What are Schwartz Rounds and how do they benefit nurses? A conversation with Prof Jill Maben, RN, OBE.

Posted February 13, 2023

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Show Notes —

Schwartz Rounds provide a safe space for healthcare staff to share many aspects of their work with others. This results in reflections and realisations that enable staff to be more compassionate towards themselves and others.

In this episode, Nathan Illman sits down with Jill Maben to discuss Schwartz Rounds and her evidence-based research about the effect of these rounds on nurses’ well-being.

Listen and learn in this episode.

KEY TAKEAWAYS FROM THIS EPISODE

Making a difference and helping families during their most difficult times is immensely rewarding but it’s not always easy.

The term Schwartz Rounds was named after a young American lawyer, Kenneth Schwartz who had incurable lung cancer in 1995.

When medicine can’t provide any answers, or has kind of failed, what matters most for patients and families is compassion and empathy.

Schwartz Rounds help develop more personal knowledge of your emotions and the interpersonal side of the work that you’re doing, rather than just the empirical scientific, technical, knowledge that perhaps a nurse might need to have to deliver care.

What’s unique about nursing work is they are asked to bring and deliver their full selves, emotions, empathy, and compassion all day, every day to every patient.

Schwartz Rounds are developed to provide a safety net or support mechanism to help people process those emotional, social, and ethical challenges at work.

The four stages of Schwartz Rounds: Finding the storytellers, preparation of the storytellers, the rounds, and the after-effects.

It takes time to change culture, but there’s a fertile area for conversations to grow and for us to be more compassionate to each other, but also ourselves.

The Schwartz Rounds touch on many aspects of life and the reflections that happen during these rounds encourage nurses to be more compassionate towards themselves and others.

Vulnerability builds the bridge to genuine connections.

In rounds, you allow feelings to come in, and processing them enables different things to grow.

The more rounds you attend, the more protective it becomes.

Someone who deeply understands the power of rounds can help spread the word and encourage people to attend them.

Evidence shows that rounds have more impact on regular attendance.

Today’s Guest:

Jill Maben is a nurse by background and is now a professor of Health Services Research and Nursing at the University of Surrey. She leads a workforce organisation and well-being team. They have several research projects related to nurses’ well-being or healthcare staff’s well-being.

Connect with Jill Maben here:

https://www.surrey.ac.uk/people/jill-maben

https://twitter.com/nursingpolicy

Want to start with Schwartz Rounds? Go to:

https://www.pointofcarefoundation.org.uk/

Website: https://www.nursewellbeingmission.co.uk

Facebook Group: https://www.facebook.com/groups/nursewellbeingmission

Transcription —

Nathan Illman 00:00

Welcome back to the podcast everyone. My name is Nathan founder of nurse wellbeing mission and your host for this podcast, which I am absolutely loving, recording, and bringing to you. It really gives me an opportunity to speak to some people in the field of nursing and midwifery about something that is very important to me and that is improving the lives of nurses and midwives. I’ve been busy behind the scenes creating online courses around self-compassion and managing stress recently. I absolutely love working on developing learning content, and I cannot wait to bring this to the masses hopefully later this year. So watch this space for the Nurse wellbeing mission courses. In this episode, I speak to someone very special. I talk to Professor Jill Maben, who has many many achievements in her nursing career, one of which is gaining the title of Order of the British Empire, an OBE, which is a really well-respected thing to achieve in the UK and recognized obviously internationally as well. And this is for Jill’s amazing contribution to nursing research. In today’s episode, we focus on Schwartz Rounds. And my interest stemmed from my own experience of participating in these several years back when I worked in different hospital settings and really found them an amazing space with which to reflect on the human aspect and the emotional aspects of the difficult work that we were doing at the time when I was working in brain injury rehabilitation. So in this episode, Joe talks about her research, and we dive deep into what Schwartz Rounds are, where they came from, and why they’re beneficial. So personal experiences of their benefits, but also the results of Jill’s research that she has published. So before I bring you the conversation, just a quick reminder, if you don’t already follow us on Instagram, you can find us @_nursewellbeingmission. If you would like to receive well-being resources, including videos and articles by me, you can join our free Facebook group just type nurse and midwife wellbeing mission on Facebook. Also, just a reminder that if you’re listening to this podcast on your headphones through an audio player, you can always watch our conversations that I have with my guests on YouTube as well. So just type and search for Nurse wellbeing mission and you will find a playlist of all our episodes and you can visit our YouTube channel there. So whoever you are, wherever you are, I hope you’re doing really well. And here is this amazing conversation with Professor Jill Maben. Welcome to the Nurse wellbeing mission podcast hosted by me Nathan Illman. This is the place where nurse and midwife well-being is at the top of the agenda. Each episode aims to help nurses and midwives around the world flourish through informative, inspiring, and practical content and conversations. Jill, thanks so much for joining me on the Nurse Wellbeing Mission podcast, and if you don’t mind just introducing yourself, to begin with just tell us a bit about your background and a little bit about your kind of research journey if you like as well.

