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 Incentive spirometer - this device is off the charts with excitement in name alone. The patient is "incentivized" to increase their lung capacity by trying to blow a foam piston up a shaft for as long and as high as possible. The "reward" that derives from diligent practice on the incentive spirometer is raising a little plastic marker a few centimeters higher, indicating the patient's new personal best.
Ok, maybe incentive spirometers are not all that exciting. Still, this device is vital for nurses and respiratory care therapists dealing with patients recovering from respiratory ailments. Despite the monotony, a fuller and quicker recovery comes with diligent repetition on the incentive spirometer.
The nurses and respiratory care therapists at Sinai Hospital of Baltimore have not done away with their incentive spirometers and peak flow meters. However, they have added something else to their arsenal of respiratory care tools - harmonicas.
Let the Creative Juices Flow
"The harmonicas are way more fun for the children than the incentive spirometers are," said Pat Moloney-Harmon, MS, RN, CCNS, FAAN.
These harmonicas are providing a unique form of therapy to Sinai patients, especially the young ones.
"As nurses, we are always looking for creative ways to better care for our patients. This is especially true in pediatrics where many of the children are away from home for long periods of time. These harmonicas are a way to make the hospital a little more bearable," said Moloney-Harmon, a clinical nurse specialist for children's services.
Moloney-Harmon is one of the many people at Sinai who has been instrumental in introducing harmonica therapy to the hospital. The harmonicas have added something that is often missing in respiratory care - fun!
 "All of our therapies are not fun - this is. This incorporates many of the same things, like pursed breathing, but it gives you a happy feeling. It lifts the spirits," said Ann Ludwig, BS, RRT-NPS, performance improvement and education coordinator for respiratory care services.
The program was oddly easy to get off the ground. A Sinai employee approached Ludwig and Moloney-Harmon and told them her father played the harmonica and it might be a unique to opportunity to encourage lung capacity in pediatric patients. The pair agreed and set in motion a program that would introduce harmonica therapy for children dealing with breathing issues such as asthma or pneumonia. A private donor provided the first batch of harmonicas and songbooks to get the program up and running.
Buddy Wakefield, 86, a veteran harmonica player, was brought into the hospital to teach the nurses, doctors and respiratory therapists. In a seminar called "Tune into Better Breathing," Wakefield explained the respiratory benefits of playing the harmonica.
"It is like doing push-ups for your lungs," said Wakefield.
Adding, Not Replacing
The harmonicas at Sinai are not going to replace the standards of respiratory care; rather, the harmonicas will be used in concert with other respiratory instruments such as peak flow meters and incentive spirometers.
The harmonicas get patients to want to work on their lungs, which will improve lung capacity and promote productive coughing. Repetition is the benefit the harmonica therapy provides; children do not even realize that they are doing therapy.
With pediatric patients that actually want to do their therapy, the nurses at Sinai must be doing something right. Prior to the harmonicas, pediatric nurses used walking to a fish tank as an incentive for patients to work their lungs. Needless to say, walking to the fish tank was a reward with diminishing value.
A benefit of the harmonicas, with patients consistently doing their breathing therapy, is that it assists in other respiratory measurements. The harmonica helps with pursed-lip and diaphragmatic breathing, and research has come out suggesting it can strengthen the muscles needed to inhale and exhale.
"What is hard for us is getting younger kids to do peak flows; it is hard for them to even get on the meter. If they can do peak flow, we want them to do peak flow. The harmonica helps get them on the charts," said Ludwig.
The Unique Role of the Nurse
"Nurses have a strong multidisciplinary attitude. Either the nurses or the respiratory care therapists can take the initiative to give the harmonica to one of the patients. It is a fun way for them to expand their lungs and it is a good way to get them coughing," said Moloney-Harmon.
At Sinai, the harmonica therapy is shared by nurses and respiratory care therapists. However, the nurses at this hospital have a special role in the pediatrics department-caring for the whole child. Rather than an atomistic view of the patient, Moloney-Harmon strives for a holistic approach to pediatric nursing and harmonicas.
"As I prepare to put this harmonica therapy program into a nursing journal, I keep thinking about one thing: the harmonica as part of a bigger question. The harmonicas are a way to ask ourselves, 'What are we doing to help kids expand their lungs?'" she noted.
Just like many individual notes on the harmonica come together to form a song, nurses strive to view the many facets of a patient's health as being interconnected; viewing the whole person in unison is what sets nurses apart from other healthcare occupations.
An Upbeat Future
The future of the harmonica therapy program at Sinai is upbeat. Though it began as a pediatrics therapy program, there are plans to expand it into adult care for patients dealing with pneumonia, ALS and other chronic ailments.
"The hospital is trying to get it going in the chronic care setting. For those with ALS, it will simply help them to have fun while in the hospital. The only question is how to fund it," Ludwig explains.
Though the harmonica therapy program only requires funding for new harmonicas and songbooks, money is still an issue. As is common with most non-essential hospital programs, establishing a connection between a given program and a decrease in length of stay is the golden ticket to funding. If a program is equated with a shortened length of stay, it will receive funding. Moloney-Harmon and Ludwig are confident they will be able to do this with their harmonica program.
"We can possibly use this program to show improvements in our pneumonia patients. If we can determine how the harmonicas have helped decrease their length of stay, we can get long-term funding," said Ludwig.
If a connection between length of stay and the harmonica therapy cannot be determined, Sinai will have to consider other sources to fund their harmonica therapy program.
Possibly a patient-led concert is the solution. With a little more practice, the children at Sinai Hospital will soon be able to compete with the Baltimore Symphony Orchestra. Perhaps someday they will sell out the Meyerhoff Symphony Hall themselves.
A. Trevor Sutton is a frequent contributor to ADVANCE.
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