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The Pause: Why Healthcare Workers Need 45 Seconds After a Code · Banter At The Bedside

• 0:00
  SPEAKER_00: Well, let's just take a minute to pause.
• 0:04
  SPEAKER_06: Um Hey everybody, welcome back to Banter at the Bedside.
• 0:16
  SPEAKER_06: Today we have a fun episode.
• 0:18
  SPEAKER_06: We actually have a hospital chaplain with us who is going to educate us a little bit on a special type of debrief known as the pause.
• 0:27
  SPEAKER_06: This is new for some of us, or maybe we've done it and haven't actually heard it phrases as this actual term.
• 0:33
  SPEAKER_06: So we're gonna be getting some education today.
• 0:36
  SPEAKER_06: As always, this is for entertainment purposes.
• 0:38
  SPEAKER_06: This is not medical advice.
• 0:39
  SPEAKER_06: We don't represent any organization.
• 0:42
  SPEAKER_06: And I'm Kaylee, if you haven't seen us before, and I have Abby with us, who's our other main co-host.
• 0:48
  SPEAKER_06: Hey guys.
• 0:49
  SPEAKER_06: And then we have returning Cody, one of our recurring guests slash co-hosts.
• 0:54
  SPEAKER_06: Yeah.
• 0:55
  SPEAKER_06: And then we have Linda.
• 0:56
  SPEAKER_06: Linda, why don't you introduce yourself and then tell us a little bit about your job?
• 1:00
  SPEAKER_00: Thank you so much, Kaylee, and the rest of y'all.
• 1:02
  SPEAKER_00: I'm excited to be a part of this.
• 1:04
  SPEAKER_00: Uh it's a chance to kind of talk more about what we do and also about the pause, which I'm very passionate about.
• 1:11
  SPEAKER_00: Um but like you said, I am a chaplain.
• 1:14
  SPEAKER_00: I am actually a board-certified chaplain.
• 1:16
  SPEAKER_00: And that means um an at board-certified clinically trained chaplain, and I work in a trauma center.
• 1:23
  SPEAKER_00: And as a board certified chaplain, we are actually just like you have RN and MPMD, I have the credentials of BCC board certified chaplain.
• 1:35
  SPEAKER_00: And we go through pretty much 10 years of education, including residency internship, and we all have master's degrees and um 2,000 plus clinical hours that we are trained to do and be masters in after that.
• 1:52
  SPEAKER_00: And also we're trained in specialties in different areas of our work.
• 1:57
  SPEAKER_00: I happen to be the chaplain that covers emergency services and trauma.
• 2:01
  SPEAKER_00: I've been in this work counting my internship 15 years.
• 2:06
  SPEAKER_00: And right.
• 2:08
  SPEAKER_00: That's what I say some days.
• 2:10
  SPEAKER_00: And I did my training um at a trauma center in it and been in my current sitting for 12 and a half years.
• 2:18
  SPEAKER_00: Wow.
• 2:18
  SPEAKER_00: We are so excited to have you on.
• 2:21
  SPEAKER_06: Thank you.
• 2:22
  SPEAKER_06: You know, a lot of people may not know that that resource is out there.
• 2:26
  SPEAKER_06: We have hospital chaplains who are there 24-7.
• 2:28
  SPEAKER_06: We have, you know, one who's a Catholic priest.
• 2:31
  SPEAKER_06: We have some that are, you know, and they cover different areas and they're a great resource for patients and families and even the staff, which is, I'm sure what you're about to speak on.
• 2:41
  SPEAKER_06: But I would like to say thank you for what you do because I know our job is hard and we see a lot, but I can only imagine that it's got to be hard on you um day in, day out.
• 2:53
  SPEAKER_06: So thank you very much.
• 2:54
  SPEAKER_01: Yeah.
• 2:55
  SPEAKER_01: The journey is I'm sure I'm sure you've walked many walked many a journey with many patients and their families.
• 3:03
  SPEAKER_01: And I know I've seen you all respond when there's a code or there's a crisis and just seeing you in those moments.
• 3:13
  SPEAKER_01: It's always amazing um how to me you all are able to carry yourself.
• 3:20
  SPEAKER_01: And I guess that comes with such an extensive training, which I already didn't I knew there was some, but I didn't didn't realize how extensive.
• 3:28
  SPEAKER_01: So I would love in another episode.
• 3:31
  SPEAKER_01: I think we'll definitely have to cover that deep that journey deeper on what that all looks like.
• 3:37
  SPEAKER_00: Yeah, people that's usually people get very surprised about that training and even more surprised about to keep our credentials 50 CEUs every year.
• 3:46
  SPEAKER_00: So um, so it's definitely not w I tell folks we used we're not pastors, we're not ministers, uh, but we're trained to be of support to all faith or no faith, um, and to be there in those distressing times.
• 4:02
  SPEAKER_00: So um, and as Kaylee said, yes, I'm very passionate about staff support in the midst of the crises.
• 4:09
  SPEAKER_00: And um and thank you very much for recognizing our work.
• 4:13
  SPEAKER_00: I appreciate that.
• 4:14
  SPEAKER_00: Okay, so you're gonna tell us a little bit about or a lot about pause.
• 4:17
  SPEAKER_00: Yeah.
• 4:19
  SPEAKER_00: Um Well, let's just take a minute to pause.
• 4:23
  SPEAKER_00: Um sorry, I couldn't resist doing that.
• 4:28
  SPEAKER_00: No, I love it.
• 4:31
  SPEAKER_00: Uh the pause is literally a moment of silence.
• 4:35
  SPEAKER_00: Uh it um we had a a colleague had tagged me in a previous um podcast of yours about the pause, and it's something I introduce when I talk to new nurses, when I talk to respiratory therapists.
• 4:50
  SPEAKER_00: Um, just recently I talked to medical students, M4 students about it and residents.
• 4:56
  SPEAKER_00: Um it takes place after you have a code event and it does not end the way that you had hoped.
• 5:03
  SPEAKER_00: Uh so once time of death is called, um, someone within that group, it can be anyone, just takes a moment of silence and say, okay, everyone, let's just have a moment of silence for Mr.
• 5:15
  SPEAKER_00: Smith.
• 5:17
  SPEAKER_00: And it's very intentional to recognize who the patient is, and especially families in the background.
