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How Schwartz Center Rounds® can help maintain staff wellbeing and quality of patient care

Alison Thompson Royal Brompton and Harefield NHS Foundation Trust 20 December 2013

Alison Thompson, ward sister at Royal Brompton and Harefield NHS Foundation Trust, reflects on how Schwartz Center Rounds® can help maintain staff wellbeing and quality of patient care.

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Three years ago I was approached to join a steering committee which sought to introduce Schwartz Rounds to the Trust.  The committee comprised surgeons, anaesthetists, cardiologists, senior nurses and clerical staff.  As a ward nurse it was felt I may be able to contribute some of the experiences that myself and my front line colleagues had shared.

When I joined the committee, I didn’t know a great deal about Schwartz Rounds, but I soon found out! I was asked to present at the first Round we held and I did so alongside a senior consultant colleague, his specialist registrar and one of the clinical nurse specialists. The Round focussed on our   experience of caring for a young woman who was acutely unwell with limited options for treatment. She was from a very close-knit family, and as a team we worked hard to try and help her.  However, as her health deteriorated it became apparent that she was not going to survive.  The situation was heart-breaking for both her, her family and also the team who were working hard to manage her symptoms. At the Round it was daunting to admit to my colleagues how much I had struggled looking after the patient and her family, how guilty I felt that, despite my best efforts and those of the team, the patient became no better. I also considered myself to be selfish that I sometimes dreaded entering the patient’s room because I found it hard to cope with the emotions of the patient and the family.

The Schwartz Round was the first time I had ever talked about such emotions at work and I was nervous about what people would think.  However, the dialogue that followed showed that many of the 55 staff who attended had also found this case emotionally difficult. Many of the senior clinicians acknowledged how complex the case must have been and appreciated the difficulties we had faced as a team.

At the end of the Round, I was surprised by how therapeutic it was to share my experience with others and realise that I was not alone in struggling to cope with the case. Moreover, it was exciting to observe the increased enthusiasm among my colleagues in the days after the Round.  They commented that they too had found it refreshing to be able express their own emotional challenges while caring for the patient. Equally, I have been fortunate enough to present about Schwartz Rounds at conferences in the UK and overseas to an international nursing audience.  I received fantastic feedback which highlighted that there is a real need for such a forum whereby we can express ourselves in a confidential environment and talk about issues that we tend to avoid.

What I like about the Rounds is that any member of staff, from porters to executive directors, can attend and share their experiences.  A facilitator is required to ensure the Round remains focussed on the emotional aspects of caring and does not become a problem solving exercise. This is important when starting Schwartz Rounds because people are more used to attending meetings whereby outcomes and problem-solving are the focus.

In fact, when starting Rounds, one of the challenges is ensuring staff understand their purpose. A space for reflection and support is so unusual that it is important to communicate succinctly – through the intranet, posters, team cascades, and at the beginning of each session – what Rounds are about and what is involved. It’s also important that senior people champion the Rounds. Our director of nursing and senior medical and surgical staff are on the steering committee. All are very influential, so staff are more inclined to attend. Without that level of commitment, it could be very hard to get Rounds running successfully.

Working with patients, we have all experienced or observed compassion fatigue. The reasons for this are complex and many. However, through better support of colleagues, improved communication and the sharing of experience, staff can be reminded of their value and why they entered a caring profession. Improved staff wellbeing can only be good for ourselves and  our patients.