Providing Trauma-Informed Care to Pregnant Patients

Podcast Transcript

Carol Pehotsky (00:04):

One of the most fundamental things we do as nurses is to meet our patients where they are. Sometimes we get 30 seconds to (laughs) figure that out, sometimes we're able to walk the journey with them together in ambulatory settings or along the course of their care. That individualized care that we're able to provide when we meet them where they are and learn about them as people and not just patients, is so important to ensure that we reach the best possible outcomes together, no matter what type of patients we're caring for.

Carol Pehotsky (00:32):

I'm so thrilled to be joined today by Tricia Gilbert, the M-Power Program coordinator, who's gonna tell us a bit more about providing individualized trauma-informed care to pregnant patients. Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care, to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

Carol Pehotsky (01:07):

All right. Welcome back everyone. Glad to be recording in 2024, and looking forward to another fantastic year of amazing guests and really interesting conversations here at Nurse Essentials. And if you're like me and you don't always listen to the end of the podcast and you're a skipper like I am, then I'll put this plug up front that we want to make this a conversation with you, our audience. So if there are topics we haven't addressed, or you think we missed the ball on something, you wanna share a story, we wanna hear from you. And that email is nurseessentials, that's two Es in the middle, @ccf.org.

Carol Pehotsky (01:43):

I'm surrounded by incredibly talented people who help make this podcast happen. I just happen to be the voice of it, but it really is a collaborative effort as we think about, what are the right episodes to bring to you, the audience, and in what sequence? So we've had people talk about topics that are very easily, for any nurse or nursing student, to relate to. We've had some topics about you as humans and how we support your wellness. And then we've gotten into some other specialty topics.

Carol Pehotsky (02:08):

And I hope you, as the listener, really thinking about, even if that isn't your specialty, how does it make you think differently about what it means to be a nurse, what it means to take care of your patients, even if that isn't a direct one-to-one relationship? And what can we learn from every nurse we interact with? And so, sometimes that leads us down really interesting paths, and I think you will agree with me by the end of the episode that we're going on a very interesting path today. So, today we're gonna talk about something that's very special and unique to Cleveland Clinic.

Carol Pehotsky (02:36):

And we know that not all of you are from here, but again, I'm gonna challenge you to think about, what does that mean for you and the delivery of care for your patients, no matter where you are? We're gonna be talking about the care of pregnant patients today and how we can really meet their unique needs, especially when they need help in the form of trauma-informed care. So all of us had a labor and delivery rotation at some point in our nursing career. I loved it, and then I hated it, and then I absolutely knew (laughs) it wasn't for me. (laughs)

Carol Pehotsky (03:04):

Some of you may have had a similar experience, and some of you, you are in labor and delivery. You've made that path, and it's, uh, been really meaningful for you. Not all of us have had pregnancies or supported somebody we love having a pregnancy. For me, it was very much a one and done experience. (laughs) And so, we come to this topic with all sorts of perspectives, but I'm sitting across from an absolute expert in this topic. And so it's my sincere pleasure to introduce you all to Tricia Gilbert. Tricia is the M-Power Program Coordinator for the Cleveland Clinic. Welcome, Tricia.

Tricia Gilbert (03:35):

Thank you so much for having me.

Carol Pehotsky (03:36):

We're so glad to have you today. And I'm hoping just to kick us off, you can share with our audience a little bit about your nursing journey, and how it's led you to this important work.

Tricia Gilbert (03:44):

Thank you. Yes, so I have been a nurse now for about 21 years.

Carol Pehotsky (03:49):

All right.

Tricia Gilbert (03:49):

I started out in obstetrics.

Carol Pehotsky (03:51):

Okay.

Tricia Gilbert (03:51):

And it was not the path that I thought I would take.

Carol Pehotsky (03:54):

Really? (laughs)

Tricia Gilbert (03:55):

I thought I would go cardiac.

Carol Pehotsky (03:56):

Mm.

Tricia Gilbert (03:56):

But when I did my OB rotation-

Carol Pehotsky (03:59):

Something, something-

Tricia Gilbert (03:59):

... hook, line and sinker-

Carol Pehotsky (04:00):

... there you go. (laughs)

Tricia Gilbert (04:01):

... I was set.

Carol Pehotsky (04:01):

(laughs)

Tricia Gilbert (04:02):

I started out in OB.

Carol Pehotsky (04:04):

Okay.

Tricia Gilbert (04:04):

And about eight years into my career, I was able to participate in a training.

Carol Pehotsky (04:10):

Okay.

Tricia Gilbert (04:10):

This was in North Carolina with a training called When Survivors Give Birth.

Carol Pehotsky (04:15):

Oh, wow. Okay.

Tricia Gilbert (04:16):

It is based on a book that was written by Penny Simkin-

Carol Pehotsky (04:19):

Mm-hmm.

Tricia Gilbert (04:19):

... and Phyllis Kra- Klaus, and Penny came and did the training. And it talked about the impact of childhood sexual abuse on childbearing women.

Carol Pehotsky (04:29):

Mm. Okay.

Tricia Gilbert (04:30):

And it was such an eye-opening-

Carol Pehotsky (04:33):

Yeah, I bet.

Tricia Gilbert (04:34):

... training to me.

Carol Pehotsky (04:34):

Mm-hmm.

Tricia Gilbert (04:35):

Because I had just enough years of experience that I had remembered patients that childbirth was not a good experience.

Carol Pehotsky (04:43):

Oh, okay. Sure.

Tricia Gilbert (04:44):

There were some patients that would go through some very basic things-

Carol Pehotsky (04:48):

Mm-hmm.

