The response to Bartels' action was positive. "People who were not necessarily religious per se came up to me and said, 'You gave me space to do this, and I thank you for that,' " he recalls. "It opened the door for others to imitate it, and others started to practice it. That's really how it took off—it was just people seeing it done once and then being empowered to do it themselves."
A Movement of Stillness
Thus, The Pause was born. It began to spread beyond the ED into UVA's other care areas. Trauma surgeons and anesthesiologists requested care teams to take part. It has spread to other healthcare facilities and settings, both nationally and internationally, as well.
"Other institutions have formalized it. Cleveland Clinic is now using it across the board," Bartels says. "It's being done for organ transplants in South Africa. When patients are donating, they do it for the donor and they do it for the recipients. In hospices, they're doing it, and they're also doing it out in the field for EMS care providers."
He adds that the University of Virginia's school of nursing is working on a preliminary national/international study to look at both the spread of The Pause and how different areas/cultures define it.
Anecdotally, those who take part in the ritual have had favorable experiences. "The results of that have been mostly qualitative reporting. 'This made me feel better; it felt right; it helped the family to see us do the practice,' " he says. "EMS [staff] and healthcare providers tell me [The Pause] shows that you really care. It's not just enough to try and save a life; it's that extra demonstrative of compassion."
As direct care providers, nurses are in a prime position to identify areas that need improving and, like Bartels, come up with solutions.
"Nurses are not only implementing the instructions and the guidance of the physicians; they are the eyes and ears of healthcare. They provide a huge portion of the direct hands-on care 24/7, and that affects outcomes," he says. "The way I see nursing really influencing is in helping to look at what outcomes are being worked [toward] for our patients. It's not just healing the disease, it's healing the whole patient. It's not just stating, 'I'm offering compassionate care'; it's actually giving compassionate care."
Bartels encourages executives to look to those nurses who are "informal leaders" to facilitate change.
"Leaders are not just the leaders who are identified by the institutions," he says. "These are leaders who are identified by their peers. Use them as change agents."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.