Monthly Archives: May 2014

Excellence in nursing: Marie Koldborg

In honor of Nurses Week, we’re celebrating the amazing and inspiring work of our nursing staff. Read a profile of Marie Koldborg, RN, who works in the Minneapolis Emergency Department (ED).

Marie Koldborg, RN, has been with Children's for 37 years.

If you ask a colleague in the Minneapolis ED to list off their nursing mentors, chances are Marie Koldborg would rank highly on the list. Marie has been with Children’s for 37 years and has worked in the Minneapolis emergency department (ED) for 24 years. As a staff nurse, course instructor and mentor, Marie has become well known for her excellent nursing skills, professionalism and kindness.

“In her nearly 40 years with Children’s, Marie has made a difference to an incredible number of patients, families, nurses, physicians and countless others across Children’s and the nursing community,” said Claudia Hines, patient care manager in the Minneapolis ED. “She exemplifies the true meaning of nursing and the passion needed to make a difference. Her incredible energy and enthusiasm are consistently demonstrated in all aspects of her practice.”

Marie has a passion for learning and looks for ways to challenge and push herself in her daily work. She has stepped up, and stepped out of her comfort zone, to take on education and training for her unit and in the community. Marie is a certified instructor for five courses required for ED nurses. Since she began teaching in 2004, Marie has logged countless miles to train more than 4,000 nurses, physicians, emergency medical technicians and others on emergency care.

“I love getting out and doing the trainings and working with other professionals,” said Marie. “Over the years, the trainings have taken me to Bemidji, Duluth, Albert Lea, Cass Lake, Fergus Falls, Osceola, Red Lake, Eau Claire and many other rural communities, plus hospitals in the Twin Cities. It’s great to share the knowledge that Children’s has, but also to see what other communities are doing to help care for children.”

“The trainings Marie has done are an amazing contribution to the education of pediatric healthcare professionals in our region,” Claudia said. “She is a wonderful teacher and makes it a fun learning experience for her peers. Her dedication and passion for teaching has not only touched health care professionals but more importantly has impacted the emergency care children receive in all regions of the state.”

Marie has been a leader on her unit through her participation in unit council and as part of the nursing practice structure committee. She has helped train and mentor many new ED team members and helped develop the unit’s new employee orientation program. Her colleagues respect her for her strong nursing skills and for the human touch she brings to her care.

“Marie is a role model for all nurses on our unit,” Claudia said. “She goes out of her way to comfort distressed families when they arrive in our ED. She has a big heart and is quick to offer a hug to a parent or grandparent and helps them keep calm while we assess and care for the child. She’s a great example to her colleagues and represents the patient- and family-centered care that Children’s is known for.”

For Marie, the people, patients and the ongoing activity of the ED keep her motivated and energized.

“It’s been a love affair,” Marie said of her time in the ED. “I love working with patients and families, and I love the daily challenge that the ED brings. Every day is different; we see everything from the normal to the extreme. I like the variety, the unique patients we serve and the opportunity to continue to research and learn in order to provide the best care for kids.”

Thank you, Marie, and to all Children’s nurses for all you do to care for our patients and families!

Celebrating our nurses: Sarah Lovern

In honor of Nurses Week, we’re celebrating the amazing and inspiring work of our nursing staff. Read a profile of Sarah Lovern, RN, who works nights in the Cardiovascular Care Center (CVCC) in Minneapolis.

Sarah Lovern, RN, plays music on her phone to a baby during the first surgical case with International Children's Heart Foundation in Voronezh, Russia.

Sarah Lovern always knew she wanted to be a healer. As a student at the University of North Carolina at Chapel Hill, Sarah majored in biology and Spanish, with a minor in chemistry. During that time, she worked as a nursing assistant in a neuroscience intensive care unit (ICU) and newborn nursery. After receiving a touching thank you letter from the family of a patient she cared for, Sarah knew she was destined to go on to become a nurse. Since then, she has combined her love of science and languages in her career as a staff nurse in the Cardiovascular Care Center (CVCC) at Children’s – Minneapolis and through her volunteer work around the world.

“Sarah is a talented nurse as well as a committed volunteer,” said Maureen Kelpe, patient care manager, CVCC. “She volunteers on our unit as a quality coach and on our unit council. She takes her commitment to caring for children even further by giving her time, expertise and energy to local and global organizations dedicated to improving the lives of children.”

As one of two quality coaches on her unit, Sarah is responsible for doing prevalence studies one day per month to assess patients’ skin and peripheral IVs. She has received specialized training in skin, wounds and IVs, and passes that training on to her colleagues in the unit. She is continuously working to improve her practice and is currently pursuing an advanced degree in Nursing Leadership/Administration. She also plans to receive her certification in critical care nursing and receive her certification as a nurse executive. She has a passion for learning, and enjoys sharing what she knows with others.

