Compassion Fatigue & YouGina M. Berg, PhD, MBA

Learning Objectives

• Become Aware• Definitions• Incidence & prevalence• Risk to profession• Risk to patient

• Identify Strategies for Self• Recognition• Resuscitation• Management• Prevention

• Consider Strategies for Team• You as a Leader

• Faculty/Presenters/Authors/Content Reviewers/Planners disclose no conflict of interest relative to this educational activity.

Disclosure Statement

• To successfully complete this course, participants must attend the entire event and complete/submit the evaluation at the end of the session.

• Society of Trauma Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Successful Completion

1st Disclaimer• Today’s talk is not going to

change the way you feel TODAY.

• Feelings change AFTER behaviors change

Journal of Trauma Nursing, 2016

Compassion (Berg Sage In Press)

• Emotion of being deeply moved by distress of another coupled with the desire to relieve their suffering

• Derived from the Latin words com (together) and pati (to suffer) and means “co-suffering” or “to suffer with”

• An internal obligation to do whatever will relieve another’s distress • Caregiving is compassion in action

Compassion Fatigue (Berg Sage In Press)

A form of suffering experienced by caregivers who may not regularly practice self-care

CS-CF Model

Professional Quality of Life

Compassion Satisfaction

Compassion Fatigue

Burnout Secondary Trauma

DescriptionsCompassion Fatigue Burnout

DEFI

NIT

ION “Cost of caring" for others in emotional

and physical pain (Figley, 1982)

Consequence of severe stress and high ideals experienced by people in “helping” professions (Freudenberger, 1974)

MAN

IFES

TS

• Physical exhaustion• Emotional exhaustion• Decrease in ability to feel empathy

for patients (& others)

• Exhausted• Listless• Unable to cope

EXPR

ESSE

D • Increased cynicism• Loss of enjoyment career

• Alienation from job-related activities• Reduced performance

UN

TREA

TED • Transform into depression

• Affect work/personal relationships• Transform into depression• Affect work/personal relationships

http://www.compassionfatigue.org/pages/RunningOnEmpty.pdf http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/

Trauma, Emergency, Critical Care Nurses• Compassion Fatigue

• Repeated and prolonged exposure• Trauma (even secondary)• Volume and acuity• Specific triggers

• Inability to see success• Burnout (Maslach and Leiter, 1997)

• Workload • Control• Rewards• Community• Fairness• Values

Incidence & Prevalence• Nursing units

• 34% hospital nurses (higher in greater acuity)• Trauma (Berg 2016, Hinderer 2014)

• Critical care (Mason 2014; Slocum-Gori 2011; Epp 2012; Meadors 2008; Embriaco 2007; Poncet 2007; Bakker 2005)

• Emergency department (Duffy 2015; Adraienssens 2011; Hooper 2010; Dominquez-Gomez 2009)

• Varying practices (Beck, 2011; Coetzee, 2010)

• Trauma nurses• 27.3 - 35.9% consistent score with CF/BOS (Hinderer 2014)

• 1/3 (>2000 respondents) severe BOS symptoms (Poncet 2007)

I’m not sure how much longer I can

go on like this

Am I crazy? Is something wrong with me?

I can’t tell you how defeated

I feel…

Drummond 2014

Impact on You

http://www.brainenergysupportteam.org/tag/compassion-fatigue/

Symptoms• Nightmares• Flashbulb memories regarding disturbing cases that went really well

or really badly• Second-guessing clinical decisions• Hyper-vigilance regarding injury

• Increased perception of risk of serious injury for their own children or family members

• Restricting their own and their children's activities for fear of injury• Desensitization to injury when occurred

Journal of Trauma Nursing, 2016

Impact on Patient Care

• Lower levels of empathy• Dread or avoid patients• Impaired performance• Missed changes in patient

condition• Communication errors• Medication errors• Overuse of resources

• Neglect• Reduced adherence to

treatment plans• Adverse events• Death

PROVIDER PATIENT

Four Root Causes of Burnout (Drummond 2014)

• The Practice of Nursing• Your Specific Job• Having a Life• Conditioning

Patient Stress Triggers• Events of abuse (both pediatric and geriatric)• Any case involving a child • Trauma scenarios with multiple family members injured• Injuries from avoidable situations• Senseless deaths• Patients who were similar to personal relationships• Patients who were similar to past negative experiences