Tricia Gilbert (04:48):

... part of childbirth that seemed so much more stressful to them.

Carol Pehotsky (04:51):

Hmm.

Tricia Gilbert (04:52):

And I always wondered why, but-

Carol Pehotsky (04:53):

Sure.

Tricia Gilbert (04:54):

... I never made a connection.

Carol Pehotsky (04:55):

Mm-hmm.

Tricia Gilbert (04:56):

And through the When Survivors Give Birth training, I was able to see these experiences through their perspective.

Carol Pehotsky (05:03):

Wow.

Tricia Gilbert (05:03):

Different ways-

Carol Pehotsky (05:04):

Mm-hmm.

Tricia Gilbert (05:04):

... and understand how I may or may not know this person's journey and their past.

Carol Pehotsky (05:09):

Sure.

Tricia Gilbert (05:10):

But understanding that childbirth is not always the easiest thing for everyone to go through.

Carol Pehotsky (05:15):

It's hard enough for (laughs) for everybody at some level, but absolutely.

Tricia Gilbert (05:19):

Right.

Carol Pehotsky (05:19):

Yeah.

Tricia Gilbert (05:20):

So we, you know, I was able to practice, start practicing with this knowledge.

Carol Pehotsky (05:24):

Okay.

Tricia Gilbert (05:24):

Understanding that these journeys that we have before we step foot in the hospital still come with us, and-

Carol Pehotsky (05:31):

Absolutely. (laughs)

Tricia Gilbert (05:32):

... so (laughs) thing is, I continued on my journey.

Carol Pehotsky (05:34):

Mm-hmm.

Tricia Gilbert (05:34):

And when I came here, I was able to present this awareness that I had-

Carol Pehotsky (05:39):

Mm-hmm.

Tricia Gilbert (05:39):

... to my manager.

Carol Pehotsky (05:41):

Great.

Tricia Gilbert (05:41):

And my manager at the time was Dusty Burke.

Carol Pehotsky (05:44):

Mm-hmm.

Tricia Gilbert (05:44):

She is now the director of nursing operations. But she agreed with me that this is an area that there is a lack of awareness. There-

Carol Pehotsky (05:52):

It became that moment for you, guys. Yeah.

Tricia Gilbert (05:55):

It was that moment.

Carol Pehotsky (05:55):

Mm-hmm.

Tricia Gilbert (05:55):

And so we started doing some research.

Carol Pehotsky (05:58):

Okay.

Tricia Gilbert (05:58):

We started at Cleveland Clinic with a literature review grant.

Carol Pehotsky (06:01):

Oh, very nice.

Tricia Gilbert (06:02):

And we created a poster and started looking, what is out there for perinatal trauma-informed care?

Carol Pehotsky (06:07):

Sure.

Tricia Gilbert (06:08):

Nothing.

Carol Pehotsky (06:08):

Yeah.

Tricia Gilbert (06:09):

So, we started there, and then channels just started working. And I came up with the plan for this program to support patients that have a history of trauma-

Carol Pehotsky (06:19):

Mm-hmm.

Tricia Gilbert (06:19):

... before they come in to give birth. We got the backing, and now we are live in all nine Cleveland Clinic OB hospitals.

Carol Pehotsky (06:26):

Really?

Tricia Gilbert (06:27):

Yes.

Carol Pehotsky (06:28):

Fantastic. And, uh, how long has the program been in place?

Tricia Gilbert (06:31):

So, the... We went live with M-Power in August of '22.

Carol Pehotsky (06:35):

Okay.

Tricia Gilbert (06:37):

So we're-

Carol Pehotsky (06:37):

Yeah.

Tricia Gilbert (06:38):

... not quite a year-and-a-half.

Carol Pehotsky (06:39):

Okay.

Tricia Gilbert (06:39):

So we kicked off Florida last year. So, Ohio-

Carol Pehotsky (06:44):

Nice.

Tricia Gilbert (06:44):

... has been live for a year-and-a-half.

Carol Pehotsky (06:46):

Okay.

Tricia Gilbert (06:47):

We've had over 700 referrals to the program. We've completed over 300 consults.

Carol Pehotsky (06:53):

Wow.

Tricia Gilbert (06:54):

And we have over 200 patients that are early referrals in their pregnancy that are waiting to-

Carol Pehotsky (07:00):

Okay.

Tricia Gilbert (07:00):

... be scheduled for their consults.

Carol Pehotsky (07:01):

Okay. We'll get into the nitty-gritty a little bit-

Tricia Gilbert (07:04):

Mm-hmm.

Carol Pehotsky (07:04):

... but I also want you, the listener, to think about, again, if labor and delivery isn't your passion, but reflecting on, Tricia took something that was an interest and a passion, and now you get to do it full-time, right?

Tricia Gilbert (07:14):

Exactly. (laughs)

Carol Pehotsky (07:15):

And so, so, just being able to, to build on that interest and that passion and, and make care better for not just the patients you're serving, but so many more-

Tricia Gilbert (07:24):

Mm-hmm.

Carol Pehotsky (07:24):

... that's amazing. So we'll get into some of the details perhaps.

Tricia Gilbert (07:28):

Mm-hmm.

Carol Pehotsky (07:28):

And, you know, certainly of course, as nurses, we, we treat our patients s- as individuals. We acknowledge, like you said, the road that, that we, that we bring to the hospital-

Tricia Gilbert (07:38):

Mm-hmm.

