Courageous Care: 2015-2016 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
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. 325 9 12 2
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) 13 16 14 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) 15 18 3
Professional Quality of Life (ProQOL) Scale Available for use: www.proqol.org 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) 19 22 A DEMONSTRATION OF COMPASSION DOES NOT ALWAYS LEAD TO NEGATIVE EMOTIONAL STATES OR OUTCOMES ProQOL Measurement Slocum-Gori et al, 2011, pp. 173 20 23 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) 21 24 4
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) 25 28 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. 26 29 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) 27 30 5
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