Objectives. Literature Search. Background. Courageous Caring to Promote Compassion Satisfaction. Courageous Care: Theme NOTE:

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Courageous Care: 2015-2016 Theme Courageous Caring to Promote Compassion Satisfaction Tara L.

1 Courageous Care: Theme Courageous Caring to Promote Compassion Satisfaction Tara L. Sacco RN, MS, CCRN, AGCNS-BC, ACCNS-AG 2015 Critical Care Symposium Rochester, NY 1 4 Objectives Differentiate the aspects of compassion satisfaction, compassion fatigue, burnout, and moral distress in acute care nursing. Reconstruct thinking to support ongoing conversations of compassion satisfaction in the nursing workforce. Discover methods to promote compassion satisfaction in acute care nursing. These concepts are not unique to nursing and have been reported in other helping professionals. Each is a subjective feeling that may vary person to person. An understanding of each has the potential to enhance the work environment for all members of the healthcare team. NOTE: 2 5 Background Literature Search 12 years of experience in the Adult Critical Care Units at Strong 3+ years teaching at St. John Fisher College Research Internship: Professional Quality of Life in Adult, Pediatric, & Neonatal Critical Care units PhD Student, Villanova University Dissertation focus: Healthy Work Environment, Compassion Satisfaction & Compassion Fatigue Ovid Compassion Fatigue: 255 Burnout: 8,975 Secondary Traumatic Stress: 105 Moral Distress: 344 Compassion Satisfaction: 55 CINHAL Compassion Fatigue: 297 Burnout: 5,131 Secondary Traumatic Stress: 115 Moral Distress: 441 Compassion Satisfaction: 71 **Search completed in June** 3 6 1

2 Moral Distress: Definition First described in 1984 by Jameton: When someone knows the right thing to do, but can t due to constraints (internal/external) The mental suffering that results from being aware of the morally appropriate intervention, but despite efforts it cannot be implemented. (Cavaliere et al, 2010; de Veer et al, 2013; Gallagher, 2011; Pendry,2007; Sauerland et al, 2014; Sauerland et al, 2015; Wilson et al, 2013) Compassion Fatigue (CF): Definition A state where compassionate energy expended by helpers is greater than the helper s restorative processes resulting in an inability to recover Develops as a result of the exposure to patients experiences and the caregivers empathetic response. A consequence of caring, the loss of the ability to nurture patients. Cynicism and emotional exhaustion in health professionals; sustained exhaustion and decreased capacity for work. Two main components: Burnout & Secondary Traumatic Stress (Coetzee & Klopper, 2010; Collins & Long, 2003; Flarity et al, 2013; Hinderer et al,2014; Jenkins & Warren, 2012; Sacco et al, 2015) 7 10 Moral Distress Nurses are susceptible due to the moral undertones of nursing practice, closeness of the nurse-patient relationships, and the caring role. Causes Poor-quality/futile care Unsuccessful advocacy Unrealistic hope Anything that may interfere with the ability to provide optimal care Physical symptoms Headache, neck pain, GI disturbances, sleeplessness Psychological symptoms Anger, guilt depression, frustration, anguish, reduced self-worth, withdrawal from family/friends, powerlessness Effects Traumatization Effects on patient care Compassion Fatigue Results from continuous & repeated exposure to stressors (patient suffering or others within the work environment). Stressors lead to emotional exhaustion Can result in depersonalization, poor performance, loss of empathy, poor judgement Symptoms: difficulty concentrating, intrusive imagery, loss of hope, exhaustion, irritability, absence of energy, emotional breakdown, feeling overwhelmed, lack of enthusiasm for patient care, weight gain/loss, loss of endurance, other physical complaints (Cavaliere et al, 2010; de Veer et al, 2013; Gallagher, 2011; Pendry,2007; Sauerland et al, 2014; Wilson et al, 2013) (Coetzee & Klopper, 2010; Jenkins & Warren, 2012; Smart et al, 2014; Yoder, 2010) 8 11 INTERPERSONAL RELATIONSHIPS THAT INCLUDE EMPATHY AND EMOTIONAL ENERGY, I.E. THE NURSE-PATIENT RELATIONSHIP, ARE A KEY FACTOR IN THE DEVELOPMENT OF COMPASSION SATISFACTION AND COMPASSION FATIGUE. (Sabo, 2008) THE MANAGER S MOST EMPATHETIC EMPLOYEES ARE MOST LIKELY TO EXPERIENCE COMPASSION FATIGUE WHEN DEALING WITH SUFFERING PATIENTS Slatten et al, 2011, pp

