1. Collins, Amy M.


'The Pause' honors patients who have passed and the medical team that cared for them.


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Although Jonathan Bartels had early experience in the health care field-he worked as an orderly at age 18-he admits that he tried to "run away" from a career in nursing. He'd been told by the nurses he worked with to avoid the profession because it was a hard one, and so he pursued other interests. But while doing graduate work in comparative religion he received a call from his family that his brother was dying of glioblastoma and they needed his help. In the process of helping to care for his brother, he had an epiphany. "The thing I'd been running away from all my life was actually the thing that answered most of the questions I had. And so, nursing became a calling," he said. "After I'd gone through the death of my brother, I realized if I could do it for him, I could do it for anyone's brother, sister, mother, whoever."

Figure. Jonathan Bar... - Click to enlarge in new windowFigure. Jonathan Bartels, RN. Photo courtesy of Jonathan Bartels.

Bartels started off in medical-surgical nursing, working with patients undergoing organ transplants. His was a combined unit with postoperative trauma, urology, and medicine, which he says exposed him to many care approaches. But when a new palliative care unit opened in his hospital, and they needed someone with acute care experience, Bartels was interested. So, they trained him to be a hospice nurse, which he says he loved. "But I did get burned out in that process," he added. "I didn't know about self-care at that time. After so much exposure to death and not knowing how to deal with it, it just kind of pushed me out."


From palliative care he decided to go into trauma-"the next logical step," he says. "I joke about it, because it was last thing I wanted to do, but it was also the best thing I could have done." He stayed in trauma and emergency nursing for 11 years.



It was during his time as a trauma nurse that the idea for "The Pause" was born. Bartels says it occurred to him after a seven-day retreat in Santa Fe, New Mexico, with Roshi Joan Halifax, a Zen Buddhist teacher and pioneer in resiliency work with health care providers. The retreat, which taught mindfulness, neuroplasticity, yoga, and the physical aspects of trauma and grief, "blew me away," he says. When it came to an end, Bartels remembers Halifax saying to the attendees, "You have to use the benefit of what you just received and go make a difference."


Bartels returned to his ED trauma unit and saw a way he could make a change. "After we [try to] resuscitate someone, and that person dies, the tendency is to push it down, push it back, push it away, and move on, because someone else is coming in, and there's no time to hold that space." At those times, he would look around the room and see other providers' disappointment, sadness, and sometimes even anger at the patient for "dying on them" as they walked away. "I thought, walking away from that, even if unintentional, was a nonhonoring of the life that had just passed. As someone who studied comparative religion, I realized that death is the last rite of passage we will all face."


So, Bartels found a way to "hold that space" in a way that was meaningful and universal not only for him but for everyone in the room. The next time they lost a patient, he asked the attending physician if everyone in the room could take a moment of silence to honor the patient. "I said, 'Before we leave, can we honor this person who was loved, who had a life before they came here? Can we also take a moment to honor the work we did to try to save them and honor their family in their loss? And if we can do this in silence, but do it in our own way, we can hold that space. Would that be okay?'" They all agreed and took a minute in silence and honored the patient. Bartels stressed that The Pause isn't about religion. "I'm not going to impose my religion on you. What I'm really doing is triggering the return of honoring our patients, whatever that means to you. What I'm imposing on you is an honoring, a respect in silence."



After The Pause that day, some of the providers in the room approached Bartels and said how much the act of honoring the patient had touched them. "I knew I had something when people started spontaneously imitating it and doing it for themselves and owning the practice in their own way," he said. "It was a grassroots, ground-up, ED kind of thing where people did it because it was right."


Other clinicians coming through the ED noticed the practice and started doing it in different areas of the hospital. Then, after Bartels was interviewed for a local National Public Radio (NPR) station, the idea went viral. Around this time, he also wrote an article about The Pause for Critical Care Nurse (February 2014). National NPR soon covered the story, and his idea began to spread across the country. He has since been invited to give talks throughout the United States, and he gets calls from people worldwide wanting to hear his story and learn more.


One thing Bartels says he finds most gratifying about publicity surrounding The Pause is that it has led to other types of "honorings." For example, there is now an "honor walk" for transplant patients across the country. He says emergency medical services providers, firemen, and other first responders are doing The Pause in the field, and it's also happening in nursing homes after expected deaths. He says he even asked the surgeon before a major procedure he himself was undergoing if they could pause and do an honoring before they performed the surgery.


Bartels was recognized for his work as one of six finalists for the Schwartz Center for Compassionate Healthcare's 2017 National Compassionate Caregiver of the Year Award and as the winner of the American Association of Critical-Care Nurses (AACN) 2018 AACN Pioneering Spirit Award.



Bartels is now the palliative care liaison nurse for inpatients at the University of Virginia (UVA) Medical Center in Charlottesville. He is also a founding member of the UVA School of Nursing's Compassionate Care Initiative, which takes the initial resiliency work Bartels did with Halifax and applies it to nurses. "Even now, in most programs, you may see a paragraph in a book that says, 'You should take care of yourself.' But not a lot of focus is on how to do self-care, promote resiliency, and promote compassion within yourself. That's where the Compassionate Care Initiative has its roots." Bartels's predominant role in the initiative is to be a facilitator for the resiliency retreats that are offered to nursing students at all levels.


Bartels says he sees growing interest in self-care from fellow staff members and administrators, who need to maintain staff. "If you can't retain a nurse, you've got to figure out a way to do better," he says. And he stresses that there is no one way to take care of yourself. "You have to find what it is that feeds you and do more of that, whether it be your faith, friendships, art, or singing. That's what you need to find so you can heal and continue. But I don't want to train people to be resilient so they can be kicked harder. I want them to have resiliency so they can last longer in their field."


For more information on Bartels and The Pause, go to M. Collins, managing editor