Caring for Our Caregivers

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1 Caring for Our Caregivers Burnout: meeting the needs of the care team Theresa Weisenbach MBA, MSN, RN, NE-BC, BMTCN, OCN Franciscan Health Director of Nursing, Bone Marrow Transplant & Oncology Administrative Director, HLA & Stem Cell Lab

2 Financial Disclosure I have not had any relevant financial relations during the past 12 months to disclose. Schroeter (2014)

3 Off Label Use Disclosure I do not intend to discuss an off label use of a product during this activity Schroeter (2014)

4 Objectives Define Compassion Fatigue & Burnout Identify the signs and symptoms of Compassion Fatigue Recognize the impact and effects of Compassion Fatigue on caregivers and employers Discuss self-care, preventative measures, and strategies to prevent Compassion Fatigue

5 What is the Buzz Word? Compassion Fatigue Burnout Vicarious Trauma Secondary Traumatic Stress Compassion Stress Emotional Contagion Co-Victimization Secondary Traumatic Stress Disorder

6 Definition of Compassion Fatigue Result of a progressive and cumulative process caused by prolonged, continuous, and intense contact with patients, involving of self, and exposure to stress State where compassionate energy that is expended by the caregiver has surpassed their restorative process, with recovery power being lost Manifest with marked physical, social, emotional, spiritual, and intellectual changes that increase in intensity with each progressive state Coetzee & Klooper (2010)

7 Definition of Burnout Combination of many stressors factors causing care team members to feel overwhelmed and experience feelings of exhaustion Often a perception of how one feels based on stress factors Russel (2016)

8 Compassion Fatigue verses Burnout Compassion Fatigue arises from the caregivers relationships with patients and families Burnout associated with workplace stressors lack of teamwork, long hours, increased workload

9 Cost and Consequences of Caring The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. -Remen

10 Multidisciplinary Care Team Physician Nurse Case Manager Social Worker Pharmacist Chaplin Medical & Administrative Assistants

11 Signs and Symptoms of Compassion Fatigue Boyle (2015)

12 Signs and Symptoms of Compassion Fatigue Physical Spiritual Emotional Work Social

13 Oncology Nurses Compassion fatigue is a phenomenon identified in Oncology Nursing Oncology Nurses acquire compassion fatigue through repeated exposure to patients suffering the effects of trauma, such as side effects of aggressive treatment and the end stages of cancer (Potter et al., 2010)

14 Measuring Compassion Fatigue Pro QOL ( Professional Quality of Life) Version 5 30 item scale to measure Compassion Fatigue, Compassion Satisfaction, and Burnout Recommend for screening, but not diagnostic purposes Based on a 0 (never) to 5 (very often) Likert scale ProQOL.org. Available at:

15 Compassion Satisfaction Ability to receive gratification from caring for others Positive feelings contributed to the work setting and or greater good of society ProQOL Version 5

16 Compassion Fatigue studies & findings Russel (2016), study about burnout, prevention, and effects on patient care in an inpatient setting Ko and Kiser-Larson (2016) study of stress levels in nurses in an outpatient setting Giarelli et al. (2016) study of quality of work life and risk for compassion fatigue among Oncology Nurses

17 Compassion Fatigue study Potter et al., 2010

18 Consequences of Compassion Fatigue Correlations have been found between compassion fatigue, nurse retention, turnover, patient satisfaction, and patient safety (Potter et al., 2010). Work performance and efficiency may be impaired, increase in errors, some may even decide to leave the profession (Boyle, 2015)

19 Compassion Fatigue Interventions Three Key Categories 1. Self-Awareness 2. Self-Care 3. Work Setting Strategies Boyle (2015)

20 Self Care for Care Givers Maintain a healthy career by performing: Self-reflection Self-care Preventing & recognizing compassion fatigue Seeking guidance and support Fetter (2012)

21 Self Care for Care Givers The ABC s of hardiness 1. Awareness 2. Balance 3. Connectivity Schroeter (2014)

22 Self Care for Care Givers Self awareness to ones needs, limits, emotions Knowing your renewal & comfort zones Practicing Mindfulness Accepting and acknowledging that we are changed by what we do Schroeter (2014)

23 Create a Self Care Plan Embrace wellness Nutrition Exercise Adequate sleep Stress reduction Hobbies Activities that bring you joy Spiritual Health Boyle (2015)

24 Organizational Interventions Identify work setting interventions and resources Establishing and maintaining healthy work environments Provide interventions that can be individualized Ko & Larson (2016)

