ppasue.pptxppasue.pptxppasue.pptxppasue.pptx

ppasue.pptxppasue.pptxppasue.pptx

1. Manuscript “Sacred Pause” in the ICU Evaluation of a Ritual and Intervention to Lower Distress and Burnout

2. Background Increased exposure to deaths in the intensive care unit (ICU) generate grief among ICU staff, which remains unresolved most of the time. Unresolved grief becomes cumulative and presents a risk factor for burnout. “sacred pause” is a ritual performed at patient’s death to honor the lost life and recognize the efforts of the health-care team.

3. Objective and methods To study the impact of the ritual of sacred pause on the attitudes and behaviors of the ICU physicians and nurses. ** Ten-question online anonymous survey was sent to ICU physicians and nurses in the medical ICU of a tertiary care hospital in July 2017

4. Resultand conclusion Results: Thirty-four ICU team members completed the survey including 12 physicians and 22 nurses. Seventy sacred pause rituals were performed from July 2016 to June 2017. Seventy-nine percent respondents believed that the ritual brought closure and helped them overcome the feelings of disappointment, grief, distress, and failure after the death of their patient in ICU. Seventythree percent agreed that the ritual has instilled and encouraged a sense of team effort. Eighty-two percent responded that the ritual makes their efforts feel appreciated. Many felt that the ritual should be a universal phenomenon in all ICUs. Only 55% respondents felt that the practice has a potential to decrease ICU burnout, many of them (42%) were undecided. Conclusion: Sacred pause brings closure, prevents cumulative grief and distress, builds resilience, promotes team effort, and improves professional satisfaction of ICU team. It may lower burnout syndrome in ICU, but further studies are warranted.

5. Why to do pause ? ** death is a common phenomenon in the ICU, increased exposure to unexpected patient deaths, prolonged dying patients, and actively grieving families generate overwhelming feelings of grief and loss among the ICU staff, especially the nurses.2,3 The fast-paced ICU environment and workload limit the time available to the ICU staff to grieve and emotionally process the death of their patient, often leading to their feelings going unrecognized ** , there is no formal training for critical care professionals regarding strategies to deal with grief

6. Others researshes about death in icu Naidoo and Sibiya studied the experiences of critical care nurses in dealing with death and dying in the ICU.5 They found that death takes a huge emotional toll on nurses and spirituality places an important role in coping. A literature review by Wilson and Kirshbaum concluded that death in ICU affects nurses both in and outside of the ICU environment.2 Shorter and Stayt studied critical care nurses’s experiences of grief in adult ICU and concluded that repeated exposure to death and grief may lead to occupational stress and ultimately burnout.6 The nurses may develop compassion fatigue and emotionally dissociate themselves from dying patients and their families.6

7. Its bring closure , what is closure? “Closure” describes completion of a grieving process and may be achieved by attending funerals and services, sending condolence cards, or talking to bereaved families.23 Closure brings a sense of resolution but it is difficult to achieve with every death in healthcare setting, especially in ICU. Multiple other strategies at organizational and personal levels have been utilized to help ICU staff in the grieving process like creation of “grief support groups,” “bereavement debriefing sessions,” personal counseling , education of staff around grief theory, self-care, spirituality, relaxation techniques like yoga, meditation and music, maintaining work–life balance, and so on.24-36 Mindful selfcare has shown to improve professional satisfaction and lower burnout rates among hospice care professionals.36

8. How pasue started? The practice of “pause” was first initiated by an emergency department nurse at University of Virginia Medical Center to honor and recognize the lost human life and acknowledge team’s efforts to save the patient.37 This practice brought “closure” to the team taking care of patients in the emergency department. Since then, many institutions have adopted the practice of pause, but none have studied its impact on ICU staffs’ attitudes and behaviors .

9. Now according to the study : We adopted the similar practice at our institution in all ICUs starting July 2016 with the support of spiritual care department and named it “sacred pause.” The objective of our research was to study the impact of the practice of sacred pause on the attitudes and behaviors of ICU physicians and nurses in the 18-bed medical ICU

10. How ? The chaplains are present 24 hours in our hospital, and the practice was performed anytime death occurred, be it day or night. After the death of an ICU patient, the primary nurse or the in charge nurse called the chaplain who usually led the sacred pause ritual. The ritual was explained to the deceased patient’s family who had an option to decline conduct of the ritual. Permitting no other emergent ICU issues, the sacred pause was attended by ICU team including physicians (attending, fellow, resident), nurse practitioners, physician assistants and ICU nurses (primary nurse and other nurses), respiratory therapist, chaplain, and deceased patient’s family. The chaplain or a nurse would start by thanking and acknowledging the efforts of the ICU team and patient’s family and honor the life of the patient who just died. The team would observe 45 seconds to 1 minute pause after that. The team would thank each other and family for their efforts and return to their assignments.

11. Result : The online survey was completed by 12 full-time ICU attending physicians and 22 full-time ICU nurses (response rate of 89%) working in the 18-bed medical ICU of Baylor St Luke’s Medical Center in the month of July 2017. Of 78 deaths in the medical ICU over 1 year (from July 2016 to June 2017), sacred pauses were performed in 70 of them. There was 100% staff retention (nurses and physicians) over the study period. Fifteen respondents (ICU attendings and nurses; 44%) had up to 5 years of professional experience outside of fellowship and nursing trainings and 19 (56%) with more than 5 years of professional experience working in the critical care setting

12. in the language of number: e 1. Seventy-nine percent respondents believed that the practice brings closure and has helped them overcome the feelings of disappointment, grief, distress, and failure after the death of their patient in ICU. Seventy-three percent felt that the practice has instilled and encouraged a sense of team effort among the ICU team. Eighty-two percent responded that the practice makes their efforts feel appreciated. Seventy-three percent felt that the practice has improved their professional satisfaction. Eightyfive percent felt that the practice of sacred pause should be a universal phenomenon in all ICUs. Only 55% respondents felt that the practice has a potential to decrease ICU burnout, many of them (42%) were undecided. Most (70%) were of the belief that the practice has helped their bodies handle stressful situations in ICU better. Referral to table 1 and 2 In the study for more info

13. Conclusion In conclusion, the ritual of sacred pause brings closure, prevents cumulative grief and compassion fatigue, promotes compassion satisfaction, builds resilience, promotes team effort, and improves ICU work environment and overall professional satisfaction of team. Adoption of this ritual can improve ICUs’ overall well-being. Further studies looking at validated measures of burnout are warranted, but the ritual has a potential to decrease burnout when used with other key interventions