Code Lavender: Creating a Culture of Compassion and Support for Healthcare Workers
The current pandemic has emphasized the importance of providing a supportive environment for healthcare workers in a variety of ways. As leaders and clinicians, it is imperative that the staff’s emotional needs are addressed in a timely manner. This can be accomplished by putting systems in place to provide support when adverse and emergent situations arise.
What emotional strain do healthcare workers experience?
Healthcare workers can experience an array of emotions in their daily duties at work and in their personal lives. Many healthcare workers are motivated by the positive emotions that come from helping patients in difficult situations such as delivering a baby, discharging an infant after a successful heart surgery, or stabilizing a patient after a life-threatening motor vehicle accident. Unfortunately, negative emotions are a natural response to the challenge’s healthcare workers encounter daily. Challenging situations can include a maternal death due to a hemorrhage, a failed resuscitation of an infant that leads to brain damage, or any unexpected outcome. When a healthcare worker faces trauma, adverse events, or emergency situations, the clinician can experience emotional stress, grief, and an array of negative emotions after the event known as the second victim experience or secondary traumatic stress. ²
For second victims, unresolved stress can progress to post traumatic stress disorder (PTSD) and possibly unresolved grief if a death is involved. Many second victims feel personally responsible for the adverse outcome and begin to question their clinical judgment, skills, and knowledge base. Unresolved stress or grieving can lead to depression, mental exhaustion, damage to relationships, and potentially end the clinician’s career. According to a study by Beck and Gable, healthcare workers who are second victims can experience similar symptoms of PTSD like intrusion, avoidance, and arousal symptoms.² The study found that 63% of labor and delivery nurses experienced secondary traumatic stress and 25% met the criteria for PTSD.
Symptoms of PTSD can include:
- Experiencing flashbacks
- Distressing dreams
- Reliving event
- Avoiding situations similar to the traumatic event
- Avoiding thoughts about the event
- Suppressing feelings about the event
- Exaggerated startle reflex
- Sleep disturbances
- Irritability or anger
- Difficulty concentrating
Many hospitals and healthcare organizations embrace the importance of debriefing after an adverse event, but oftentimes the debriefing practice involves only reviewing system processes. It is important to review and identify what went well and what could be improved from a clinical standpoint. While those steps are important, it is also critical to teach coping mechanisms to deal with emotions and stress responses. Encouraging open conversation about emotional needs and stress responses during a debrief allows staff to decompress, reduce tension, clear up misinformation, and begin healing. Unmanaged stress can lead to negative patient outcomes unless there are systems in place to address immediate emotional needs of healthcare workers.
Therein Lies Code Lavender
Code Lavender is a term pioneered by the Cleveland Clinic in 2008 as a crisis intervention tool to support any person in a Cleveland Clinic Hospital after any stressful event such as a death, traumatic event, or diagnosis of a chronic disease. A Code Lavender is a psychological first aid tool where support is given to patients and staff by providing: ³
- Purposeful physical presence
- Individual or team support
- Debriefing and follow up
- Complementary therapies
- Prayer and other affective based interventions
- Tea and snacks
In November 2020 at the Synova Perinatal Leadership Forum, Dr. Megan Lochner, Assistant Professor of Obstetrics and Gynecology, presented the Stony Brook Code Lavender Program. Dr. Lochner and her colleagues surveyed the Stony Brook Maternity and Neonatal Intensive Care Units (NICUs) and found that 86% of respondents experienced an adverse event that resulted in feelings of distress including insomnia, anger, frustration, self-doubt or sadness. Their research found 29% of respondents stated that their distress continued for over two weeks. The survey findings indicated that there was a significant need for emotional support and resources for staff that experienced an adverse event.
Following the survey, Dr. Lochner spent the next year creating a Code Lavender pilot program to respond to the emotional needs of staff on maternity and NICU units. The Code Lavender team includes hospital chaplains, physicians, social workers, nurses, behavior/mental health professionals, and other hospital administrators. The program is founded on evidence-based relaxation and restoration interventions to help meet immediate patient care responsibilities while attending to their own emotional needs.
Following the implementation of the Code Lavender program, the Maternity and NICU staff were re-surveyed and almost 80% replied that the culture on their units had improved over the previous year. Eighty percent of staff knew of support resources available for their needs as opposed to only 20% prior to the pilot. Staff expressed improvement in cohesiveness between the two units. The availability of a Code Lavender program signals to staff and patients that in depth support is available to help manage emotional distress, suffering or grief. It shows that self-care is an integral component of a healthy working environment.
Access Dr. Lochner’s 2020 Synova Perinatal Leadership Forum presentation:
Why a Code Lavender program?
The COVID-19 pandemic has prompted healthcare organizations to focus more closely on caregiver well-being, self-care, and restorative environments in healthcare facilities. At the American Nurses Credentialing Center 2020 Summit, nurse leaders addressed the need and importance of respite and resilience for clinicians. The American Nurses Association and nurse leaders now recognize the importance of promoting clinician well-being as it directly impacts Quadruple Aim benefits, staff retention, and organizational strength. Nurse leaders around the country are using a variety of solutions to meet the emotional and psychological needs of their staff including Code Lavender Programs and designing creative respite spaces.¹
The need for addressing caregiver well-being will continue to be a priority for healthcare spaces in the future. Program designs to address the well-being of caregivers will be unique to each organization, yet imperative for addressing the emotional needs of healthcare workers. Healthcare systems should begin conversations with staff, clinicians, and hospital administrators to develop organizational strategies that will address supportive environments and initiatives that promote the wellness of healthcare workers. How are you planning to address the emotional needs of your staff?
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