Jill Maben 03:20

Sure. Thanks, Nathan, very much. And thank you for the invitation. So my name is Jill Maben. I’m a professor of health services research and Nursing at the University of Surrey, where I lead a workforce organization and well-being team. And in that, we have a number of research projects related to nurse wellbeing or health care staff wellbeing. I’m a nurse by background as it says in my title. I haven’t been in clinical practice for a while. But I think when I became a professor, you give her a lecture that kind of looks back on your life. It’s called an inaugural lecture. And it was really then that the penny dropped. And I kind of made sense of why this mattered so much to me, and why my research interests had gone in the direction they have in terms of staff wellbeing and psychological ill health because I qualified as a nurse some time ago, and I nursed in some very challenging wards. And I found it really difficult and at times and I think I got burnt out very quickly. I couldn’t nurse in the way that I wanted to. I felt there was a big gap between how I wanted to nurse and what I could do. And so I left actually I left nursing I thought for good in 1982 after nursing for about two years as a qualified nurse and I’ve done three years as a student nurse, and I went and did a history degree. Literally, I thought I had left nursing forever. I could never imagine being back as a professor of nursing and studying this or getting a Master’s or Ph.D. or anything academic. So, yeah, it’s been a personal journey and it personally matters a lot to me.

Nathan Illman 05:09

Thanks for sharing that, Jill. Well, perhaps you could just talk a little bit more about what kind of got you back into it. So after the history degree, that’s interesting. I never knew that about you. What made you change your mind again? What experiences did you have that made you change your mind?

Jill Maben 05:24

So I nursed when I was studying history, I nursed as an agency nurse. And I think that sort of having less responsibility, I think one of the things I found most challenging was being in charge of a ward. We had about six or seven deaths. One week, we had an aggressive patient, it just felt very overwhelming as a, you know, I think I was the same age as my daughter is now I think, was 22 or 23. And it was a lot to take on. And I just felt really out of my depth. And I didn’t really feel I was being compassionate and able to nurse in as I said, in the way I wanted to. So I did nurse when I was studying for my history degree, but I could dip in and out and as an agency nurse, and I didn’t have that level of responsibility. And then I went traveling with my now husband didn’t know he was going to be my husband, then we survived two years of traveling around the world and I nursed in Australia. So I worked in Australia for a year, and it was a great thing to travel with nursing. Didn’t know quite what to do with a history degree if I’m honest. And so I nursed in Australia. And I just felt incredibly supported there in a way that I hadn’t as a newly qualified nurse in the NHS. I felt like people have my back, I was never left in charge, and I had more investment in training in the year I worked in Australia than I had in the two years or more in the NHS. So it just felt like a very different environment. And it really sort of reignited the fire and the passion in me for nursing because that had never really left. I love nursing, and I love patient care. And I love making a difference to people. That’s what I came into nursing to do. And that’s what I had really felt had got lost along the way very quickly.

Nathan Illman 07:03

And what about your interest in research, then? When did that begin? And yeah, sort of, I suppose Where were you working when that all started?

Jill Maben 07:13

Sure. So I came back to the UK. And had done quite a number of years of shift work and nights. And I didn’t really think I wanted to do that anymore. And I was just casting around for something else. And I think I probably had a little bit of a chip on my shoulder if I’m brutally honest. I did my nursing degree in Cambridge. So Addenbrooke’s and I had a lot of friends who were at Cambridge University, and I cut, there’s a bit of me thinking, I can do this. I’m sure I can do this, which I think is why I went to do a degree in history. And then because I hadn’t really pursued that I think academia kind of beckoned in a tangential way. So I saw a job advertised at King’s College London was a one-year contract. And I happened to get the job. It was quite serendipitous. If I got a different job, perhaps my life would have gone in a different direction, but I did get that job. And yeah, then I got the bike really for research. Did my master’s, did my Ph.D. Yeah, the rest is history really good. I’ve got a post about 10 years ago, so. So yeah, it was quite serendipitous. But I did enjoy research. And I did enjoy that. Finding things out, inquiring making a difference, providing evidence for practice, understanding, really, and I think, as I say, said earlier, I think I was sort of almost trying to understand my own journey and history in a way.