Carol Pehotsky (07:38):

... or any care area when we're with a patient. And certainly, of course, we, we, if you think about whether we had eight weeks labor and delivery or eight years, (laughs) you know, the emotional and physical needs of every pregnant patient is-

Tricia Gilbert (07:47):

Mm-hmm.

Carol Pehotsky (07:48):

... very important to that specialty. What special considerations are addressed with this program? Or, even if you don't have that program, what should we be thinking about for patients who have come forth and said that they are survivors of sexual assault and violence?

Tricia Gilbert (08:01):

It's always keeping in mind the patient's perspective.

Carol Pehotsky (08:04):

Okay.

Tricia Gilbert (08:05):

Always. Because there are certain things that we may see as stressful that they may see as something totally different.

Carol Pehotsky (08:12):

Hmm.

Tricia Gilbert (08:13):

One of the things I've been blessed to be able to do is do a lot of training with caregivers.

Carol Pehotsky (08:16):

Mm-hmm.

Tricia Gilbert (08:17):

And I usually pull up a picture of my two chocolate Labs.

Carol Pehotsky (08:22):

Aw. (laughs)

Tricia Gilbert (08:23):

To me, that's the same thing. I look at them, I think of it as loving and nurturing, you know, they're sweet.

Carol Pehotsky (08:28):

Oh, I see where you're going. (laughs)

Tricia Gilbert (08:30):

But to someone-

Carol Pehotsky (08:31):

Yep.

Tricia Gilbert (08:31):

... who has had a history of a dog bite-

Carol Pehotsky (08:33):

Mm-hmm.

Tricia Gilbert (08:34):

... that can be a triggering thought.

Carol Pehotsky (08:36):

Oh, it's a fantastic analogy.

Tricia Gilbert (08:37):

So, just always keeping that perspective.

Carol Pehotsky (08:40):

Mm-hmm.

Tricia Gilbert (08:40):

So, and when it comes a little more specific to labor and delivery, you have a patient that, when we start talking about epidurals, we think pain control.

Carol Pehotsky (08:49):

Okay.

Tricia Gilbert (08:50):

But we also need to think about, what comes with an epidural?

Carol Pehotsky (08:52):

Hmm.

Tricia Gilbert (08:53):

Loss of mobility.

Carol Pehotsky (08:54):

Sure.

Tricia Gilbert (08:55):

What if it's the ability to escape?

Carol Pehotsky (08:57):

Oh, gosh, yeah. That control piece, too. Yeah.

Tricia Gilbert (09:00):

So, it can be.

Carol Pehotsky (09:00):

Mm-hmm.

Tricia Gilbert (09:01):

It's having that perspective that maybe that-

Carol Pehotsky (09:03):

Mm-hmm.

Tricia Gilbert (09:03):

... an epidural is extremely stressful because of what it brings with it.

Carol Pehotsky (09:07):

Sure.

Tricia Gilbert (09:08):

And so it's always having that perspective in mind.

Carol Pehotsky (09:10):

You... Intention and function don't always align. You're, you're trying to do something good. That's your intention, but, okay. And, can this be elicited in patients who have had prior traumatic birth experiences? Do we find that there's a need for trauma-informed care there as well?

Tricia Gilbert (09:25):

Absolutely. That is one area that we do also. We started the program looking more at history of sexual abuse-

Carol Pehotsky (09:32):

Sure.

Tricia Gilbert (09:32):

... and sexual assault, and we are finding even more-

Carol Pehotsky (09:35):

Really?

Tricia Gilbert (09:35):

... with previous traumatic birth.

Carol Pehotsky (09:37):

Okay.

Tricia Gilbert (09:38):

Now, also, a little bit easier to say traumatic birth than, you know, with a history of sexual assault, sexual abuse. But we do absolutely have patients that come to us with previous traumatic birth, and it's starting out with listening to the patient.

Carol Pehotsky (09:53):

Mm. Sure.

Tricia Gilbert (09:53):

Sometimes letting them explain what happened so that we can sit behind and say, "All right, now what was it that caused-

Carol Pehotsky (10:00):

Mm.

Tricia Gilbert (10:00):

"... that to be traumatic?"

Carol Pehotsky (10:01):

Sure.

Tricia Gilbert (10:02):

I've had patients that had pretty impactful births, but they didn't consider it traumatic-

Carol Pehotsky (10:07):

Mm.

Tricia Gilbert (10:07):

... because of the way things were handled in that situation.

Carol Pehotsky (10:10):

Okay.

Tricia Gilbert (10:11):

So, you know, listening.

Carol Pehotsky (10:13):

Mm-hmm.

Tricia Gilbert (10:13):

Was it that they were not part of the communication?

Carol Pehotsky (10:15):

Oh, okay.

Tricia Gilbert (10:16):

Was it, you know, other things like that.

Carol Pehotsky (10:18):

Sure.

Tricia Gilbert (10:18):

So, absolutely. We do have patients that come.

Carol Pehotsky (10:21):

Mm-hmm.

Tricia Gilbert (10:21):

We listen to them, find out how can we improve if that same scenario were to happen again?

Carol Pehotsky (10:27):

Okay. Yeah.

Tricia Gilbert (10:28):

How can we improve?

Carol Pehotsky (10:29):

Well, and I think it's a good note to any of us who, who may someday venture on that journey to be becoming pregnant-

Tricia Gilbert (10:36):

Mm-hmm.

Carol Pehotsky (10:36):

... that this can arise as a need-

Tricia Gilbert (10:38):

Mm-hmm.

Carol Pehotsky (10:39):

... even if you don't have a history-

Tricia Gilbert (10:39):

Mm-hmm.