• 5:23
  SPEAKER_00: Family may be there watching the code event.
• 5:25
  SPEAKER_00: And but it's to recognize the moment of silence of to honor the patients and the work that they do, the honor the family and also the honor the work that the staff did, the effort.
• 5:39
  SPEAKER_00: Um and it I'm talking to the choir here when I say the effort that it takes to run a code event and the compressions and the medicines and the the organized chaos of everybody in their right steps.
• 5:52
  SPEAKER_00: And when you put in all of that work and it doesn't go the way you had hoped, the pause is something that can just settle things down before everyone has to run, run away.
• 6:03
  SPEAKER_00: Um, and I'll I'll break that down a little bit more, but it was actually started by Jonathan Bartels, who was a trauma nurse at UVA Medical Center in Charlottesville.
• 6:14
  SPEAKER_00: Um if you B-A-R-T-E-L-S and The Pause, he actually has a website called thepause.me.
• 6:22
  SPEAKER_00: And you can look it up for more specific information.
• 6:25
  SPEAKER_00: There are actually TED Talk videos and YouTube videos about it.
• 6:29
  SPEAKER_00: Um and it actually, believe it or not, if you have seen The Pit, it was done on the pit in the first season in the first episode of the second season.
• 6:39
  SPEAKER_00: Wow.
• 6:40
  SPEAKER_00: I was quite impressed.
• 6:42
  SPEAKER_00: I'm still a little concerned that they haven't brought the chaplain in yet, but that's a story from another time.
• 6:48
  SPEAKER_00: Um but with the pause, it's any, like I said, anyone can introduce it.
• 6:55
  SPEAKER_00: If you're just bringing it into your facility, it's always helpful to have a leader do it.
• 7:01
  SPEAKER_00: Maybe it is the doctor who ran the code or the charge nurse, or but it it goes to that moment and it doesn't take a lot.
• 7:09
  SPEAKER_00: It's not it's literally 45 seconds, including the introduction of let's everyone take a moment to pause.
• 7:16
  SPEAKER_00: Again, you're recognizing the patient.
• 7:18
  SPEAKER_00: We want to recognize Mr.
• 7:19
  SPEAKER_00: Smith.
• 7:20
  SPEAKER_00: We want to be able to honor his life.
• 7:22
  SPEAKER_00: He was a father, he was a husband.
• 7:26
  SPEAKER_00: Um, if you even know that at this point in time, if it's in the ED, you know very little about the patient in that moment.
• 7:32
  SPEAKER_00: If they're on the ICU, then you might know some more about them.
• 7:36
  SPEAKER_00: Um and again, recognize it's just honoring them in their life and also honoring them in their transition of death.
• 7:44
  SPEAKER_00: And and then also honoring the work that you do.
• 7:47
  SPEAKER_00: It's very helpful, I think, because we're so used to uh, and I'm sure y'all can speak on the codes that y'all have been a part of, but when I witness codes, as soon as time and death is called, everyone scatters.
• 8:00
  SPEAKER_00: And um because you have a ton of other things to do, you've got other patients to see, and sometimes the scattering is a protective mechanism as well.
• 8:10
  SPEAKER_00: And um, but just that moment to settle the adrenaline down, to recognize the work and the effort that was put into it, because this is for the staff as much as it is for the patient and the family.
• 8:25
  SPEAKER_00: Um that's a brief piece of what it is.
• 8:28
  SPEAKER_06: Okay.
• 8:29
  SPEAKER_06: Are you guys like turning off all of the monitors so that it's silent?
• 8:34
  SPEAKER_06: Because like, hmm, that might seem like a weird question, but we have to physically go off and like physically turn off our monitors for them to stop alarming once somebody has passed away.
• 8:44
  SPEAKER_06: Like they're continuously in v fibrocystically or whatever.
• 8:47
  SPEAKER_06: So there wouldn't be like silence unless we did that, which can take a, I don't know, maybe five to ten seconds.
• 8:52
  SPEAKER_06: Don't you think, Cody?
• 8:54
  SPEAKER_06: Like go in there and hold it long enough for everything to boot off.
• 8:57
  SPEAKER_06: Is that on in like things turned off so that nothing's like being an alarming before you start that?
• 9:02
  SPEAKER_00: Yeah, that's the hope.
• 9:03
  SPEAKER_00: And of course, there's going to be the beeping and alarming of everything.
• 9:07
  SPEAKER_00: And usually how it takes place is that after time of death is called, um, probably giving a few seconds, then the doctor or whoever's in that room can say, okay, let's have a moment of silence.
• 9:20
  SPEAKER_00: And if the monitors are going off, maybe that gives the cue to someone to turn the monitor off and to just give it that moment to where it can be turned off.
• 9:29
  SPEAKER_00: But that is a very good question.
• 9:30
  SPEAKER_00: Uh, because you I dare call it a sacred moment because it's not religious.
• 9:35
  SPEAKER_00: There's no amen, there's no prayer.
• 9:38
  SPEAKER_00: Um, it's for anyone who wants to be involved.
• 9:41
  SPEAKER_00: So that having that few seconds of that moment of pause and gives you a chance to kind of turn off those monitors as well.
• 9:48
  SPEAKER_01: Yeah.
• 9:48
  SPEAKER_01: I think I like I don't know, I was tearing up just listening to you.
• 9:52
  SPEAKER_01: I don't know if it's how calm your voice is or maybe I need to go to therapy again today.
• 9:59
  SPEAKER_01: Um But I think one of the things you kind of talked about was recognizing the the work that the staff just put in.
• 10:10
  SPEAKER_01: And I think sometimes that's what I feel at the end of these moments is like I I tell people a lot, like I don't like to lose because every day I lose at work.
• 10:22
  SPEAKER_01: Like I, you know, we've always are battling death.
• 10:26
  SPEAKER_01: And um so outside of work, I like to win because I don't always get a lot of wins at work.
• 10:33
  SPEAKER_01: And so I always kind of feel that defeat, that let down, that I've let them down.
• 10:40
  SPEAKER_01: And so I kind of have those emotions right after.
• 10:44
  SPEAKER_01: And so when you you said rec having that pause to recognize the patient in their life and also recognizing the staff in our effort, I think is really kind of what hit me.
• 10:57
  SPEAKER_01: I don't know if that's what you've seen or experienced, but that's just kind of what stood out to me.