3 Burnout (BO): Definition Syndrome of emotional exhaustion*, depersonalization, lack of personal accomplishment that develops over time. Secondary Traumatic Stress (STS) Considered an occupational hazard Has the same symptoms as PTSD, but results from witnessing a trauma rather than directly experiencing it Any extreme stressor can trigger STS Symptoms: increased arousal, intrusive thoughts/images, difficulty separating work/life, inability to tolerate frustration, angry outbursts, dread of work, depression, ineffective or self-destructive coping behaviors, decreased feelings of competency, diminished sense of purpose, hopelessness. (Beck, 2011; Beck & Gable, 2012; Oyeleye et al, 2013; Spence Laschinger et al 2010) (Beck, 2011; Beck & Gable, 2012; Collins & Long, 2003; Dominguez-Gomez & Rutledge, 2009; Duffy et al, 2015; Hedney et al, 2014; Sacco et al, 2015; Von Rueden et al, 2010) Burnout (BO) Tied to unhealthy work environments and negative working conditions Emotional resources depleted inability to give yourself psychologically, negativity, cynicism depersonalization Negative self-evaluation, dissatisfaction with professional work lack of personal accomplishments Worsens over time, symptoms include fatigue, illness, cynicism, anger, insomnia, helplessness/hopelessness (Faller et al, 2011; Hegney et al, 2014; Hinderer et al, 2014; Jenkins & Warren, 2012; Kim, 2013; Oyeleye et al, 2013; Sabo, 2008; Sacco et al, 2015; Spence Laschinger et al, 2010) 17 Consequences MD has been linked to the development of burnout, decreased job satisfaction, and turnover BO can lead to the transfer of frustrations to others, low organization commitment, and turnover CF can result in poor job performance, substandard patient care, absenteeism, interpersonal conflicts, and diminished sense of effectiveness, competency, and accomplishment, and stress related illnesses Risk to patient safety and patient dissatisfaction may result from CF All can negatively affect the nurse s personal life. (Cavaliere et al, 2010, de Veer et al, 2013; Drury et al, 2014; Jenkins & Warren, 2012; Oyeleye et al, 2013; Sabo, 2008; Slocum-Gori et al, 2011; Spence Laschinger et al, 2010) Secondary Traumatic Stress (STS): Definition Emotions and behaviors that result from knowing about someone else s traumatic event and wanting to help that person; can result from one or more exposures. Measurement Tools Moral Distress Moral Distress Scale, also available in pediatric/neonatal version Compassion Fatigue Professional Quality of Life Scale (ProQOL) Compassion Fatigue Self Test Compassion Satisfaction and Fatigue Test Compassion Fatigue Scale Revised Burnout ProQOL Mashlach BO Inventory Copenhagen BO Inventory Secondary Traumatic Stress ProQOL Secondary Traumatic Stress Scale Compassion Fatigue Self Test Compassion Satisfaction and Fatigue Test Compassion Fatigue Scale Revised (Beck, 2011; Beck & Gable, 2012; Von Rueden et al, 2010)

4 Professional Quality of Life (ProQOL) Scale Available for use: Compassion Satisfaction (CS) May be a protective mechanism, a counterbalance to CF Maintains well-being Motivation to care for patients is tied to the satisfaction caregivers get from helping Achieved from the connection with patients and their families, an emotion reward Feeling supported by colleagues and contributing to the organization may contribute to feelings of CS May outweigh the negative aspects of a job Less robustly researched as compared to MD, CF, STS, and BO (Collins & Long, 2003; Hegney et al, 2014; Hinderer et al, 2014; Hunsaker et al, 2015; Meyer et al, 2015; Slocum-Gori et al, 2011; Smart et al, 2014; Todaro-Franceschi, 2013) A DEMONSTRATION OF COMPASSION DOES NOT ALWAYS LEAD TO NEGATIVE EMOTIONAL STATES OR OUTCOMES ProQOL Measurement Slocum-Gori et al, 2011, pp Compassion Satisfaction (CS): Definition The sense of accomplishment and reward derived from caregiving The joy, purpose, and meaning derived from the work of a helper Rewarding aspects of a job that connects a helper with suffering patients. Being able to empathize and relieve suffering while not becoming emotionally exhausted Consequences Positive feelings towards colleagues Positive contributions to the work environment and beyond Improved patient satisfaction As a motivational factor, it may improve recruitment and retention rates Has been linked to self-efficacy, a sense of community, and healthy coping mechanisms (Flarity et al, 2013; Hooper et al, 2010; Kim, 2013; Sacco et al, 2015) (Kim, 2013; Li et al, 2014; Smart et al, 2014)

