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Transcript of Disclosure 1. No planner, presenter, faculty, authors, or content expert has identified a conflict...
Disclosure1. No planner, presenter, faculty, authors, or content expert has identified a conflict of interest that would affect the educational activities.2. No commercial interest has provided financial or in-kind support for this educational activity. 3. The Arkansas Nurses Association has provided financial or in-kind support for this educational activity in the form of printing and food costs. 4. Neither ANCC, SCAP, or ARNA endorse any commercial products discussed/displayed in conjunction with this educational activity.
South Central Accreditation Program (SCAP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Compassion Fatigue in Health CareWendy L. Ward, Ph.D., ABPP
Objectives To identify signs and symptoms of CF List prevention techniques List treatment techniques and how to
obtain
What is Compassion Emotion: when moved by the distress or
suffering of another Foundational to nursing practice Nurses must repeatedly generate
compassion to foster connectedness and offer nurturance
The Call to Nursing
Emotionally committed Healing others
physically and emotionally
Selfless/putting your needs last
The toll that this takes is immense; and it is easy to get depleted of positive energy
Nurses are particularly at-risk Present at critical times Become partners in patients’ healthcare journeys Prolonged, repeated interactions over time Nurses work within a family framework that may
be fraught with anticipatory loss, tension, disbelief,
They stay after bad news or death Witness tragedy and suffering Little to no respite Sleep disruption Self-sacrifice
Compassion FatigueJoinson (1992) ‘loss of the ability to nurture’In a study on nurses and burnout
Varied definitions Exhaustion Severe malaise The ‘cost of caring’ Emotional Strain Preoccupation with patient’s trauma Feelings of frustration, powerlessness, sadness Neglect own needs even basic ones—eating,
sleeping, hygiene Somatic complaints The associated decrease in morale and work
performance
Varied Terminology Across Studies
Borrowed stress Compulsive
sensitivity Disabled resiliency Empathic distress Empathic strain Empathy fatigue Empathy overload
Existential suffering Fatal availability Indirect trauma Secondary
victimization Soul pain Vicarious trauma Wounded healer
Distinguishing Compassion Fatigue From Burnout
Conflict, frustration, and/or exhaustion from the work setting
VsEmotional engagement and interpersonal intensity associated with witnessing tragedy within the work setting
Manifestations of Compassion Fatigue
Emotional: Anger Apathy Breakdown Cynicism Desensitization Discouragement Dreams, flashbacks, preoccupation (r/t patient
experiences) Feelings of being overwhelmed Attitude of hopelessness Irritability Lessened enthusiasm Sarcasm
Manifestations of Compassion FatigueIntellectual: Boredom Concentration impairment Disorderliness Weakened attention to detailPhysical: Increased somatic complaints Lack of energy Loss of endurance Loss of strength Proneness to accidents Weariness, sense of fatigue, exhaustion
Manifestations of Compassion FatigueSocial: Callousness Feelings of alienation, estrangement, isolation Inability to share in or alleviate suffering Indifference Loss of interest in activities once enjoyed Unresponsiveness Withdrawal from family or friendsSpiritual: Decrease in meaning Disinterest in introspection Lack of spiritual awareness
Manifestations of Compassion FatigueWork: Absenteeism Avoidance of intense patient situations Desire to quit Diminished performance ability (i.e., medication errors,
decreased documentation accuracy/record-keeping) Stereotypical/impersonal communications Tardiness
Sources: Aycock & Boyle, 2009; Coetzee & Klopper, 2010; Showalter, 2010
Applied to Family Caregivers and Across Multiple Professional Groups
Risk Factors for CFCaring professionals Complex patient physical needsComplex emotional needsExpanding workload Budget cutsLong hoursEHR and administrative demandsLittle awareness/low priority for self-careLittle or no formal supports in place
Assessment of Compassion Fatigue Different, overlapping definitions Variety of measures Needs more research
Compassion fatigue has not been explored, described, or explained in a manner that would allow nurses to identify and combat compassion fatigue effectively.
Coetzee and Klopper (2010)
Available Instruments Fall Short Domains fail to capture unique aspects
of the nurses' role May target only select populations (e.g.,
trauma).
The Compassion Fatigue Scale The Secondary Traumatic Stress Scale The Professional Quality of Life Scale
Outcomes Reduces nurse’s ability to provide
compassionate care Nurse’s physical and emotional health Absenteeism Staff turnover Good people leave the nursing profession
Self-care enables nurses to invest time and energy into nurturing the self, in order to nurture others.
What To Do Prevention Early Intervention Intervention
Prevention In general, an
increased awareness of the emotional demands facing today’s nursing workforce is of utmost importance
Prevention: Self-Awareness Physical health Intellectual health Social health
Spiritual health Emotional health
Relaxation 5 senses Deep, diaphragmatic breathing Blank Mind Mantra Visualization
How meditation changes your brainhttp://io9.com/how-meditation-changes-your-brain-and-makes-you-feel-b-470030863
Early Intervention
Signs You are Stressed Feel that you need a drink at the end of the
day Irritable and short-tempered Overeat or lose your appetite Headaches, stomachaches, fatigue Make more mistakes than usual Trouble paying attention Poor sleep, especially if you repeatedly wake
up very early in the morning, worrying Turn down social invitations because seeing
friends and family seems too much like effort
Early Intervention Education and self-awareness Becoming aware of danger-signal
responses...is necessary Identifying key triggers of these
responses significant personal introspection particularly when nurses ignored their
symptoms and did not attend to their own emotional needs
Early Intervention Re-assess areas of wellness as you did today Enhance proficiency boundary setting Stress management training Time management training Increase time with social support Protect sleep time Increase physical activity Engage in self-soothing activities Reduce workload, work hours, change type of work, take vacation/sick time
Intervention
Intervention Identify personal, successful coping
strategies Respite Social support Positive daily events An activity a week that has meaning Life coach/Strategic Life Planning Talk with your boss Individual therapy Psychotropic medication Individualized employment plan (FMLA
Work Setting Interventions On-site counseling These resources
must be visible, accessible, and offer practical solutions
Support groups for staff De-briefing sessions Art therapy Massage sessions Bereavement interventions, for
example funeral attendance, memorial service participation, and the sending of sympathy cards to families
Attention to spiritual needs
Institutional Benefits Increased staff morale and productivity,
engagement in facility initiatives, reduced sick time, lower turnover rates, and higher patient and family satisfaction
Conclusion
Encouraging self-care strategies and offering interventionsAddressing the real but unrecognized phenomenon of compassion fatigue in nursing has the potential to influence both the recruitment and retention of highly effective nurses.
Research on personal qualities, such as resiliency, hardiness, and social support, could shift the focus from pathology to effective adaptation in those engaged in caring work with patients experiencing pain, suffering, and trauma
Compassionate Care
(Sabo, 2006). An enhanced understanding of other characteristics that can predict, minimize, or buffer the consequences of compassion fatigue, such as age, gender, coping style, spiritual orientation, tenure/longevity, peer cohesion, and the role of nurse managers, is direly needed (Abendroth & Flannery, 2006; Erickson & Grove, 2007; Najjar et al., 2009; Newsom, 2010; Perry, 2008). Investigation of opportunities to promote compassion satisfaction are also of value (Alkema et al., 2008; Coetzee & Klopper, 2010).