• 11:04
  SPEAKER_00: And thank you for saying that, Abby.
• 11:07
  SPEAKER_00: It is there is a lot of effort that is put into the work that is done for a code event.
• 11:13
  SPEAKER_00: Um, and each one is going to be unique to everybody.
• 11:16
  SPEAKER_00: It could be someone who's been in the ICU for a long time that you know, um, or it could be in the ED where it just happened that quickly.
• 11:24
  SPEAKER_00: Um, or the age obviously is a factor younger, older, or um, if the code goes on a lot longer than it probably needed to go.
• 11:34
  SPEAKER_00: Um, but just like you said, in the c you you are trained to save lives.
• 11:41
  SPEAKER_00: And so you're gonna put every effort into doing what you need to do to help save this particular individual.
• 11:48
  SPEAKER_00: And despite the efforts, you can't save every single life.
• 11:52
  SPEAKER_00: And um and that's when we we are reminded that of what you had attempted to do, the efforts that you took, and I do see it.
• 12:01
  SPEAKER_00: I and I think that's a part, and y'all might be able to help me a little bit more just from my point of view.
• 12:07
  SPEAKER_00: I think that might be one of the reasons everyone scatters away.
• 12:12
  SPEAKER_00: Um there's many reasons, but I think that's one underlying reason of okay, let me just cut that off and finish off and take a breath and go on to the next thing.
• 12:24
  SPEAKER_00: Yeah.
• 12:24
  SPEAKER_01: I I think the scattering probably has some for some people a level of that.
• 12:31
  SPEAKER_01: And I think you said it.
• 12:32
  SPEAKER_01: I think there is a level of protection, especially if this was your patient or you knew them.
• 12:39
  SPEAKER_01: Um and I think that the other side is everyone's like, okay, well, I gotta go, I gotta go back and I'm gonna close that emotion off.
• 12:50
  SPEAKER_01: Um, so I I like this idea of of the pause.
• 12:54
  SPEAKER_01: Do you find, or I don't know if you can answer this or not, but what would what is the cost of not doing the pause?
• 13:04
  SPEAKER_01: What do you think that long-term cost is?
• 13:07
  SPEAKER_01: Or for those of us that have never done it, do you think, like, do you know?
• 13:12
  SPEAKER_01: Have they talked about it?
• 13:13
  SPEAKER_01: Or I guess what is the what is the long-term of teens that do the pause regularly?
• 13:20
  SPEAKER_00: I know there is research out there, and I know that they're starting to do um, there's more articles written about taking that moment.
• 13:30
  SPEAKER_00: There are articles written about um be sure you I call this a part of the emotional debriefing, just to kind of settle going back to settling yourself down.
• 13:40
  SPEAKER_00: I do think recognizing that you need to have that moment of pause is beneficial because if you don't, especially in cases where there might be that connection, um it's going to turn into a burnout situation or a compassion fatigue situation.
• 14:00
  SPEAKER_00: Uh or as if we don't recognize that we're human sometimes, from a staff point of view, uh, it it can bring out some of the symptoms of the uh burnout or fatigue about cynicism or isolation or irritability.
• 14:17
  SPEAKER_00: Um, I think just recognizing that moment helps us to remember we have a moment to where we can take care of ourselves.
• 14:27
  SPEAKER_00: Um and I think that would be more beneficial than not, because you those very people in that room with you in that moment are the only ones who will be able to understand what you just did.
• 14:39
  SPEAKER_00: And if you scatter, no one else will be able to understand what you're feeling if if you're if you're going down the hall or or at the end of shift change and you're you're the person taking over for for you will obviously understand it to an extent, but they weren't there in the moment.
• 14:57
  SPEAKER_00: And you've got however many people are in that room with you, and you've got this minute to where you all have this commonality and this connection um for your efforts.
• 15:06
  SPEAKER_00: And if it's not done, then sure, we can go on about our day.
• 15:10
  SPEAKER_00: And I say that from my own personal experience too.
• 15:12
  SPEAKER_00: I still have the family, I still have other situations that if especially if there aren't many of us there, I'm getting calls on the pager.
• 15:21
  SPEAKER_00: And um, but if there's that the if there's not a moment to recognize what we just encounter, the emotions are up and down.
• 15:30
  SPEAKER_00: And um having that moment, I believe, will honestly help you to release some of that uh that grief or sadness or anger um or uh self deprecating or self-questioning of what could I have done differently.
• 15:48
  SPEAKER_01: Yeah.
• 15:50
  SPEAKER_01: I don't think I have thought about it until just now when you said it, that no one else will understand that experience.
• 16:00
  SPEAKER_01: And I think you know, each code is different, and we've had big bad codes, long codes, codes, as you said, that went on too long, and errors in codes and all of that.
• 16:13
  SPEAKER_01: And I've never thought of that.
• 16:16
  SPEAKER_01: That yes, we all to an extent when you come on and you're like, oh, that was a bad code.
• 16:20
  SPEAKER_01: Like I I get it, I've been in bad codes, but that specific code with that specific patient is still going to be a specific memory and a specific experience that no one else outside of those per actually present will fully be able to understand.
• 16:38
  SPEAKER_01: I think that's just such an interesting thing that I've never thought about until you just said it.
• 16:46
  SPEAKER_00: And and your senses will continue on.
• 16:50
  SPEAKER_00: You'll still hear the person yelling out for epi or or um there's a reason I'm not on the medical side of it doing the epi or saying a two minutes out time pulse check and and the different people that are yelling and screaming of what's going on.
• 17:08
  SPEAKER_00: And you're still gonna hear that for a while, despite our best efforts to kind of shut it down.
• 17:13
  SPEAKER_00: And um, and I and I do believe in in even if it's it recognizes just the moment, even if it's not an emotional heavy impact.
• 17:26
  SPEAKER_00: And for the other side of it, and and we can still talk more about the emotional piece, it also helps those to recognize that that was a patient, that was a Mr.
• 17:37
  SPEAKER_00: Smith.
• 17:38
  SPEAKER_00: Yeah.
• 17:39
  SPEAKER_00: And not just and not just someone that they found who collapsed at the restaurant and and ran in real quick and you did everything, but you you couldn't get them back.
• 17:47
  SPEAKER_00: And um, and to remember who that person was, and that they're not just a person that came in 243 overnight or um and that it it helps you to see to remember that we are human as are those patients.
