ago today my Dad was intubated and transferred to the ICU with severe ARDS (Acute Respiratory Distress Syndrome) resulting from the H1N1 flu he contracted while on the stem cell unit. Needless to say, the last 3 weeks have been filled with many ups and downs as I have had to experience what it feels like to be an ICU family instead of the ICU nurse. I have learned many things that I know will influence the way that I practice as a nurse, and as my Dad continues to recover, I hope to begin to blog about some of these experiences in order to help others learn from them as well. For now, he is getting better each day. A week ago he got a trach and they still have a long way to go on weaning the vent, but his other systems still appear to be working fine and his oncologist is 99% positive that his myeloma is in remission after the transplant, so we are thankful for that. Yesterday he had his eyes open for most of the day and was able to respond to a few commands from my mom and me, albeit very slowly. He remains on some sedation, so we are hopeful as he wakes up more that he will become more responsive.
Unfortunately, NMH does not have a music therapist available for patients! This continues to be shocking to me, given all of the resources they have available there. But I have definitely been singing to my Dad when he is agitated. A few weeks ago he had a lot of problems with fighting the ventilator, so I used singing with him to help calm him and patted gently on his chest to give rhythmic cues as to when to breath. His nurse was amazed at how he responded, despite all of the sedation. Often times we were able to get him calmed that way instead of having to bolus him with sedation.
Another cool "music therapy moment" occurred when my Dad was getting a 24-hour video EEG to check for seizure activity. His VEEG was fine, which we were thankful for, but the neurologist and I also noticed that when we were playing his favorite music it correlated to increased activity on the VEEG. Basically, his waves were very suppressed because of the amount of sedation that he had been receiving, but when we played his favorite music for him, the waves became more active. So cool to see!! Needless to say, I updated his iTunes playlist with more of his favorite music to play for him, especially when we are not able to be there. We are hopeful that music can continue to help orient him as he begins to wake up more. I am sure it will also play a large part in his rehab as well!
Unfortunately, NMH does not have a music therapist available for patients! This continues to be shocking to me, given all of the resources they have available there. But I have definitely been singing to my Dad when he is agitated. A few weeks ago he had a lot of problems with fighting the ventilator, so I used singing with him to help calm him and patted gently on his chest to give rhythmic cues as to when to breath. His nurse was amazed at how he responded, despite all of the sedation. Often times we were able to get him calmed that way instead of having to bolus him with sedation.
Another cool "music therapy moment" occurred when my Dad was getting a 24-hour video EEG to check for seizure activity. His VEEG was fine, which we were thankful for, but the neurologist and I also noticed that when we were playing his favorite music it correlated to increased activity on the VEEG. Basically, his waves were very suppressed because of the amount of sedation that he had been receiving, but when we played his favorite music for him, the waves became more active. So cool to see!! Needless to say, I updated his iTunes playlist with more of his favorite music to play for him, especially when we are not able to be there. We are hopeful that music can continue to help orient him as he begins to wake up more. I am sure it will also play a large part in his rehab as well!
Saturday, February 12, 2011
Exciting News!
While I was in Mexico, I received an email from a music therapist in Australia asking permission to use the Pediatric Inpatient Music Therapy Assessment Form (PIMTAF) that I developed as part of my master's project at Iowa and published in a 2006 edition of Music Therapy Perspectives. It is the second request that I have received from a facility in Australia requesting permission to use the form, which I find very interesting. I asked that the music therapist requesting permission to use it provide me feedback on how well the tool works in her setting. It is nice to know that all of my hard work is being put to some use! It is also re-ignited my passion for academic writing. I have revisions that need to happen from my nursing master's project, as well as several other articles that I would like to write to submit to various journals, so I am happy to have some inspiration to get started!
Monday, February 7, 2011
Hola from Mexico!
I am writing this post from the balcony of the beautiful condo we are renting in Playa del Carmen, Mexico with our friends Mark and Julie. Playa is about an hour south of Cancun on the Caribbean Sea. The weather here is beautiful- in the 80s and humid- and is providing some much needed sun after the huge blizzard in Chicago last week.
Since we are staying at a private condo, we have the luxury of having a full kitchen to use to prepare food. Yesterday was our first full day here, and included a trip to the local "Mega" (basically a Mexican version of a Super Target) to stock up on food. Several people recommended that we just head to the local Super Wal-Mart, but we decided we preferred to get the more authentic experience by shopping at a store where everything is not in English (plus we have found we get better prices on things when trying to speak Spanish and staying away from the super touristy areas).
One of the things being a nurse has made me much more aware of is the importance of taking steps to prevent chronic disease. I am very interested in working with people to help them make healthy lifestyle changes to help prevent obesity, hypertension, type II diabetes, and heart disease, among other things. However, during my community practicum at a clinic in a rough neighborhood on the west side of the city, I realized how difficult this can be for people who do not have much money or resources. Buying healthy foods can be expensive, and getting enough exercise can be hard when the streets may not be safe to walk on and buying a gym membership is out of the question. I really enjoyed helping my patients brainstorm ways that they can eat more healthy foods and incorporate exercise in a way that works for them.
