A unique partnership with the Highmark Caring Place grief center helps equip nurses with the tools they need.
Leaders of a workshop originally designed to teach nurses to interact with and nurture children visiting critically ill loved ones at Penn State Health Milton S. Hershey Medical Center quickly shifted direction after realizing that nurses needed to focus on their own trauma and grief before being able to care for visiting children.
Penn State Health in Hershey, Pennsylvania, has collaborated with Highmark Caring Place, a center for grieving children, adolescents, and their families, on a project to help nurses working in ICU/CCU units process their experiences of grief and loss caused by the COVID-19 pandemic, along with the difficult work they must do.
Nurses continue to struggle with their own psychological stress and trauma from the harsh effects of the COVID-19 pandemic and the conditions it has caused.
Unaddressed trauma can significantly increase the risk of mental and substance use disorders, along with chronic physical diseases, but with proper support and intervention, people can overcome traumatic experiences, according to the Substance Abuse and Mental Health Services Administration.
HealthLeaders spoke with Mary Jane Bijelic, nurse practitioner for Penn State Health’s Neuroscience Critical Care Unit (NCCU) and lead advanced practice provider for the Department of Neurosurgery, and Terri Bowling, manager of Highmark Caring Place, about the workshop they created to help nurses with their trauma.
HealthLeaders: The partnership between Highmark and Penn State Health began pre-COVID. How did that come about?
Mary Jane Bijelic: The project initially started as a way to support children at the bedside when they're visiting a dying loved one, or someone who is critically ill in the ICU, and it developed into how to care for our nurses to be able to care for the family and to be able to care for those children at the bedside.
When COVID hit, with all the trauma from that, we started to delve into how we are coping with COVID during our workshops and that became big discussion points at our workshops during the pandemic and after the pandemic. We’ve been doing it a little over five years now.
HL: How, exactly, do the workshops work?
Bijelic: We spend eight hours of a day with the nurses and Highmark the Caring Place does their session in the morning. After lunchtime is where they really work with our nurses exploring their feelings about death and dying, exploring grief, and how their personal grief affects them on their job.
It helps to recognize grief, because before these workshops, you would think you were suffering alone, and then once you start hearing what other nurses are feeling, you realize we are all going through similar things.
Eventually, we have our chaplain services and music therapists come and talk with the nurses and those two conversations are different from other workshops where there is mainly a family and patient focus. Their message here is, “We are here to support you as nurses, as providers of these patients. We know we need to care for you in order to care for our patients and our family better.” And so, it's a bit of a different message.
HL: Are the workshops regular or as needed?
Terri Bowling: We’ve had to keep this project alive through COVID, so that’s created all kinds of challenges. When we started out, we had a goal of getting every nurse trained in the Neuro ICU unit, which is where [Bijelic] is housed, to, in theory, make sure that everyone had a core foundation for what we were trying to do and to see if it would prove out that the interrelationships on the unit would actually be impacted and change and start to shift culture in a different way.
We had successes early with that and then we had to flip everything into a virtual or hybrid platform [because] hospitals weren't accepting us as clinicians, and we weren't able to come in, so we had to be on screen. Right now, our biggest challenge, as a result of COVID, is staffing and trying to work this in schedule. We can't take many nurses out of a single unit at any one point in time because of the staffing shortages.
HL: How did you recognize even before COVID that something like this was needed for nurses?
Bowling: We initially were getting nurses together to talk about the child's point of view, but very early on, the conversation kept coming back to themes such as, “I'm struggling with having to keep patients alive and I don't have time; how am I possibly going to take care of someone at a bedside?” and, “I've got so much I'm dealing with and then I'm crashing and burning,” or “I'm totally emotional after that and I've got to suck it up and go into that next room.”
Those were emerging themes that we saw very early on that kind of put the brakes on [the original child-focus] and we realized we needed to take a step back. [We approached it as], “The work you're doing is so very impactful and intense and in straddling that every day you're on the job on the floor, you are experiencing a world between life and death, and that is impactful and that's really hard. How are you managing that? And until you can do that with yourself, how are you possibly going to do that with others?” So that was the impetus; it naturally bubbled to the surface early on that we need to help take care of these nurses.
HL: How do you begin to counsel nurses on the moral distress and trauma they’ve been through?
Bowling: Some of it is helping them label some of what they're experiencing and helping them through an experiential perspective. We do a lot of hands-on activities through some art activities, and through sharing of those moral dilemma situations so we can process some of that out in a dialog way.
We include some psychoeducation in there to help them label and understand that what they're experiencing is normal and that this is really hard stuff. We help through compassion and caring that we generate throughout the group, creating that safe environment for processing and debriefing. There are complicated scenarios that the nurses don't have time to talk about and process, and to do that with each other and get different perspectives from people that might be on the other side of that is really valuable and brings people together.
HL: How are nurses responding to the sessions and what outcomes are you seeing from these workshops?
Bijelic: Right from the beginning, we knew that it had an impact on our staff from the feedback from the surveys. I also would see them in the unit, and they would come up and start talking to me about the workshop, saying things like, “We've never been through anything like that. Thank you for doing this workshop. Keep doing it.”
Many of them would love to do this workshop every six months. We’ve already talked about as we move forward, what this would look like and it’s just a matter of keeping the program going and expanding it.
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
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