• 18:03
  SPEAKER_00: Um if that makes any sense.
• 18:06
  SPEAKER_01: No, it it does.
• 18:08
  SPEAKER_01: We actually have another episode where we fully talked about the how we can de accidentally dehumanize patients in healthcare and ways we can not, and so it sounds like the pause also falls under under those strategies of this is how we can not dehumanize a patient.
• 18:32
  SPEAKER_01: And it is easier when we sometimes, you know, not that we don't recognize that they're human, we know that they're human, we want to take care of them, but it's sometimes a protective mechanism for us too, of all that we just did.
• 18:50
  SPEAKER_01: Like if you sit back and think, Man, I just sat there and crushed on some other some other person's ribs and broke all of them, and I would never want that done to me, but I did it to them.
• 19:03
  SPEAKER_01: That dehumanization part kind of helps make it okay.
• 19:08
  SPEAKER_01: Um or able to cope with it.
• 19:12
  SPEAKER_00: Right.
• 19:13
  SPEAKER_00: And to go back to something else that you picked up on Abby, um everyone in that room were a part of that same experience, including brand new staff that could very well be there.
• 19:27
  SPEAKER_00: And they and this moment of pause needs they need to witness that and be a part of that, knowing that it's okay to have that pause.
• 19:36
  SPEAKER_00: Um and that's and it's the veterans who are saying it's okay.
• 19:42
  SPEAKER_00: Uh, instead of saying, no, you gotta move on, suck it up, do whatever you need to do.
• 19:47
  SPEAKER_00: And so every person in that room, from every moment of experience, from it being their very first code to the veteran um who's who's recording everything to the one to the one running it.
• 20:01
  SPEAKER_00: So it impacts everyone on every level.
• 20:05
  SPEAKER_06: I'm just gonna say I it almost makes me feel bad because like the type of person, the type of nurse that I am, like I feel like I show my compassion or like by doing, like by getting things done or like doing things for you that you couldn't do for yourself or by helping.
• 20:22
  SPEAKER_06: And I feel like oftentimes at the end of a code, if the family has is not in there, it's like I'm like, okay, let's get them cleaned up, like take away enough stuff so that it's a little bit more peaceful in here so that the family can get back and have their time because they only get two hours with the patient after they've passed.
• 20:38
  SPEAKER_06: You know, a lot of times whoever runs a code will be like, Good job, everybody, thank you.
• 20:43
  SPEAKER_06: And here quick, sign this real quick, and then let's let's get all this done like in let's take you know five minutes and get all this wrapped up so the family can come back.
• 20:51
  SPEAKER_06: So it's like I've never even thought about having a pause before that, even though like in my head it's like gosh, this person just died, you know.
• 21:01
  SPEAKER_06: And and some of that is like you just don't have the luxury of time, but it does I love that you're saying it, but it does make me feel bad, like if I've missed these opportunities to do that for the patient or for the staff, like hundreds and hundreds of times.
• 21:14
  SPEAKER_06: But I like it's a good perspective.
• 21:16
  SPEAKER_00: And like, okay, the chaplain's coming out, you're fine, let go of that.
• 21:21
  SPEAKER_00: Um and it's um you do what you can do in the moment, and you're still providing the care by doing everything you can to clean up everything and and to have the disease presentable for the family, for the nurses and the and everyone, the care partners too, who take part in that.
• 21:40
  SPEAKER_00: Um the pause kind of helps the adrenaline to slow down too.
• 21:44
  SPEAKER_00: Um, so you can be more intentional about and not have to rush.
• 21:49
  SPEAKER_00: Um, the family from the family point of view, I wouldn't want you to rush to do everything you can to help come to because that's a part of their comfort and healing too, is to see that you.
• 22:00
  SPEAKER_00: took such good care of them.
• 22:01
  SPEAKER_00: Um and it helps the person who needs to go and tell the family and talk to the family to help settle them down.
• 22:08
  SPEAKER_00: And um so that I mean every bit of it is a part of the carry.
• 22:12
  SPEAKER_00: So you're doing fine.
• 22:14
  SPEAKER_03: Yeah I I'm gonna piggyback off of kind of what Kaylee said.
• 22:17
  SPEAKER_03: I think we're not but I'm like accustomed, especially on our unit, frequency of codes that we have and deaths is it's almost like second nature to us.
• 22:29
  SPEAKER_02: So I guess like we that's kind of why we don't take the that moment to like just stop.
• 22:37
  SPEAKER_03: We kind of like in the mindset of get them prepared, they only have two hours and then all right what's the next patient that needs to come with that kind of mentality.
• 22:49
  SPEAKER_06: And it's not to be disrespectful.
• 22:51
  SPEAKER_06: Um it's just like we've all talked about we we do get desensitized or it's like keep on and carry on like it's just our job.
• 23:01
  SPEAKER_06: But as we know over the over time and over the years, doing that without reflecting it shows up.
• 23:08
  SPEAKER_06: And it might show up at work or it might show up in your personal life or yes.
• 23:12
  SPEAKER_06: So that's why I think you know we need to be aware of that and try to break that cycle if we can um by doing things like this.
• 23:22
  SPEAKER_06: I mean I've it seems so simple but I've never heard about it like in this way like right and that's it.
• 23:28
  SPEAKER_00: It's literally 45 seconds and um and y'all can h help me more on this but we as we build on not doing that moment or not taking a minute to step back and giving yourself a minute to settle things down or a mindfulness moment if you want to call it that or just um it's going to show up in other ways.
• 23:54
  SPEAKER_00: And I and I've had people even say to me, because I've experienced before to where I've let things just or just dig and dig and dig.
• 24:03
  SPEAKER_00: And my colleagues will be the first one to say why are you being so irritable today and I never noticed it um or I like to call it my general my GCS scale my general compassion scale is a lot lower today than um but it it will creep up in some way and um and I have a I work with all new nurses.
• 24:29
  SPEAKER_00: I do a compassion fatigue class for the new nurses the new graduates when they come in every year.
• 24:35
  SPEAKER_00: And um I will that I meet with them they're probably halfway through their orientation and some have experienced their first code some haven't some have experienced their first cynical veteran who says you can't be crying you're not going to do well if you keep crying um different things like that to the to not knowing how to even process it or talk about it.
