Compassionate care supports patients and caregivers.

Takeaways:

• Compassionate care promotes hope in patients and supports caregivers.
• Schwartz Rounds^® provide a structured forum for members of the interprofessional healthcare team (clinical and nonclinical) to share their vulnerability and openly discuss their feelings about working in healthcare in a judgment-free environment.
• Self-care is considered a core value of holistic nursing, tending to the body, mind, and spirit.

Ana* is an experienced nurse working in an urban intensive care unit. She’s worked 40 hours, rotating between days and nights, for 32 years. In the past 2 months, she’s cared for more than 18 young adults who’ve been injured or died from gun violence. Ana is emotionally exhausted and wonders why she still works at the bedside.

Jackie keeps asking herself: “I was hired as a nurse on an oncology pediatric unit. What did I expect? I knew it wasn’t going to be easy, but I can’t bear to watch one more child die of cancer. My heart physically aches for the children and the parents. Am I the only one who feels like this?”

James has been an emergency department nurse for 1 year. He just participated in his first major trauma in which four college students died in a head-on car collision. All four families gave permission for organ donation. James is feeling shell-shocked, emotionally drained, and overwhelmed.

Peter has just completed a 36-hour shift on a medical-surgical unit. Patient acuity is higher than usual, and a new electronic health record was just adopted. Peter leaves work feeling as if he missed key components of documentation and that he didn’t spend enough time with his patients.

Nursing is one of the most trusted, diverse, and rewarding professions, but it’s also one of the most demanding (physically, mentally, and emotionally) and can even be dangerous. Nurses are at the bedside with patients and families during difficult times, and we frequently bear the burden of a complex healthcare environment. Theoretically, we know that properly caring for patients and families (and sometimes colleagues) requires us to take care of ourselves. But how many nurses actually put themselves first and practice adequate self-care? Do you?Do you bring your best to work with you every day?

Self-care

If you’ve ever flown, you know that the first rule in an emergency is to place the oxygen mask on yourself before you attempt to assist someone else. The same rule should apply to nurses. Proficient self-care is a delicate balance of your personal and professional life in a way that nourishes your body, mind, and spirit. Here are a few examples you can implement into your self-care regimen:

• adequate sleep (6 to 8 hours per night)
• proper nutrition
• stress-relief activities (meditation, listening to music, reading, yoga)
• effective time management
• regular exercise (walking, running, stretching, weight lifting, cycling)
• pampering activities (manicures, massages, facials)
• spiritual practices (worship services, meditation, gratitude)
• laughter and time with friends and loved ones
• Schwartz Rounds.

Schwartz Rounds: The ultimate self-care gift

Schwartz Rounds were created as a result of one man’s courageous battle with cancer and the legacy he left behind: A legacy that honors the four characteristics of compassionate care: relationships based on empathy, effective communication, respect for patient and family participation in care, and knowledge of the patient as an individual. (See Schwartz Rounds legacy.)

Relationship-based care (RBC), as defined by Creative Health Care Management,is composed of three pivotal relationships: caregiver to patient/family, caregiver to colleagues, and caregiver to self. The basic principles of RBC (and important goals of Schwartz Rounds) promote caring and healing environments and are the underpinnings for every team member’s ability to provide high-quality compassionate care.

A strong relationship exists between the well-being of a caregiver and that of his or her patients. In the current healthcare environment, few organizational interventions exist that actually tend to the emotional needs of staff. Schwartz Rounds provide a safe environment in which caregivers can openly discuss the difficult emotional and social issues they face as a direct result of caring for others. What better place to have an open dialogue about these stressors than right where they originate?

Nurses who’ve participated in Schwartz Rounds report several benefits:

• increased ability to give support and receive it from others
• improved teamwork and appreciation of others’ roles
• more effective communication
• improved interdisciplinary collaboration
• increased retention rates
• better patient experience
• increased patient/family well-being
• increased patient/family and staff satisfaction scores
• decreased feelings of anxiety, stress, and isolation
• increased appreciation and understanding of the emotional impact of patient care on caregivers.

Many participants express feelings of relief, inclusion, and support. Sharing your feelings and fears is a healthy self-care practice, and listening to and expressing shared emotions exemplifies care for your colleagues. Schwartz Rounds supports a healthy work environment and is the greatest self-care gift that an organization can invest in.

Overcoming obstacles to Schwartz Rounds

Although Schwartz Rounds provide many benefits, real and perceived obstacles exist, including:

• administration/risk management hesitancy to invite public sharing of sensitive cases
• Schwartz Rounds membership fees to access training and other resources
• organizational delivery care model that doesn’t promote rounds
• staff unwillingness to share their feelings for fear of being judged
• discomfort with public speaking
• risk of individuals monopolizing the conversation
• lack of trained facilitators
• lack of engagement and an attitude by staff that they don’t have the time
• benefits unknown to potential participants
• historical failure to practice self-care.

Overcoming these challenges requires strategies that promote attendance. Some options include alternating staff attendance, additional staffing, managerial assignment coverage during Schwartz Rounds, or authorized payment for attendance. Any monetary investment is rewarded with staff retention.

Personal and professional obligation

When organizations embrace RBC and Schwartz Rounds, they’re positioned to enhance their ability to deliver high-quality compassionate care while supporting caregivers.

Schwartz Rounds have been successfully implemented internationally and are considered an exemplar in the provision of compassionate care and healthcare worker support. If you’re fortunate enough to work in an organization that promotes and conducts Schwartz Rounds, love yourself enough to attend. If not, work with your leadership to implement them in your organization. Schwartz Rounds are the ultimate self-care gift. You owe it to patients and families as well as to yourself.

Susan A. Goncalves is an assistant professor of nursing at Sacred Heart University College of Nursing in Fairfield, Connecticut. 

*Names are fictitious.

Selected references

Chadwick RJ, Muncer SJ, Hannon BC, Goodrich J, Cornwell J. Support for compassionate care: Quantitative and qualitative evaluation of Schwartz Center Rounds in an acute general hospital. JRSM Open.2016;7(7): 2054270416648043.

Halm M. The role of mindfulness in enhancing self-care for nurses.Am J Crit Care.2017;26(4):344-8.

Koloroutis M, Manthey M, Felgen J, et al. Relationship-Based Care: A Model for Transforming Practice. Minneapolis, MN: Creative Health Care Management; 2004.

Koloroutis M, Abelson D. Advancing Relationship-Based Cultures.Minneapolis, MN: Creative Health Care Management; 2017.

Lown BA. Mission critical: Nursing leadership support for compassion to sustain staff well-being. Nurs Adm Q.2018;42(3):217-22.

Lown BA, Dunn H, Muncer SJ, Chadwick R. How important is compassionate healthcare to you? A comparison of the perceptions of people in the United States and Ireland. J Res Nurs. 2017;22(1-2):60-9.

McClelland LE, Gabriel AS, DePuccio MJ. Compassion practices, nurse well-being, and ambulatory patient experience ratings. Med Care. 2018;56(1):4-10.

Robert G, Philippou J, Leamy M, et al. Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009–2015. BMJ Open. 2017;7:e014326.

Schwartz Center for Compassionate Healthcare. Schwartz Rounds. theschwartzcenter.org/supporting-caregivers/schwartz-center-rounds

Thompson A. How Schwartz rounds can be used to combat compassion fatigue. Nurs Manag (Harrow).2013;20(4):16-20.