Nathan Illman 08:31

I normally ask people at the end of these conversations about kind of advice they have for people. But this feels like a very, sort of good point to ask this actually about what advice would you give to nurses who are working in clinical settings who may have an interest in pursuing a research path?

Jill Maben 08:47

Absolutely. Do really consider it. I mean, I recognize it’s a really challenging thing to do alongside a clinical career, but I do support people at the University of Surrey who do a Master’s alongside a clinical career. We definitely support you I know often it’s done in your own time. But yeah, make connections. Some people do undergraduate dissertations. They get the bug then but I think we haven’t always been great at making research feel real for clinicians, particularly nurse physicians. You know, the so what why would I do this? Why would I be interested? What can it do for me? And what can it do for nursing? What can it do for patient care? I guess I work alongside a lot of very inspiring colleagues also at Kings where I was before who do a huge amount for making things better for patients but also for staff. And that’s definitely what I’m trying to do. I’m trying to help nurses deliver the care they want to do and to maintain their compassion and their empathy which we know patients want, but we know is really difficult to keep across a career when it’s quite easy to get burnt out. And it’s a very stressful job where we’re encountering human distress on a level that most members of the public do not encounter. We’re seeing people dying, we’re seeing people get a very difficult diagnosis. We’re having to deal with some challenging colleagues, sometimes. It’s quite a hierarchical system in the NHS. There are lots of challenges in that work. But most of us are driven by wanting to make a difference, wanting to care for patients wanting to help families at some of the most difficult times in their lives. So it’s an immensely rewarding job. But it’s not always easy.

Nathan Illman 10:28

Yeah, absolutely. So there’s a multitude of different things that we could talk about. But obviously, today, we’re gonna focus on Schwartz Rounds. And I think what you’re just talking about, there’s a nice segue into that. So let’s dive into Schwartz Rounds. And I think if we come at this from the perspective of perhaps people listening who’ve never attended one, they might not know what a Schwartz Round is, you might have heard that term before. So let’s, let’s go from that perspective. Could you just talk us through what a Schwartz round is, to begin with?

