Caring for Caregivers in the Aftermath of Trauma
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1 Caring for Caregivers in the Aftermath of Trauma Beth A. Lown, M.D. Medical Director, The Schwartz Center for Compassionate Healthcare Associate Professor of Medicine, Harvard Medical School
2 Goals Acknowledge that, to care for and heal others, we must tend to the stress, pain and suffering that caregivers witness and experience daily Discuss a multidisciplinary forum to support caregivers in their work, the Schwartz Center Rounds Discuss evidence that compassion for caregivers and staff translates into compassion for patients and families
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4 Kenneth Schwartz
5 Schwartz Center for Compassionate Healthcare Mission To promote compassionate care so that patients and their caregivers relate to one another in a way that provides hope to the patient, support to caregivers and sustenance to the healing process.
6 Schwartz Center Rounds 450 sites in the US, UK and Canada
7 Schwartz Center Rounds Goals Provide a safe forum to discuss the psychosocial, emotional issues that arise during the care of patients, and their impact Provide and receive support Facilitate the expression and understanding of multiple perspectives across disciplines and professions Model behaviors of nonjudgmental listening and respect Return with renewed compassion and insight to the patients we serve
8 Trading places: Caring for an ill colleague Great expectations but whose? Death foretold: Coping with genetic abnormalities Trading places: When you become the patient I disagree but can I say so? Lost in translation: Caring across cultures Competency and capacity: Whose agent are we? When your best isn t good enough for the patient Sailing through the perfect storm I want you to do everything! : Coping with moral distress When a child dies Celebration of life
9 Transporter Schwartz Center Rounds
10 Aurora, Colorado, July 20, 2012 Aurora, Colorado, July 20, 2012
11 San Francisco, July 12, 2013
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13 Boston Marathon, April 15, 2013
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17 In the aftermath of violence: Caring for others, caring for ourselves Continuing distress Guilt over not having done enough Administrative betrayal Collaboration and teamwork Strategies for healing Positive reverberations
18 Caregivers suffer emotional risk Burnout (30% 60%) Physician suicide ( 130%> ; 40%>population) 2 trauma Moral distress Exposure to abuse, disrespectful behaviors 1 Wallace JE, Lemaire JB, Ghali WA. Lancet 2009;374: Schernhammer E. NEJM 2005;352:
19 Schwartz Center Rounds: Dose response among attendees Patient Interaction Scale Teamwork Scale Lown BA, Manning CF. Acad Med. 2010; 85:
20 Impact of Schwartz Center Rounds on caregiver distress 20
21 Compassion for employees correlates with Compassion Practices Scale Recognition programs to reward employees for caring shown to patients and families Recognition programs to reward employees for helping one another Compassionate caregiver awards Counseling, pastoral care Support sessions to help employees deal with workplace stress, trauma, conflict, crises patients experiences Results from 269 hospitals: In all regressions, compassion practices remained positively and significantly associated with HCAHPS ratings and likelihood to recommend the hospital, even after including robust control variables that capture technical quality of care (e.g. readmissions) and quality of organization (e.g. Magnet status) McClelland L, Vogus T. Health Serv Res. 2014; 49:
22 One year later: Moving forward with healing and renewed compassion Apprehension Healing and moving forward Drawing strength from the survivors
23 Marathon Rounds: Caregivers reactions Rounds provided opportunities for caregivers to: Share coping strategies, pathways to healing Gain new insights into colleagues perspectives, experiences Celebrate their own strengths and strength derived from community Feel less isolated as they coped with their responses Be more open to expressing thoughts, questions, feelings about patient care with colleagues in the future
24 As we are treated, and as we treat each other and ourselves, so shall we treat our patients and their families
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27 Know that compassion is multidirectional
28 Compassion is good medicine Compassion heals those who are distressed and suffering It reminds us why we chose this work and creates a sense of purpose Compassion nurtures our wellbeing and the wellbeing of those we serve Compassion reminds us of our common humanity
29 Love and compassion are necessities not luxuries. Without them humanity cannot survive. His Holiness, the 14 th Dalai Lama
30 Beth A. Lown, M.D. Medical Director, The Schwartz Center for Compassionate Healthcare
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