Carol Pehotsky (10:41):

... of violence or sexual assault in your childhood, that really, how can we as nurses meet patients where they're at no matter what that looks like?

Tricia Gilbert (10:48):

Right. Mm-hmm.

Carol Pehotsky (10:48):

Fantastic. So we've talked about a few examples. Any other examples you can share with us in terms of appreciating that patients are very individualized? What are some other sort of hallmark processes of the labor and delivery experience that could be triggering for patients?

Tricia Gilbert (11:02):

So, there is a direct correlation with patients that have a history of traumatic events that may be linked to childhood.

Carol Pehotsky (11:10):

Sure.

Tricia Gilbert (11:10):

And there's an increased correlation with those patients in not having a supportive system.

Carol Pehotsky (11:15):

Oh, okay.

Tricia Gilbert (11:15):

So also starting out with-

Carol Pehotsky (11:17):

Sure.

Tricia Gilbert (11:18):

... not just always assuming the person that's in that room-

Carol Pehotsky (11:21):

Mm.

Tricia Gilbert (11:21):

... is an invited or supportive person.

Carol Pehotsky (11:24):

Sure.

Tricia Gilbert (11:25):

So taking that time-

Carol Pehotsky (11:27):

Mm-hmm.

Tricia Gilbert (11:27):

... you know, to, instead of your support person's going to be here, who-

Carol Pehotsky (11:32):

What do you want?

Tricia Gilbert (11:32):

... would like?

Carol Pehotsky (11:32):

Yeah. Okay.

Tricia Gilbert (11:34):

Who would you like in the room with you?

Carol Pehotsky (11:35):

Mm-hmm.

Tricia Gilbert (11:35):

Giving them that opportunity to speak up, to have those conversations. Other things. In labor and delivery exposure can be a very big thing.

Carol Pehotsky (11:45):

Oh, my gosh, yeah. Yeah.

Tricia Gilbert (11:46):

So, listening. When you have a patient that comes up and, you know, sometimes with our patients, we talk about, you know, "When you think about coming in, where does your mind go?"

Carol Pehotsky (11:54):

Mm.

Tricia Gilbert (11:54):

I've had patients before that are like, "Well, I'm gonna have to wear a gown? I'm gonna have... Is it open in the back? Am I gonna have to be... Who's gonna see me?" Dah, dah.

Carol Pehotsky (12:00):

Sure. Oh, gosh.

Tricia Gilbert (12:01):

Is it really about the gown?

Carol Pehotsky (12:03):

Yeah.

Tricia Gilbert (12:03):

Or is it about the exposure?

Carol Pehotsky (12:04):

Sure.

Tricia Gilbert (12:05):

And finding out, how can we accommodate and how can we work together so that we can make it-

Carol Pehotsky (12:11):

Sure.

Tricia Gilbert (12:11):

... less of a trigger, less of a stress. So exposure can be huge.

Carol Pehotsky (12:15):

And those are really two great examples that could happen anywhere. It's lovely. This is happening with our, with this specific population.

Tricia Gilbert (12:21):

Mm-hmm.

Carol Pehotsky (12:21):

But we've had Michele Sorrell on and talking about, um, you know, human trafficking, and that same sort of-

Tricia Gilbert (12:26):

Mm-hmm.

Carol Pehotsky (12:27):

... experience around that person who's with me may not be supportive.

Tricia Gilbert (12:31):

Right.

Carol Pehotsky (12:31):

That's great.

Tricia Gilbert (12:32):

Right.

Carol Pehotsky (12:33):

Great learning. So, tell us a bit bit more about the process, if you will. So you mentioned that you've had some referrals and you've-

Tricia Gilbert (12:38):

Mm-hmm.

Carol Pehotsky (12:38):

... you've brought patients successfully through that program. Can you give us sort of a high level overview of what that looks like from soup to nuts, so to speak? (laughs)

Tricia Gilbert (12:44):

Absolutely. So, the program starts out with prenatal appointments. So, patients are screened two separate times in their prenatal journey.

Carol Pehotsky (12:55):

Okay.

Tricia Gilbert (12:55):

Very generic questions. Just, "Do you have a history?"

Carol Pehotsky (12:59):

Okay.

Tricia Gilbert (13:00):

And lets the patient say if they feel like it's gonna be an impact-

Carol Pehotsky (13:04):

Sure.

Tricia Gilbert (13:04):

... on their birth or not.

Carol Pehotsky (13:05):

Okay. Mm-hmm.

Tricia Gilbert (13:05):

So they're asked two times. They can self-refer.

Carol Pehotsky (13:09):

Oh, how nice.

Tricia Gilbert (13:09):

So-

Carol Pehotsky (13:10):

Yeah.

Tricia Gilbert (13:10):

... if the provider can either put in an order to the program-

Carol Pehotsky (13:13):

Mm-hmm.

Tricia Gilbert (13:14):

... or the patient can call the 800 number that we have.

Carol Pehotsky (13:17):

Oh, that's fantastic.

Tricia Gilbert (13:18):

So, once they're referred-

Carol Pehotsky (13:19):

Mm-hmm.

Tricia Gilbert (13:19):

... then they are scheduled for a consult in their third trimester.

Carol Pehotsky (13:23):

Okay.

Tricia Gilbert (13:23):

We want their mind thinking, you know, towards birth-

Carol Pehotsky (13:26):

Getting ready towards that, right. (laughs)

Tricia Gilbert (13:28):

Yeah, so that they're kind of thinking about that pain control.