Jill Maben 10:59

Definitely. So I think we have to start with the name because it’s not always obvious what that means. And I remember in our research study, one of our public members said it made them think of spices, Schwartz spices right? Now, okay, hadn’t even thought of that. But yes, it doesn’t exactly tell you what it is on the tin, so to speak. So what is a short trend? And why is it called a short trend? So it made him think probably quite unusually for a patient, maybe, but he thought, what is it like to work here? What does it like to be in a setting where perhaps you’re nursing someone who’s the same age as you? Who might have the same age children, that actually makes staff confront their own mortality? And how difficult is that on a daily basis? So it made him think, what does the staff need to keep doing this work? How do they process this? How do they make sense of this work? And his oncologist, Thomas Lynch, and, his oncology nurse, Mimi Bartholomew, and his sister-in-law came together to develop Schwartz Rounds. Very interestingly, they started originally in Grand Rounds in sort of medical Grand Rounds. And then they morphed into what is now a Schwartz round. But that’s about I was very deliberate, we actually went to Boston to interview Thomas Lynch, which was really fascinating. And he told us that it was really important for him that doctors were involved and that you didn’t want it to be seen as a soft and fluffy sort of thing over here, that was for others, and the nurses, that it actually is for the whole multidisciplinary team. And that’s what’s really critical about it. And there were very few interventions, well-being interventions, or interventions that help you process the work challenges that are for everyone. And that is a key part of why they work and how they work in my opinion. So Schwartz Rounds were born. And they moved from these grand rounds. The first Schwartz round had X-rays being held up and things that seemed bizarre now given them we know what they are, which I’m going to tell you in a minute. But yeah, that’s how they started. And they’re named after Ken Schwartz. He was a patient. Yeah. Well, it’s named after an American lawyer called Kenneth Schwartz. And he was a patient in 1995, so many years ago now, and he was a relatively young man, he was 39. And he had incurable lung cancer. And he wanted, he set up the combat center for compassionate care in Boston, and Schwartz Rounds were named after him. And why that was, is because what he noticed was that when he wrote a fabulous article in The Boston Globe, where he talked about what it was like to be at the end of life, really, or to know that there was no curative treatment and that what mattered to him, was how people connected with him how staff talked to him about his children, about their children about, you know, they connected on a human level. And he talked about when medicine can’t provide any answers or has kind of failed, what mattered most was that the staff were compassionate and empathic to him. And what that did for him was made, he said the unbearable bearable, but what he noticed was that some staff could do it some days, and not others or some staff couldn’t do it at all. Thanks for that background. Yeah, there’s, there are so many fascinating points about that. I think, like, as you were talking, you know, I sort of reminded myself of the background of Schwartz Rounds as well and I was thinking about the experience I had last year with my dad and I think I’ve shared with you when we first met that my dad was in ICU and then he died and I was thinking about the compassionate care that I witnessed my dad getting and as a family member noticed, really notice when staff made that little connection with you and it really helped mine and my family’s experience. And it’s really important, isn’t it to support staff to actually empathize with patients? And something else that I was thinking about as well as the idea of different forms of knowledge and how we get, we’ll get into this, but I guess Schwartz Rounds to help with developing that kind of more personal knowledge of your emotions and the interpersonal side of the work that you’re doing, rather than just the kind of empirical scientific, technical, knowledge that perhaps a nurse might need to have to deliver care for example. I think you’ve made something so important there that, I think what’s quite unique, I would say about nursing work, but healthcare work generally, but nurses are at the bedside, much more in the community 24/7, you know, seven days a week that not many people are asked to bring their full selves to work every day, to bring their emotions to bring their empathy, to bring their compassion, and to deliver that all day, every day to every patient. So it’s a lot to ask, I think, and I think that’s, you know, really at the nub of my work, how do you keep doing that? How do you keep connecting with people and keep making that time to connect, you know, what you saw and what you noticed? In your dad’s situation, what I’ve noticed as a patient is when somebody comes and sits on your bed and really takes time to listen to you, they’re not just coming to do a task, and that’s what Schwartz Rounds are developed to do, to provide a sort of a safety net or support mechanism to help people process those emotional, social and ethical challenges at work that we all face. And provide a safe space to talk about them with other colleagues and make sense of them. And what we know from our work, but other work is that actually talking about them, and sharing them actually can provide some element of closure, some processing of that. And people can sort of put those experiences in a different place, but kind of learn from others, you know, what’s worked, but also end up really admiring colleagues and feeling much more bound together as a team, when they hear about the extraordinary things that people do every day in the NHS,

Nathan Illman 17:15

I think you’ve touched on something really important there, which is it’s not just about sharing experiences because I think a lot of people would agree. Okay, yeah, sharing things can be helpful. And something I love about your research is that you really look specifically at why that’s sharing, what the conditions are necessary for that to work, and for who that works. So before we get into that a little bit more, I know you and your team have sort of delineated the four stages of shorts rounds. So do you want to just talk us through those stages? And what that looks like, if you can remember them?