“After all, everything we know in nursing, we learn from each other,” Sarah said.

As part of her unit council work, Sarah is working with Child Life Specialist Judy Sawyer to roll out “Beads of Courage,” a nation-wide arts-in-medicine program that helps support and empower patients going through a serious illness. As patients celebrate milestones in their treatment, they will be given a colorful bead as a symbol of their courage. Sarah and Judy have secured the funding, supplies, and training and will be launching the program for all CVCC caregivers during Nurses Week and enrolling patients before summer.

Outside Children’s, Sarah gives her time to Camp Odayin, which provides safe and supportive camping experiences for kids with heart disease. She has also volunteered at Neighborhood Involvement Program, a free community clinic in Minneapolis for low-income families, where she provided vaccinations and primary care services.

Sarah Lovern, RN, plays with children during developmental assessments at an orphanage in Haiti.

“Service volunteerism is one of my greatest passions,” said Sarah. “I love traveling to new places and seeing how non-governmental organizations can develop sustainable programs to alleviate disparities and health gaps for pediatric cardiovascular (CV) patients. In the last year alone, I’ve been on mission trips to Haiti, Spain, Nicaragua and Russia to observe what nurse leaders there are doing to care for critically ill patients. It’s been eye-opening and extremely inspiring to see how we can use the information to improve outcomes for kids around the world.”

On her trips, Sarah partnered with non-governmental organizations such as the American Red Cross, Project Health for León, Children’s HeartLink and the International Children’s Heart Foundation to observe what nurse leaders are doing across the world to care for critically ill patients.

In all of her work inside and outside Children’s, Sarah’s compassion for her patients shines through.

“Whether she is on the floor or in a foreign country, Sarah has a clear dedication to bettering the lives of children,” said Maureen. “She is a compassionate and caring nurse who forms bonds with all of the patients and families she interacts with. Her professionalism, excitement for learning and dedication to improving cardiovascular outcomes make her an inspiration to all nurses.”

Thank you, Sarah, and all Children’s nurses for all you do!

Austin’s story: A pioneering surgery provides hope

For 3-year-old Austin Graue, his short life has been anything but typical.

At birth, he was delivered via emergency C-section after doctors determined he wouldn’t be able to breathe on his own. He was rushed from the hospital in his family’s hometown of Northfield, Minnesota, to Children’s – St. Paul.

Austin Graue, of Northfield, Minnesota, was born in August 2010.

“It was disbelief and shock,” said Mary Graue, Austin’s mother, when she thinks back to her baby’s first days. “What we thought was happening [having a healthy baby boy] was exactly the opposite. We asked ourselves: ‘Is he even going to survive?’ ”

Confusion and doubt swirled.

After discharge and a precious few days at home, Austin was readmitted to Children’s when he continued to experience breathing problems and near-constant vomiting prevented him from gaining weight. Diagnosed with pyloric stenosis (a narrowing of the pylorus, the opening from the stomach into the small intestine), Austin would require surgery.

Surgery was a success and Austin was discharged, albeit with a tracheostomy (a hole made in his neck that went through to his windpipe) to help him breathe (“His nasal passages were the size of pencil tips,” Mary said) as well as a gastronomy tube for feeding. His only visits to Children’s now would be for quarterly checkups. However, things quickly changed during his three-month visit when doctors told the Graues that the “soft spots” on Austin’s head were closing too quickly and he would need surgery, again.

A new diagnosis: Austin had Pfeiffer syndrome.

“Austin had experienced challenges since birth and now we finally had the answer why,” Mary said. “It was such a relief to finally have an answer.”

Hope for Austin’s future was growing.

Pfeiffer syndrome is a rare genetic disorder which only affects about 1 in every 100,000 people. Because of his condition, the bones of Austin’s skull had prematurely fused together, putting increased pressure on his brain. If left untreated, Austin’s brain would not be able to fully develop, causing a host of developmental problems. Physically, Austin would begin to develop bulging and wide-set eyes, a high forehead and an underdeveloped jaw.

At just 1 year old, Austin and his family met Robert Tibesar, MD, one of the craniofacial surgeons at Children’s ENT and Facial Plastic Surgery, the first and only ENT and facial plastic surgery practice in Minnesota that cares exclusively for kids.

“Austin had fusion of many of his sutures – or joints – in his skull,” Tibesar said. “That meant that his mid-face, forehead and the back of his head were not growing properly. The fused sutures had constricted growth and were causing Austin to have an abnormally shaped head, as well as put him at an elevated risk of pressure inside his skull.”

First, Tibesar, along with Joseph Petronio, MD, Children’s neurosurgery medical director, performed surgery to advance the front part of Austin’s head and eyebrows, allowing him to better close his eyes and improve the contour of his forehead.

