Compassion Fatigue: Prevalence among Oncology Nurses
Transcript of Compassion Fatigue: Prevalence among Oncology Nurses
Missouri Oncology Society
Spring 2015 Membership Meeting
April 14, 2015
Compassion Fatigue:
Prevalence among
Oncology Nurses
Patricia Potter RN, PhD, FAAN
Director of Research, Patient Care Services
Barnes-Jewish Hospital
St Louis, Mo 1
Burnout The chronic condition
of perceived demands
outweighing perceived
resources*
Secondary Traumatic Stress Emotional distress
resulting from exposure to
another’s trauma
Compassion Fatigue
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Impact on the Healthcare Environment
o Burnout and Secondary Traumatic Stress are associated with: o Increased turnover or turnover intention o Absenteeism o Decreased work performance o Decreased patient satisfaction o Difficulty in recruiting and retaining staff
Garman, Corrigan and Morris, 2002; Vahey, et al.,2004; Jones 2004; Yoder, 2010; Sung, Seo, Kim, 2012).
o Both associated with patient satisfaction with nursing care - a significant predictor of overall patient satisfaction with hospital care
“That which is to give light must endure burning”. -Viktor Frankl
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2009 ________________________________________________2015
Our Journey
Compassion Fatigue – Oncology Nursing
o 2009 -oncology nurse managers identified behaviors characteristic of “compassion fatigue”
o Unknown concept o Surveyed RNs, Techs, MAs, Radiology Techs o ProQol IV – 3 Constructs: compassion satisfaction,
secondary traumatic stress, burnout. o Construct validity and reliability coefficients for the three
subscales range from 0.71–0.9 (Aycock & Boyle, 2009; Boscarino, et al., 2004).
Study of Oncology Healthcare Staff
o Participants (153) – 34% response rate
o Registered Nurses - 132
o Patient Care Technicians - 6
o Medical Assistants - 10
o Radiology Technicians – 5
o Age: M = 39.9 years (Range 21-63)
o Years in Healthcare: M = 14.8 years (Range 1-43)
o Years in Oncology: M = 8.9 years (Range 1-33)
Results o Comp Satisfaction - 38.3/37
o Burnout – 21.5/22 o Comparable to average scores reported by Stamm
(2005).
o Secondary traumatic stress score – 15.2/13 - higher than average score reported by Stamm (2005).
o Staff working on inpatient nursing units had the highest percentage of high risk compassion satisfaction scores (p=.008)
o High-risk scores for secondary traumatic stress were relatively
equal among inpatient (37%) and outpatient staff (35%).
Build a Professional Resiliency Program for Oncology Staff
o Trained 3 facilitators (pastoral care/MSW/PA) to present a compassion fatigue program for oncology nurses.
o Dr. Eric Gentry – consultant
o Program Elements o Education about Compassion Fatigue components, including
contributing factors
o Compassion Fatigue Prevention & Resiliency
Course Design – Oncology Staff
o 5 wk program – 90 minute sessions following day shift o 4th week – 4 hr retreat off site o A mixed model repeated-measures design - compared
outcome measures across four time points (before and immediately, 3-months, and 6-months after the program)
o Adjusted for covariates (age, years in nursing, and years in oncology).
Outcome Measures
o ProQol IV – 30 item measure (Stamm, 2005)
o Revised Impact of Events Scale (Beck et al., 2008) 22-items. Rates subjective distress caused by traumatic events experienced during the past week.
o RN Satisfaction (Hinshaw & Atwood, 1983) – 28 item scale (five-point Likert).
Table 4
Pilot program outcomes (N=13)
Instrument Pre (p) Post 0 mth (p) Post 3 mth (p) Post 6 mth (p)
ProQOL-R-IV
Compassion 39.53 39.92 (ns) 38.53 (ns) 40.76 (ns)
Satisfaction
Burnout 23.46 22.61 (ns) 23.69 (ns) 22.30 (ns)
Secondary 19.76 17.61 (ns) 17.92 (ns) 16.23 (p 0.04)
Traumatic Stress
Impact of Events Scale R
Avoidance 1.27 1.06 (ns) 0.57 (p.007) 0.90 (ns)
Intrusive 1.79 1.34 (ns) 0.75 (p.000) 1.03 (p.004)
Hyperarousal 1.38 0.80 (p.01) 0.58 (p.000) 0.74 (p.006)
Total score 4.45 3.21 (p .04) 2.05 (p.000) 2.68 (p.005)
Staff Program Evaluation
o “It was most helpful to get together with a group and have discussions, to know other people have the same kind of day I do and experience the same things”.
o “I learned how to relax a little bit about things. I learned to not take myself so seriously. I learned some relaxing techniques that kind of helped at home, too”.
o “I have a tendency to take all the work on myself. I know now that it's okay to make patients wait, so I take time and don't make stupid mistakes.”
