Gratitude for the Human Connection: A Formula for Compassion Satisfaction Traci Hanlon, MN, RN, CHCM Consultant Cindy Lefton, PhD, RN, CPXP Bonnie Barnes, FAAN Mark Barnes, FAAN Objectives Identify the concepts that define the human connection between nurse and patient/family. Discuss the impact of gratitude and meaningful recognition on organizations, nurse engagement and the patient/family experience. Today Defining the See Me As A Person Framework Compassion Fatigue and Compassion Satisfaction The Impact of Honoring Extraordinary Compassionate Care the Evidence Special Inspiration 1
Presence Paired Interactions Have you had experience with anyone in the state of mind you imagine this man to be in? Does a name or descriptor come to mind for this state of mind, this state of being? Have you or someone you love been in such a state? 2
See me. Listen to me. Give me your undivided attention. Attunement Connection increases Healing ~ Isolation increases Suffering 3
We are neurologically wired for attunement. Wondering 4
Wondering A state of mind characterized by curiosity, openness and acceptance. Wondering happens when we have a devotion to the principle that the patient always has something to teach us, without which we cannot really do our jobs. Following Following A series of intentional acts of devotion to being led and taught by the patient and family Following refers to the practice of listening to, respecting, and acting on what we learn from our patients about who they are and what they need and want. 5
Holding Holding A devotion to safeguarding the person in your care Clinical competence Respecting personhood/dignity Communicating information Anticipating and preparing for transitions Being a sturdy and nonjudgmental presence My Caregiving Stance for Today 6
BREAK 10 MIN Compassion Fatigue and Compassion Satisfaction: Impact to Care Cindy Lefton, PhD, RN, CPXP Vice President, Organizational Consulting Psychological Associates Patient Experience Manager and Researcher, Emergency Services Barnes-Jewish Hospital So, What Exactly Are Compassion Fatigue and Compassion Satisfaction? 7
Current State of Healthcare Vulnerability Uncertainty Complexity Ambiguity The Nurse s Experience I have been struggling to keep my heart in my job, wondering if I should leave my job to do something that would be easier, less demanding of my time and energy. 8
Nuts and Bolts of Compassion Fatigue Compassion Fatigue Burnout Secondary Trauma Draining Your Emotional Energy Think of an example of Compassion Fatigue that you have you experienced. Did it lead you to question yourself as a nurse and/or think about leaving the nursing profession? Why? In groups of two, share with each other. (5 min) Consequences of Compassion Fatigue Emotional Distress Safety Risks Apathy Loss of Empathy Workdays Lost Desire to Quit Poor Judgment Coetzee & Klopper, 2010; Jenkins & Warren, 2012; Kelly, et al 2015 9
Professional Quality of Life Compassion Satisfaction Compassion Fatigue Burnout Secondary Trauma Compassion Satisfaction Compassion Satisfaction The ability to receive gratification from caregiving Simon, Pryce, Roff & Klemmack, 2005 (pg. 6) 10
Restoring Your Emotional Energy Think about a positive patient care experience which energized you. How did it make you feel? How did it reinforce your choice to be a nurse? Why? In groups of two, share with each other. (5 min) Benefits of Compassion Satisfaction Caring Patient Satisfaction Retention Self-esteem Feelings of contribution Energized Moments Perry, 2008; Hooper et al., 2010; Stamm, 2010, 2012 BREAK 10 MIN 11
The DAISY Foundation Bonnie Barnes, FAAN Mark Barnes, FAAN Co-Founders, The DAISY Foundation Our Story of Gratitude November, 1999 Tena and Pat (and baby Riley) The Expected Clinical skill 12
The Unexpected Not just what but how Kindness, thoughtfulness Of Pat And all of us Pat as a whole person Our Awesome Experience Confidence and Trust Never rushed Our interpreters Included us Educated us Engaged us Patient, tender, gentle There is no hug like a nurse s hug. 13
Pat s Nurses Our Nurses Truly Patient and Family-Centered Care The DAISY Foundation Diseases Attacking the Immune SYstem Founded November, 1999 In memory of J. Patrick Barnes Gratitude To Nurses J. Patrick Barnes Grants For Nursing Research and Evidence-based Practice Projects 14
Gratitude Beyond Borders Over 2,600 healthcare facilities and colleges of nursing committed to honoring their nurses with The DAISY Award Over 80,000 nurses honored Over 850,000 nurses nominated Fundamental Principles of our Gratitude On-going recognition Simple to implement Flexible to meet organization needs and cultures Criteria reflect each organization s nursing model and description of nursing excellence Compassionate care is key Gratitude in Action Nurses are nominated with stories of extraordinary care and compassion Stories describe how nurses live organization s mission and values Honorees chosen by committee of peers 15
