12/12/2017. Addressing Compassion Fatigue in the Intensive Care Unit (ICU): An Interdisciplinary Staff Support Group. Disclosure slide.

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1 Addressing Compassion Fatigue in the Intensive Care Unit (ICU): An Interdisciplinary Staff Support Group Combined Sections Meeting 2018 New Orleans, LA, February 21-24, 2018 Miriam Gross PT, DPT, NCS Senior II Physical Therapist, MICU NYU Langone Health- Rusk Institute of Rehabilitation Jessica Marshall, MS, LCSW Senior Social Worker, MICU NYU Langone Health Disclosure slide Miriam Gross does not have any conflicts of interest in presenting today. Jessica Marshall does not have any conflicts of interest in presenting today. Objectives Define and identify compassion fatigue and its presentation. Discuss indications and evidence for staff support groups. Apply strategies for staff to use during their work and careers to mitigate compassion fatigue. 1

2 Outline Compassion fatigue Literature review Support group discussion Literature review Evidence Based practice Interdisciplinary ICU support group at Tisch Hospital at NYU Langone Health Individual roles, group development and growth, Social work involvement Group goals Barriers Next steps Identifying Compassion Fatigue Compassion Fatigue Definition Cost of caring for others in emotional and physical pain (Figley, 1982) By the numbers Components contributing to compassion fatigue Secondary trauma stress Burnout Occupational stress 2

3 CF Signs and Symptoms At work Absenteeism Reduced ability to feel sympathy and empathy Diminished sense of enjoyment in career Personal Problems with intimacy in personal relationships Difficulty separating work and personal life Intrusive imagery Compassion Fatigue Literature Compassion Fatigue in the Literature Focused on RNs and physicians in oncology, hospice, military Difficulty in isolating Compassion in surveys/questionnaires Research in compassion fatigue and rehabilitation services OT SLP PT SW 3

4 Support Groups Defining a Support Group Overview Bring together people facing similar issues, whether that's illness, relationship problems or major life changes (Mayo Clinic 2015). Benefits of Support Groups Feeling less lonely, isolated or judged Improving your coping skills and sense of adjustment Talking openly and honestly about your feelings Reducing distress, depression, anxiety or fatigue Getting practical advice or information about treatment options (Mayo Clinic, 2015) 4

5 CF Surveys and Questionnaires Using surveys/questionnaires For pre/post assessment For individual progress Feedback for enhanced programming To facilitate programming permanence Sample survey questions Ie ProQol: Compassion Fatigue Self Test (Figley & Stamm 2009) I find it difficult to separate my personal life from my life as a [helper]. I get satisfaction from being able to [help] people. Current Interdisciplinary Support Group Research Literature highlights how interdisciplinary staff support patients and their families Focus on pediatric patients and their parents, not staff Hospice, oncology, pediatrics focused The staff support groups that exist primarily focus on nursing and are not interdisciplinary Literature emerging on psychoeducation and its benefits for healthcare professionals (Klein et al. 2017) Alternative Medicine Wellness Clinic at A Major Military Hospital Evaluation of a Pilot Program (Duncan et al. 2011) Code of Ethics (PT) Physical Therapy Code of Ethics Principle #1: Physical therapists shall respect the inherent dignity and rights of all individuals. Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. Principle #4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public. 5

6 Code of Ethics (RN) Nursing Code of Ethics Provision 1. The nurse, in all professional relationships, practices with compassion and the recognition of human dignity and worth that is present in every individual. Provision 3. The nurse seeks to protect the health, safety, and rights of the patient. Provision 4. Responsibility and Accountability. Code of Ethics (SLP) American Speech-Language-Hearing Association Principle of Ethics I Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner. Code of Ethics (OT) The 2015 Occupational Therapy Code of Ethics Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. Principle 3. Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent. Principle 6. Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity. 6

7 Code of Ethics (SW) Social Work Code of Ethics Multiple Categories: To Clients, To Colleagues, Practice Settings, To The Profession, Broader Society For Clients: Commitment to Clients Self-Determination Cultural Competence and Social Diversity Clients Who Lack Decision-Making Capacity SW Code of Ethics For Colleagues: Respect Confidentiality Interdisciplinary Collaboration Disputes Involving Colleagues Consultation Referral for Services Unethical Conduct Tisch Hospital- NYU Langone Health Interdisciplinary ICU Support Group 7

8 Identifying Roles in the Support Group Traditional roles of facilitator and members Our unique roles/individualization of the group Role of supervisors/management Our Group Development: MICU/SICU Who? Where? When? Why? Involvement of Social Work The need for appropriate facilitation of the group. Pros: Knowledge of the unit, Environment, Patients, and Team Dynamics. Barriers: Maintaining neutrality and appropriate boundaries as the facilitator. 8

9 Support Group Growth Identified the need for an increasing awareness and additional training in the rehab therapy field when working with critically ill patients. The group initially began for PTs only interdisciplinary Integration of therapy departments sparked discussion about the group and interest developed across disciplines. Group Safety Establishing Group Rules confidentiality limitations Providing options for follow up care outside of group Decision tree for involving administration Group Goals Providing a safe space. Assistance in identifying professional boundaries. Promoting meaning making from patient care. Encouraging appropriate self-care. Preventing Compassion Fatigue, secondary trauma stress and Burnout. 9

