On a Monday afternoon about 120 staff from a large academic medical center in Michigan gathered in the auditorium for the hospital’s monthly Schwartz Center Rounds® session. The facilitator set the tone for the meeting, stating that the goal of the program is to support caregivers and enhance their ability to provide compassionate care. Self-care and awareness of how caregivers’ own needs impact their ability to practice excellent care are important components of sustainable compassion. This was the start of a conversation that encouraged caregivers to be more mindful of taking care of themselves.
The facilitator began by defining the term “hangry,” which combines “hungry” and “angry.” The idea for the day’s session came from a recent study discussed on NPR in which couples were given voodoo dolls and push pins. The couples with low blood sugar were two times as aggressive as those with normal blood sugar, sticking twice as many push pins into the doll. The article suggested that important and/or emotionally charged conversations were best held when people were not hungry.
There were three panelists: a 4th year internal medicine/pediatrics resident, a child life specialist, and a charge nurse from a general medicine ward.
The child life specialist shared an experience he had a few months before. It was late on a Friday and he was hoping to leave on time to meet friends after work. He had not eaten lunch because he was in a hurry to finish his tasks, and didn’t have any evening snacks with him since he had dinner plans. Two children were dying at the same time in the neonatal intensive care unit (NICU) that day. The right thing to do for patient care was to remain at the hospital, so he stayed until 9 p.m. However, his ability to give them the attention they needed was hampered by being hungry.
The nurse then talked about ward culture where some view it as a badge of honor to say, “I went all day without eating.” She reflected on the detrimental effect this type of behavior can have on patient care, clinical judgment, and the ability to effectively collaborate with others. And so she works hard to discourage this behavior and has initiated practices that have helped to change the culture.
The physician reflected on her first day of residency, when she skipped breakfast and in the midst of her busy day at the hospital was unable to get any coffee, lunch or dinner. When she finally arrived home in the evening she broke down in tears, and remembered saying to her roommate that she wasn’t sure she could be a doctor. She then vowed to eat breakfast and has done so ever since. Now, as a senior resident, the busier her team is the more she encourages breaks. She takes them regularly for coffee and bagels to foster this behavior.
The discussion that followed centered on the busyness of hospital care and identifying strategies for taking breaks, eating meals, and supporting each other in practicing good self-care. A palliative care social worker wondered how differently some of her team’s patient encounters might have gone if only they’d eaten beforehand. Maybe that “problem” patient or family wasn’t actually a problem. She also wondered how often collaboration with colleagues or referring teams is impacted because everyone is hungry, stating, “Oh great, every professional in this hospital is probably “hangry” and overly aggressive as a result—that’s a scary thought.”
On the flip side, another social worker spoke of how often patients are unable to sleep normally or eat at regular intervals, and pondered the impact this has on patient-caregiver interactions. Visiting family members who remain at the bedside for long periods of time are also in the same position. An awareness of how the lack of food and sleep affects coping, memory or behavior is helpful for maintaining compassion. The audience offered ideas for helping to encourage patients and families to practice self-care while in the hospital.
The conversation then broadened to other ways caregivers can care for themselves and support coworkers to do the same. A chaplain shared that she takes the stairs in between seeing patients. The exercise is a bonus as is the break, which she uses to re-center herself and prepare to receive the next patient’s story. A surgeon shared that he encourages operating room staff to rotate out of the OR to take breaks, which is better for patient care and for his staff’s health. A child life specialist discussed how humor can be refreshing, and shared the example of the Snicker’s Super Bowl advertisement where a man playing tackle football appears and acts like Betty White until he eats a Snicker’s bar, and then he’s back to his old self. The tagline: “You’re not you if you’re hungry.” Another social worker said she keeps small snacks in her desk just in case she gets hungry or needs to stay late unexpectedly.
This session ended with the audience reflecting on the challenges and rewards of providing care in a busy environment, and the importance of fostering a culture of self-care which includes taking the time to eat.
Please note that names and some case details have been changed to protect patient confidentiality.