Carol Pehotsky (13:30):

Mm.

Tricia Gilbert (13:30):

They're thinking about who's gonna be there with them.

Carol Pehotsky (13:33):

What that experience is gonna be. Sure.

Tricia Gilbert (13:34):

Mm-hmm. Right. So, they come in in their third trimester. They meet with a resource nurse-

Carol Pehotsky (13:38):

Mm-hmm.

Tricia Gilbert (13:39):

... on labor and delivery, where they're-

Carol Pehotsky (13:41):

Oh, sure.

Tricia Gilbert (13:42):

... going to be. So they're able to see, what, what a room looks like.

Carol Pehotsky (13:46):

Mm.

Tricia Gilbert (13:46):

So they can see a little bit about monitoring. So they can see where baby would go if we had concerns.

Carol Pehotsky (13:51):

Okay.

Tricia Gilbert (13:52):

Sometimes we do a tour so they're able to see where the NICU is, the transfer of rooms. So you're talking about patients with a variety of concerns.

Carol Pehotsky (14:01):

Sure.

Tricia Gilbert (14:01):

So we're talking about patients with elevated concerns.

Carol Pehotsky (14:04):

Yes. (laughs) Yes.

Tricia Gilbert (14:04):

So sometimes walking that flow-

Carol Pehotsky (14:07):

Mm-hmm.

Tricia Gilbert (14:07):

... or knowing who's gonna be involved in your care, lets them know a little bit more-

Carol Pehotsky (14:12):

Mm-hmm.

Tricia Gilbert (14:12):

... so it brings that anxiety down. Then we summarize that time, the resource nurse summarizes that in a note.

Carol Pehotsky (14:18):

Okay.

Tricia Gilbert (14:18):

It's available for whoever's involved in their care when they come in.

Carol Pehotsky (14:21):

Oh, nice. So it comes through the EHR so everybody can see-

Tricia Gilbert (14:24):

Mm-hmm.

Carol Pehotsky (14:24):

... what that patient wishes.

Tricia Gilbert (14:26):

Right.

Carol Pehotsky (14:26):

That's great.

Tricia Gilbert (14:27):

And then it's part of the expectations that everyone that is involved in their care, whether it's the nurse, the provider, anesthesia-

Carol Pehotsky (14:35):

Mm-hmm.

Tricia Gilbert (14:35):

... you know, they're supposed to read that note-

Carol Pehotsky (14:36):

Okay.

Tricia Gilbert (14:36):

... so they have a little better idea of how we can best support the patient.

Carol Pehotsky (14:42):

Well, I think you put it perfectly, you know. Uh, there's so much conversation as somebody's getting towards that experience of delivery that talks about a birth plan, but also, you know, the, the jokes out there that, "It will never work," right? Because the birth plan (laughs) is a five-page document sitting at home.

Tricia Gilbert (14:55):

Mm-hmm.

Carol Pehotsky (14:55):

So the idea that it's taking those elevated concerns and making it...

Tricia Gilbert (14:58):

Mm-hmm.

Carol Pehotsky (14:58):

So how did you help the team understand it was an expectation to see that?

Tricia Gilbert (15:03):

A lot of communication.

Carol Pehotsky (15:04):

Sure.

Tricia Gilbert (15:04):

Uh, we have the chart flagged a couple of places-

Carol Pehotsky (15:07):

Okay.

Tricia Gilbert (15:07):

... so that it is expectation. It is now on the main grease board. So when you come on the unit-

Carol Pehotsky (15:12):

Mm.

Tricia Gilbert (15:12):

... you can see if a patient has completed-

Carol Pehotsky (15:14):

Okay.

Tricia Gilbert (15:14):

... a consult, and it is supposed to be, you know, with the huddles, with the shift changes, that information is supposed to be passed down to read that note-

Carol Pehotsky (15:21):

Excellent.

Tricia Gilbert (15:22):

... so that it can better te... Help you guide your care.

Carol Pehotsky (15:24):

Absolutely. What sort of outcomes are you seeing? I mean, I'm just, I'm warm and fuzzy just hearing about this, (laughing) but are you, are you measuring outcomes? Or what are you hearing from patients who've been through this experience?

Tricia Gilbert (15:34):

We are measuring some outcomes. You know, we've got really good returns. Almost 100% would recommend-

Carol Pehotsky (15:38):

Oh, yeah.

Tricia Gilbert (15:39):

... the program. You know, they'd found that they were more prepared for birth. And the m- most impactful is that we do a scale of anxiety. Level of anxiety-

Carol Pehotsky (15:50):

Oh, sure.

Tricia Gilbert (15:50):

... regarding upcoming birth.

Carol Pehotsky (15:51):

Okay.

Tricia Gilbert (15:51):

Pre- and post-consult. We're seeing a 54% reduction-

Carol Pehotsky (15:55):

That's fantastic.

Tricia Gilbert (15:55):

... in anxiety.

Carol Pehotsky (15:56):

Wow.

Tricia Gilbert (15:56):

So it's definitely, you know, been helpful-

Carol Pehotsky (16:00):

Mm-hmm.

Tricia Gilbert (16:00):

... decreasing some of that fear of the unknown, you know.

Carol Pehotsky (16:03):

Sure.

Tricia Gilbert (16:03):

The, the what if questions, you know, that kind of come, that they've got a little bit more knowledge of what to expect.

Carol Pehotsky (16:09):

And have you been able to assess, you know... We've had these consults. There, there's notes in the chart, there's really expectation.

Tricia Gilbert (16:16):

Mm-hmm.

