Bartels explains that he introduced the pause into the emergency department at the University of Virginia Health System in 2009 “to be together and present in a singular moment of grief and loss. I would ask each to, in their own way, offer silent recognition of the lost human life—someone’s mother, father, sibling, or child—to remember that the person who had died loved and was loved, to understand that the person’s passing deserved recognition, and to acknowledge that our own efforts, too, were worthy of honor." He elaborates further in his introduction video (below - produced by Stephen Brannon).
Bartels adds: “The pause slows our racing minds, offering mental space so that we are not drawn into the vortex of failure versus success. We bear witness to a reality devoid of projections. We give ourselves the opportunity to forgive—and be forgiven. This practice removes the impotence that colors loss in health care. It empowers each individual to offer support without imposing beliefs on others. It is both communal and individual, and it allows for secular, religious, and humanistic perspectives. It is simplicity infused with complexity. We are called to bear witness to the reality of loss and the acceptance of reality.”
The pause can also help families. Bartels tweeted that “ when families see you stand and silently honor...it helps them too.”
It also helps families heal. It was not my original intent, but when families see you stand and silently honor...it helps them too.— Jonathan Bartels RN (@JonathanBarte17) February 4, 2018
Bartels' website thepause.me offers more information about the what, who, when and how. He advises allowing the pause to become naturally integrated into how things are done in your place of work rather than a policy or procedure.
Cleveland Clinic, in the USA, introduced “The Pause”. After a patient death, the team gathers at the bedside for a 15-30 second silence. “The purpose is to honour the human life and the efforts of the team”, writes Silvia Perez Protto, MD.
The suggested script is:
“Let us take a moment to pause and honor (patient’s name or this person). He/she was someone who loved and was loved; was someone’s family member and friend. In our own way and in silence let us take a moment to honor (patient’s name). Let us also honor and recognize the care provided by our team.”
15-30 seconds of silence
“Thank you everyone”
“The pause” @ClevelandClinic was piloted at 5 units during 2017, using voluntary feedback from caregivers the final script is below. Practice is voluntary, initiated by anyone from the care team. Happy to share details!! [email protected] @EiranGorodeski @traulc pic.twitter.com/GW3mugvC8i— Silvia Perez-Protto (@perez_protto) February 3, 2018
Siliva Perez-Prottoe, Medical director of End of Life Programs at Cleveland Clinic explained in a tweet that if the family is there they ask for permission. “If they prefer us not to do it, we gather at other location, usually at the nurses room.”
Providence Health Care has also introduced the practice, and provides instructions:
- One person in the room (the Pause can be initiated by anyone in the room) simply says something like, "Let's take a pause to honor the passing of this patient, who was someone's brother (father, mother, son, partner, parent, etc.)."
- In addition, caregivers recognize their own contribution with a statement, such as, "We all worked to provide the best care possible for this patient and should acknowledge that care."
- Lastly, everyone simply stands silently at the bedside for 30 seconds or so before going to care for other patients. The Pause is not mandatory but it is an example of the Providence promise to answer the call of every person we serve to "Know me, Care for me, Ease my way."
The Pause (Providence Health Care Spokane, WA, USA)
Bartels J (2017) Patients come first podcast. Virginia Hospital & Healthcare System.