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• To understand the concept and aims of Schwartz rounds
• To learn how to organise, prepare for and facilitate a Schwartz round
• To increase your knowledge of the benefits of Schwartz rounds for healthcare professionals and students
Rationale and key points
Schwartz rounds are a group-based model of reflective practice originally designed to assist medical staff to develop more compassion in their care. The aim of Schwartz rounds is to help healthcare professionals such as nurses ‘reconnect’ with why they first entered the caring profession.
• Schwartz rounds are designed to assist multidisciplinary healthcare professionals with the emotional, social and ethical aspects of caregiving.
• Schwartz rounds can also be used to support resilience training and boost workforce morale.
• The use of Schwartz rounds can assist nurses to understand the moral challenges they may encounter while caring for patients.
Reflective activity
‘How to’ articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of:
• How this article might help you organise Schwartz rounds in your clinical area.
• How you could use this information to educate your colleagues about Schwartz rounds.
Nursing Management. doi: 10.7748/nm.2023.e2094
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Duncan D (2023) How to organise and run Schwartz rounds. Nursing Management. doi: 10.7748/nm.2023.e2094
DisclaimerPlease note that information provided by Nursing Management is not sufficient to make the reader competent to perform the task. All clinical skills should be formally assessed according to policy and procedures. It is the nurse’s responsibility to ensure their practice remains up to date and reflects the latest evidence
Published online: 20 July 2023
Nurses are familiar with the use of reflection to help shape their learning and practice. Schwartz rounds are a group-based model of reflective practice (Maben et al 2021) developed in the US more than 25 years ago, inspired by the experiences of a patient, Kenneth Schwartz, who died of lung cancer aged 40 years. Kenneth Schwartz appreciated the support and empathy shown by his caregivers but was aware that some staff struggled to connect with him as a human being. A team of staff from the centre where he was treated developed Schwartz rounds to support colleagues with the emotional, social and ethical aspects of care giving (Schwartz 1995).
The aim of Schwartz rounds is to assist multidisciplinary healthcare professionals such as nurses to connect with their original reasons for entering the caring profession (Lown and Manning 2010), thereby promoting compassion and enabling them to reflect on the emotional aspects of care.
Schwartz rounds are a licensed intervention that were introduced in the UK in 2009 by the Point of Care Foundation and have since become popular, particularly following the Francis report into care failings at the Mid-Staffordshire NHS Foundation Trust (Goodrich 2012, Francis 2013). By 2019, there were more than 200 healthcare organisations running Schwartz rounds across the UK and the Republic of Ireland (Flanagan et al 2020). The Point of Care Foundation provides training for Schwartz rounds in the UK and while they can be challenging to implement, they provide support that can lead to a significant improvement in healthcare professionals’ psychological well-being (Maben et al 2018).
Schwartz rounds have been found to be an effective intervention when used to develop a compassionate and supportive culture among medical staff (General Medical Council 2019). They have also been used to support resilience training to enhance workforce morale among nurses (Duncan 2020), particularly during the coronavirus disease 2019 (COVID-19) pandemic when nurses had to care for patients during challenging circumstances (Trueland 2018, Maben and Bridges 2020, Mills et al 2020).
Schwartz rounds take the form of a monthly group that meets onsite in a ward or unit, or offsite provided the setting represents a safe space. They are open to all multidisciplinary healthcare staff and focus on their experiences of caring for patients and the subsequent feelings that may arise (Maben et al 2018).
• The author of this article has been involved in several Schwartz rounds. Initially, she was concerned about how they worked because she had not been involved in similar groups before, but careful preparation helped to alleviate some of this anxiety.
• The Point of Care Foundation provides training for Schwartz rounds in the UK. For any nurse wanting to organise Schwartz rounds, preparation should involve exploring the information provided by the Point of Care Foundation (www.pointofcarefoundation.org.uk/our-programmes/staff-experience/getting-started/), which includes:
• An introduction to Schwartz rounds.
