​Nursing is UHN's largest workforce and many nurses, as well as all point-of-care staff, struggle with moral distress, communication breakdown, insufficient self-care techniques and conflict regarding decisions about patient care.

Combined, these issues can make for a stressful environment, resulting in burnout, depression and, sometimes, nurses leaving the profession. Critical care providers working with higher acuity patients in ICU environments may have an even higher concentration of these problems. Which means it's a group that needs additional education, emotional support and targeted wellness activities.

CACCN.jpgThat's why representatives from Nursing, Medicine, Palliative Care, Bioethics, Social Work, Physiotherapy, Pharmacy, Respiratory Therapy, Wellness and Spiritual Care developed an interprofessional end of life program—The Building Bridges Initiative. The goal of the program, led by nurse educators Janine Boston, Liz Gordon, Brenda Ridley, and spiritual care advisor Eileen Dahl, was to create opportunities for interprofessional dialogue regarding moral distress and end-of-life to minimize isolation and increase understanding between professions and within UHN's ICUs.

"The integration of full point-of-care staff teams into the planning, presentation and attendance was a critical success factor for this initiative. Organizers and participants had the opportunity to build bridges with each other and across teams and programs, by engaging in interprofessional learning, sharing narratives and consolidating increasing awareness of resources with facilitation from staff across UHN," says Brenda Ridley, nurse educator and member of UHN's Chief Nursing Executive.

The first and largest educational initiative of its kind at UHN, the Building Bridges Initiative involved 12 eight-hour sessions throughout 2010 with over 200 attendees from TGH's three ICUs. During the sessions, participants explored common elements of ICU work on moral distress through storytelling and sharing personal examples.

"Point-of-care providers often see patients take one step forward and two steps back," says Janine Boston, Clinical Educator in the Peter Munk Cardiac Centre, noting that it can be tough giving comfort to families that are waiting for something to happen—good or bad—to their loved one.

"We all experience the same feelings, but from different perspectives. That's why we started the building bridges program, to break down barriers between professions and units—learning, healing and growing together."

A number of tactics were identified in the Building Bridges Initiative that all health-care providers can implement at the bedside to improve communication with patients, families and staff. For example, staff wellness activities such as meditation, yoga and stretching that are adaptable to the bedside and during breaks. Also, new communications techniques were developed for dealing with conflict, both within the team and with patients and families, as well as a family meeting checklist.

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