DAISY Stories April Cole, RN North Mississippi Medical Center Leena Sesay, BSN, RN Children s National Medical Center Discussion What was meaningful/extraordinary in these stories? Why? What was the connection in these stories? (Wondering, Following and Holding) In groups of two, share with each other. (5 min) How do nurses feel when their stories are read aloud, celebrated publicly? 16
First, Shock Then, Pride Surprise Celebration in the Unit Each DAISY Honoree Receives 17
At Every DAISY Celebration I didn t do anything special. I was just doing my job. BREAK 10 MIN 18
Meaningful Recognition: Evidence of Impact Cindy Lefton, PhD, RN, CPXP Principles & Elements of a Healthy Work Environment Skilled Communication Appropriate Staffing True Collaboration Effective Decision- Making Meaningful Recognition Authentic Leadership American Association of Critical-Care Nurses. AACN Standards for establishing and sustaining healthy work environments: A journey to excellence. 2 nd Edition, 2016. 19
What is Meaningful Recognition? A powerful form of positive feedback that Acknowledges how a person s actions affect the life of another Nurses desire recognition for their work and commitment to their patient. When recognition is meaningful, an individual s true essence and uniqueness are recognized and honored. Is relevant to the recipient Nurses consistently rate recognition from patients, families and other nurses as the most meaningful Is equivalent to his or her contribution Effective recognition programs do not occur automatically and require formal structures and processes to ensure the desired outcomes American Association of Critical-Care Nurses. AACN Standards for establishing and sustaining healthy work environments: A journey to excellence. 2 nd Edition, 2016. Benefits of Meaningful Recognition Retention (Madden et al, 2012) Job Embeddedness (Hayes et al, 2006) What We Know - Meaningful Recognition Lit Review 20
Impact of Meaningful Recognition Physiology of Extraordinary Nursing and Positive Patient Experiences Catch Staff Doing Something Extraordinary Augments Patient Satisfaction Scores Extraordinary is Ordinary Shapes and Drives an Organization s Culture What is the Patient Experience? It reflects what patients appreciate Physiology of Extraordinary Nurses: Patient/Family Perspective Rank Theme # Noms 1 Demonstrates genuine compassion and caring 286 2 Reeks of professionalism 175 3 Contagious positive attitude 126 4 Accomplishes more than ever expected 102 5 Teaches others 97 6 Helpful 90 7 Calming/patience 79 8 Connects with family 77 9 Exalted by co-worker 69 10 Intentionally present 65 11 Tireless advocate for patients 64 Rank Theme # Noms 12 Teamwork 63 13 Exalted by patients 58 ] Tied 14 Keeps patients informed 58 15 Puts patient first 48 16 Provides inspiration 46 17 Demonstrates tenacity 45 18 Calm 39 19 Relentless Commitment 27 20 Communication 13 21 Nurse-Doctor Collaboration 8 22 Praises Others 3 21
Catch the Extraordinary She sat by our side as we battled the monsters that this condition brought forth. I know few things for sure, but one of these is that this woman was put on earth to heal and comfort and God have mercy on anyone who stands in her way. Nominations Tell You the How and Why Behind Patient Satisfaction Ratings Just when I was ready to give up, she was there to give me the extra nudge I needed to make it through. She gave me the will to live. Meaningful Recognition Authentic Leadership Appropriate Staffing Effective Decision Making Skilled True Communication Collaboration Interactions from patients, families and colleagues are the back door to meaningful recognition 22
Patient Satisfaction when a hospital explicitly rewards compassionate acts by its staff and supports its staff during tough times, it is associated with patients more highly rating the care experience and being more likely to recommend the hospital. McClelland & Vogus, 2014 Restoring Emotional Energy: Key components of Compassion Satisfaction Positive Feedback The times you get thanked stand out in your mind. Clinical Outcomes Seeing a patient get better right before my eyes. Quality Teamwork Knowing the people I work with have my back. Increasing One s Self-Awareness Recognizing that I am affecting you more than I realize. Surprise Inspiration 23
Marie Manthey, on the right at age 5, with a friend has always appreciated the importance of relationships! Florence Marie Fisher---- relationships were important to her too! Meaningful Recognition She never knew. Marie Manthey, MSN, RN, FAAN Founder, CHCM 24