Jill Maben 17:47

Yeah. So I mean, I’ll tell because I realized I’ve sort of given so much context and background, which is probably me talking as a realist researcher, you know, context and background is everything to help us understand. But around is a group session really, where people come together, possibly once a month, that’s how they usually work in a space, often at lunchtime, but not always, food is always provided. And that’s part of the contract, which is important because it’s both practical that people don’t have to get their lunch before they come, they can grab their lunch and have it in the round. But also it’s symbolic of breaking bread and eating together and building teams. So and that’s how Schwartz rounds facilitated. There are usually two facilitators, preferably, or clinical lead and a facilitator. And the round starts with anywhere up to three or four people sharing a pre-prepared story. So it’ll be the round will have a title that could be what keeps me awake at night, a patient never forgets, when things don’t go as planned, things like that, that bring things together. That’s a themed round, where each of the storytellers will go intern speak for five minutes, and they will share something on that theme. So they will each say what keeps them awake at night, and that might all be different. There’s another type of round, which is a patient case round, which you see in the NHS much more. We don’t have that so much in rounds at the University of Surrey, where we run them for our undergraduates, but a case-based round would be where there’s a patient case that has become quite famous or infamous, or lots of people know about it, or it’s been particularly challenging and difficult for various reasons and the facilitator as I think this would make a good topic for Schwartz round. So in that case, you would get 2, 3, 4 different perspectives on the same case and the same patient and that can be particularly fascinating because you might get a nurse experience, the doctor experience, the social worker, that speech therapist, sometimes the lawyer from the hospital and so what that can do is deepen our understanding of each other’s roles. And what we do. Once the stories have finished, the facilitator opens it out to the audience to tell, and offer their insights. Some people will tell share second stories, and some people will comment on what they’ve heard. It’s important that it’s not a q&a session, or it’s not problem-solving. It’s a space that is held quite tightly by the facilitators as a space to talk and process not to problem-solve. And in our research, we talked about making it a countercultural space. So it’s very countercultural, it’s very different from the rest of the NHS because it’s a space where stillness and silence are valued. There are often silences in rounds, particularly when the storytellers have stopped speaking, people are thinking, it’s a space where it’s not sort of protocol-driven, outcome-orientated as a lot of NHS is. It’s also where hierarchies are flattened. So everybody is there as a human being, it doesn’t matter if your consultant A or healthcare assistant, B, or Porter, see, you are all equal in rounds because you will, everyone provides patient care and, and has the same mission really in an organization, which is to provide the best patient care and to support each other. So I think there are important differences. So that would go on, for sort of facilitated discussion would go on sort of 45, 50 minutes. And then the last word always goes back to the panelists. So it’s quite structured and quite set almost in a way that a therapy session might always end on time. It’s always predictable. And the last word goes to the panelists who then reflect on what they’ve heard, sometimes they will have, yeah, reflected differently just because they’ve heard their colleagues reflect on things and they’ve heard their colleagues respond to their stories in a certain way. So they say, well, they don’t have to, but they can share, you know, how they found the experience and how it’s made them think about their experience, and perhaps in a different way, or the same way. And then the round closes, and then we do evaluation forms, etc. But I think that we were very struck, when we did our research, by how consistent they were across the country, I probably observed about 50 rounds, and they were all, they weren’t all the same by any means. They’re very different. But the structure was the same. And I think that provides helps provide a safe, psychologically safe, and containing space. They are confidential, you sign a confidentiality statement, and when you come in, you can talk about rounds generally, but you can’t talk about what people say or and I think that’s important, too. Yeah, so the four stages. Sorry, I will finally get to your question, Nathan. The four stages are, we decided that that really, rounds begin much earlier than getting in that room. And that was one of the sorts of key findings of our research so that the coming together in that hour, looks kind of seamless, and here we are together for an hour, but there’s a lot of preparation that goes on. So the first thing is finding a storyteller finding stories ear to the ground. What are the stories out there? Who can tell this? Finding a storyteller. The next phase is probably one of the most important phases, which is the panel preparation, the preparation of the storytellers, and ideally meet together with the storytellers. So they can each hear each other’s stories, and if there’s more than one, they decide an order in which to go in. But they’re not surprised or hijacked by someone else’s story, because they’ve heard it. So that’s all about preparing the ground for it to be psychologically safe. We check whether it’s, it’s okay for the story to be told. Is it true? Or is it that was it going to upset people as they’re going to be a lot of controversies? And we also encourage help people to tell their stories in five minutes. Another key thing there is getting people to paint a picture really, so the best rounds and the best stories, because the stories are really the vehicle for the round. They’re the engine of the round. They trigger resonance and reflection you hope in the audience. So you picking the stories to be okay, we might know this some people for the community. So we want a community story, or you’re picking it to be resonant with the audience, but also to paint a picture. So when someone’s telling a story, you can actually imagine yourself in that room, or in that scenario with that person. And they are the most powerful stories. And I’ve been in rounds where you can literally hear a pin drop, and it is so extraordinary. You know, there are around full of a room full of 60, 70, 80 people. And there is not a sound because everyone is listening so carefully, because they, you know, they’re hanging on every word of the storyteller. What’s going to happen next what’s going on, you know, what happened? What’s the outcome? What words where’s this story going? So, helping storytellers prepare, what is a little bit of a performance really, but keeping it to five minutes and to keep an eye on the time, not going away and writing lots of notes and then reading it, because that kind of kills the storytelling that is really important. And then the round itself, I’ve explained, that’s the hour. And then stage four is the after-effects and the ripple effects. So as I said, rounds are not expected to have outcomes or change practice. That’s not there, you know, that’s not their raison d’etre. But they do. And a lot of our data would talk about these ripple effects, and have conversations changed how compassion grew in organizations, but it’s quite a slow intervention, it takes time to change culture, but people would say things like conversations, how about having a space to grow? Now there’s a fertile area for conversations to grow, and for us to be more compassionate to each other, but also to ourselves. I think that’s something else that rounds do it encourages you to be compassionate to yourself. And my experience is that not many healthcare professionals are great at being compassionate to themselves, we put ourselves definitely second and patients always first. And we come last on the list, of our needs being met, but also the people getting compassion.