Pfeiffer syndrome is a rare genetic disorder which only affects about 1 in every 100,000 people.

“As expected in children with Pfeiffer syndrome, the problems with Austin’s skull could not be solved with just one operation,” Tibesar said. “The fused sutures in the back of his head continued to constrict the growth of his skull.”

“The back of Austin’s head was flat,” Tibesar continued, “and that was preventing his brain from fully developing. The back part of the brain serves important functions for vision and balance, and we needed that to be decompressed to allow his brain to grow normally.”

Tibesar would use his knowledge of the jaw distraction procedure – a procedure pioneered at Children’s – to perform a “cranial vault expansion” on Austin, which would be coupled, for the first time, with image-guidance technology.

“In looking at the literature, there are no other case reports of this exact procedure for this exact problem,” Tibesar said.

As Austin’s dad, Phil, described it, Tibesar and his team were going to “move an island of bone” on Austin’s head.

Tibesar likened image guidance to using a GPS in favor of a paper map. “When you’re trying to get somewhere using a map, you may not know exactly where you are; sometimes you have to make your best guess. With GPS, you know exactly where you are at all times. The same is true with image guidance. During surgery, we know exactly where we need to make each bone cut.

“For Austin, and for many other kids to come, this represents a significant advance in terms of precision, and, therefore, safety for these types of surgeries.”

Austin would become a pioneer.

In the operating room, Tibesar and his colleagues opened Austin’s skull and attached four “distractors” over his head from ear to ear – these distractors would allow Austin’s skull to expand and grow. At the completion of the surgery, four small key holes protruded from Austin’s head, and his parents were entrusted to turn a special key twice a day to slowly expand his skull, causing little to no pain for Austin.

Doctors opened Austin’s skull and attached four “distractors” over his head  to allow his skull to expand and grow.

“It was really hard at first,” Phil said. “You are literally moving his skull… I couldn’t believe I was doing it.”

After 30 days back home, Austin’s skull had expanded nearly 3 centimeters and was starting to grow properly on its own.

In February 2013, Tibesar and his colleagues removed the distractors in order to allow the bones of Austin’s skull to fill in more completely. Since the surgery, Austin has experienced few complications and has only been back to Children’s for routine check-ups.

Before (right) and after (left) X-rays of Austin’s skull

According to Tibesar, the next-closest place that offers surgery for kids with Pfeiffer syndrome is in Chicago. Thankfully for Austin and his family, he would be able to be treated less than an hour from home.

“Things have been normal,” Mary said. “We have our daily worries, but otherwise Austin is going to school, talking more and making friends. As time goes on, we are getting more normal around here.”

Austin Graue with his mother, Mary

For other parents that will face a similar journey, Mary encourages them to “take things one day at a time.”

Austin will have to undergo another surgery in a few years to ensure that the bones of his face grow along with the rest of his skull, but he’s well on his way to a much more typical life.

“We need parents who put their trust in us,” Tibesar said. “It’s a big honor to have that trust, but really, [the children] become the pioneers and we are able to apply this technology to the benefit of others.”

More about Austin Graue’s story is available here.

Five Question Friday: Sarah Woolever

This week’s edition of Five Question Friday gives a nod to Music Therapy Week. Let’s learn more about Children’s music therapist Sarah Woolever. 

Children's music therapist Sarah Woolever writes, records and performs songs around the Twin Cities.

How long have you worked at Children’s?

1½ years

Why did you decide to go into music therapy?

I did a lot of service projects in high school and was very involved in the choir and marching band (go, drumline!). I knew I loved working with people, and I personally gained so much out of my musical experiences beyond learning how to play an instrument. Performing as a profession wasn’t for me, and I didn’t want to be in education. Music therapy was the perfect balance of both my passions.

Do you have a favorite memory from working at Children’s?

I have so many great memories it’s hard to pick one! Recently, I received a referral from a child life specialist in the hematology/oncology clinic. A 2-year-old girl had been in the clinic for procedures every day for the entire week. She was tired of being there and needed an intervention that would change the environment and her mood, as well as give her an alternate focus during procedures. I brought developmentally stimulating tasks that really motivated her. She smiled, sang, danced (while sitting on her bed) and successfully played new instruments. She was in charge by making choices and leading her mom and myself while playing our instruments or thinking of new words to familiar songs. She focused on the session for over 40 minutes – a really long time for a 2-year-old! It was a normalizing experience where she could be herself. During this time, her nurses were able to do their work without protests and mom was able to relax as well.

How do you spend your time outside of work?

I love spending time with my husband and our 17-month-old, Declan. I love hosting dinner parties as well as practicing yoga.

What’s one interesting fact about you?

I know I just wrote that performing wasn’t for me… but I do write, record and perform songs around the Twin Cities with my bandmate. Writing music is a great outlet for me, and it keeps my musical skills sharp.