Carol Pehotsky (16:16):

Have, have you been able to assess, is that actually happening? What happens if, you know, somebody with good intention comes in and hasn't read the notes? Or, are, are you-

Tricia Gilbert (16:23):

Mm-hmm.

Carol Pehotsky (16:23):

... able to course correct? How does that look?

Tricia Gilbert (16:25):

Right. It is multiple steps, (laughing) you know, and, and, you know, and birth is somewhat unpredictable.

Carol Pehotsky (16:30):

Absolutely.

Tricia Gilbert (16:31):

There are going to be times that things are going to come up that are not-

Carol Pehotsky (16:34):

Mm-hmm.

Tricia Gilbert (16:35):

... the patients', and as we say, preferences.

Carol Pehotsky (16:37):

Sure.

Tricia Gilbert (16:37):

You know, then how do we accommodate that? So, it is having the awareness of the team, you know. Making sure-

Carol Pehotsky (16:44):

Sure.

Tricia Gilbert (16:44):

... that there are multiple people part of the team that are checking in.

Carol Pehotsky (16:47):

Mm-hmm.

Tricia Gilbert (16:48):

And then, when things do change course, you know, making it so that debriefs are happening-

Carol Pehotsky (16:53):

Good.

Tricia Gilbert (16:54):

... with the patient, you know.

Carol Pehotsky (16:55):

Oh, perfect.

Tricia Gilbert (16:56):

So it's not just the team-

Carol Pehotsky (16:57):

Things have to change-

Tricia Gilbert (16:57):

... that's debriefing.

Carol Pehotsky (16:58):

... but we're gonna involve you in that change.

Tricia Gilbert (16:59):

Right. Exactly. Just making sure that the patient is connected in there so that that communication is clear.

Carol Pehotsky (17:05):

Which is really, again, pretty much baseline, we should be doing for all of our patients. And when you think about speaking up, another great opportunity for nurses-

Tricia Gilbert (17:11):

Mm-hmm.

Carol Pehotsky (17:12):

... to speak up if they see a member of the care team coming in who didn't have a chance to look at that note, or maybe-

Tricia Gilbert (17:18):

Mm-hmm.

Carol Pehotsky (17:18):

... doesn't quite embrace it to the extent that, that the rest of the team has been doing, so.

Tricia Gilbert (17:22):

Yes.

Carol Pehotsky (17:23):

Excellent. So, I'm sure there's pregnant patients out there that maybe haven't shared this part of their life story with-

Tricia Gilbert (17:29):

Hmm.

Carol Pehotsky (17:30):

... their loved ones, or somebody they do find very supportive and-

Tricia Gilbert (17:32):

Mm-hmm.

Carol Pehotsky (17:33):

... they wanna bring that person along on their journey, but this is maybe something they haven't shared with them. How do teams ensure that they, they've really talked to the patient and they have that plan, but they're not, so to speak, outing the need for this care to that support person?

Tricia Gilbert (17:48):

Yes. First of all, the way that we have set up the program is, we're not even required to know the reason that they're coming.

Carol Pehotsky (17:55):

Okay.

Tricia Gilbert (17:56):

It does not even require a disclosure.

Carol Pehotsky (17:59):

Mm.

Tricia Gilbert (17:59):

Now, because of the fact that we do spend a couple of hours with those patients, a lot of times things do come up in those consults.

Carol Pehotsky (18:05):

Sure, sure.

Tricia Gilbert (18:06):

But we put the ball in the patient's court (laughs)-

Carol Pehotsky (18:08):

Mm-hmm.

Tricia Gilbert (18:09):

... to say, because we ask them, "Is this something you want in this summarized note?"

Carol Pehotsky (18:13):

Oh, okay.

Tricia Gilbert (18:14):

Or is it something-

Carol Pehotsky (18:15):

Okay.

Tricia Gilbert (18:16):

... not, because I can get a point across without having to (laughing) divulge that-

Carol Pehotsky (18:21):

Nurses are very creative.

Tricia Gilbert (18:21):

... private, intimate detail.

Carol Pehotsky (18:21):

Yes. (laughs)

Tricia Gilbert (18:23):

So, first of all, there's no disclosure required-

Carol Pehotsky (18:25):

Okay.

Tricia Gilbert (18:25):

... for it. So, when we talk about the M-Power program-

Carol Pehotsky (18:28):

Mm-hmm.

Tricia Gilbert (18:29):

... we talk about the fact that this is a patient that had significant enough concerns to reach out for additional resources.

Carol Pehotsky (18:36):

Alright.

Tricia Gilbert (18:36):

That's it.

Carol Pehotsky (18:36):

Yeah.

Tricia Gilbert (18:37):

You know, it does not need to be any disclosure. And, you know, uh, we let the patient decide if they want that included or not in their note. So it may not even be in their chart.

Carol Pehotsky (18:47):

Okay.

Tricia Gilbert (18:47):

It's not required to be in their chart-

Carol Pehotsky (18:49):

Nice.

Tricia Gilbert (18:49):

... because if someone has a significant history, I don't need to know those details-

Carol Pehotsky (18:53):

Sure.

Tricia Gilbert (18:53):

... in order to take really good care of them.

Carol Pehotsky (18:55):

And what a reassurance it is for those patients to really, again, meet them to say-

Tricia Gilbert (18:59):

Mm-hmm.

Carol Pehotsky (19:00):

... you know, "I'm here for you. If you wanna share those details-

Tricia Gilbert (19:02):

Right.

Carol Pehotsky (19:02):

"... but that's not gonna change how I take care of you."