Professional Quality of Life Model Fostering Compassion Satisfaction Resiliency Training Some suggested topics: self-regulation, intentionality, perceptual maturation selfvalidation, connection and

5 Professional Quality of Life Model Fostering Compassion Satisfaction Resiliency Training Some suggested topics: self-regulation, intentionality, perceptual maturation selfvalidation, connection and support, and self-care revitalization (ProQOL.org, 2015) (Flarity et al, 2013) Fostering Compassion Satisfaction Positive self-concept Understanding of others Development of self-awareness Workplace empowerment Psychological empowerment Caring for oneself personally and professionally Listening to ones physical and mental needs Self-care activities BALANCE (Beck, 2011; Collins & Long, 2003; Duffy et al, 2015; Faller et al, 2011; Hooper et al, 2010; Jenkins & Warren, 2012; Oyeleye et al, 2013; Slatten et al, 2011; Spence Laschinger et al, 2010; Young et al, 2011) WE, AS NURSES, ARE RESPONSIBLE TO AID ONE ANOTHER TO FOSTER COMPASSION SATISFACTION, WHILE BEING ABLE TO RECOGNIZE THE SIGNS OF COMPASSION FATIGUE AND BURNOUT Fostering Compassion Satisfaction Use of alternative therapies: massage, reflexology, aromatherapy, mindfulness Mentoring/Strong Co-worker Relations Formal or informal, with debriefing Participation in professional development Giving (and receiving) positive feedback Formal support systems Ex. Pastoral care Availability of a quiet space Contact info: Tara_sacco@urmc.rochester.edu or tsacco@sjfc.edu (Collins & Long, 2003; Drury et al, 2014; Hegney et al, 2014; Hinderer et al, 2014; Slatten et al, 2011; Slocum-Gori et al, 2011; Young et al, 2011)

6 References Beck, C. T. (2011). Secondary traumatic stress in nurses: A Systematic Review. Archives of Psychiatric Nursing, 25, Beck, C. T. & Gable, R. K. (2012). A mixed methods study of secondary traumatic stress in labor an delivery nurses. JOGGN, 41, Cavaliere, T., Daly, B., Dowling, D., & Montgomery, K. (2010). Moral distress in neonatal intensive care unit RNs. Advances in Neonatal Care, 10, Coetzee, S. K. & Klopper, H. C. (2010). Compassion fatigue within nursing practice: A concept analysis. Nursing and Health Sciences, 12, Collins, S. & Long, A. (2003). Too tired to care? The psychological effects of working with trauma. Journal of Psychiatric and Mental Health Nursing, 10, de Veer, A. J. E., Francke, A. L., Struijs, A. & Willems, D. L. (2013). Determinants of moral distress in daily nursing practice: A cross sectional correlational questionnaire survey. International Journal of Nursing Studies, 50, Dominguez-Gomez, E. & Rutledge, D. N. (2009). Prevalence of secondary traumatic stress among emergency nurses. Journal of Emergency Nursing, 35, Duffy, E., Avalos, G. & Dowling, M. (2015). Secondary traumatic stress among emergency nurses: A cross-sectional study. International Emergency Nursing, 23, Drury, V., Craigie, M., Francis, K., Aoun, S, & Hegney, D. G. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: Phase 2 results. Journal of Nursing Management, 22, Faller M. S., Gates, M. G., Georges, J. M., & Connelly, C. D. (2011). Work-related burnout, job satisfaction, intent to leave, and nurse-assessed quality of care among travel nurses. Journal of Nursing Administration, 41, Flarity, K., Gentry, J.E., & Mesnikoff, N. (2013). The effectiveness of an educational program on preventing and treating compassion fatigue in emergency nurses. Advanced Emergency Nursing Journal, 35, Gallagher, A. (2011). Moral distress and moral courage in everyday nursing practice. Online Journal of Issues in Nursing, 16, 1. Gift from Within (2015). What is compassion fatigue: Prevention & treatment PTSD resource. Available: Figley.html Hegney, D. G., Craigie, M., Hemsworth, D., Francis, K., & Drury, V. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression, and stress in registered nurses in Australia: Study 1 results. Journal of Nursing Management, 22,

