Strategies for the mind and spirit. (Business Strategies).

The events of September 11 and the months following generated among our citizens a generalized fear of attacks in the air, on land and even through the mail. Health and mortality were catapulted into the forefront of our thoughts. A spotlight was focused on healthcare, but very little attention was given to those who would be providing the care--administrators, clinicians, and the professional and ancillary caregivers who are on the frontlines every day. And that means administration must think about caring about those who care for others.

I sought the thoughts and suggestions of two veterans of the healthcare industry: Rita Munley Gallagher, PhD, RNC, senior policy fellow of the American Nurses Association (ANA), and Rick Menchaca, general manager of Interim Healthcare, Inc., of Los Angeles, one of the nation's largest home care and supplemental healthcare staffing companies, providing home care since 1966.

Hyatt: What are you, as a leader of a very significant healthcare organization, suggesting that healthcare administrators and managers do to nurture their own minds and spirits, as well as those of their staff?

Dr. Gallagher: I know this sounds trite, but I really am trying to live life as directed by Erma Bombeck in her piece "If I Had My Life to Live Over," written after she found out she was dying of cancer. Among things she said was, "I would have talked less and listened more." "I would have taken the time to listen to my grandfather ramble about his youth." "There would have been more 'I love you's.' More 'I'm sorry's."' In short, Laura, I really am trying to stop sweating the small stuff...not easy for me.

As for the organization, the ANA responded immediately after 9/11, and brought in professional grief counselors from the employee assistance program, who provided an overview of methods to deal with the issue--from simple suggestions, such as, "Don't keep watching the World Trade Center being hit with the airplane over and over on TV," to one-on-one therapy. In addition, there was a plethora of handouts related to coping with a crisis, including where to find referrals for assistance. The staff was also encouraged to meet at will to discuss the issues of the day and also to pray, if they so desired.

Menchaca: I believe that every disaster or tragedy, whether large or small, forces those involved to re-evaluate their priorities. The September 11 tragedy touched every American and made us all realize how vulnerable we are and how precious life is. We were forced to realize that at any moment in time our lives could be changed forever.

To nurture my mind and spirit, I had to stop and consider my reasons for waking up every morning--what is truly important in my life. The first is my spiritual being. For me, this is a personal relationship between God and myself. I take time every morning to say a prayer and give thanks for my health, the well-being of my family and the chance to live one more day. As a husband, a father of two teenage sons and friend to those close to me, I stopped to consider the possibility of losing a loved one in an accident, to a terminal illness or to something as horrible and senseless as the attack on the World Trade Center. If anything positive came out of this tragedy for me, it was gaining a greater understanding of the important role that my family and friends play in my life.

Time is one of the most important assets we have in developing relationships. Time is what I am trying to give to my family and friends--time to talk, time to laugh, time to just be together. The things that we do together to create a closer connection and deeper understanding of each other are more intense. For my youngest son, it is riding our bicycles and enjoying the outdoors together; for my oldest, it is listening to music (and these days it's classic rock); and for my wife, it is just sitting in front of a fire and spending time with our sons.

The economy has taken a drastic turn for the worse since September 11. The staff can't open the newspaper without reading about a major layoff or poor performing companies--and healthcare is no exception. I started my new position as general manager around the time of the September 11 tragedy. I feel my responsibility, as our staff's new leader, is to instill confidence and make them feel that their jobs are secure. An effective leader is someone who can clearly define his or her goals and convince the team about what needs to be accomplished to achieve them. I have spent time with my staff sharing my vision, collectively setting goals and developing plans on how we are going to succeed. My message to them has been, "We all have to work to survive, and it is our responsibility to make it fun."

I have encouraged our staff to take time for themselves. I have not been extremely strict with their time. We are a team and a strong team picks up the missing pieces and makes sure the job gets done.

Hyatt: Those in the healthcare field often find themselves caring for those who are compromised and are, therefore, dependent for many of their needs. What do you think might assist administrators, managers, nursing supervisors, etc., to help those they care for during these times?

