NEW YORK NURSE: April 2008
by Joely Johnson
Hospitals and other healthcare facilities are not usually the setting for heart-to-heart talks among professional caregivers.
In fact, during a shift, asking fellow nurses how they feel about a particular patient or talking with a doctor about the emotional aspects of a case may be seen as a waste of precious time.
But even the best practitioners are often unprepared for how challenging and isolating the non-clinical aspects of patient care can be. And acknowledging the personal impact of professional caregiving is important. “Patient care can take its toll,” says Michael Chacon, nursing representative at Maimonides Medical Center in Brooklyn. “It can be hard for nurses and others to identify with difficult cases. So you may wind up not becoming attached to your work at all.”
Meetings called Schwartz Center Rounds were created to provide a safe outlet where caregivers can share their feelings with colleagues. Unlike most traditional rounds, Schwartz Rounds are not about medical solutions or what could have been done differently. The informal, hour-long conferences with chairs set “in the round” are multidisciplinary and institution-wide. All employees, from nurses and doctors to chaplains, librarians, and students are welcome to hear about and relate emotionally to the tough cases that “land right on you,” as one attendee put it.
These deeply personal and honest conversations help caregivers nurture compassion about their work. This can be particularly important for nurses. “RNs are closest to the patient’s experience because they spend so much time directly attending to the patient’s needs,” said Alan Astrow, Schwartz Rounds physician leader at Maimonides. The Rounds offer more than emotional catharsis, however; they also foster communication between RNs and doctors, which improves patient care. “If physicians don’t listen to nurses,” continued Astrow, “they will not have a complete picture of that patient and that patient’s illness.” Rounds are about engaging with what other caregivers are going through in order to get a better understanding of the patient care situation.
A powerful Schwartz Rounds was held at Maimonides in early March. A small panel consisting of an RN, a patient representative, and a resident presented the tragic case of a young woman’s low-risk pregnancy that resulted in a stillbirth. The lunchtime event was standing-room-only, with more than 150 hospital employees including physicians, nurses, social workers, psychologists, physical therapists, and others in attendance. On flyers announcing the meeting, the topic was listed as “When the Unthinkable Happens Right Before Our Eyes.”
Bethann Olsen, a labor and delivery charge nurse, was closely involved in the case and presented at the Rounds.
She described her experience this way: “The nurses had a very primary role in the resuscitation of the baby, which lasted about 30 minutes. Everyone was very stressed and very sad. The hardest part for me was preparing the baby’s body and taking photos of a little girl who looked like she was sleeping. Emergencies happen all the time, but we are not used to results like that.”
Patient representative Malkie Gips explained how difficult the case was for the caregivers. “We are human. We did act professionally, but we also let our emotions show. This is extremely hard for professionals and we need to help each other develop coping skills for the future.”
Attendees then shared their own thoughts and feelings. As the conversation warmed, a number of women in the room told poignant stories of pregnancies or children they had lost. Their stories showed how the care they had received either helped or hurt their emotional healing. One said to the presenters, “I salute you for allowing this mother to hold her dead child. I am so glad that we can learn a better way to care in this kind of situation.”
In cases with unexpected negative outcomes, often no one can believe that they didn’t do anything wrong. The sense of team effort can transform into a feeling of team failure. Schwartz Rounds are a place to air these disappointments without fear of judgment and to receive support from others who have been there before. “I thought it was an excellent give-and-take for everyone involved,” said Grace Katen, Maimonides surgical nurse who presented on a hostile family situation at the facility’s first Rounds in January. “The Rounds helped.”
Topics discussed vary with the case presented and have included pain management for addicted patients, delivering bad news, healthcare team conflict, and care of the elderly, among other sensitive themes. To view a 10-minute video of actual Rounds that took place at two Massachusetts hospitals, go to www.theschwartzcenter.org/programs/rounds.html.
The Schwartz Rounds exist because of one man’s illness and death. In 1995, father, husband, and healthcare attorney Ken Schwartz wrote, “I cannot emphasize enough how meaningful it was to me when caregivers revealed something about themselves that made a personal connection to my plight. It made me feel much less lonely. The rule books, I’m sure, frown on such intimate engagement between caregiver and patient. But maybe it’s time to rewrite them.” Schwartz had been diagnosed with lung cancer at age 40 in November 1994. Just days before his death in September of the following year, he founded the Kenneth B. Schwartz Center at Massachusetts General Hospital.
Through its various programs, the Schwartz Center is dedicated to humanizing the relationships between patients and caregivers. The Schwartz Center Rounds do that by providing a place for caregivers to receive the supportive feedback and encouragement necessary to practice compassionate health care. “The Rounds put people on a level playing field. Caregivers realize they are not alone when they deal with difficult issues,” said Marjorie Stanzler, director of programs for the Schwartz Center.
According to a recent survey of Rounds participants, nearly all respondents said the experience had positively influenced their attitudes about patient care. And most of those who have attended Rounds said they felt more compassion and had more energy in their relationships with patients and families. Rounds were shown to help counteract the pressures to approach patient care as a business and reminded professional caregivers that they are human. All of these insights enable practitioners to better empathize with one another and, ultimately, with their patients.
Currently, four NYSNA facilities participate in Schwartz Rounds, all located in the metropolitan area. Any employee who has contact with patients is welcome to attend. If you work at one of the facilities listed here, watch for notices of time and location of the Rounds. You can also look for someone at your facility wearing a button that states, “Ask Me about the Schwartz Center Rounds.”
The Center is eager to see the Rounds spread to even more locations, particularly in New York State. If you are interested in starting Rounds at your facility, you’ll need to take a number of preparatory steps, including securing permission and guidance from the Schwartz Center. The setup process can take three to six months to complete. The non-profit Center provides plenty of support, including funding for the first year, and stays involved once Rounds are in place.
To learn more about bringing Schwartz Center Rounds to your facility, contact Marjorie Stanzler, director of programs for the Center, at 617.726.0914.