Letter to the Editor, Re: Time Out in the Cardiac Cath Lab at St. John Macomb Hospital

I am writing to inform you of a “best practice” identified in the Cardiac Catheterization Lab at St. John Macomb Hospital in Warren, Michigan. Our department began using a Tibetan gong at the start of a “time out” to set the intention of the procedure and obtain the attention of staff involved in the procedure.

My colleague Erica Brenckle and I both graduated from the Holistic Nursing Intensive Program offered through St. John Providence Hospital in Southfield, Michigan. We were educated on different holistic modalities that we have been utilizing in our cath lab, such as aromatherapy, mindfulness, and setting intentions. We were also taught the history of Tibetan gongs. When the gong is struck, it symbolizes the beginning of a spiritual event, such as prayer, meditation, or a ceremony. The energy and vibration that forms when the gong is struck clears the mind, enhances focus, and connects with the energy in the room.

Our department was challenged on properly performed time outs. We struggled with obtaining all the staff’s attention during the time outs. Erica and I came up with the idea of incorporating the Tibetan gong in order to help ease the challenges of the time outs and incorporate the intention setting.

St. John Hospital Macomb Center was recently surveyed by a mock Joint Commission inspector. One of the “best practice” identifiers was the use of the gong in the cath lab. The surveyor stated that she was going to share our idea with other hospitals.

With the support of the staff in the cath lab, my manager Kathy Budka and director Anne Marie Kaminski, along with the guidance of the St. John Providence holistic nurses, Surita Sieben, Peggy Vandenhemel, Vicki Boyce, and Mary Natschke, we were able to incorporate a best practice for time outs. My intention of writing is to inform you of this practice in order to help other facilities with the challenges of time outs.

Thank you!
Delia Gealer, RN, BSN
St. John Macomb Hospital
Warren, Michigan

Q&A from CLD 

Where did you buy the gong?

Our cath lab purchased the gong through Staples.

Who is in charge of striking the gong before the time out?

The cath lab staff member who is monitoring and recording the case performs the time out, which begins with a gong strike.

How was this concept introduced to the team? Do you have any written materials you used during that process?

Erica Brenckle and I held a staff meeting and informed the cath lab team members about the gong. We informed the staff about the history of the Tibetan gong and how it is used in ceremonial practice. We also included information that we learned in our holistic nursing intensive class and provided the team with web links on the use of Tibetan gongs, including:

•     https://www.delamora.life 

    Personal transformation through the power of a gong bath meditation.

•     https://www.chopa.com 

    Meditation gongs.

•     https://www.aumamen.com

    The scientific reason behind bells in Hindu temples.

If a lab would like to implement a practice of using a gong to begin their time out, what do you recommend?

I would recommend an informational meeting for ALL staff members regarding the history and use of the Tibetan gong. This includes administration, physicians, and clinical personnel. I would also recommend being patient. The gong is not a traditional process used in the cardiac cath lab and some staff members were hesitant. St. John Providence Hospital supports holistic nursing and incorporates the work of nursing theorist Jean Watson. Once the staff members had a thorough explanation of the gong and witnessed its use, the team was more compliant.  

If you have any further questions, please feel free to contact me.

Thank you!
Delia Gealer, RN, BSN, Cardiac Cath Lab, 
St. John Macomb Hospital, Warren, Michigan
Tel. (586) 573-5132 
delia.gealer@stjohn.org