• Feedback from people who have taken part in Schwartz rounds.
• An introduction to the core roles – facilitator, clinical lead, administrator and steering group.
• Practicalities including venue choice.
• Appropriate topics and speakers for the first three to six Schwartz rounds.
• How to evaluate Schwartz rounds.
• Schwartz rounds are led by a facilitator who is supported by a clinical lead from the local healthcare organisation, an administrator, who deals with practical issues such as room bookings, and eight to 12 steering group members comprising multidisciplinary staff from across the organisation. Together they form the project team, with the aim of planning and leading the Schwartz rounds.
• Schwartz rounds should be held in a confidential safe space, so the facilitator should identify a suitable room. This should be an accessible but closed space such as a ward office or staff meeting room that will enable staff to speak freely. The facilitator may also want to consider practical issues such as the availability of refreshments.
• The next step is to identify patient stories that are suitable for the Schwartz round and which will enable the participants to reflect on similar clinical experiences. This may require one or two planning meetings where the steering group, facilitator and clinical lead discuss appropriate stories, identify themes and explore the topics that will support reflection. The facilitator should also ensure that the chosen stories are appropriate for the group; for example, where there might be ethical concerns involved, or an ongoing investigation into an episode of care.
• Schwartz rounds can be an emotional experience for all involved. Although they are confidential and not recorded, participants can still feel anxious or nervous. Part of the preparation is ensuring that the participants are aware that Schwartz rounds are a safe space in which to discuss their practice and reflect on their feelings.
1. Each Schwartz round is held monthly and will last about one hour.
2. The facilitator, clinical lead, steering group members and participants meet in the designated space at the designated time.
3. The facilitator introduces everyone in the group.
4. The facilitator reminds the participants that they are in a safe space to discuss the social, ethical and emotional challenges of looking after patients and their families (Maben et al 2021).
5. Each Schwartz round focuses on a particular theme, with one of the steering group members sharing a patient story and relating its effect on them, before the facilitator opens the discussion to the group for a confidential exploration of the issues raised. Sometimes there is a pre-prepared presentation by the steering group featuring one main patient story or various stories based around a common theme.
6. The participants are asked to listen to and reflect on the patient story (Maben et al 2021). Common examples of the themes and topics that can be generated by the patient stories and which might be discussed during a Schwarz round include:
7. The underlying philosophy of Schwartz rounds is to provide a forum for healthcare professionals to connect and learn how to treat patients and colleagues with compassion and empathy. To achieve this, the facilitator will use communication skills such as active listening and coaching to guide the participants as they discuss care episodes they have been involved in.
8. As participants attend more Schwartz rounds, they often become less anxious about taking part. In addition, confronting and examining significant clinical events ultimately enables participants to understand what took place and their reactions, thereby assisting them to enhance their physical and emotional well-being (Maben et al 2018).
9. Taking part in a Schwartz round can provoke unpleasant memories of care episodes for some participants or remind them of clinical mistakes they might not wish to revisit. Because of this, some participants may become distressed or even angry. If a participant expresses anger, the facilitator may suggest that the person discusses their issue outside of the group. If a participant becomes distressed, the facilitator and steering group members will offer support to the person within the group.
10. Much like the aim of clinical reflection, it is hoped that participants may adapt their behaviour after attending Schwartz rounds; for example, changing their approach to a clinical skill such as wound care or adopting a more tolerant attitude to patients perceived as challenging. It is also hoped that any changes participants experience as a result of taking part in the Schwartz rounds will in turn influence their colleagues’ practice.
11. At the conclusion of each Schwartz round the facilitator will ask the participants to reflect on the meeting before requesting any feedback (a ‘roving’ microphone may be required, depending on the size of the group). The facilitator will then summarise the discussion that took place.
While nurses are used to learning from case studies, Schwartz rounds offer them an opportunity to share experiences and to listen to the experiences of their multidisciplinary colleagues. This reflects the suggestion from psychologists Rogers and Farson (1957) that listening with empathy has the power to promote personal growth and development.