Potter P, Berger, J, Clarke M, Deshields T, Chen L: (2013). Evaluation of a Compassion Fatigue Resiliency Program for Oncology Nurses,
Onc Nurs Forum, 40(2):180-187.
Hospital Wide Class Design
o Offered twice a month
o 8 hour class – participatory, small groups
o 2-3 facilitators – clinical and non-clinical
o Prior to class – complete ProQol IV – 3 dimensions
o Post class evaluation – ranges from 3 to 12 months
o YTD > 660 attended
Compassion Satisfaction
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
21.3%
13.0% 14.7% 18.2% 18.4% 19.1% 21.3% 21.3% 22.6% 23.8%
30.3% % A
t R
isk
Low Compassion Satisfaction - Risk by Specialty
Burnout
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
21.6%
9.1% 10.2% 11.8% 13.2% 14.8% 17.0% 23.4%
28.1% 31.5% 33.3% %
At
Ris
k
Burnout - Risk by Specialty
Secondary Traumatic Stress
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%
100.0%
37.3%
14.3% 20.8%
27.7% 34.8% 38.2% 42.6% 42.6%
47.6% 48.3%
% A
t R
isk
Secondary Trauma - Risk by Specialty
Time on Unit
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Compassion Satisfaction
Burnout Secondary Trauma
24.1% 20.5%
42.9%
24.6% 28.0%
44.0%
18.7% 18.3%
32.1% % A
t R
isk
ProQOL Scores by Time on Unit
1 Year or Less (n=115) 1-5 Years (n=209) 5+ Years (n=306)
Follow-Up Evaluation
o Linked Surveys: n=130; 22%
o Time Since Class o <6 months ago: 65% (71%) o >6 months ago: 35% (29%)
o Demographics o Female: 94.6% (91.0%)
o Male: 5.6% (8.7%)
o Average age: 43.2 (42.0)
o Average number of years on unit: 10.0 (8.3)
o Average number of years at BJH: 11.9 (9.9)
• Roles – Nurse: 69.2% (69.2%)
– Physician: 0% (0.3%)
– Allied Health: 7.7% (7.9%)
– Tech/clerical: 8.5% (8.4%)
– Interpreters/Other: 14.6% (14%)
• Service – ED: 8.5% (8.3%)
– IP Services: 30.8% (29.6%)
– Oncology: 7.7% (14.0%)
– Surgery/OR: 16.2% (14.0%)
– Educ/Support: 11.5% (8.5%)
– Radiology: 4.6% (5.4%)
– OP Services: 8.5% (7.4%)
Linked Follow-up Surveys
37.0 37.7
22.3
20.3 16.7
14.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Average Score: Baseline (n=130) Average Score: Followup (n=130)
Me
an S
core
ProQOL scores from PreTest to PostTest: Linked Surveys
Compassion Satisfaction Burnout Secondary Trauma
ns
t(129)=4.53; p<.01
t(129)=5.37; p<.01
Course Evaluations
1 2 3 4 5 6
...in your daily work
...in your personal life
5.45
5.41
Unlikely (1) to Very Likely (6)
Likelihood Will Practice... (n=659)
1 2 3 4 5
Would recommend to a co-worker
4.69
Unlikely (1) to Very Likely (5)
Would Recommend to a Co-Worker
(n=653)
1 2 3 4 5 6
Average facilitator rating
Overall rating
Relevance to your daily …
5.74
5.65
5.60
Lowest (1) to Highest (6)
Compassion Fatigue Course Ratings
(n=660)
Is your job stressful?
• If so, what are some of the causes?
• What are some of the effects?
