Rhae Newbill held up her hand to silence the more than 60 students packed in a room at Rustburg Elementary School.
The Centra nurse wanted to show these second-, third- and fourth-graders a neat trick — how to see their heart beat. The children doubted she could pull off such a feat.
Armed with a mini marshmallow on the end of a toothpick, Newbill placed the marshmallow on pulse point on her wrist and the toothpick ticked from side to side in time with the beating of her heart. Then the children got to try it on their own wrists.
The exercise is one Newbill and fellow nurses Kristie Napier and Toni Elkins use to help children understand the role of the heart in the body as they show the children to CPR. The goal is to introduce the concept in hopes that if these children are ever faced with an emergency, they will act.
“I think the more exposure you give to kids as they grow, the less scared they will be,” Newbill said. “One of the barriers we find in that situation is people are scared to do anything or they are scared they won’t do it right or they’ll mess up.
“So part of our goal when we go out and teach CPR is to tell people that you can’t do it wrong. The only way to do it wrong is to not do anything at all. …When you start young and put a little impression on them a little at a time, they won’t be so scared when they finally hit adulthood and, Lord forbid, it happens.”
Newbill’s career as a medical ICU nurse got her thinking about ways to improve outcomes for her patients. The best way is for the patient to get good CPR in the initial moments of an emergency, but few people go into cardiac arrest with a trained nurse at their side.
Teaching community members to perform CPR can get that life-saving care to a patient in the initial moments of an emergency. CPR certification, however, costs upwards of $60 and very few people need certification for their employment.
So, Newbill organized a cadre of ICU nurses who volunteer to provide free CPR training to anyone who asks. The training does not provide certification but does give people the necessary skills to save a life.
On a Friday in October, Newbill, Napier and Elkins introduced more than 200 children to CPR using the marshmallow trick, CPR mannequins and a video demonstrating proper technique using characters from “Star Wars.”
Why “Star Wars?” Because the “Imperial March” song is paced at 104 beats per minute, the proper speed at which to perform chest compressions.
Napier talked to the students about important functions the heart performs as she and Elkins coached them through CPR.
“We’re going to push 100 times,” Napier said. “How are we going to do it? We’re going to go at it hard and fast. We’re going to push hard and fast to give the brain what?”
“Sugar and oxygen,” the children replied.
“Before we do that, who are we going to call?” Napier asked. “Not Ghostbusters. Who are we going to call?”
“9-1-1!” the children scream.
Newbill has spent most of her 12-year career in the medical ICU. The idea to start the classes began after she attended a conference on improving CPR in the hospital setting.
“So we tried to figure out how to go out into the community and teach the community CPR so that when somebody does fall out they have somebody there that does know what to do,” she said.
The barrier she found to widespread CPR training is cost. To get over that hurdle, the nurses teach what’s called Family and Friends CPR through the American Heart Association.
“We build it to whatever their needs are,” Newbill said.
The nurses teach CPR on a volunteer basis. In two years, they have taught more than 60 classes, helping about 700 people how to perform CPR.
Centra provides the mannequins, which take about an hour to set up for the two-hour adult class. They have taught in churches, homes and schools — they just need a little space and a television to run an American Heart Association DVD.
“In the medical ICU, one of our primary patient populations is cardiac arrest,” Newbill said. “And so for us, it’s a way of trying to help that family and that patient before they ever come to the ICU. … We are patiently waiting for somebody to come in and say, ‘I’m alive because you taught my wife to do CPR, or so-and-so did CPR on the street and they learned if from you all.’
“That hasn’t happened yet, but hopefully one day.”
In her nomination of Newbill to The News & Advance, nurse Betty Kerr wrote Newbill received the Circle of Excellence Award from the American Association of Critical Care for the community CPR classes.
Newbill’s work in the medical ICU also has led to several initiatives to help patients suffering the effects of post-ICU syndrome, similar in symptoms to post-traumatic stress disorder.
To help a patient understand what happened while in the ICU, Newbill got together a group of nurses in 2014 to start journals. While families are encouraged to write in the journals, the staff also writes in them.
“The idea is when the patient is discharged, maybe they were sedated and on life support and don’t remember anything; they are able to read it if they want to,” she said. “If the patient is not able to leave the ICU, the families get to take the journal and keep it as a keepsake.”
Newbill’s brother died of a traumatic brain injury while she was in nursing school. Her mother, Bonita Smith, started a journal for those who visited to share thoughts and memories. Smith, also a nurse, still has that journal and said it brings her comfort.
The journal helps patients fill in missing chunks of time and sort through jumbled memories, she said.
Newbill also helped start a support group, which began in April, for former ICU patients and their families.
“Some have been fresh out of ICU and some have been out for 11 years, so they know what it’s like to have the recovery at home,” she said. “… They are able to meet together and share their experiences. The hope is this will be a steady group of people that are there and willing to help other people who have experienced these things.”
Newbill attends to address questions about what may have happened at the bedside, but she also represents someone who has lost a loved one in the ICU.
Some patients, Newbill said, have difficulty sorting through false memories they may have from their time in the ICU.
Newbill gave the example of the support group leader, who spent time at the Virginia Commonwealth University Medical Center’s ICU. He had a memory of a helicopter coming in and dumping toxic sludge that filled his room. The hospital staff, he thought, was afraid to come in and he believed everyone was going to die while he was stuck helplessly in the bed.
What actually happened was he was in a part of the hospital where the helicopters landed; medical staff likely was standing outside his door discussing his case, and news coverage on the television talked of a fatal disease. Because of the medications, it all twisted in his mind.
“It’s a memory but it’s not a true memory,” Newbill said. “That’s why we write in the book, ‘Today you were on the breathing machine and we took you to radiology, so you might remember getting placed on a stretcher and remember going through a cold hallway.’”
In addition, the nurses are establishing a post-ICU clinic for patients to receive extra help with physical or mental health needs that arise after the patient goes home. The referral clinic pairs patients with support one month after release of the ICU, regardless of whether they were hospitalized in a Centra facility.
Her desire to help doesn’t end with her work in Lynchburg.
At the end of November, Newbill traveled to Rwanda with a group of doctors and nurse practitioners for 10 days to help teach physicians how to care for critically ill patients in the first 24 hours of an illness or injury. She also has worked with Gleaning for the World to provide donated medical supplies to places in need.
For Newbill, her mother’s example coupled with the loss of Newbill’s brother, shaped her career and volunteerism. It helps, she said, that her husband is supportive and helps pick up the slack a home so she can help her community.
“So all this stuff … is basically just my way of giving back, just knowing what it’s like to be the family member and see the patient from a different side than just being a patient,” she said.
Newbill recalled an incident from her childhood, where a driver backed into a UPS deliveryman, pinning him against his truck. Her mother jumped out to help and Newbill directed traffic.
“I guess that was my first exposure to a critical situation,” she said. “I knew that was what I wanted to do.”
Smith recalled something different about the incident. Her daughter jumped up to help when others didn’t.
“Everybody else was just gawking at what was going on and she just goes out and starts directing traffic,” Smith said. “She didn’t say, ‘What can I do?’ She went out and did something.”