Shopping at a Mexican store was quite the experience. We had fun navigating the aisles, trying to figure out how to say "turkey" (pechuga), which type of cheese would work best on sandwiches, trying to find the milk (all shelf stable here in Mexico), and deciding what flavor of yogurt to buy. The flavors in itself were interesting as the options only included strawberry, peach, mango, or apple (no lemon, lime, or vanilla). Even in juices and sodas the only flavors available were the ones I mentioned (Mike tried to buy lime juice to make margaritas, but instead had to make his own by juicing limes). The most interesting thing I noticed is that all of the food here seems to be fortified. There was special yogurt for women that had folic acid in it. Other types of yogurt had fiber and omega-3 (we are still trying to figure out if the yogurt with fiber had actual cereal in it or just included soluble fiber). The bread has omega-3s and folic acid. Even the peanut butter (hard to find- only 2 options, clearly not a popular choice in Mexico) includes Vitamin A & E, folic acid, omega-3s, magnesium and phosphorus. Artificially sweetened yogurt was almost non-existant, and all of the dairy products had no hormones or antibiotics. As my friend Julie just mentioned, it did not appear to be all a marketing scheme either. Essentially all of the packaged products were fortified with the various vitamins and nutrients, regardless of brand. Now, I am clearly not a proponent of eating only processed foods. In fact, we definitely try to limit them in our everyday diet at home. However, in a country where people may not be able to afford to eat as much, and fruits and vegetables are very expensive, I found it to be an interesting concept for nutrition.
Since we are staying at a private condo, we have the luxury of having a full kitchen to use to prepare food. Yesterday was our first full day here, and included a trip to the local "Mega" (basically a Mexican version of a Super Target) to stock up on food. Several people recommended that we just head to the local Super Wal-Mart, but we decided we preferred to get the more authentic experience by shopping at a store where everything is not in English (plus we have found we get better prices on things when trying to speak Spanish and staying away from the super touristy areas).
One of the things being a nurse has made me much more aware of is the importance of taking steps to prevent chronic disease. I am very interested in working with people to help them make healthy lifestyle changes to help prevent obesity, hypertension, type II diabetes, and heart disease, among other things. However, during my community practicum at a clinic in a rough neighborhood on the west side of the city, I realized how difficult this can be for people who do not have much money or resources. Buying healthy foods can be expensive, and getting enough exercise can be hard when the streets may not be safe to walk on and buying a gym membership is out of the question. I really enjoyed helping my patients brainstorm ways that they can eat more healthy foods and incorporate exercise in a way that works for them.
Shopping at a Mexican store was quite the experience. We had fun navigating the aisles, trying to figure out how to say "turkey" (pechuga), which type of cheese would work best on sandwiches, trying to find the milk (all shelf stable here in Mexico), and deciding what flavor of yogurt to buy. The flavors in itself were interesting as the options only included strawberry, peach, mango, or apple (no lemon, lime, or vanilla). Even in juices and sodas the only flavors available were the ones I mentioned (Mike tried to buy lime juice to make margaritas, but instead had to make his own by juicing limes). The most interesting thing I noticed is that all of the food here seems to be fortified. There was special yogurt for women that had folic acid in it. Other types of yogurt had fiber and omega-3 (we are still trying to figure out if the yogurt with fiber had actual cereal in it or just included soluble fiber). The bread has omega-3s and folic acid. Even the peanut butter (hard to find- only 2 options, clearly not a popular choice in Mexico) includes Vitamin A & E, folic acid, omega-3s, magnesium and phosphorus. Artificially sweetened yogurt was almost non-existant, and all of the dairy products had no hormones or antibiotics. As my friend Julie just mentioned, it did not appear to be all a marketing scheme either. Essentially all of the packaged products were fortified with the various vitamins and nutrients, regardless of brand. Now, I am clearly not a proponent of eating only processed foods. In fact, we definitely try to limit them in our everyday diet at home. However, in a country where people may not be able to afford to eat as much, and fruits and vegetables are very expensive, I found it to be an interesting concept for nutrition.
Thursday, January 27, 2011
Too Much of a Good Thing
As I have mentioned, I currently work as a nurse in the pediatric intensive care unit at a large academic medical center where we see a wide variety of children of all ages and abilities. Throughout all of the new nurse classes I was required to attend as part of my orientation, the instructors continuously encouraged the use of the music channel available on our televisions to help soothe your patients. While I appreciated the fact new nurses were being encouraged to use music to help modify the environment, I also had a few concerns. I had noticed when walking around the unit at night that I did hear the the music channel playing... over, and over, and over, and over..... for hours on end, even if the child was fast asleep. Add to that the fact that the channel essentially repeated the same 3-4 "soothing" songs (ironically several were CCR covers played on the xylophone) over and over again all night long. I found that I was having trouble falling asleep after my shift because the songs were playing over and over in my head.
