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Nurse Champions Compassionate Culture With ’The Pause’


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By Jennifer Thew, RN

It's no surprise when leaders are lauded for action that moves an organization forward. But Jonathan B. Bartels, RN, BSN, CHPN, palliative care liaison nurse at the University of Virginia Health System in Charlottesville, is being credited for encouraging others to be still.

Bartels' concept of "The Pause," where care teams take about a minute after a patient's death to stop and honor the life that has left them, has garnered national and international interest.

This week, the American Association of Critical-Care Nurses will honor Bartels with the 2018 AACN Pioneering Spirit Award at the 2018 National Teaching Institute & Critical Care Exposition in Boston. The award recognizes significant contributions that influence high-acuity and critical care nursing and relate to the association’s mission, vision, and values.

"As an [emergency department] nurse, Jonathan created The Pause to help deal with his own feelings and help his colleagues after the death of a patient. That moment of reflection and compassion has grown into a movement that has profoundly impacted caregivers around the world," says AACN board president Christine S. Schulman, MS, RN, CNS, CCRN-K, in a news release.

Pause and Connect

The practice, Bartels says, gives healthcare providers permission to stop and honor loss, and it's a movement away from what he describes as "the industrialized/scientific/professional detachment" that healthcare practitioners have been trained in.

In short, it reconnects patients, family members, and providers with the essence of healthcare: humanity.

The ground for The Pause was laid around 2010, after Bartels attended a retreat that focused on developing resilience. Participants were challenged to go back to their healthcare facilities and create changes. At the time, Bartels was working in the emergency department, and he noticed how staff handled an unsuccessful resuscitation.

"During one of our intense resuscitations, I had noted that when we were done, we kind of just walked away from the situation," he says. "I realized that we had lost a ritual of honoring, so I knew that's where I could possibly [have] influence."

After losing a patient, Bartels took inspiration from the actions of a hospital chaplain who once requested the care team stop and pray after an unsuccessful resuscitation. "I emulated what a chaplain had done, but instead of offering a Judeo-Christian prayer, I asked that the room stop and honor the patient in humanistic language."

His example of such language: "Could we stop and honor this patient who was alive prior to coming in here, who was loved by others, who loved others, who had a life—and also take the moment to honor all the efforts we put into caring for the patient? I ask that we hold the space, to honor this patient in your own way and in silence." This allows staff to own the practice and honor a patient's last rite of passage when a chaplain is not available, he says.

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."