Thank you Mark Barnes, FAAN Co-Founder, The DAISY Foundation Questions? References Bodenheimer, T. and Sinsky, C. From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine. 2014; 12(6):573-576. Chambliss, D. (1996) Beyond caring: Hospitals, nurses, and the social organization of ethics. Chicago: The University of Chicago Press. Consumer Reports. How not to get sick(er) in the hospital. February 2015. 32-37. Doyle, C., Lennox, L., and Bell, D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open.2012 Hachem, Fadi; Canar, Jeff; Fullam, Francis MA; Gallan, Andrew S. PhD; Hohmann, Samuel; and Johnson, Catherine (2014) The relationships between HCAHPS communication and discharge satisfaction items and hospital readmissions, Patient Experience Journal: Vol. 1: Iss. 2, Article 12. Available at: http://pxjournal.org/journal/vol1/iss2/12 Gawande, A. (2014) Being mortal: Medicine and what matters in the end. New York: Henry Holt and Company. Halpern, J. (2001) From detached concern to empathy: Humanizing medical practice. New York: Oxford University Press. 25
References Kleinman, A. (1980). Patients and healers in the context of culture. Berkley, CA: University of California Press Koloroutis, M. and Trout, M. (2012) See me as a person: Creating therapeutic relationships with patients and their families. Minneapolis: Creative Health Care Management. Koloroutis, M. ed. (2004) Relationship-Based Care: A model for transforming practice. Minneapolis: Creative Health Care Management. Remen, N. (1980) The human patient. Garden City, New York: Anchor Press. Schenck, D. and Churchill, L. (2012) Healers: Extraordinary clinicians at work. New York: Oxford Press Siegel, D. (2007) The mindful brain: Reflection and attunement in the cultivation of well-being. New York: W.W. Norton, References- Cindy Lefton American Association of Critical-Care Nurses. Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence, 2nd edition, 2016. Barnes B, Lefton C. The Power of Meaningful Recognition in a Healthy Work Environment. American Association of Critical-Care Nurses, April-June 2013; 24(2), 114-116. Barnes B, Koloroutis M, Sweeney C. Inspiring nurses to see the extraordinary in their ordinary. California, March 2015. Beach M, Inui T. Relationship-centered care: A constructive reframing. J Gen Intern Med, 2006; 21(S1), S3 S8. Coetzee SK, Klopper HC. Compassion fatigue within nursing: A concept analysis. Nurse Health Sci, 2010; 12(2), 235-243. Epstein R, Siegel D, Silberman J. Self-monitoring in clinical practice: A challenge for medical educators. J Contin Ed Health Prof, 2008; 28(1), 5-13. Grepmair L, Mitterlehner F, Loew T, et al. Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind, controlled study. Psychother Psychosom, 2007; 76(6), 332-338. Jenkins B, Warren NA. Compassion fatigue and effects upon critical care nurses. Crit Care Nurs Q, 2012; 35(4), 388-395. Kelly L, Runge J, Spencer C. Predictors of Compassion Fatigue and Compassion Satisfaction in Acute Care Nurses. J Nurs Scholarsh, November 2015; 47(6), 522-528. Koloroutis, M, editor. Relationship-Based Care: A model for transforming practice. Minneapolis, MN: Creative Health Care Management, 2004. References Cindy Lefton Koloroutis M, Trout M. See Me as a Person: Creating therapeutic relationships with patients and their families. Minneapolis, MN: Creative Heath Care Management, 2012. Lefton C. Strengthening the Workforce Through Meaningful Recognition. Nurs Econ, November-December 2012; 30(6), 331-338. Lefton C, Kelly L. Effect of Meaningful Recognition on Registered Nurses Compassion Satisfaction and Compassion Fatigue. California, January 16, 2016. Malloch K, Sluyter D, Moore N. Relationship-centered care: Achieving true value in healthcare. J Nurs Admin, 2000; 30(7-8), 379-385. McClelland LE, Vogus TJ. Compassion practices and HCAHPS: Does rewarding and supporting workplace compassion influence patient perceptions? Health Serv Res, 2014; 49(5), 1670-1683. Ortman J, Velkoff VA, Hogan H. An aging nation: The older population in the United States. Population estimates and projections current population reports. May 2014; 25-1140. Available from: https://www.census.gov/prod/2014pubs/p25-1140.pdf Shapiro S, Carlson L, Astin J, et al. Mechanisms of mindfulness. J Clin Psychol, 2006; 62(3), 373 386. Simon CE, Pryce JG, Roff LL, Klemmack D. Secondary traumatic stress and oncology social work: Protecting compassion from fatigue and compromising the worker s worldview. J Psychosoc Oncol, 2005; 23(4), 1-14. Siegel D. The neurobiology of we : How relationships, the mind, and the brain interact to shape who we are [CD]. Louisville, CO: Sounds True, 2008. 26
Traci Hanlon, MN, RN Creative Health Care Management thanlon@chcm.com www.chcm.com Cindy Lefton, PhD, RN, CPXP Psychological Associates clefton@q4solutions.com www.q4solutions.com Bonnie and Mark Barnes bonniebarnes@daisyfoundation.org www.daisyfoundation.org 27