Tricia Gilbert (19:03):

Right.

Carol Pehotsky (19:04):

So that, that can remain confidential. So, really amazing work. How have you gone about educating caregivers? And ho- you know, to really make sure that, you know, you are an army of one (laughing) and how we, how, how you've been able to enlist other people in these efforts?

Tricia Gilbert (19:18):

Mm-hmm. It's been a lot of different opportunities.

Carol Pehotsky (19:22):

Mm-hmm.

Tricia Gilbert (19:22):

Right now I do training with all the nurses that come in for the OB service line.

Carol Pehotsky (19:28):

Okay.

Tricia Gilbert (19:28):

So when they do their residency classes. I've been to [inaudible 00:19:31]-

Carol Pehotsky (19:31):

Oh, fantastic.

Tricia Gilbert (19:31):

... a slot that-

Carol Pehotsky (19:32):

So they're getting it early on. (laughs)

Tricia Gilbert (19:32):

Yes. Getting it early on. I do staff meetings. I'm on the unit, because I also still do consults. We have those conversations.

Carol Pehotsky (19:40):

Wonderful.

Tricia Gilbert (19:41):

So it's even being on the unit being present, and maybe sometimes when you have someone that has a list of demands, or cou- you know, it seems like a patient that says-

Carol Pehotsky (19:52):

Sure.

Tricia Gilbert (19:53):

... "I cannot have this. I will not." Being that person to have-

Carol Pehotsky (19:56):

Give me a call and I can help.

Tricia Gilbert (19:56):

... that conversation and say-

Carol Pehotsky (19:57):

Sure. Mm-hmm.

Tricia Gilbert (19:58):

... "Well, have you ever thought-

Carol Pehotsky (19:59):

Mm-hmm.

Tricia Gilbert (20:00):

"... about maybe, there may be something there that is giving the need for this type of control?"

Carol Pehotsky (20:06):

Mm-hmm. Sure.

Tricia Gilbert (20:06):

And so advocating on the units, educating, and then, I've done trainings with the residents.

Carol Pehotsky (20:12):

Oh, fantastic.

Tricia Gilbert (20:13):

And we're looking at adding on with the medical students now, too.

Carol Pehotsky (20:16):

Oh, perfect. Excellent. So we talked earlier about outcomes with the patients.

Tricia Gilbert (20:20):

Mm-hmm.

Carol Pehotsky (20:21):

How are the nurses receiving it? What's, what's that been like?

Tricia Gilbert (20:23):

We have gotten some really good feedback. Some nurses and providers have said they like having the notes because-

Carol Pehotsky (20:29):

Mm.

Tricia Gilbert (20:29):

... it kind of gives them an advantage. Charge nurses have said, it helps with making the assignments-

Carol Pehotsky (20:34):

Oh, gosh, yeah. Mm-hmm.

Tricia Gilbert (20:35):

... because you kinda have a little, uh, idea. Yet again, this is someone that has increased concerns.

Carol Pehotsky (20:41):

Sure.

Tricia Gilbert (20:41):

That's all you need to know.

Carol Pehotsky (20:41):

For whatever reason. Yeah.

Tricia Gilbert (20:43):

But it lets them help to make some assignments.

Carol Pehotsky (20:45):

Mm-hmm.

Tricia Gilbert (20:45):

Anesthesia has said it kind of helped them out because if, if it's pain control-

Carol Pehotsky (20:50):

Right.

Tricia Gilbert (20:51):

... that is one of their bigger stressors, then we'll address that.

Carol Pehotsky (20:54):

Sure.

Tricia Gilbert (20:54):

We'll... Educate options.

Carol Pehotsky (20:55):

Mm-hmm.

Tricia Gilbert (20:55):

And then sometimes we give anesthesia that extra advantage to know in advance-

Carol Pehotsky (21:01):

Right.

Tricia Gilbert (21:01):

... that this is a stressor.

Carol Pehotsky (21:02):

Fantastic. Great.

Tricia Gilbert (21:03):

So, so far really good feedback. (laughs)

Carol Pehotsky (21:05):

Yeah. So we're so blessed to have you in this program at our organization. You've sparked an interest in at least one of our listeners-

Tricia Gilbert (21:11):

Mm-hmm.

Carol Pehotsky (21:11):

... if not many, many, and they don't work at Cleveland Clinic. What would you say to them if they want to learn more, if they would like to pursue this as a treatment m- modality for their patients at their organization?

Tricia Gilbert (21:22):

I would absolutely recommend, you know, starting where I started, for one.

Carol Pehotsky (21:27):

Mm-hmm.

Tricia Gilbert (21:28):

When Survivors Give Birth, and there are a couple of other books out there that talk about the impact of sexual abuse-

Carol Pehotsky (21:35):

Mm-hmm.

Tricia Gilbert (21:35):

... sexual violence and childbirth.

Carol Pehotsky (21:37):

Okay.

Tricia Gilbert (21:37):

Start doing your research.

Carol Pehotsky (21:39):

Mm-hmm.

Tricia Gilbert (21:39):

Get that knowledge so you can understand. Then start being your advocate on your unit. Help caregivers that maybe have not had any training-

Carol Pehotsky (21:48):

Sure.

Tricia Gilbert (21:49):

... or an awareness, just to be the one that say, "Well, have you ever thought about..."

Carol Pehotsky (21:53):

Mm-hmm.

Tricia Gilbert (21:54):

Start those conversations. Let people understand that there can be another reason behind these increased concerns.

Carol Pehotsky (22:01):

Sure.