10 Group Objectives Preventing Compassion Fatigue Professional boundaries Define Professional Boundaries Define Transference and Countertransference Strategies for Maintaining Professional Boundaries Identifying transference and countertransference independently, Rotating Caseloads, Coverage changes, Communicating with other colleagues, staff or supervisors. Creating Supportive Relationships and Effective Communication Group members are available to support one another on the units when issues arise inbetween group meetings. There is an established trust and rapport which provides ongoing support on a daily basis. 10

11 Promoting Expression Of Feelings Examples: Avoiding self-judgment, Analyzing their internal dialogue, and reflecting on their self-talk. Application: Staff are identifying when they need to remove themselves from a case, or lessen their involvement. Staff are also volunteering to relieve one another when individuals have identified their difficulty with a specific case. Meaning Making Create meaning from their work by allowing themselves to take a step back and see the broader picture. Making meaning from our work is an important protective factor that mitigates development of compassion fatigue. Example: PT, OT, and SLP are trained to see potential, create achievable goals, and focus on healing, growth and strength building. Application: Not losing sight of the overall picture of the patient s illness, prognosis and their own individual/family goals of care. Encouraging Self-Care Example: Be mindful of the physical aspects of self-care. Application: Getting enough sleep Eating well Exercising 11

12 Additional Supportive Services Discussed/Utilized in Group Hospital Meditation Hotline Information Human Resources Support Integrative Health (Chair Yoga, Reiki, Mindfulness training, acupuncture) Animal Assisted Therapy (Barker et al. 2005) Utilize a tool kit of skills to prevent compassion fatigue Barriers to Success and Ways to Overcome Them Group Barriers to Success Participation Scheduling Consistency Confidentiality Daily Workflow 12

13 Expansion of the Interdisciplinary Support Group Who? What? Where? When? Why? Next Steps Sharing our work within our departments to encourage additional groups in other specialty areas Expansion of resources to rehab therapists outside of the MICU/SICU Complete additional and more extensive evaluations of the group Contribute to expanding literature in our respective fields Questions? 13

14 References American Nurses Association. Code of ethics for nurses with interpretive statements. Nurses.html. First published January Accessed December Aycock N, Boyle D. Interventions to manage compassion fatigue in oncology nursing. Clin J Oncol Nurs ;13(2): Banach M, Couse LJ. Interdisciplinary co-facilitation of support groups for parents of children with Autism. Soc Work Groups. 2012;35(4): Barker SB, Knisely JS, McCain NL. Measuring stress and immune response in healthcare professionals following interaction with a therapy dog: a pilot study. Psychol Rep. 2005;96: Brosche T. A grief team within a healthcare system. Dimensi Crit Care Nurs. 2007;26(1):21-8. Code of ethics: American Speech-Language-Hearing Association. Effective March 1, Accessed March Cohen MZ, Brown-Saltzman K, Shirk MJ. Taking time for support. Oncol Nursi Forum. 2001;28(1): Dean R. Occupational stress in hospice care: causes and coping strategies. Am J Hosp Palliat Care. 1998;15(3): Dennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud ;Mar;40(3): Duncan AD, Liechty JM, Miller C. Employee Use and perceived benefit of a complementary and alternative medicine wellness clinic at a major military hospital: evaluation of a pilot program. J Altern Complement Med. 2011;17(9): Figley CR, ed. Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner- Routledge;2005. Grunfeld E, Whelan TJ, Zitzelsberger L, Willan AR, Montesanto B, Evans WK. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction. CMAJ. 2000;Jul 25;163 (2): References Jones SH. A self-care plan for hospice workers. Am J Hosp Palliat Care. 2005; Mar-Apr;22(2): Klappa SG, Howayek R, Reed K, Scherbarth B, Klappa SP. Compassion fatigue among new graduate physical therapists. Global Journal of Medical, Physical and Health Education. 2015;3(4): Klein CJ, Riggenbach-Hays JJ, Sollenberger LM, Harney DM, McGarvey JS. Quality of life and compassion satisfaction in clinicians: A pilot intervention study for reducing compassion fatigue. Am J Hosp Palliat Med. 2017;Jan 1:pages 1-7. Loumpa V. Promoting recovery through peer support: possibilities for social work practice. Soc Work Health Care. 2012;51(1): Mathieu F. Running on empty: compassion fatigue in health professionals. Rehab & Community Care Medicine. Spring 2007 Peterson U, Bergström G, Samuelsson M, Åsberg M, Nygren, Å. Reflecting peer-support groups in the prevention of stress and burnout: randomized controlled trial. J Adv Nurs. 2008; Sep;63(5): National Association of Social Workers. Code of ethics of the National Association of Social Workers. Approved 996, revised Accessed March Slatten LA, Carson KD, Carson PP. Compassion fatigue and burnout: what managers should know. Health Care Manag. 2011;30(4): Support groups: Making connections, get help , accessed March Stamm BH. The Concise ProQOL Manual, 2 nd Ed Pocatello, ID:ProQOL.org. Swisher LL. A retrospective analysis of ethics knowledge in physical therapy. Phys Ther. 2002;Jul;82(7): The American Occupational Health Association, Inc. Occupation Therapy Code of Ethics (2015). Sept 2015;69doi: /ajot S03: 14

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