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Virginia LeBaron is an Assistant Professor at the University of Virginia School of Nursing. She holds advance practice certifications as an acute care nurse practitioner (ACNP-BC) and in palliative care (ACHPN) and oncology nursing (AOCN). Virginia has been engaged in global health work since 2004 when she joined the Palliative Access Team of the International Network for Cancer Treatment and Research. She is passionate about improving the delivery of oncology palliative care services in low-and-middle income countries and supporting nurses who care for patients with advanced cancer. Virginia spent 9 months in India as a Fulbright Fellow studying cancer care at a government hospital, and is working on publishing a book related to her research.

Don't Just Do Something, Stand There: The Power of 'The Pause'

Sometimes the most productive thing we can do is to stop.
Sometimes the most productive thing we can do is to stop. Stop what we’re doing. Stop what we’re saying. Stop what we’re thinking.  Just simply…stop. We don’t usually think of this advice in terms of healthcare, but we should—and not only for critical safety checks to make sure, for example, that the right patient is about to be wheeled in to the operating room.  
At a conference I attended years ago, a speaker summed up the essence of palliative care with the pithy, counter-intuitive phrase: ‘Don’t just do something, stand there.’ ‘Standing there’ is in stark contrast to how we typically function in healthcare, (and let’s face it, life in general), which tends to look a lot like running from patient to patient, talking on the phone while simultaneously answering a page, wolfing down lunch (if you get one at all) in a break-room while your colleagues pop in to ask you multiple questions about various patients.
The saddest consequences of this frenetic pace occur when the stakes are high and patients, families, and healthcare providers are at their most vulnerable, such as immediately after a failed code (cardiopulmonary resuscitation).When you lose a loved one, the world stops; ask anyone who’s been there. And yet the jarring reality for family members is that the world, of course, hasn’t stopped. People are still laughing by the vending machines, the phones at the desk still ring incessantly, someone needs you to fill out paperwork. A life may just have been irreversibly and fundamentally altered by loss, but for family members the world simply keeps pressing forward, unfazed. A similar phenomenon affects healthcare providers who are expected to witness profound loss, and then quickly move along to the next patient who needs care.
One of my colleagues at the University of Virginia (UVa) Health System  has developed an innovative approach to this challenge called The Pause. When I first learned about The Pause, I was struck by its elegant simplicity and the potential for the practice to make a powerful impact across disciplines and settings, without costing a dime. In this post, I interview Jonathan Bartels, former trauma and emergency room nurse and current Palliative Care Liaison at UVa, about the creation and implementation of The Pause. 

When did you know The Pause was necessary and a good idea?
It was about 5 years ago when I was working in the emergency room. I had just been part of a failed code. The chaplain came in and led a prayer. I felt it was important, but the language didn’t speak to me. I felt there was a real need for something that was more inclusive, that everyone could participate in, regardless of his or her individual beliefs. About a week later, I tried something different after a code—we were all still in the room, after the patient had died, and I simply said, “Can we stop and just take a moment to honor the person in this bed who has died, the life they led, the people they touched?” We all just stopped for about 30 seconds of silence. I got really positive feedback from one of the residents about it, and I realized this was a practice that needed to be more widely implemented. 
What, exactly, is The Pause?
The Pause is a structured invitation for members of the healthcare team to stop and honor a patient who has just died under their care. The silence can be whatever the person wants it to be, it is simply an acknowledgement of the humanness of the person who has just died. Anyone can request The Pause—the nurse, doctor, social worker—anyone. There is no strict protocol. It’s just a matter of being brave enough to stop and say something like, “Can we take a moment to silently honor this person who has touched lives, this person who has a family, who has been a father, a brother, a husband.” No one is forced to participate, it certainly is not mandatory. But if a team member is uncomfortable standing in silence for 30 seconds after a patient dies, it may be a red flag that this person needs more support. The Pause can be an important way to build resilience and avoid burnout for healthcare providers.
Why do you think The Pause resonates with people so strongly?
I think because we often approach death from a scientific standpoint, a point of detachment that sterilizes the event for healthcare providers who are socialized to view death as a failure.  Healthcare providers want a way to acknowledge death as a human rite of passage, and The Pause provides a way to focus on the basic importance of human-to-human care.
Where is The Pause being practiced now?  What feedback have you received about it from others?
The Pause can be practiced in any setting. I’ve heard it is being used in four different hospitals in Sante Fe, New Mexico. EMS (emergency medical service) first responder teams are using The Pause in the field. A hospital in Dublin, Ireland contacted me about implementing The Pause, and also a healthcare provider in Malaysia has reached out to me. It’s popping up in Texas and Connecticut, It’s being taught at the UVa School of Nursing. After the NPR interview it really seems to have caught on, across cultures and countries. The overriding feedback I hear from healthcare providers is, “Thank goodness this is happening!” I’ve also heard amazing feedback from families who may be in the room after a code. They are very grateful to have their family member acknowledged as a person; it is a very important memory for them to be able to hold on to.
If a reader wants to implement The Pause in their healthcare setting, what should they do? What resources are available?
I created a video that describes how to implement The Pause. It’s not complicated, and in fact I strongly caution against making the practice in to a ‘protocol’, but the video gives some helpful suggestions and tips and strategies

I'd encourage us all to stop and consider making The Pause a part of our practice.

You can read more about Jon Bartels and his groundbreaking work with The Pause here,
here, and here and listen to the NPR feature interview here.

Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
More from Virginia LeBaron, APRN, PhD, FAANP
As I patted myself on the back for having no trash to put out for the 2nd week in the row it occurred to me: healthcare needs more of this.
PUBLISHED: Tue September 01 2015
Yes, that dress. The one that blew up social media and has the world squinting over laptops, accusing friends, co-workers, and family members of color blindness as they ask: ‘so, what color is this dress?'
PUBLISHED: Tue March 03 2015
The man I found standing in the women's restroom looked uneasy, like he was about to get in trouble.
PUBLISHED: Tue January 06 2015
"I'd love to do global oncology work! But I don't know where to start. What should I do?"
PUBLISHED: Mon December 08 2014
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