It’s not only patients and their families who are overwhelmed by end-of-life and intensive care situations. Nurses and other healthcare providers suffer, too, but they might not have a forum to discuss their feelings.
To answer this need, Overlook Hospital, Summit, New Jersey, has instituted multidisciplinary Schwartz Center Rounds, the signature program of the Boston-based Kenneth B. Schwartz Center that can be found in hospitals across the U.S. At these rounds, caregivers from diverse disciplines — nurses, physicians, clergy, and social workers — talk about and reflect on the emotional side of patient care, something that they don’t usually get a chance to do at end-of-shift reports or staff meetings.Kathy Leifeste, RN
Tracey Apgar, RN, BSN, CNRN, CHPN, recalls a case in which nurses had a difficult time with a patient’s withdrawal from artificial life support. Apgar, a Neurointensive Care Unit and Palliative Care nurse at Overlook Hospital, who was this patient’s bedside nurse, gathered information about who the patient was before she was hospitalized and presented it at the rounds.
“The nurses were having a hard time; I used the case as a debriefing tool, so that they could better understand the personhood behind this patient. Sometimes, we only see the person in the bed, and when you learn about what made that person a human being, it’s easier to understand why things happen the way they do,” Apgar says. Other frequently discussed issues are patients and death and when family and patient wishes on life and death matters are not congruent.
Anatomy of a Schwartz Round
In part, the Schwartz Rounds are multidisciplinary so that each profession learns to respect and support other members of the healthcare team, according to Jeanne Kerwin, DMH, coordinator of Ethics and Palliative Care, Overlook Hospital. “We sit around in a circle and have a physician leader who introduces the topic and the goals of the day. As the facilitator, I go over the ground rules,” Kerwin says. Ground rules for the rounds include confidentiality; the meeting focuses on sharing feelings and offering support, not finding solutions to problems.
Then, someone presents a case. “It’s usually a five-minute scenario of a difficult situation or something that made that person very sad or gave him or her joy. Then everyone at the meeting joins in the discussion,” Kerwin says. Staff members are usually invited to attend if they are connected to the case being discussed, but anyone can join the meeting, and attendance is voluntary.Tracey Apgar, RN
Kathy Leifeste, RN, MSN, AOCN, Overlook’s Oncology nurse educator, says that although many of the cases are from Oncology, they can originate from other units of the hospital. Regardless of the type of patient, she says, there are similarities in care and understanding. “Once a month at lunchtime, as part of the rounds, we meet and discuss a particularly difficult case for the staff to handle, such as continuing with treatment when you feel it is futile — issues that people struggle with,” Leifeste says. It is not a forum for people to offer advice, because there is no right or wrong; rather, it is a discussion, Leifeste says.
The lasting effects
The nonprofit Kenneth B. Schwartz Center recently commissioned a third-party evaluation of its signature rounds, which, according to the group’s press materials, are conducted regularly at 140 healthcare facilities in 27 states.
The survey of about 500 rounds attendees at 16 hospitals, including Overlook, revealed that staff around the U.S. finds them valuable, both personally and professionally. The findings showed that —
86% reported that rounds made them more likely to consider the effects of illness on the personal lives of their patients
84% reported that rounds have helped them have more compassion for patients and their families
84% reported that rounds have helped them feel more energized about their work with patients
93% reported that they have a greater appreciation for the roles and contributions of colleagues from other disciplines
88% reported feeling a sense of belonging to a caregiving team
76% said they feel less alone in their work with patients
According to the Kenneth B. Schwartz Center national survey, rounds encourage a culture of teamwork and have spurred program changes; for example, including greater use of palliative care teams and changes in nursing care in the ICU.
The opportunity is invaluable for nurses, and it’s not hard to implement, says Leifeste. She suggests that hospitals could try them initially on a quarterly basis. “It’s important to talk about how difficult it was to care for a patient, because sometimes when you’re running around or working in the moment, you just can’t talk to people about it. It helps us to examine where we are when issues occur and that helps us, perhaps, to be more ready for future situations that are similar,” Leifeste says.
“The rounds are a learning and caring tool for the staff. It’s a communication forum for us — almost a support group. These rounds help nurses to continue to be caring and empathetic people,” says Apgar.
For more information, contact Jeanne Kerwin, DMH, coordinator of Ethics and Palliative Care, Overlook Hospital at: (908) 522-5329, or Kathy Leifeste, RN, Oncology nurse educator, Overlook Hospital, at: (908) 522-2230.