• 24:59
  SPEAKER_00: And um so this kind of helps and I challenge them as so you guys be the one to call the pause because I tell them a little bit about the pause in in that class and and that they can have the voice and be that voice for them.
• 25:13
  SPEAKER_00: I think that's great.
• 25:15
  SPEAKER_06: Yeah I do think we're guilty of that as veteran nurses.
• 25:17
  SPEAKER_06: It's not like stop crying like get it together.
• 25:20
  SPEAKER_06: It's just like you're not gonna make it through the rest of your day you can't you're out of some way yeah to carry on and like we have to deal with this later but I don't think we do a good job of saying like but you do need to deal with this at another time.
• 25:34
  SPEAKER_06: Like you can't just cry for the next two hours.
• 25:36
  SPEAKER_00: Yeah.
• 25:36
  SPEAKER_00: And it's hard.
• 25:37
  SPEAKER_00: It's tough.
• 25:38
  SPEAKER_00: Yes yeah on the humor side of things I had a new nurse there was a code event that did not end well and this was before pause c even came into my picture and I wanted to check on her because it was her patient and I came to check on her she looked at me she's like don't come near me I'm okay right now if you come near me I'm gonna cry don't you dare come near me.
• 25:58
  SPEAKER_00: I was like okay because I just kind of hooded I just kind of stood behind the corner.
• 26:02
  SPEAKER_01: I still watched her but I just kind of she's like no not right now and then somebody's like are you okay and you're like no no acknowledge me just ignore me yeah that's that's me most of the time when people are like are you okay my I was just asked why are you showing me kindness for me I'm fine I'm just fine do you have any stories of when you saw the pause enacted or used and then you could kind of see the effect or you could kind of like this this really works and um really kind of brought it in and started kind of your education of it?
• 26:48
  SPEAKER_00: Yes.
• 26:49
  SPEAKER_00: Um it was on one of the units I cover and I won't mention the unit but they uh they are pros at compartmentalizing everything and they're pros about moving on to the next thing and and doing like Kaylee said just getting everything cleaned up and settled and do everything that needs to be done so family can come back.
• 27:11
  SPEAKER_00: The doctor was the one that did the pause that day.
• 27:14
  SPEAKER_00: No I I'm sorry I take that back.
• 27:16
  SPEAKER_00: I was the one that said it that day and and I said let's just have a moment of silence because I was really nervous about it and um because I know how um I know how they are with you know needing to to do this and this and this.
• 27:32
  SPEAKER_00: And then uh we took that moment and no monitors went off or anything and and just had that moment of of silence.
• 27:39
  SPEAKER_00: And then it was a little while later that um that a couple of the veteran nurses especially and I'm not pick I'm not trying to pick on them but pick on the veterans but they they're really good about moving on to the next thing and keeping things in in control and doing what they need to do.
• 27:55
  SPEAKER_00: They one they looked at me said thank you so much for doing that.
• 27:58
  SPEAKER_00: We we needed to remember what we did and and who we're the who we were there for.
• 28:04
  SPEAKER_00: So that I mean that was the first impact for me of okay all right it wasn't a Linda why did you make us do that emotional thing and it was um because of course I get teased sometime about focusing on on the emotional side of it when I say are you okay?
• 28:23
  SPEAKER_00: Yeah yeah I'm good.
• 28:24
  SPEAKER_00: I was like no really how are you?
• 28:26
  SPEAKER_00: But just that one moment of of them recognizing that this this is a is this important and it didn't take that long.
• 28:36
  SPEAKER_00: But just to have that moment really helped them.
• 28:38
  SPEAKER_00: And so it's and I've seen it to where others doctors who who have come in from the outside or fellows first first or second year fellows who learned it at their outside hospitals have come in and done it and and the staff were impressed and and I was impressed.
• 28:54
  SPEAKER_00: I even gave one I said oh you get 10,000 points for doing that.
• 28:58
  SPEAKER_00: Thank you so much.
• 28:59
  SPEAKER_00: And they're like what are the points for I say you'll find out later but just that but the impact that you see on the staff of and it it's a lot more meaningful even if it was just that minute and then they moved on.
• 29:12
  SPEAKER_00: So I have seen some good results from it.
• 29:15
  SPEAKER_00: I love that I was like I've seen it once or twice where the family is present and that helped them because they they witnessed that and that the team recognized um efforts and recognized the patient.
• 29:30
  SPEAKER_00: And so having that was very helpful and healing and s and in the and very minor but simple peace for them too.
• 29:40
  SPEAKER_01: Yeah.
• 29:42
  SPEAKER_01: I can imagine for the family and it's nice peaceful to see that that we are recognizing their loved one and just taking that moment.
• 29:53
  SPEAKER_06: I just can't imagine a family member saying your your family member be coded.
• 29:57
  SPEAKER_06: I think about that because we talk about doing things to people um and it if you want us to save your life then it's necessary I guess um it's so traumatic what we do to people's bodies and if they die after all that like I just feel like it's in a lot of ways it's not very dignified.
• 30:16
  SPEAKER_06: Like it's it's not private.
• 30:18
  SPEAKER_06: You're semi-naked, your bones are broken, you've been stuck with needles and tubes stuck down and I I just feel for these families even if that's what they think they wanted like as much as that affects us like I that's gotta be hard for them.
• 30:34
  SPEAKER_00: Um witness that and I thank you Kaylee I felt the same way too um when I first started because I did I don't want that last image in a family member to see the the everything that you see in a code event and and seeing the the punches on the chest and and everything.
• 30:57
  SPEAKER_00: But it's been through a part of the work that we do is actually research as a part of that.
• 31:02
  SPEAKER_00: So I've been reading a lot of research on the impact of family seeing the code event and it actually is more helpful than not.
• 31:11
  SPEAKER_00: Yes, there is a there's a visual impact but there is also a visual impact of how much work and effort that the staff put into it.
• 31:20
  SPEAKER_00: And um and they see that you did do everything you could and they also see what you did do.
• 31:29
  SPEAKER_00: And they can see that you did try everything you could and they see what is happening to the patient despite your efforts.
• 31:36
  SPEAKER_00: So I've I've I've come a long way from from the beginning with that and but that's a that can be a discussion for another time but I agree with you.
• 31:47
  SPEAKER_06: It's important for a couple different reasons but yeah.