Nathan Illman 26:11

I’m curious to know why. What are your thoughts on why it helps people to be more compassionate towards themselves from your experience of witnessing or participating in them? And your research?

Jill Maben 26:21

Yeah. So I think I think there’s some role modeling that goes on in rounds, which I think is really critical. So often, the storyteller can be quite can be anyone but I think as I’ve said before, you can see into other people’s lives and experiences that you may know very little about. And I think sometimes you can have a senior clinician who is struggling with the death of a patient or whether an experience or a decision they’ve had to make. And that can be quite difficult for some people. Not difficult, exactly, but quite surprising. How is it that after 30 years, you haven’t kind of got this cracked? Yeah. So yeah, I think that role modeling by senior clinicians shows that actually, one has to develop something of a hardened exterior to cope with the vagaries and the challenges of life as a healthcare professional, because you can’t care deeply about every single patient every single day or asked you would never function, but there’s always some patience or some experience that will get through to you. And we’ll almost crack this armor that we have to put on.

Nathan Illman 27:31

Yeah,

Jill Maben 27:31

and that that vulnerability, and people role modeling that vulnerability allows others to be vulnerable and allows I think, sometimes that’s self-compassion in so by seeing others become perhaps distressed or be vulnerable, or share experiences, I think the reflection that happens in around enables staff to think about their own experiences, sometimes their own personal experiences, I mean, rounds touch every aspect of your life, really, and allow some reflection on why am I so hard on myself? What, why why don’t I forgive myself? You know, their questions, people asking rounds off themselves. And so I think it allows self-compassion to grow really.

Nathan Illman 28:16

Yeah, that’s certainly my experience. And I guess my understanding, I think, is we often have these shoulds about how we should be able to manage situations, don’t we? Many people working in healthcare, definitely nurses, I should be able to cope, I shouldn’t be feeling burnt out. And then like you said, when you actually see that vulnerability of people, particularly people who might be higher than you in the hierarchy, sharing that actually, they’re not coping very well with this particular situation, it makes you feel human, doesn’t it, it makes you see that we’re all imperfect, and actually, that it’s okay to not be managing that idea of cracking the armor, or, I guess with rounds, the way they’re set up, it’s almost like you’re saying if you’re going to participate in you’re kind of taking your armor off for intervention

Jill Maben 29:05

And leaving it at the door really, along with your, your title and your badge and your, you know, it kind of strips you down to being human and to being a human being, and that’s why we’re all equal in rounds because we’ve all got these difficulties, these challenges. Hardly anybody or nobody’s got it cracked every single time every single day. So sharing those experiences, I think allows others to learn and be compassionate to each other. I mean, we definitely heard that in our research people being able to be compassionate to other colleagues, learning more about colleagues realizing what a great job they’re doing, and how they could be compassionate to others. And so wanting to refer their patients to them, and, you know, it was a lot of learning goes on and around that is perhaps unexpected or was not always anticipated.

Nathan Illman 29:56

I had a really wonderful quote sometime earlier this year. think someone said like, vulnerable vulnerability built, builds the bridge to genuine connection. And I know that in your research, you identified some of the benefits rounds have on team functioning and, and teams and that was certainly my experience when I participated in rounds was the conversations that happened afterward, it was a felt sense of a greater, deeper connection between people knowing that you understood a bit more about the feelings of your colleagues, and you’re able to probably have deeper conversations with them outside the rounds as well.

Jill Maben 30:35

Yeah, definitely, definitely. And I think people talk about it being an opportunity to kind of step off the treadmill and come in and be in a different space and, and allow some of those feelings to come. Because I think we had an extremely powerful quote in one in our and our research was on when we talk about, you know, the feelings and how they push them down, push them down, push them down, they must have said push them down about five times. And that’s the norm, that we almost can’t allow those feelings to come to the surface, because you would worry about not functioning or breaking down all the time, but actually, in rounds, you will allow some of the feelings to comment that processing of them enables different things to grow, I think and different things to come in.

Nathan Illman 31:20

So if we think about this, from the perspective of nurses, more might be some of the barriers from your personal experience for nurses to attend these, I mean, some practical ones, but also maybe personal ones that you’ve encountered.