25 Organizational Interventions Acknowledge, openly discuss (staff meetings) Recognize staff for their contributions to patients & organization Education on Compassion Fatigue Rotate the care of challenging patients Provide Quiet Rooms for staff

26 Organizational Interventions Encourage debriefing (informal and formal) Develop a mentor/ buddy system Encourage personal journaling Encourage support groups and meetings outside of work

27 Organizational Interventions Access to counseling Ensure physical nourishment (taking lunch breaks) Organizational internal resources External resources: formal programs Schroeter (2014)

28 Resilience Ability to confront immeasurable challenges with strength and fortitude Self-confidence and self-assurance Seeing oneself as a survivor Optimistic and hardy attitude Learn how to deal with life s challenges, but not immune to stress Bush & Boyle (2012)

29 Conclusions Caregivers have a high risk for compassion fatigue which impacts their physical, social, emotional and spiritual well-being Day to day compassion provided by the oncology nurse and other care team members puts them at risk for compassion fatigue Taking care of our caregivers is essential to retain compassionate and experienced care team members Developing a self-care plan is beneficial for caregivers Prevention of compassion fatigue will improve patient care, quality outcomes, and employee engagement

30 Ten Laws for Healthy Caregiving

31 References 1. Boyle, D. A. (2015). Compassion fatigue: The cost of caring. Nursing, 45, doi: /01.nurse a1 2. Boyle, D. A. (2011). Countering compassion fatigue: a requisite nursing agenda. Online Journal of Issues in Nursing, 16(1), Boyle, D.A. and Bush, N. (2012). Self-Healing through Reflection. A Workbook for Nurses. Pittsburg, PA: Oncology Nursing Society. 4. Coetzee, S.K., & Klopper, H.C. (2010). Compassion fatigue within nursing practice: A concept analysis. Nursing and Health Sciences, 12 (2), Compassion Fatigue Awareness Project (2013) Fetter, K. (2012). We Grieve Too: One inpatient Oncology Unit s Interventions for Recognition and Combating Compassion Fatigue. Clinical Journal of Oncology Nursing, 16 (6). 7. Figley, C.R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner-Mazel.

32 References 8. Giarelli, E., Denigris, J., Fisher, K., Maley, M., Nolan, E. (2016). Perceived Quality of Work Life and Risk for Compassion Fatigue Among Oncology Nurses: A Mixed- Methods Study. Oncology Nursing Forum, 43(3). E121-E131. doi: /16.ONF.E121-E Harris, C. and Griffin, Q. (2015). Nursing On. Journal of Christian Nursing, 32(2), doi: /CNJ Joinson, C. (1992). Coping with compassion fatigue. Nursing 22(4), 116, , Ko, W. and Kiser-Larson, N. (2016). Stress levels of Nurses in Oncology Outpatient Units. Clinical Journal of Oncology Nursing, 20 (2), doi: /16.CJON Potter, P., Deshields, T., Divanbeigi, J., Berger, J., Cipriano, D., Norris, L., & Olsen, S. (2010). Compassion fatigue and burnout: Prevalence among oncology nurses. Clinical Journal of Oncology Nursing, 14 (5), E56-E62. doi: /10.CJON.E56- E62.

33 References 13. ProQOL.org. Available at: Accessed March 1, Russel, K. (2016). Perceptions of Burnout, Its Prevention, and its Effect on Patient Care as Described by Oncology Nurses in the Hospital Setting. Oncology Nursing Forum, 43 (1) doi: /16.ONF Schroeter, Kathryn. Compassion Fatigue: An Unwanted reflection of Your Reality. Journal of Trauma Nursing 21.2 (2014): Slatten LA, David Carson K & Carson PP. (2011). Compassion fatigue and burnout: what managers should know. Health Care Manager, 30, doi: /hcm.0b013e f7

34 Caring for our Caregivers The probability that we may fall in the struggle ought not to deter us from the support of a cause we believe to be just. -Abraham Lincoln

35 Caring for our Caregivers THANK YOU FOR YOUR TIME AND ATTENTION

JBI Database of Systematic Reviews & Implementation Reports 2013;11(12) 81-93

JBI Database of Systematic Reviews & Implementation Reports 2013;11(12) 81-93 Meaningfulness, appropriateness and effectiveness of structured interventions by nurse leaders to decrease compassion fatigue in healthcare providers, to be applied in acute care oncology settings: a systematic