• 31:49
  SPEAKER_01: In terms of like the pause does it is it only after a code event or is it something that's encouraged even like if you know they're comfort care, hospice care as we call it.
• 32:05
  SPEAKER_00: Um I only know of it after a code event and I know that that was for Jonathan Bartell's that was the focus after a code event because of the adrenaline and the energy and the emotions um I've not seen or heard of it from a palliative or hospice standpoint.
• 32:24
  SPEAKER_00: Um and I can understand that because you are more prepared for that.
• 32:30
  SPEAKER_00: Yeah and and more than likely have already had moments um whether it's the family or or whether it's the staff as you do the comfort extubation um you're there with the family to support them or when the decisions have been made to do comfort care, um you have different pauses for if you will for them at that time.
• 32:52
  SPEAKER_00: But this the focus here tends to be on the suddenness the sudden onset of the code event and the the energy um that that it takes and the effort and when it doesn't and well that's that's why it's implemented.
• 33:07
  SPEAKER_01: Cody you've worked at a number of hospitals have you seen this enacted or seen a different approach after a code event?
• 33:19
  SPEAKER_03: Uh it's been pretty consistent like with every hospital everyone just kind of scatters like ants after the time of death.
• 33:31
  SPEAKER_00: And it's not the first place um it it's definitely not the first units and it's taken I've been trying to do this as a chaplain for a few years now and still have not been able to get everyone to do it.
• 33:46
  SPEAKER_00: And of course I'm not going to get everyone to do it.
• 33:48
  SPEAKER_00: I'm only one person um but just to have it introduced um whether it's with new nurses or the fellows that are coming in or sharing it with y'all today um and just taking it out um will be helpful.
• 34:03
  SPEAKER_00: And and I tease a little bit about the pit but I mean I text back and forth with um a a doctor who introduced it to the ED so before I even came on board to the ED.
• 34:16
  SPEAKER_00: I said guess what?
• 34:17
  SPEAKER_00: They showed it they showed it and I've seen more and more of that.
• 34:22
  SPEAKER_00: So it takes time and it's we're not used to taking that moment because that you've got to go in and do something else and but you also have to take care of you and too.
• 34:35
  SPEAKER_00: Yeah.
• 34:36
  SPEAKER_01: I this is a question probably more for Cody and Kaylee but that that moment of silence with the pause and just think that's so abnormal in the ICU.
• 34:50
  SPEAKER_01: How do you two think that would actually feel to do like that we actually take that moment how would that feel as like nurses?
• 34:59
  SPEAKER_06: I mean I'm in my healing era I'm about it like I think we should be doing it.
• 35:06
  SPEAKER_07: I'm just kidding I'm heavy on the the personal work right now.
• 35:13
  SPEAKER_06: I think it might like be weird.
• 35:17
  SPEAKER_06: I think people might be surprised but I think honestly that a lot of people would appreciate it and and I think maybe because when Cody and I work together it's night shift it's a lot of newer nurses so I do think that they might appreciate it.
• 35:30
  SPEAKER_06: Um maybe they don't even know especially since the newer to it don't you think it would I think it might go over well.
• 35:38
  SPEAKER_03: Yeah because I feel like the newer generation of nurses like have dehumanized patients like early on in in their career.
• 35:58
  SPEAKER_07: So we don't get so attached to a patient so that we don't get like burned out we don't get burned out on the passion fatigue emotional weight.
• 36:09
  SPEAKER_06: So I think it would benefit tremendously on night shift or even like both shifts but like our newer but our new most of our newer nurses are all I mean I think that people might be shocked if I was like hey let's have a moment of silence even though like I if if families are around during the code if there's plenty of people there to run it I'm very happy to go see them.
• 36:34
  SPEAKER_06: Like sometimes I'll just go stay in with them or like offer to call the chaplain because we don't call our codes overhead so they don't know that we're having a code unless we call them right um because I I feel like that's really tough.
• 36:45
  SPEAKER_06: But you know I think if the charge nurse or the person running the code were to do that I think that it would be good and it would be fine and maybe that would become more normal for people to see.
• 36:56
  SPEAKER_06: They kind of follow our leads like if we were doing it I think that it would be like oh don't give me a minute to chill we gotta get our heart rates now because we're old and we had to do chest impressions like yes please it's gonna be like let's have a moment of silence the patient kind of even be like you could take more if you need to patient yeah moment of silence 45 minutes it's like I'm gonna be sitting really enjoying this moment of silence it I'm really I'm not sitting for my own personal benefit I promise.
• 37:40
  SPEAKER_00: Has anyone seen Cody?
• 37:41
  SPEAKER_01: No he's taken a moment of silence over here on to this well it would definitely be me too over here because you know I'm top heavy you don't have to worry about it you you run the code you don't have to you don't have to do your job because I'm too top heavy for those I as we're moving towards kind of closing this conversation though I think it it sounds so simple.
• 38:07
  SPEAKER_01: If someone does bring it up and someone says they don't have time have you have one have you ever witnessed that and two as someone that probably has better words that work than the three of us to that response what would you say in response to someone that says ah I just don't have time for that in 45 seconds?
• 38:32
  SPEAKER_00: Um good question.
• 38:35
  SPEAKER_00: One thing that uh the nurse who brought this up who started it wants to make clear it's not mandatory.
• 38:41
  SPEAKER_00: If you need to walk away you can walk away um it is literally just a moment of silence and if someone does walk away that's fine.
• 38:49
  SPEAKER_00: In the case of I would recommend following up with them and saying hey I'm just checking is there a reason not to force anything obviously but is there are you okay?
• 38:59
  SPEAKER_00: Is there a reason that you you couldn't do this or um because there for me it tends to be something underlying why the underlying them as to why they couldn't do it.
• 39:10
  SPEAKER_00: It's a moment of s literally of silence there's no prayer there's no evangelism or religious talk of anything it's open to everyone and and to keep it open to everyone it's simply silence and whoever the only person talking is a person who introduced it.
• 39:30
  SPEAKER_00: And then at the end we'll say okay thank you so much and thank you for your time so um I I tend to go on the lines of if um checking in with them and finding out why what's underlying why they couldn't stand still for just those few seconds and not do anything in the moment because that will take away um and if they say something out loud that's something for them to process and everyone else present will be a part of that and just check on them later.