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CAUSE AND EFFECT
Past learning
Perceived threat
Sympathetic dominance
CAUSES of Stress
Insufficient staff
Angry collegue or patient
Poor access to supplies
Unreasonable time frame
Bad Coffee
EFFECTS of Stress
Frustration
Sense of failure
Cannot sleep
Angry
Sad
Very tired
Anxious
High Anxiety Increased basal ganglia activity
Normal Note the lessened activity
of the basal ganglia
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Physiological Brain Mechanics Other Effects
▲Heart Rate ▲ Basal Ganglia & Thalamic Fx ▲Obsession
▲ Breathing Rate ▼ Neo-cortical Fx ▲Compulsion
▼ Breathing Volume ▼Frontal Lobe activity
▼Executive Fx
▼Fine motor control
▼Emotional regulation
▼ Speed & Agility
Centralized Circulation
▲ Muscle Tension ▼Temporal Lobe Activity
▼Language (Werneke’s)
▼Speech (Broca’s)
▼ Strength
▲ Energy ▼ Anterior Cingulate Constricted thoughts & behaviors
▲ DIS-EASE Fatigue
FIGHT or FLIGHT 27
Avoidance symptoms • Loss of enjoyment in self-care activities
• Loss of energy
• Relational difficulties – turn patients off
• Loss of hope
• Self soothing behaviors
Arousal symptoms • Increased anxiety
• Sleeplessness
• Impulsivity
Intrusive symptoms • Work issues encroach on personal time
• Inability to “let go” of work related issues
• Thoughts and feelings of inadequacy as a
caregiver
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“Burnout is a psychological syndrome of
emotional exhaustion,
depersonalization and
reduced personal accomplishment”
(Maslach & Goldberg, 1998; 2003)
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In the work place: • fatigued
• often nervous
• has increased sick days
• is more cynical and pessimistic
• has a loss of self esteem
• directs anger towards coworkers
• dreads going to work
• often feels like quitting their job
At home: • sleeplessness
• loss of interest in sexual activities
or social events
• change in appetite
• weight loss/gain
• relational problems
• nightmares about work experiences
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Compassion Fatigue
The Problem
Disease is the absence of
Effective Antibodies not the presence of a
Toxic environment
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CDC definition
RESILIENCE Compassion Fatigue “Antibodies”
1. Self-regulation – ability to immediately shift from sympathetic to
parasympathetic dominance (especially when perceiving threat)
2. Perceptual Maturation– Detoxify Workplace & Personal
Optimization
3. Intentionality – Principle-based vs. demand driven; living
mission
4. Connection/Support – develop and utilize support network
5. Self-care/Revitalization – aerobic activity, healthy pursuits;
refueling
RESILIENCY SKILLS Antibody 1: Self Regulation
Chill
Developing “bodyfull-ness”
o Relaxing tension of pelvic floor muscles switches from sympathetic to parasympathetic dominance
o Psoas, Sphincter, and Kegels (anterior + posterior)
o Regaining of neocortical functioning in 20-30 seconds
o Relieves pressure on vagus nerve
o Impossible to experience stress – comfortable in one’s own skin
Self-Regulation
B. Scaer (2006) NIMH (2004)
D. Bercelli (2003) R. Sapulsky (1999)
Porges (1999)
1. While sitting, put your hands under your bottom.
Feel the two pointed bones (Ischial tuberosities upon which you are sitting.
2. Next, touch the two boney points on your hips (anterior iliac spine)
on your right and left side just below the waist.
3. Visualize the four point you’ve touched and connect the points to make a square
4. Close your eyes, breath deep and slowly, feel the area in the middle of the square
and allow the square to expand.
5. Release and relax all muscles in the area of the square.
Self-Regulation
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Antibody 1: Self-Regulation
No Clenching
Antibody 2: Perceptual Maturation
“Change the way you look at things and the things you look at change.”
Can You See The Arrow?
Where is the Horse?
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Perceptual Maturation
o Evolving perception of our workplace can significantly “detoxify” our work experience
o Environmental stimuli are less likely to be perceived as threats.
Perceptual Maturation
o Just as you can regulate your body, you can regulate your thinking
o Disciplined process of your thinking and attention
Antibody 3: Intentionality
• Requires self-regulation
• Mission driven
• Internal locus of control
• Principle-based
• Tolerance of pain for growth
• Maturation of spirituality
Do I go where I aim myself?
Antibody #3: Intentionality
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Writing your covenant
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Compassion Fatigue “Antibodies”
1. Self-regulation
2. Intentionality
3. Perceptual Maturation/Self-validation
4. Connection
develop and utilize support network
5. Self-care
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Qualitative Study: Nurse Residency
o “Hearing what your co-workers who you don’t get to work with, you guys have something in common. Kind of nice to be reassured that “Oh, that patient gave you a hard time?”
o These stories help, especially from our preceptor mentors. When they are like “I once had this and this is how I handled it: I file it kind of back there and I say the same words maybe the next time and it helps”.
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Compassion Fatigue “Antibodies”
1. Self-regulation
2. Intentionality
3. Perceptual Maturation/Self-validation
4. Connection
5. Self-care
aerobic activity (3x/week) primary
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• Aerobic activity (3x per week)
• Fuel for “enduring burning”
• Music/Art/Sport that combines
discipline and improvisation
• Active instead of passive
• Solitude/Spirituality/Nature
• Intentional Plan
Antibody #5: Self Care / Refueling
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1. Self-Regulate
scan your body for muscle tension and stop squeezing muscles (200 – 500x/day)
2. Mature Perceptions
attend to what you can control & accept the rest, be at choice, self-validated, not in danger
3. Be Intentional
follow your Mission/Code-of-Honor, bring into alignment transgressions (even small ones)
4. Connect with Peers
share difficulties, get support
5. Care for Yourself
Put on your running/walking shoes 3 x/week, evolve spirituality, be creative, get good sleep, eat well
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“Between stimulus and response there is
a space. In that space is our power to
choose our response. In our response
lies our growth and our freedom”. - Viktor Frankl
BJC Compassion Fatigue program & materials developed from the work of J. Eric Gentry, PhD., Compassion Unlimited, 2013
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