7 Hinderer, K. A., VonRueden, K., Reidemann, E., McQuillan, K. A., Gilmore, R., Kramer, B. & Murray, M. (2014). Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. Journal of Trauma Nursing, 21, Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., Reimels, E., & Greenville, D. R. (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing, 36, Hunsaker, S., Chen, H., Maughan, D. & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47, Jenkins, B. & Warren, N. A. (2012). Concept Analysis: Compassion fatigue and effects upon critical care nurses. Critical Care Nursing Quarterly, 35, Kim, S. (2013). Compassion fatigue in liver and kidney transplant nurse coordinators: A descriptive research study. Progress in Transplantation, 23, Li, A., Early, S. F., Mahrer, N. E., Klaristenfeld, J. L., & Gold, J. I. (2014). Group cohesion and organizational commitment: Protective factors for nurse residents job satisfaction, compassion fatigue, compassion satisfaction, and burnout. Journal of Professional Nursing, 30, Meyer, R. M. L., Li, A., Klaristendfeld, J., & Gold, J. I. (2015). Pediatric novice nurses: examining compassion fatigue as a mediator between stress exposure and compassion satisfaction, burnout, and job satisfaction. Journal of Pediatric Nursing, 30, Oyeleye, O., Hanson, P., O Connor, N. & Dunn, D. (2013). Relationship of workplace incivility, stress, and burnout on nurses turnover intentions and psychological empowerment. Journal of Nursing Administration, 43, Pendry, P. S (2007). Moral distress: Recognizing it to retain nurses. Nursing Economic$, 25, ProQOL.org (2015). Professional Quality of Life. Available: Sabo, B. M. (2008). Adverse psychosocial consequences: Compassion fatigue, burnout and vicarious traumatization: Are nurses who provide palliative and hematological cancer care vulnerable? Indian Journal of Palliative Care, 14, Sacco, T. L., Ciurzynski, S. M., Harvey, M. E., & Ingersoll, G. L. (2015). Compassion satisfaction and compassion fatigue among critical care nurses. Critical Care Nurse, 35, Sauerland, J. Marotta, K., Peinemann, M. A., Berndt, A. & Robichaux, C. (2014). Assessing and addressing moral distress and ethical climate, part 1. Dimensions of Critical Care Nursing, 33, Sauerland, J., Marotta, K., Peinemann, M. A., Berndt, A., & Robichaux, C. (2015). Assessing and addressing moral distress and ethical climate part II: Neonatal and pediatric perspectives. Dimensions of Critical Care Nursing, 34,

8 Slatten, L. A., Carson, K. D., & Carson, P. P. (2011). Compassion fatigue and burnout: What managers should know. The Health Care Manager, 30, Slocum-Gori, S., Hemsworth, D., Chan, W. W. Y, Carson, A., & Kazanjian, A. (2011). Understanding compassion satisfaction, compassion fatigue and burnout: A survey of the hospice palliative care workforce. Palliative Medicine, 27, Smart, D., English, A., James, J., Wilson, M., Daratha, K. B., Childers, B., & Magera, C. (2014). Compassion fatigue and satisfaction: A cross-sectional survey among US healthcare workers. Nursing and Health Sciences, 16, Tordaro-Francheschi, V. (2013). Compassion Fatigue and Burnout In Nursing: Enhancing Professional Quality of Life. New York : Springer. Von Rueden, K. T., Hinderer, K. A., McQuillan, K. A., Murray, M., Logan, T., Kramer, B., Gilmore, R., & Friedmann, E. (2010). Secondary traumatic stress in trauma nurses: Prevalence and exposure, coping, and personal/environmental characteristics. Journal of Trauma Nursing, 17, Wilson, M. A., Goettemoeller, D., Bevan, N. A., & McCord, J. M. (2013). Moral distress: Levels, coping and preferred interventions in critical care and transitional care nurses. Journal of Clinical Nursing, 22, Yoder, E. A. (2010). Compassion fatigue in nurses. Applied Nursing Research, 23, Young, J. L., Cicchillo, V. J., & Bressler, S. (2011). Compassion satisfaction, burnout, and secondary traumatic stress in heart and vascular nurses. Critical Care Nursing Quarterly, 34,

Burnout in Palliative Care. Palliative Regional Rounds January 16, 2015 Craig Goldie

Burnout in Palliative Care. Palliative Regional Rounds January 16, 2015 Craig Goldie Burnout in Palliative Care Palliative Regional Rounds January 16, 2015 Craig Goldie Overview of discussion Define burnout and compassion fatigue Review prevalence of burnout in palliative care Complete