• 40:03
  SPEAKER_00: And so we don't they never wanted it to make it mandatory to make it uncomfortable or forced.
• 40:09
  SPEAKER_00: And so I've not seen anybody leave um leave a situation and and they just bow their heads for a second or just stand still for a second.
• 40:20
  SPEAKER_01: That's definitely more therapeutic than what I would have said.
• 40:24
  SPEAKER_01: So I'm glad you have that script now.
• 40:33
  SPEAKER_01: Yeah I would have been like oh you don't have 30 seconds for them?
• 40:36
  SPEAKER_01: Okay.
• 40:37
  SPEAKER_01: Okay.
• 40:37
  SPEAKER_00: You know for two hours Yeah you've been scrolling on TikTok but sure now I do I want to say okay what's your problem?
• 40:47
  SPEAKER_00: Yes.
• 40:51
  SPEAKER_06: A deflection I don't know I think that people just don't sit in silence like we don't sit in silence ever.
• 40:59
  SPEAKER_06: We're not good at it.
• 41:02
  SPEAKER_03: Hardly um and you know some people are just um oh well let me rephrase I was gonna say some people just don't have that sort of nature so that's okay too yeah and everybody we need everybody make the world go around I think the double edged sword of the matter could be like as an ICU nurse our minds never fully shut off so during that 45 seconds we would probably not be calming down and taking a moment.
• 41:30
  SPEAKER_03: We're thinking of the 50 other the 50 other things that we have to get done before our shift finishes because we've just spent there's 30 minutes hours on this one patient and now we're behind on charting our other patient care.
• 41:43
  SPEAKER_03: I mean I know it doesn't seem like it's not it's 45 seconds is no time at all.
• 41:48
  SPEAKER_03: It's nothing but it's the will we actually be at peace during that 45 seconds and like let the adrenaline leave.
• 41:57
  SPEAKER_06: Yeah that's a good point.
• 41:58
  SPEAKER_06: We'd have to really try hard to just shut it down I it's it's tough.
• 42:02
  SPEAKER_06: I'm sure at first it wouldn't but if you keep practicing I'm not gonna be one of those people even still like if a if you're physically having a moment of silence and you're just breathing, even if your mind is going then at that point at least you're doing it for the patient and it's a moment of silence for the patient and their family.
• 42:22
  SPEAKER_06: Like you said.
• 42:22
  SPEAKER_06: So yes it's for us um but if if it's not gonna help us then it's just a way to you know honor that patient for a minute if we haven't had a chance to do that.
• 42:32
  SPEAKER_00: So and make it about the patient until it gets to a point I mean Abby was getting ready to hit on it until there's that consistency and that it's they won't be shocked when somebody says, okay let's have a moment of silence and and your brain may settle down some.
• 42:49
  SPEAKER_00: I get it completely I'm thinking a bunch of different things but I with the consistency and the practice of it um and just even just taking a de allowing yourself permission just to take a deep breath to do that.
• 43:05
  SPEAKER_06: I think if we did that more in our jobs and in our lives you know taking a pause and taking a breath uh would benefit a lot of us in many situations.
• 43:15
  SPEAKER_06: I agree in the hospital and outside what it's very simple.
• 43:26
  SPEAKER_01: It is it's very simple.
• 43:28
  SPEAKER_01: Um but outside of like just starting that you know going in tomorrow and saying I'm going to do this what's one way or one small step that you think people could listening could take from this to move forward?
• 43:45
  SPEAKER_00: Good question.
• 43:46
  SPEAKER_00: Um giving yourself permission to to take the deep breath or to even start it let your leadership know your nurse manager or um and or for let attending know who who's on that day.
• 44:02
  SPEAKER_00: Hey, can we try this?
• 44:03
  SPEAKER_00: And and I recognize the fact sometimes Kaylee said it earlier, if it's someone if it's a person running the code or if it's a charge nurse, sometimes it needs to be that person to do it first, maybe.
• 44:16
  SPEAKER_00: Um and just introduce the idea maybe at your next staff meeting um or unit council that you can bring it up and um and just start that way and throw the idea out to some folks and see how it goes and and giving yourself permission and helping them to realize it it's not that long and it actually is very meaningful and impactful.
• 44:44
  SPEAKER_00: Just say, hey, give it a chance, see how it is.
• 44:47
  SPEAKER_00: Um and if you want to bring in the research piece you and the quality you've got the quality improvement awards and you can definitely do research about once you've implemented it and see how it goes and how morale is and how burnout might be and how it helps with patient care and family connections and how it helps the team.
• 45:08
  SPEAKER_00: And you can do research and make the big posters and everything for that too.
• 45:13
  SPEAKER_01: Now you're now you're speaking to my leadership D I know I know I knew it I mean this whole time I this whole time I've been like how could we implement this and study it though?
• 45:26
  SPEAKER_01: Like yes how and you just gave it to me.
• 45:29
  SPEAKER_01: Guess what you guys are going to be doing really we should also start debriefing more we don't need we should we keep even if a code God forbid runs smooth.
• 45:45
  SPEAKER_07: Um coding that's not fair do run smoothly.
• 45:55
  SPEAKER_03: Huh?
• 45:59
  SPEAKER_03: We could at least like debrief like the good things that happen what we could improve.
• 46:03
  SPEAKER_03: And it doesn't need to be like sick um singling people out but we don't even like get praise when things are done good.
• 46:11
  SPEAKER_00: Yes.
• 46:12
  SPEAKER_00: And this is different this obviously this is a little different than a debrief but I the debriefing goes into improvements and into talking as a team um and doing being in a safe place where that's allowed and don't blame anyone don't be too critical and just learn from learn from the mistakes and and move on.
• 46:35
  SPEAKER_00: And I I think in a debrief setting and you guys tell me from the medical side of things it helps to acknowledge it and then because maybe don't debrief you're just going to harp on it.
• 46:46
  SPEAKER_00: Yeah I think and just harp okay I should have done this and that's the that's your voice the rest of the day I should what could I done differently is is my experience.
• 46:56
  SPEAKER_01: I'll argue that if we start making this a part of our regular moments the pause and you bring that adrenaline down then we would probably at the end of that we could be like and in 45 minutes we will have our debrief.
• 47:12
  SPEAKER_06: Yeah but I think everybody meet in this room if you want to participate we're going to do a debrief.
