Technology has done great things for medicine: Machines can help keep hearts beating and lungs breathing. Electronic medical records help doctors keep track of their patients’ treatment and prevent mistakes. But all that technology needs a lot of monitoring – and that can be frustrating for nurses who want to be tending people, not machines.
To combat this problem, healthcare provider Kaiser Permanente is implementing a new program to help nurses relax a bit, and shift their focus back to what’s really important. KALW’S Christopher Connelly has more on what they’re doing.
CHRIS CONNELLY: Okay, everyone: Close your eyes. Now, take a deep breath.
BANU PERIASAMY: As you breathe in, breathe in loving kindness, equanimity...
It feels good, right?
PERIASAMY: As you breathe out, you breathe out frustration and anger.
Now, picture doing this every day, right when you get to work.
PERIASAMY: Breathe in gratitude and trust.
Do you think you’d do a better job?
PERIASAMY: Breathe out despair or pain. The pain you have been holding on, just let it go.
Okay, you can open your eyes now. The woman you’re listening to is Banu Periasamy. She's the afternoon managing nurse at Kaiser's Richmond Medical Center. She works on the medical surgical floor. And she leads her staff in this centering exercise every day at the beginning of their shift. The whole thing lasts about three minutes.
On the other side of the Richmond Hills, at Kaiser’s Antioch hospital, the sound of wind chimes plays throughout the hospital three times a day.
Nurses, aides, managers, and even some doctors stop for 30 seconds as the bells twinkle through the halls. Some close their eyes, take a deep breath, and use those few moments to clear their minds.
Erica Drongowski, a nurse manager at Kaiser Antioch, describes what it’s like.
ERICA DRONGOWSKI: Breathe, center pause, reflect, release. Those little chimes are very powerful.
Over In Vacaville, they work on techniques they call “heart math” to reduce stress in the moment.
In San Jose, nurses spend about an hour a week in a journaling club.
And in Santa Rosa, they channel alternative healing energies using Reiki and Gin Shin Jyutsu.
The programs are all part of Kaiser’s Caring Sciences program, a new initiative in 21 Northern California facilities. It’s based on what’s called the theory of human caring, a nursing theory that’s actually been around since the ’70s.
Anne Foss-Durant, who oversees Kaiser’s program, says it basically comes down to relationships.
ANNE FOSS-DURANT: Relationships with the patient and family. Relationships with our healthcare team and our healthcare members. Relationships with the community. And most importantly relationships with ourselves. Because we have to be in a good place in order to provide care to others.
It’s not always easy for nurses to stay in that “good place.” Nursing is, by its nature, a pretty stressful job.
Six years ago, Foss-Durant started thinking about ways to relieve that stress. She was the clinical adult services director at Kaiser’s Vallejo hospital, and every day, she could see how stressed her nurses were.
FOSS-DURANT: They were anxious before they got their assignment. And then they’d go out to take this assignment and they would be just so overwhelmed that there was this sense that they just couldn’t do it.
She worried that this anxiety was affecting patients. After all, talking with those stressed out nurses was often their main interaction with the hospital.
FOSS-DURANT: The age-old, I guess, saying, is that anxiety begets anxiety. And anxiety’s contagious. It’s not anything verbal, it's not anything we can touch or feel, but we can sense that. And as healthcare providers as we walk in the room with that state, our patients sense it as well.
So she started looking for something to make a change. She thought back to a theory class she took in nursing school, and remembered something called the theory of human caring. She thought it could help her nurses put their work into perspective.
FOSS-DURANT: This is really an invitation to go back to the way we were taught to practice. And it’s a way to refocus what you do and begin to make sense of all the tasks that we’ve been given.
Foss-Durant said the changes at Vallejo had an almost immediate effect – to the point that when Kaiser built a new medical center in Antioch, the human caring theory guided everything from staff policies to the design of the actual building. It’s a decision Erica Drongowski, the hospital’s chief nursing officer, says has improved the hospital experience for staff and patients.
DRONGOWSKI: Although this is our day-to-day work environment, this is a strange and scary space for them.
Kaiser designed the hospital to minimize the fear factor. The building’s hallways form intersecting triangles that cut down on noise and avoid having centralized crowded nursing stations. Patients get individual rooms. There aren’t set visiting hours, so family members can visit whenever they want, and the rooms have full couches if a patient’s loved one wants to stay the night. They’ll even provide toothpaste and a toothbrush, if you ask them for it.
DRONGOWSKI: This is our patients’ environment and they invite us in. The patient’s care isn’t just dictated to them anymore. They’re part of it.
This is also the hospital where they play the chimes. Drongowski says she loves hearing them.
DRONGOWSKI: The busy-ness and stress contribute to medical errors. It contributes to us not being authentically present to the patient that we’re caring for, so the chimes gets us to relax, pause, center.
Kaiser is measuring the program’s success in a few ways: patient satisfaction, staff satisfaction, and workplace injuries. Down the road, they're also looking to see if people heal more quickly, and if there are fewer medical errors. So far, the Antioch hospital has consistently out-performed other Kaiser hospitals in the region. Again, Anne Foss-Durant.
FOSS-DURANT: Patient satisfaction was the highest in the region and maintained the high levels over two-and-a-half years. So, over time it became obvious that it wasn’t just the new building.
Convinced that using the caring theory made a difference, last year Kaiser expanded the program to include nurses across the entire Northern California hospital system. More than 2,000 Kaiser nurses have taken part in some kind of Caring Science training. Many of them went back to start projects at their own hospitals. One of those nurses was Banu Periasamy – you remember her, from our breathing exercise.
PERIASAMY: The nurses are frustrated and the nurses are yelling at each other. We have patients, we forget that there are patients that are very sick. They need to heal, they need to rest. They’re all task-oriented – they forget the patient in the chaotic environment. So I thought I need to bring the change with my staff. Then my patients’ experience is going to be excellent.
Kaiser is not the first to use the theory of human caring in their hospitals: Medical centers in Texas, North Carolina, and Massachusetts all incorporate similar ideas. But Kaiser may be the first to do so on such a large scale.
And before you make up your mind about these ideas, you might consider taking a moment to breathe.
For Crosscurrents, I’m Christopher Connelly.
Christopher Connelly is a reporter with the UC Berkeley Graduate School of Journalism.