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| Michael LaFerney |
Mary Jones, an 84-year-old resident of a nursing home, has dementia. She has the urge to urinate and decides she can no longer wait for assistance, so she gets out of bed and makes her way to the bathroom. There, she becomes incontinent, slips on urine and lands on her back. She reaches up, puts on her call light and thinks, “Someone will come right away.”
She lies on the floor for 20 minutes before her CNA returns from lunch, makes rounds and finds her. During this time, four staff members have walked by Mary’s room and noticed her call light, but no one has stopped to look in the room and see what is needed. She has called out for help but, because she is a patient with dementia who often yells, her pleas have gone unheeded. When asked by their supervisor why they did not respond, staff members replied, “She’s not my patient.”
On another unit, an emergency is taking place. Bill Smith is choking. The RN comes out of his room and orders loudly but calmly, “Someone get the suction machine!” A minute goes by, and no one comes. The nurse then runs to the phone and calls a code. In a flash, several staff members surface and dislodge the obstruction.
What do these events have in common? Both represent a psychological phenomenon that often occurs in emergencies, the bystander effect: When there is an emergency, the more bystanders there are, the less likely it is that any of them will actually help. The phenomenon often involves one or more of the following lapses in care:
- Fail to notice the event, perhaps because of preoccupation or being in a hurry.
- Assume that, since others are not responding, it is not an emergency.
- Assume that someone else will assume responsibility.
In the first example, there is diffusion of responsibility. Because Mary Jones is in her bathroom and cannot be seen from the hallway, potential caregivers assume there is no emergency and, because a CNA is assigned to Mary, that she will be promptly helped. Busy with their own patients, staff members may also feel that Mary’s needs are best served by her CNA, who knows her better.
In the second case, several staff members heard the call for the suction machine and assumed “someone” was going to get it. Since the tone of the nurse’s voice was calm—she didn’t want to alarm the patient—they interpreted her call as “not an emergency.”
Remember, “someone” usually is interpreted as no one. In an emergency, point to and call by name the person you want to do a task.
A dramatic example of the bystander effect is the Kitty Genovese case. Genovese was stabbed to death near her apartment in New York City and, although 38 people heard her cries for help, no one called the police. More routinely, how many of us have witnessed a car accident but didn’t stop to assist, thinking, “Surely, with so many drivers on the road, someone will call 911.”
What can nurses do to lessen the chances of the bystander effect occurring in their work environment?
We must first get rid of the “it’s not my patient” mindset. Secondly, we must know our assigned roles. At the beginning of each shift, assignments for emergency response should be given. Who, for example, will be responsible for getting the suction machine or code cart? When the RN called for the suction machine, no one responded. When she called for a code, many responded because they recognized there was an emergency and knew their roles.
Remember, “someone” usually is interpreted as no one. In an emergency, point to and call by name the person you want to do a task. As we learned in CPR, we do not say, “Someone, go get help.” Instead, we point to a person and order him or her to go for help. This places the responsibility on an individual so that it is not diffused throughout the group.
Effective supervision also helps prevent the bystander effect. Staff members should be encouraged to report unacceptable behavior, such as walking past a call light or ignoring a patient calling for help. This should not be punitive, but educative. Teaching staff members about the bystander effect is an essential first step. Provide training so that, in an emergency, people feel confident about their ability to respond. Many people may desire to help but lack the skill needed to do so. Also, supervisors should model proper behavior by answering call bells when others are not available.
In summary, the bystander effect is a common phenomenon that occurs in both nursing and private life settings. Most situations will be the routine “I need to go to the bathroom” call. But you could be the person who is the first on the scene during an emergency and make a positive difference in the outcome. RNL
Michael C. LaFerney, RN, PhD, PMHCNS-BC, is a psychiatric clinical nurse specialist at Arbour SeniorCare in Rockland, Massachusetts, and adjunct faculty member at Quincy College in Quincy, Massachusetts.