• 47:17
  SPEAKER_01: Right.
• 47:18
  SPEAKER_01: So if we can start making this small thing a practice a regular practice then maybe it will lead to a regular practice in the bigger moment of the debrief because as we've said our minds running we're scattering what's next what's next what's next and I think that's what gets in the way of our debriefs a lot is it's like well we all scatter and now we all have this laundry list of things and then pulling getting the masses back together.
• 47:44
  SPEAKER_01: So just going to be a double double study I'm oh there she goes formulating I'm here for it though.
• 47:52
  SPEAKER_06: I mean I really am um and in a couple briefs only only a couple probably the whole time and they are really nice.
• 48:00
  SPEAKER_00: Um no you know kind of make it when you do the debriefs is there an emotional component to that too or is it just the clinical side?
• 48:08
  SPEAKER_06: It was the clinical side um and both times the physician was running a debrief.
• 48:14
  SPEAKER_06: Um it was really helpful though.
• 48:17
  SPEAKER_06: Um okay but we do have I remember a couple years ago when somebody put on the survey that whatever they were struggling with we then they were we're gonna do the code lavenders we have code lavenders and I think it's their is it EAP but is the chaplain help and it's basically you call a code lavender for the for the staff if something has gone bad um and they are just really struggling emotionally.
• 48:41
  SPEAKER_06: So we have that I don't know if we've done any pizza or something what'd you say Cody but what does the code lavender do?
• 48:49
  SPEAKER_03: Like don't they bring pizza or something?
• 48:51
  SPEAKER_01: I think it's through EAPs but some of the counselors I don't know if they bring pizza but like they come up with pizza like if they're struggling um yeah so code lavender is something that's starting to kind of pop up throughout the country and it's called different things but it's kind of like an emotional check or emotional wellness wellness check on staff a couple of different ways.
• 49:15
  SPEAKER_01: I've called several cold code lavenders actually in the last year for our team um after a big loss of a patient or traumatic loss um bad code the they'll come up sometimes they bring kind of like wellness gifts, fidget toys, um incense, actual lavender um things like that that can kind of help calm.
• 49:40
  SPEAKER_01: But they also will bring the um counselors or the therapists up and they'll do like emergent they've done like emergency like 15 minute on unit sessions with staff where they've pulled them into the break room and okay like let's talk about this with someone outside who's calm.
• 50:01
  SPEAKER_00: That it's good if you have somebody who wasn't a part of that event to be the one to kind of lead you through that if possible to lead you through that debrief so everyone can take part including um someone who may have been leading the debrief one another day.
• 50:18
  SPEAKER_01: But they do bring some snacks but not Pizza Cody sorry I believe chocolate.
• 50:23
  SPEAKER_00: I believe chocolate is involved there's chocolate.
• 50:30
  SPEAKER_01: You're gonna get people swarming in there even if they weren't even a part of you could really figure out like in general I think like nurses we don't turn down coffee like it's gonna be like that mean girls like everyone's in there for the debrief with all the snacks and everyone and then they're like in the gym they don't even go here in this unit.
• 50:54
  SPEAKER_07: We're there's there's free food there's free drink.
• 50:58
  SPEAKER_07: I I just we're gonna just start we're gonna start doing it the next time I work tonight.
• 51:04
  SPEAKER_06: Start tonight.
• 51:05
  SPEAKER_06: Me too something it's a big ass blood moon full moon you know it's gonna be oh yes yes pop in and pray for you start doing it see if it might take a while for people to catch on but I really think to like the nurses and people in healthcare of my age who've been there for a long time I don't think that many people are staying at the bedside as long so that could be a component but you know I've been doing it almost 20 years.
• 51:32
  SPEAKER_06: We've gone through these arts but now in like a lot of our society like we're getting into like wellness and a lot of people are going to therapy and we're becoming more in tune with our emotions and not just um shoving them down.
• 51:46
  SPEAKER_06: So I think it might be a good time to start just with the way that things are going honestly.
• 51:52
  SPEAKER_06: I think people will be more receptive to it than maybe they would have been five or ten years ago.
• 51:56
  SPEAKER_00: Very much and I take and folks like you guys to start doing it that will get other people on board I think will be helpful too and to say hey we need to do this this is important for the patient but it's important for us too and um and to take ownership in that and so I think I think that would be very helpful.
• 52:19
  SPEAKER_01: I'm sure if they were like man Abby's doing it okay I'll do it too Abby's getting in touch with her emotions I I guess I gotta do it.
• 52:32
  SPEAKER_06: There's some nurses out there that I'm trying to work with are like oh now she wants now she wants to be nice about it.
• 52:37
  SPEAKER_06: Now she cares if we're sad.
• 52:38
  SPEAKER_01: She's like hey look you got two hours two hours there's a patient I'm sorry okay sorry well any any final thoughts from anyone on the pause debriefs any final parting words for us Linda chaplain Linda but y'all made it to the top of my prayer list so you get to stay on the prayer list.
• 53:06
  SPEAKER_00: Yes I like to do that no I I am humbled and very appreciative of the opportunity to talk with you guys and um I got tagged on the conversation with Dr.
• 53:22
  SPEAKER_00: Jeff and um that y'all had with him and I know him well from when he was a baby and a baby intern.
• 53:31
  SPEAKER_00: And so um but to be able to be a part of this uh means a lot and I appreciate it and I and I thank you for the care that you have for your staff and the humor and for your patience and family.
• 53:44
  SPEAKER_00: So and for listening to the expertise of a chaplain.
• 53:48
  SPEAKER_00: So thank you for that too.
• 53:50
  SPEAKER_00: Yeah.
• 53:51
  SPEAKER_01: Thank you so much for coming and welcome this was I've learned so much and like I said I teared up at the as you were just starting and so I really think we we will start to implement this um but thank you so much for sharing for reaching out for and for doing what you do and we hope to have you again um I would love it.
• 54:14
  SPEAKER_01: Everyone listening make sure you hit the like the follow leave a comment do you practice the pause at your work if you have what's it like if you haven't do you think you're going to let us know if you want chaplain Linda to come back and give us more strategies on implementing it.
• 54:33
  SPEAKER_01: We're happy to have her but from all the shift talkers here at Banter at the bedside thanks and bye bye bye step into the light where the stories come