A 6-year-old child is struck by a car and rushed by ambulance to the emergency room. Extensive efforts to revive the child barely succeed, and he's transferred to the ICU where, days later, it's discovered the boy is brain-dead. Life support is his only reason for being.
One incident attended to by many, including several nurses, including one who has a 6-year-old son at home. His safety she now obsesses over. It is only natural.
"Denying we as humans don't have compassion and feel for other human beings is not good," says Barbara Zenker, a pediatric palliative care and pediatric hematology/oncology clinical nurse specialist at St. Vincent's Hospital in Green Bay. "It's denying what's going on inside."
Situations such as these define the need for spiritual care in a hospital setting, whether those needs are patient-related, patient- and family-related or, in increasing cases — when it comes to compassion fatigue, secondary traumatic stress disorder or burn out — staff-related.
Spiritual needs and religious needs, however, are two very different entities.
"Religious needs to me," says the Rev. Jan Bast-Dalebroux, a chaplain with the pastoral care team also at St. Vincent's, "would be a person's practice of their faith. And the spiritual needs would be emotionally the place they are at and reaching out, or the emptiness, or the desire to have help from their source."
"I kind of look at spirituality as the umbrella over the top of things like religion in a sense that religion is one way people find meaning and purpose in their life," said the Rev. Karin Derenne, director of spiritual services and clinical ethics for Affinity Health System. "But not the only way."
Simple acts of kindness from a nurse contribute to the spiritual component for patients and their families. "It's just human kindness, which we don't get a lot of day-to-day, and when they get that at that time it's very comforting to them," says Bast-Dalebroux, who formerly worked in the brain trauma program at what is now N.E.W. Curative in Green Bay. She made the decision to switch careers and become a hospital chaplain.
Being a hospital chaplain is "a matter of triaging the crises that are present and being appropriately responsive to what the needs would be," adds K.C. Schuler, supervisor chaplain overseeing pastoral care at Appleton Medical Center in Appleton and Theda Clark Medical Center in Neenah. Schuler, who used to work in Chicago, said chances are much better in closer-knit Wisconsin that nurses may have personal connections with someone who knows a particular patient, or even the patient themselves. That makes compartmentalizing one's job and life outside work even harder.
"One of those can knock you flat," says Schuler, who explains there is a continuum of care where staff can be over-involved or enmeshed, or distanced and not engaged. In the middle is professionalism, which is where medical staff should be positioned, but that's not always the case. It is, however, professional reality.
Boundaries are not black and white — they're often gray, says Sandra Wolf, a bereavement coordinator at Froedtert Memorial Lutheran Hospital in Milwaukee, who also is a master's degree nurse with experience in adult education. "I think it goes back to giving people permission to be involved and then giving people permission to try to let it go when they go home. The nurses need permission to not keep hurting for the person they worked with and made a difference in their life."
Some families, Zenker says, you just connect with.
"But you, as a nurse, need to preserve yourself to come back and continue to do what you do. Think about the interventions you are doing with the patients and family. Is it something you could write in a care plan? Is it something the colleague taking over for you could do? If not, then it's crossing a boundary."
Debriefing to get everyone's perspective on a case on an intellectual level as well as a very visceral emotional level also speeds up the recovery process, says Schuler, who also coordinates the in-house Critical Incident Stress Management team at AMC and Theda Clark. The cool thing, he adds, is "our administration has said, 'Yes, we can work through this.' Not all hospitals do."
"We talk about what went good, how do you feel, this isn't fair — all those things," Bast-Dalebroux says. "We provide opportunities where staff can get together at different time slots; a place to safely get those things off their chests. That's part of our job as chaplains."
Froedtert's Clinical Incident Response Team meets with those involved in a traumatic incident either one-to-one or in a group setting. "Part of it is saying, of course you're overwhelmed," Wolf says. "This was a horrible situation. … We also give them permission to compartmentalize it, and help them get better at that so when they go home they have their own losses and joys. And that's tricky; I can't say it's not."
Zenker, who was a bedside nurse for about 10 years, says through the course of her career she learned to compartmentalize. She had to in order to survive. "It became apparent somewhere in my career that I couldn't give everything I had at work and not take care of myself. It wasn't going to happen and I'd have to leave the career I loved.
"Looking back I think the whole spirituality piece is what has gotten me through. In digging into my perceptions and thoughts are related to the meaning of life, and what my role and purpose in this life is, it has helped me preserve myself and continue in my career."
The types of people that go into nursing get their rewards from sharing compassion. But it is a job, and sometimes in, say, a busy pediatric intensive care unit, "you've got a patient that nearly died and you are barely finishing up with that and the ER is calling you with another patient," Zenker adds. "There's just constant turnover and sometimes you're not able to deal with, in the moment, the things you need to."
Wolf was hired as part-time bereavement coordinator at Froedtert eight years ago. The position grew into full-time not only because of the needs of families but also of staff. Wolf offers a behind-the-scenes support role.
"What I've tried to do is be the back-up for nurses and staff, help them know what's best practice; it's best practice for a reason, help them know how important giving compassionate care is and help them with some of the boundaries around that, and help them by reinforcing they are making a difference," Wolf says. "Sometimes it's not about curing it's about caring. … But it hurts to care sometimes, and it hurts to witness the suffering we sometimes do."
Compassion fatigue is not a what if, it's a when, Zenker says.
"It's going to happen. So trying to understand the most current literature out there to prepare ourselves and be knowledgeable about this condition and hopefully prevent our own suffering in caring for others. … Yes, I can understand and appreciate they are going through this difficult time and enduring this suffering, but to remember it's not my suffering. As a compassionate human being I can relate and understand but not take that on as my own suffering. … I as a nurse can't fix everything. And everything in the world is not my responsibility. I have one piece and it's my role to do the best I possibly can in that situation, and beyond that I can't control things."
Nurses — and those who tend to the spiritual needs in a hospital setting — say it's a privilege to walk beside people who are in their darkest times.
"Nurses have the privilege of being there at the beginning and the end," Wolf says.
"People take time to thank us for helping them grieve, which is amazing to me that they would even think of that," Bast-Dalebroux says. "So then we know we made a difference."
"What a gift we have in being able to share that experience with them," Zenker adds. "What a gift it is to be there with those families."
But nurses, doctors and other medical staff need first to take care of themselves.
"When you take off your name badge, you are done with work. Forget about work and go on with your personal life," Zenker says. "When you go off shift, there are other people who can do what you are doing. When you leave the hospital and enter into your personal life, there's no one else that can do that for you.
"You're the only one that can be a mom or an aunt or a cousin. That's where you have to make that break. If you are in your personal life and still thinking about that patient in room 1004 … you are not helping the patient and are only hurting the people you care about the most by not being present for them."
"We need to protect our nurses or we are going to lose them, but we also have to honor how hard this is, yet how special it is," Wolf adds. "And then we'll keep them."
Keeping the workers healthy — physically and emotionally — is critical.
"In the Spiritual Services department at Affinity and throughout the whole system, caring for the spirit is very important to us because if we tend to the meaning and purpose of a person it helps them in their healing and in their return to wholeness," Affinity's Derenne said. "And certainly for some people their religious beliefs are very connected to how they feel and how they return to wholeness in their life. We connect to that piece by virtue of our mission at Affinity ... which is connected to the healing ministry of Christ source |