Jill Maben 31:34

Yeah, I think you raise a really important point because rather sadly, for me, nurses, reward-based nurses, or nurses in the community, those giving care to patients seemed least able to attend. And that was really difficult to see. And I know organizations tried hard to schedule rounds, you know, breakfast or in the evening, or different times of the day to try and accommodate people. But I think it was difficult. I mean, they usually settled on lunchtime because it suited most other people best. But it didn’t always suit nurses best because they were often feeding patients giving out lunches, you know, having handovers different things were happening then. So I did, we did encounter some allied health professionals who had a great idea of the sort of tagging going to rounds tag teaming. So they would take turns going around. So they couldn’t all get off away from practice and come to rounds. And so some would go and then they come back and talk about it anonymously, but talk with each other, and then the others would go and that seemed like a really nice solution. So we definitely heard nurses saying they couldn’t come because they couldn’t get time off the wards. What we did see was a lot of nurses in what I’d call sort of navy blue uniform. So the more senior nurses had autonomy and could manage their own schedules. So those who could fit this into their diaries, but others, sort of healthcare assistants and registered nurses often found it more difficult. I think some of the other challenges that we know from our work, but also other workers that I think most nurses have a bit of pride about being stoic and a bit resilient. If I can use that, while the controversial term is a term I particularly like, and I’m sure you don’t too, I think the problem with resilience is it can make you feel if you’re still if you’re not coping, that you’re not resilient enough, somehow, you haven’t quite done enough and actually that the responsibility for coping in what can sometimes be really difficult circumstances with no staff or no equipment, is that your fault, you’re not being resilient enough. It actually lets organizations off the hook in terms of their own responsibilities. But anyway, that’s a little soapbox on resilience. But I think nurses can have some sense of pride in being busy and keeping going and stoicism. Until, like me, they slightly hit the buffers. And then that you know, the surprise and thinking goodness, how did I get to here and how am I burnt out? And am I burnt out and what do I do now? And I had no preparation for how I felt at all. I had no nobody even I don’t think I even knew what the word burnout was or what it might look like. So there was no anticipatory prevention of that. And I guess what I would say rounds does is if you can go regularly and that’s what we definitely saw in our research, if you go regularly, it can be protective. And the more rounds you attend, the more protective it is because it gives you a space to you know, let out some of these feelings perhaps not saying it can necessarily prevent burnout, but it can give some coping mechanisms that perhaps are not available elsewhere. But I think it’s really hard for nurses to prioritize it, given the demands on their time, and patient care gets prioritized first, understandably, they can’t get away from clinical practice. So I think I think that’s challenging.

Nathan Illman 35:12

You obviously witnessed the setting by 50 Rounds and different organizations. Presumably, you saw some sites that were better at providing that practical assistance. So can you just talk a little bit about that? I mean, I guess it’s things like increased staffing, staffing, and, being a bit more flexible with staffing. So if there’s anyone listening to it, perhaps there are some of the more senior nurse nurses listening says and thinking, Oh, well, I would like to be able to encourage my support, my staff to go, what did you see that worked?