Can you say "habituation"?!?!
Luckily, since August, the music channel has expanded its repertoire. And of course, I am never shy about speaking up in all of my classes to clarify how to use the music channel appropriately. I encourage nurses to put the channel on to create a soothing environment to help distract, calm, and encourage sleep. But once the child is asleep, it is so important to remember to turn it off instead of letting it play for 12 hours straight.
I love that my hospital encourages nurses to use this resource and I hope to continue to educate on the appropriate uses of ambient music, especially in a unit where children are critically ill and restful sleep is vital. This education role is one of the things I love about being a music therapist and a nurse.
Can you say "habituation"?!?!
Luckily, since August, the music channel has expanded its repertoire. And of course, I am never shy about speaking up in all of my classes to clarify how to use the music channel appropriately. I encourage nurses to put the channel on to create a soothing environment to help distract, calm, and encourage sleep. But once the child is asleep, it is so important to remember to turn it off instead of letting it play for 12 hours straight.
I love that my hospital encourages nurses to use this resource and I hope to continue to educate on the appropriate uses of ambient music, especially in a unit where children are critically ill and restful sleep is vital. This education role is one of the things I love about being a music therapist and a nurse.
Thursday, January 20, 2011
Musical Intuition
The other day one of my colleagues said to me "It is so weird to see you as a nurse! I'm just curious, do you still use music with your patients?"
My answer was: YES. All the time. I have noticed all throughout school that even though I have learned many new nursing skills, my strength as a nurse comes from my ability to interact with people, which was developed through my work as a music therapist. And despite all that I have learned in nursing school, my brain still thinks like a music therapist. Not a musician. Not a therapist. A music therapist.
The minute a baby starts crying, my instinct immediately is to start singing to them to try to comfort them. Sometimes I don't even realize I am doing it. I had a baby a few weeks ago whose parents had left a Broadway hits CD at his bedside. I was going through my assessment, checking pulses, giving meds, changing his diaper, and apparently singing and humming along the entire time to Oliver! and West Side Story. Later my preceptor said to me "It was so cool how you were singing to the baby. He totally loved it!" I was shocked- I had no idea I was even doing it.
But I will often find myself sitting in the dark in the middle of the night, holding or comforting a crying baby, and the first thing I will try is singing to them. Some nurses immediately reach for the pacifier- or maybe even the morphine!- or try bundling, sweet ease, suctioning, decreased stimulation, but the first thing that I try is singing. And I have to say, it works every time.
I hope that I never stop thinking like a music therapist.
A New Kind of Normal
Today I took my Dad for his fourth and final day of his stem cell harvest. It was a really nice day and I realized how much I have come to look forward to the days that I take him to treatment. I found out my Dad had a tumor on his spinal cord on my 3rd day as a registered nurse in the Pediatric Intensive Care Unit. My Dad, one of the healthiest people I know, has cancer? Lying in bed the night before the surgery, I tried out the words in my head: "My dad has cancer." It felt so foreign on my tongue.
I would say I am a optimistic realist. Not a fake, never-gonna-happen, sickly sweet half-glass full kind of girl. But rather, I just try to find the best possible outcome in every situation. And while I definitely don't LIKE the fact that my dad has Multiple Myeloma- I think it SUCKS- there have been some positive memories as well. The first happened the weekend of his surgery. My brother came down from Minnesota to be with us, and we spent that weekend hanging with my dad in his hospital room, eating Portillos, and playing games. It was the first time that we had spent time as "the original family of four" for a long time. I love my husband of course, and my sister-in-law and niece, but there is something to be said for being able to spend an extended period of time together as the original 4. The people who have known you for your entire life, who you can be your authentic self with at all times. My dad felt bad as I missed the wedding of a good friend in Colorado to be with him, but honestly, there was no place in the world that I would rather have been. It was a great moment, and I was so happy to be able to share a similar time together this past Monday on the first day of the stem cell harvest.
I have also been able to spend a lot of quality time with my Dad. Hours of time just sitting together, waiting for an appointment or a test, just passing the time in the hospital by talking. We talk about myeloma and his treatment plan- but we also talk normal things as well. Everyday life. Time that we would not have had if he had not gotten sick. Fact is, most of the time, the world moves too fast. We don't take the time to just sit and talk and catch up. There is always someplace we need to be, something that needs to be done, that we miss these moments. So, I feel like the luckiest girl around to be able to spend this kind of time together.
Yesterday, a girl at work mentioned that she saw my pictures on facebook of the stem cell harvest and asked what was going on. "My dad has cancer, but he's doing great." I told her. And I noticed, for the first time, it felt ok.
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