Overview Define terms compassion fatigue and burnout Describe - PDF document

2/28/2014 Overview • Define terms compassion fatigue and burnout • Describe scope of the problem in oncology Burnout in Oncology Nurses: A Call to Action • Identify risk factors for burnout • Self-evaluation Karen Moody, MD ASBMT Feb 28 th , 2014 • Prevention of burnout Grapevine, Texas Subtitle Placeholder 2/28/2014 1 2/28/2014 2 Compassion fatigue Burnout • Compassion fatigue can lead to burnout and • Burnout is described by Maslach as “a syndrome of results from repeated exposure to the suffering of depersonalization, emotional exhaustion, and a others. sense of low personal accomplishment that leads • Individuals who suffer from compassion fatigue to decreased effectiveness at work. experience symptoms akin to post traumatic stress – Emotional exhaustion: pertains to “people-work” where the disorder even though the trauma was not their practitioner is exhausted to the degree that they feel unable to give direct experience. of themselves on a psychological/emotional level. – Depersonalization: cynicism towards patients; a negative view of • In effect these nurses “feel the pain” of their patient-families patients so acutely that they experience side – Diminished feelings of personal accomplishment: feeling devalued, effects of this painful experience. dissatisfied with one’s work and work related outcomes • It also results in poor quality of patient care. Maslach C, Schaufeli WB, Leiter MP. Wright S. The d differ erence ences b s between s een stress ss, , • Burnout differs from Burn-Out. Annual Reviews Psychology burnou out and com and compassion on f fatigu gue. 2001;52:397–422 Nurs Stand. 2013 Oct 2-8;28(5):34-5. • “I envision hospitals as places of suffering and I see nurses sweeping it all up. Then I wonder what they do with all that suffering after they have gathered it up? – A. Jameton. From a panel discussion at the National Endowment for the Humanities Summer Institute in Nursing Ethics. (1983) Medford, MA 1

2/28/2014 Scope of problem in oncology Prevalence in pediatric oncology • Nursing professionals caring for people with cancer deal with an onerous burden of stressful situations on a daily • We surveyed over 400 physicians in pediatric basis such as: oncology - 78% had at least moderate levels of – having to deliver devastating news about diagnosis and burnout. prognosis – Caring for people experiencing pain, symptom distress, • In our multidisciplinary pediatric oncology study and suffering (N=48), 100% of our sample was burned out. – prolonged direct personal contact of an emotional nature with a large number of patients – supporting patients and their families at the end of their Roth et al. Career Burnout among Pediatric Oncologists. Pediatric Blood Cancer. life 2011 Dec 15; 57(7):1168-1173 Moody et Helping the helpers: mindfulness training for burnout in pediatric oncology--a pilot program.J Pediatr Oncol Nurs. 2013 Sep-Oct;30(5):275-84. Khamisa, Peltzer, Oldenberg. Burnout i t in R Relati tion to to S Specif ific ic Contributing ting Fa Factors a and . Heal alth Out Outcomes amon among N Nurses rses: A A Syst stem ematic ReviewInt J Environ Res Public Health. 2013 June; 10(6): 2214–2240 2/28/2014 8 High rate of burnout before and after PSS-14 : Controls and intervention an intervention PRE POST High - 23 High - 24 CONTROL Moderate - 0 Moderate - 0 Low - 1 Low - 0 Personal accomplishment High - 21 High - 21 Moderate - 0 Moderate - 0 INTERVENTION Low - 0 Low - 0 High - 11 High - 5 Moderate - 11 Moderate - 19 CONTROL Low - 2 Low - 0 Emotional exhaustion High - 9 High - 8 Moderate - 11 Moderate - 12 INTERVENTION Low - 1 Low - 1 High - 22 High - 22 Moderate - 2 Moderate - 1 CONTROL Low - 0 Low - 1 Depersonalization High - 21 High - 20 Moderate - 0 Moderate - 1 INTERVENTION Low - 0 Low - 0 Both groups' average scores were more than one standard deviation higher than the national (United States) average, suggesting higher than average levels of perceived stress in this group of health care providers. Nursing shortage contributes • Nursing shortages leading to understaffing compound the problem of burnout. • There is a 2-3x increase risk of burnout with poorer patient to nurse ratios • More than 40% of hospital staff nurses score in the high range for job-related burnout • More than 1 in 5 hospital staff nurses say they intend to leave their hospital jobs within 1 year Burnout Vahe hey et et al. N al. Nurse Burno e Burnout and P t and Patie tient Sa Satisf tisfac action on. . Med Care. 2004 February; 42(2 Suppl): II57–II66. 2/28/2014 12 2

2/28/2014 Consequences of Burnout Risk factors for Nurse Burnout • Burnout can lead to a deterioration in the quality of • Personal care or service provided by the staff, and an increase in medical errors leading to poorer clinical outcomes • Interpersonal and decreased patient satisfaction. • Professional • It contributes to job turnover, absenteeism, and low morale • Health care system • It is correlated to self-reported indices of personal distress, including physical exhaustion, insomnia, increased use of alcohol and drugs, and marital and family problems. • It may be associated with serious psychiatric co- Khamisa et al. Burnout in Relation to Specific Contributing Factors and Health Outcomes among Nurses: A Systematic Review. Int J Environ Res Public morbidity including major depressive disorder and Health. Jun 2013; 10(6): 2214–2240. even suicide. Mashlach and Jackson, 1981; Chopra, Sotile, & Sotile, 2004, Mukherjee, et al., 2009; Asai, et al., 2007; Liakopoulou et al., 2008; Wippen, 1991; Dougherty, et al., 2009 2/28/2014 14 Personal risk factors for burnout Interpersonal factors for burnout • Younger age, female gender • Conflict with colleagues • Idealistic perspective • Unsupportive managers • Over involvement/inappropriate boundaries with • Low team morale patients • Depressed, angry, or psychotic patient /family • Perfectionism members • Low self esteem • Poor communication among staff • Lack of a spiritual practice • Cumulative losses • History of psychiatric disorder Khamisa 2013 Khamisa 2013 Health care system risk factors for Professional risk factors for burnout burnout – Increased workload • < 5 years experience – Understaffing • Exposure to death and dying (especially of – Increased paperwork children) – Chaotic environment • Patients with uncontrolled symptoms – Perceived inadequacy of resources • Moral and ethical dilemmas – Lack of control or input on work policies and procedures • Treatment errors – Working at an institution that does NOT have • Oncology practice services available to address burnout Khamisa 2013 Khamisa 2013 3

2/28/2014 2/28/2014 19 2/28/2014 20 Food for thought • Do you feel “stressed out” by your job? • Have you questioned your ability to keep going at your current pace? SELF EVALUATION • Do you have a regular self care regimen? • Do you make caring for yourself a high priority? A. Yes B.No 2/28/2014 21 WHO-5 well being index WHO-5 well-being index Ov Over the last er the last 2 2 All o All of Most of Most of Mor More Less Less Some of me of At At n no • Add up your score and multiply by 4 weeks eeks the th e th the time e time th than th than half lf th the time e time time time time time hal half t the e the time th e time time time • What is your score? I have felt 5 4 3 2 1 0 A. 0 - 25 cheerful and in good spirits B. 26 – 52 I have felt calm 5 4 3 2 1 0 C. 53 – 75 and relaxed I have felt active 5 4 3 2 1 0 D. 76 - 100 and vigorous. I woke up feeling 5 4 3 2 1 0 calm and refreshed. My daily life has 5 4 3 2 1 0 been filled with things that interest me. 4