Dr. Gallagher: I believe that advance preparation is the only way to go: Ensure the availability of needed supplies; know the evacuation assistance needs of patients/residents and staff, and plan for them. The Web page www.prepare.org has some excellent advice. Also, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently released a special 24-page issue of Perspectives, JCAHO's official newsletter, that provides guidance to healthcare organizations in preparing for terrorist attacks that might involve nuclear, biological and/or chemical incidents. It also offers lessons learned from hospitals located near the World Trade Center and the Pentagon.

Menchaca: Most of us in healthcare chose the profession because we are caring people. Life or death situations are not new to us. A competent healthcare provider learns to problem solve and provide comfort through trying times.

We are human; we have feelings just like everyone else. We are not above fear, pain or feelings of failure. The difference is that we can't show these feelings during a crisis. We must save them until the crisis is over. Healthcare providers should rely on each other and those closest to them for strength and comfort.

It is important to support the families of the persons we are caring for. It is essential to identify and support the primary caregiver in every situation.

Hyatt: Does your organization have or are there plans to disseminate information (e.g., a checklist of helpful ways to cope) regarding this and/or future crises that might occur?

Dr. Gallagher: Many victims of the attacks suffered burns, and many nurses working with these patients will need to help them deal with both the physical aspects and the ongoing psychological issues, including depression, posttraumatic stress disorder and anxiety. Keeping current with information and practice issues will be very helpful.

The ANA used the Nursing World Web site to disseminate information about live satellite and Web broadcasts on infection control recommendations and to address threats or actual events related to bioterrorism. Program fact sheets, with technical specifications for the live satellite broadcast, Webcast and audio line are posted at www.phppo.cdc.gov/phtn.

Nurses directly impacted by the tragic events of September 11 will be able to find relief thanks to Nurses House, a nonprofit organization designated by the ANA, the American Nurses Foundation (ANF) and the New York State Nurses Association (NYSNA) to accept contributions to assist registered nurses (RNs). Nurses House, a national fund providing financial help and guidance to nurses in need, has been providing assistance to RNs since 1922. It provides aid to nurses who have suffered injury, illness, disability or other dire circumstances. Charitable contributions designated for the disaster relief fund will be allocated to RNs on a priority basis to meet present and future needs caused by the September 11 events. The relief fund will assist nurses involved in the disaster relief activities and those directly affected by the tragedy. Nurses eligible for relief include those working in the surrounding facilities, as well as those whose spouses were injured or lost in the disaster.

Menchaca: Although Interim Healthcare is not, to my knowledge, planning on disseminating information that directly relates to the September 11 crisis, as a home healthcare provider it is our responsibility to evaluate the home environment and assist the client and their caregivers to plan for a crisis. For example, earthquakes are a possible crisis issue in southern California. The energy crisis we encountered last summer also raised some concern for those clients attached to life-supporting equipment. Before we sign on a new case, we regularly discuss possible situations that the client and/or caregivers could encounter.

What is important is that we help our clients to problem solve and develop a contingency plan before a crisis occurs. If they are on life support, they are required to register with the local hospital and fire station. We have them identify a neighbor, friend or family member who can assist them in a crisis. We assist them in identifying an alternative source of electricity, water and communication.

The most important lesson we can teach is to have a contingency plan and not to panic.

In conclusion, the attacks on the World Trade Center and the Pentagon, and the recent incidents of mail laced with anthrax, have caused many of us to think differently about our lives, our loved ones and our residents. It has reminded us to look for the best in others and seek strategies that celebrate our minds and nurture our spirits. I want to thank Dr. Gallagher and Mr. Menchaca for their participation and to express my gratitude to those who continue to support this column. Ideas that you feel would be helpful should be addressed to Laura Hyatt at [e-mail].

Laura Hyatt, MBA, is president of Hyatt Associates and a member of the business faculty at Mount St. Mary's College.