Jill Maben 35:46

So I think we saw you really need rounds champion in organizations, people who get it and who understand what rounds are, I think it’s, we interviewed people who had never been to rounds and who didn’t know what they were. And they didn’t know if they were allowed to come? Did they need an invitation? Did they need permission? So I think there’s a huge amount of sort of comms work to do in organizations, what our rounds, you know, as we said, it doesn’t know what it doesn’t say what it is on the tin, you know, you think of a Schwartz round, it doesn’t immediately tell you what it is. Certainly people in our research, we had members of our steering group who we’d been talking about short rounds for about a year. And I kept encouraging them to go, I said, please go, please go, they came back. And they were absolutely blown away. They’re like, Oh, my goodness, I had no idea it was like that. And there’s something about sitting around. And really, you almost have to feel it, feel the power of the silence, feel the power of the listening, and you can own somebody said to me, and it’s the hairs on the back of my neck stood up. I’ve never heard anything like this in the NHS, and I’ve worked in the NHS for 30 years. So I think there’s something about really understanding the power of rounds and what they are. So that you can spread the word and I think is senior nurses and other clinicians if you get them and if you get the evidence base and how they can help stress and, you know, support teams and how ripple effects to grow, then you will prioritize them for your staff. And I appreciate the current climate that is really difficult. But what we did see was people letting students who were supernumerary come to rounds, so that they were cultivating some knowledge of rounds, which hopefully would carry on into qualified practice. We saw as I say, in that allied health professional teams and taking turns, they’ve organized that themselves. So different people came. If there is a better time of day lobby, the facilitators say, actually, you know, three o’clock in the afternoon is better for my team. So can we have some of those, please? Also where they seem to be really critical. In acute drafts, you know, being in the center of a hospital where everyone could get to easily was important. So it didn’t take so long to get there for community nurses that sometimes difficult but having it, you know, near a base or something that was important. The other thing that Point of Care Foundation tried and some trust trials was what was called pop-up rounds, which were shorter rounds that were undertaken with Ward based staff, and that developed more in the pandemic and something called Team time. So in the pandemic, rounds moved online. And they were much more focused on a small team. So it might be an emergency department team or award team. And stories didn’t have to be quite so digested, they could be more recent stories. Because normal rounds are open to anyone and everyone from any discipline assignments I think I alluded to earlier. So I think having some pop-up rounds, discreet rounds, and maybe online rounds are easier for some people. And I know some trusts have kept them in post-pandemic when they have some online and some face-to-face. I mean, they are different. And I guess there’s quite a growing number of places doing rounds with undergraduates now. So again, we’re trying to develop that understanding and knowledge of rounds so that we’re encouraging our students to go and ask for them and find out where they are in their trust and make sure they can go because again, you know, the individual can sort of lobby to go and say, I really want to go this is really important to me. Not always easy to say when you’re a student. But yeah, so we’ve got a project now called short south where we’re rolling out rounds across up to seven higher education institutions for undergraduates. So we do them at the University of Surrey. So we’re trying to spread that short love across the south and supporting other organizations to run them for their undergraduates which are, yeah, enormously powerful and a great privilege to facilitate it and I’m a trained facilitator and facilitating student rounds in some is different again, but extraordinary, I’m always in awe of our students capacity, to be honest, and open and make themselves vulnerable in front of their peers and support each other, they are incredibly compassionate and generous to each other. And that’s really lovely to see.

Nathan Illman 40:09

As you know, part of my mission is all about preventative mental health for nurses and midwives. And I think it’s fantastic that you’re leading this project to embed that within higher education. I think it’s a fantastic way, as he mentioned before, and I believe that it can prevent burnout and other emotional difficulties that people experience, I guess it’s part of other kinds of interventions and things, but it’s certainly one fantastic way people can share experiences and get some support. This has been such a great overview of shorts rounds, really appreciate your time. Jill, thank you so much, for talking about this for me. And there are lots more that we could dig into it, perhaps we can just save that for another conversation. So we just finished by perhaps you can tell everyone where they can find you and your research.

Jill Maben 40:58

Certainly, if I just might sneak in one more thing. Nathan sorry. But I think in terms of the evidence base, our national evaluation has given a lot of evidence, we didn’t have evidence in the UK before about how they worked and their effectiveness. But certainly in terms of their effectiveness, what we found was through 500 questionnaires in over 10 sites of people who hadn’t been to rounds, and then we tracked them again, after eight months, we use the GHQ 12, which is a validated measure of clinical poor well being really so stressed and not being able to sleep and there are quite specific items in there. And we found that for everyone who had done the GHQ 12, 32% had poor well-being which would be sufficient to have an intervention. And that’s quite consistent across the NHS, it’s often quite surprising that there is so many staff at work unwell learning, but that’s quite consistent. What we found of those who didn’t attend, was 37% at the start of the study, so a little bit more. But eight months later, they had been no change, really. So they were a control group. So they were 34%. One of those who attended rounds and attended more than half of rounds over that eight-month period, their poor well-being dropped from 25 to 12. So it halved, and we were very surprised by that. Because it’s quite difficult to shift the GHQ 12 in that way. So I think that really gives us a good evidence base to suggest that rounds do have an effect with regular attendance. And in terms of if you want to start rounds, the best place to start is with the Point of Care Foundation. There is a charity that holds the license in the UK and you have to have a license with them. And in terms of my work and research, find me at the University of Surrey. I have quite an unusual name when you google Jill Maben J-I-L-L. And May-B-E-N. It’s me that comes up so you will be able to find me and email me at sorry or Yeah, reach out by Twitter.

Nathan Illman 43:02

Thanks, Jill. That’s fantastic. Well, we’ll leave things there.

Jill Maben 43:06

Thanks very much. Lovely to talk to you, Nathan. Thanks for the time.