April 3, 2018

From Sarah E. Power, LCSW, Regional Manager, Social Work Practice and Programs, Providence Health & Service

Acts of Compassionate Service

We cannot give what we do not have. A simple yet powerful reminder of our conditional and limited human capacity. Admitting this fallibility can be difficult, especially among staff in healthcare settings who feel called to serve some of the most vulnerable in our society. Throughout my career as a medical social worker and leader, I’ve witnessed countless acts of compassionate service that are rooted in love. These acts are delivered by a vast array of team members who hold incredible responsibility to skillfully care for patients and their loved ones who may be experiencing the worst day of their lives. Registrars, insurance verifiers, nurses, physicians, food service technicians, environmental care providers, dietitians, physical therapists, social workers, chaplains, occupational therapists, speech therapists, unit clerk . . . the list truly goes on and on. Each, a person who knows they will see and attempt to ease a stranger’s suffering as they enter their work day.

Supporting Caregivers

And, despite this shared compassion, these caregivers also fall short. This, they know. They know because patients tell them with their voices, their tears, their changing moods, their silence, they leave against medical advice, their treatment “non-compliance,” their survey comments, and sometimes, their aggression. Common examples of falling short include failing to: listen, offer and honor choice, withhold judgment, understand and accommodate safety needs, recognize and treat addiction as a brain disease, and seek interpersonal connection despite differences. It also includes organizational failures to provide adequate skill building and support to healthcare staff in order to therapeutically care for the community it serves. These failings not only cause further harm to those for whom the healthcare system is intended to help, but cause suffering to the staff who cannot meet the needs of the patients they’re dedicated to serving. As a result, we are often faced with the wounded caring for the wounded.

As healthcare environments across Oregon heed the urgent call to implement trauma-informed practices and policies, it’s critical that the needs of healthcare staff are not forgotten. Culture change cannot happen without them. Specific efforts may include:

  • Creating safe spaces for staff to discuss and reflect upon their gifts, struggles, biases, and opportunities for growth and development;
  • Modeling authenticity and vulnerability as leaders share their own experiences of providing care;
  • On-going access to trauma-informed education and skill building;
  • Access to debriefings and support following sentinel events and difficult situations;
  • Building compassion and self-compassion exercises;
  • Engagement in team resilience building;
  • Implementation of mindfulness exercises;
  • Promoting participation in employee assistance and wellness programs;
  • Including staff in the development and implementation of trauma-informed efforts, including policies and procedures; and
  • Recognizing that staff have their own trauma histories that lend strength, and for some, risk to the care they provide.

Finally, remembering that that we cannot ask our staff to give what they do not have—this is essential, and perhaps foundational, in implementing trauma informed care.