Tricia Gilbert (22:02):

So start that way.

Carol Pehotsky (22:03):

Okay.

Tricia Gilbert (22:04):

Look into your organization. Every organization is different.

Carol Pehotsky (22:07):

Mm-hmm.

Tricia Gilbert (22:07):

See if there are research opportunities.

Carol Pehotsky (22:09):

Mm.

Tricia Gilbert (22:09):

See what's being done. Don't be afraid to start some conversations.

Carol Pehotsky (22:12):

Sure. Excellent. So you've given us a lot to think about-

Tricia Gilbert (22:16):

(laughs)

Carol Pehotsky (22:16):

... and a lot that really can be very easily applied outside of labor and delivery-

Tricia Gilbert (22:21):

Mm-hmm.

Carol Pehotsky (22:21):

... setting. So, as we're starting to wrap up, I'm wondering if you could just give us some key highlights. You know, we have lots of nurses out there that maybe aren't working in labor and delivery. What are some really key nuggets that would help us all really meet our patients where they're at, if they would benefit from trauma-informed care.

Tricia Gilbert (22:36):

Right. When you are taking care of a patient and you see that they are increased stressed-

Carol Pehotsky (22:42):

Mm-hmm.

Tricia Gilbert (22:42):

... acknowledge it.

Carol Pehotsky (22:43):

Sure. Yeah.

Tricia Gilbert (22:44):

Just sometimes just acknowledging that-

Carol Pehotsky (22:46):

Mm-hmm.

Tricia Gilbert (22:46):

... can be huge.

Carol Pehotsky (22:46):

Mm-hmm.

Tricia Gilbert (22:48):

And communicate with them. You know, asking them, "How can I make this so it's not so overwhelming?"

Carol Pehotsky (22:55):

Mm, sure.

Tricia Gilbert (22:55):

"How can I best support you?" You know, making sure that they are the center of the conversations, not forgetting what it's like to have their perspective-

Carol Pehotsky (23:04):

Sure.

Tricia Gilbert (23:05):

... you know. Are those IV lines more of a restraint to them?

Carol Pehotsky (23:12):

Oh gosh, sure.

Tricia Gilbert (23:12):

Because-

Carol Pehotsky (23:12):

Yeah. Mm-hmm.

Tricia Gilbert (23:12):

... it's such a challenge to get up.

Carol Pehotsky (23:13):

Mm-hmm.

Tricia Gilbert (23:14):

So what can we do to accommodate and help them out?

Carol Pehotsky (23:17):

Sure.

Tricia Gilbert (23:17):

Just always keeping their perspective at the forefront.

Carol Pehotsky (23:20):

Fantastic. Oh, thank you so much for joining us. We're gonna flip now to the speed round section of our journey here. So, this is where our, uh, audience gets to learn a little bit more about you as a well-rounded person-

Tricia Gilbert (23:32):

(laughs)

Carol Pehotsky (23:32):

... in addition to an M-Power expert. So I'm hoping you'll start us off by telling us if you have any hidden talents.

Tricia Gilbert (23:38):

(laughs) I don't know if it's talents or passions, (laughing) but I love to play with power tools.

Carol Pehotsky (23:43):

Oh, really? (laughs)

Tricia Gilbert (23:45):

Laying flooring.

Carol Pehotsky (23:46):

Oh, my.

Tricia Gilbert (23:47):

Painting. Doing home renovation projects. Yes. That's what... I love the challenge.

Carol Pehotsky (23:53):

Okay. What's your favorite project you've done?

Tricia Gilbert (23:55):

I have laid vinyl plank flooring-

Carol Pehotsky (23:57):

Mm.

Tricia Gilbert (23:58):

... in multiple areas of my home.

Carol Pehotsky (24:00):

We should talk after this episode. No, (laughing) just kidding. So, is that a way you recharge? Are there other things you do to recharge?

Tricia Gilbert (24:07):

Yes. So I like to do that because I like the mental challenge of it.

Carol Pehotsky (24:11):

Mm-hmm.

Tricia Gilbert (24:11):

And, yes, that's one way I recharge.

Carol Pehotsky (24:13):

Mm-hmm. Mm-hmm.

Tricia Gilbert (24:14):

And finding humor and finding the ability to laugh at myself. Finding that grace to be able to decrease my expectations for perfection in life.

Carol Pehotsky (24:25):

Yeah. I mean, we think about what you're doing in your career.

Tricia Gilbert (24:28):

(laughs)

Carol Pehotsky (24:28):

You really need to be able to balance that 'cause-

Tricia Gilbert (24:30):

Mm-hmm.

Carol Pehotsky (24:30):

... you're, yeah, you are taking on some pretty heavy stuff.

Tricia Gilbert (24:32):

Mm-hmm.

Carol Pehotsky (24:33):

That's, that's fantastic. And finally, like I ask everybody else, what brings you joy?

Tricia Gilbert (24:37):

(laughs) Unplugging, and-

Carol Pehotsky (24:39):

Mm.

Tricia Gilbert (24:40):

... you know, my kids and family are huge. So I've got three teenagers-

Carol Pehotsky (24:45):

Oh, boy. (laughs)

Tricia Gilbert (24:45):

... so that presents challenges in itself, but I do thoroughly enjoy being with my family.

Carol Pehotsky (24:50):

Wonderful. I can't thank you enough for joining us today.

Tricia Gilbert (24:53):

Thank you so much.

Carol Pehotsky (24:57):

As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

Carol Pehotsky (25:32):

The information in this podcast is for educational and entertainment purposes only, and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.