Letters to the Editor

The Pause, an article in the February 2014 issue (Critical Care Nurse. 2014;34[1]:74-75) by Jonathan Bartels, presents a concept that can be used to set a culture of caring and nurturing for patients, their family, and staff. The concept, called The Pause, is a simple time out, 45 seconds to about 1 minute, that recognizes a patient’s death as well as the efforts of the clinical staff when, despite all interventions, the patient dies. This concept, according to Bartels, is not brain surgery or rocket science, but a method for comforting and healing.Hospitals do not need an educational roll-out or check-off list to begin to implement The Pause. Bartels says to just do it; start implementing The Pause right away and begin the healing of taking care of yourself and others on the team.Many departments and disciplines are involved in code blues, including laboratory, radiology, pharmacy, physicians, nurses, technicians, chaplains, respiratory therapists, and paramedics; the list goes on and on. Compassion fatigue can affect those working in health care. It is described as the medical professionals’ posttraumatic stress disorder. Seeing death, trauma, unimaginable injuries, sorrow, and pain on a daily basis can take a toll on human beings and can be emotionally draining. Holding the hand of a patient who is scared, dying, or in pain will catch up with you if you do not take care of yourself and figure out how to deal with your feelings.One way health care workers can intentionally take care of themselves is to implement The Pause. For just a short time, pause and acknowledge what has occurred and recognize that you did the very best you could. Give yourself and your team grace and honor the life that has slipped away. After The Pause you will be more ready to move on to your next task and to recognize that life can be treasured and enjoyed.Bartels, who at the time was an emergency room nurse and palliative care liaison, started The Pause at the University of Virginia Medical Center in the emergency department. The concept and the practice of The Pause spread throughout that hospital.After The Pause was published in Critical Care Nurse, the concept began spreading across the United States. In fact, Bartels has received communication that The Pause has spread to other parts of the world, including Australia and Paraguay. This is tremendous!At the National Teaching Institute & Critical Care Exposition 2014 in Boston, the American Association of Critical-Care Nurses President, Vicki Good, spoke about The Pause. Good reminded critical care nurses that often when we need to be intentional about pausing in our work is when we feel as if we do not have the time or we are not intentional about it. Speaking to this audience yielded great support and encouragement for implementing The Pause in many institutions throughout the United States.After reading Bartels’ article and hearing Good speak, I stepped forward and told anyone and everyone who would listen about The Pause. Now I would like to share how we are “pausing” in New Mexico.We started by sharing the concept of The Pause with our hospital administrator, Angela Ward, RN, MSN. She encouraged me to share the information in our department manager meeting, which leaders from all units in the hospital attend. Those leaders at Presbyterian Rust Medical Center in Rio Rancho, New Mexico, immediately embraced the concept and we implemented it the next day in our emergency department. It was that important and that easy.The response from physicians has blown me away. The first time The Pause was implemented in the emergency department, I thought the emergency department physician would excuse himself and say he was busy, but he did not. He gave me a nod and stood at the bedside in reverence.The word spread to our sister hospital downtown in Albuquerque and I was asked to share The Pause with them. In fact, it was so well received I have been asked to share this information on many other occasions. Similar to my hospital where the results have been overwhelmingly positive, the excitement voiced by many of the units from our sister hospital has been rewarding.It should be noted, in case you have not read the original article yet, that this is not a religious ritual. It is simply a moment, a pause, to honor the life that has slipped away and to honor our efforts to do what we could to preserve life.After the word rippled among nurses in Albuquerque, I was honored to present The Pause at the Transforming Care at the Bedside Annual Conference to nurses from all over the state. Their feedback was very positive.At Presbyterian Rust Medical Center we now include The Pause in our monthly hospital employee orientation, which includes staff from respiratory therapy, laboratory, nursing, pharmacy, radiology, chaplains, paramedics, and more.Thank you Jonathan for this wonderful article and initiative that I will continue to talk about for years to come. One thing I say when talking about The Pause is how beautifully you wrote the article. Your words touched my heart and changed me.As a critical care nurse, hospital supervisor, and member of the rapid response team, I have always tried to take extra time with dying patients and their families, but it never seemed like it was enough. However, with The Pause, we enhance not only the care we take of ourselves but also we show families respect for their loved ones in a significant way. This idea is just so awesome and it has made a difference in my practice and in my team’s practice.