Although Schwartz rounds involve a group activity rather than a one-to-one therapeutic relationship, participants’ experience of being listened to and listening to others can lead them to express previously hidden feelings such as anger, fear and inadequacy (Barker et al 2016). Many nurses regularly witness death and dying at work and may hide their feelings about these experiences for their own emotional protection. Although this may be ‘normal’ behaviour in the context of nursing, denial of uncomfortable or distressing feelings can impede constructive communication and lead to compassion fatigue or burnout (Maben 2013).
Maben (2013) suggested that while many nurses enter the profession with strong ideals, the nature of nursing work and the healthcare environment can reduce their personal resilience and ability to treat patients with compassion. Many nurses leave the profession because of these experiences, some in the first few years after registration (Porteous and Machin 2018, Jakimowicz and Maben 2020). Schwartz rounds can therefore be used to explore nurses’ feelings about their clinical work, enhance their resilience and even support staff retention.
Maben et al (2018) completed a national evaluation of Schwartz rounds in the UK and found that healthcare staff believed that the rounds enhanced their well-being, enabled them to feel connected to each other and to patients and to feel compassion and empathy for others. The researchers emphasised that Schwartz rounds led to some steering group members becoming more willing to be open about issues they experienced in the workplace. This emphasised the benefits experienced by the participants and the steering group members.
In a large study of Schwartz rounds in the UK, Maben et al (2021) found that they were effective when there was a high level of trust and a sense of psychological safety within the group. Therefore, the facilitator should promote a sense of safety to enable people to focus on their emotions. The facilitator should also be willing to direct the discussion, ‘stepping in’ if required to protect the steering group and participants from inappropriate comments, such as non-constructive criticism of an individual’s clinical skills or knowledge (Maben et al 2021). Preparing thoroughly before a Schwartz round will assist the facilitator to direct the discussion effectively because they will have researched the patient story and be aware of potential controversial areas that might arise (McCarthy et al 2021).
Flanagan et al (2020) found that those attending Schwartz rounds provided positive feedback whether they were clinical staff such as nurses or non-clinical staff such as ward clerks or domestic staff. As a junior member of staff attending Schwartz rounds, the author of this article believed their contribution was just as valued as that of other members of staff. Flanagan et al (2020) suggested that all staff appreciated the reflective space provided by Schwartz rounds regardless of background, role or job title. It is important, therefore, to emphasise the benefits of Schwartz rounds to all participants, no matter their role.
Barker et al (2016) found that Schwartz rounds supported the development of compassion and resilience among healthcare professionals, while a study of medical students’ responses to Schwartz rounds found that the rounds added to the students’ ‘insight and self-awareness’ (Walsh and Gleeson et al 2022). In some cases, medical students preferred Schwartz rounds to writing reflective accounts (Gishen et al 2016).
In another study of medical students’ experience, Abnett et al (2022) delivered Schwartz rounds virtually due to COVID-19 pandemic restrictions and reported that more than 87% of participants who attended the first two rounds said they intended to attend further rounds. This suggested that Schwartz rounds can enhance workplace culture and interprofessional relationships, particularly because there is involvement from all grades of staff.
Barker et al (2016) suggested that Schwartz rounds could assist medical students to develop resilience and communicate more openly, and might even mitigate rises in medical student attrition rates. Jakimowicz and Maben (2020) stated that Schwartz rounds could easily be adapted to undergraduate nursing education and found that they were useful not just for nursing students, but also for the lecturers involved.
Dhinsa et al (2021) found that Schwartz rounds should be implemented by all healthcare organisations and that clinical and non-clinical staff should be encouraged to attend to promote compassion throughout an organisation. In addition, Lown (2018) suggested that Schwartz rounds should be regarded as an organisational initiative that can enhance staff well-being and patient experience.
All nurse leaders should consider implementing Schwartz rounds in their workplace as an evidenced-based strategy for supporting the psychological and mental health of multidisciplinary team members.
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