Journal of Trauma Nursing, 2016

Environmental Stress Triggers• Difficult family members• Failure to act as cohesive team• Perceived inefficiencies in system or processes

Personal Wellness

•Recognition•Resuscitation•Management•Prevention

RecognitionTest # Purpose Cost Source

ProQoL 30 Professional Quality of Life FreePaper/Self-Score

Stamm (2012)ProQOL.org

Life Stress Inventory

43 Impact of life stress FreePaper/Self-Score

Holmes & Rahe(1967)

MBI 22 Maslach Burnout InventoryMeasures Emotional Exhaustion, Depersonalization, Personal Accomplishment

Cost $15.00 Individual Maslac, 1981

Energy Profile

12 Snapshot of current energy management skills

FreeOnline/Scored

LoehrPerformancePrograms

MEQ 19 Identifies morningness-eveningnessCircadian rhythm

FreePaper/Self-Score

Center for Environment Therapeutics

ResiliencyQuiz

20 React to unexpected difficulties FreeOnline/Scored

SiebertResiliencyAdvantage

Learned Optimism

48 Talent for joy can be cultivated FreeOnline/Scored

Seligman (1991)Stanford.edu

Patient Safety Culture

50 Assess the culture of safety in medical setting FreePaper/Self-Score

AHRQ

Energy Profile (Berg, 2016)

75%

Performance Programs.comhttps://energyprofile.perfprog.com/free

Status Score Energy Management Skills

Fully Engaged (85% +) Excellent.

Engaged (70% to 84%) High, but not sufficient.

Disengaged (51% to 69%) Significant obstacles stand in your way.

Seriously Disengaged

(50% -) • Significantly undermines ability.• Prompts disengagement in others. • Health, happiness and productivity can

become compromised.

Journal of Trauma Nursing, 2016

Journal of Trauma Nursing, 2016

There’s an APP for that!

• Provider Resilience (Military)• Professional Quality of Life Scale, v5 (ProQOL)

• Compassion fatigue• Compassion satisfaction

• Resilience rating• Suggestions for low scores

• Reminders of purpose & value• Graphs scores over time• Data are private

Resuscitation• Sources of energy

• Mind• Emotions• Spirit• Body

• Markers of capacity• Strength• Endurance• Flexibility• Resilience

2007 Harvard Business Reviewhttps://hbr.org/2007/10/manage-your-energy-not-your-time

Restore Your Balance (Drummond 2014)

• It is OK to• Take care of my personal needs• Have times when I am down• Delegate tasks to team members• Accept that good enough is really good enough

Pause In The Moment• Immediately

• Deep breath• Refocus

• Imminently• Remove self from situation• Reflect on your responses• Redirect your energy

Breathing Exercises• Single/Alternate Nostril Breathing• Moon (Left Nostril) Breathing• Box (Four Square) Breathing

Minding the breath can be like taming a wild horse.

The aspiration is to tame it with kindness and without

breaking its spirit.(Collard 2014)

Mindfulness• Being aware of bringing attention to the moment in time,

deliberately, and without judgement• Benefits

• Experience calm and relaxation• Higher levels of energy and enthusiasm for living• Increased self-confidence and self-acceptance• Less likely to experience stress, depression, anxiety, chronic pain, addition, or

low immune deficiency• More self-compassion and compassion for others

Being With Loss (Collard 2014)

Engage in wise relationship with loss• Prepare for time with the loss

• Sit comfortably• Focus on breathing (full duration at natural pace)• Wait until settled

• Focus on the loss (whatever it is)• Hold an image of the loss• Gently say “I will feel this loss”• Be with it, see it, feel it, face it – don’t pretend it isn’t there

• Release the loss• Let go of thought or image• Return mind to breathing

Coping Strategies

Individual Group

I go straight for the bathroom [at home], I fill up the tub and I get in the tub and I sit in there and shut the door.

Talking within group (people who understand)

I sit in the chapel; I make sure no one sees me [in the chapel], I don’t want them to think I am weird.

Dark humor

I go out to the courtyard and blow bubbles…. That is my alone time and you will either find me there or in the chapel just sitting there by myself.I put some serious miles on the treadmill, that’s how I burn it off.

• Differed among people and by details of case• None reported receiving any training on how to handle CF/BOS/STS• Uncomfortable or unwilling to engage in institutional services

There’s an APP for that!

Management with Positive Focus (Frederickson 2009)

• Positivity • Opens us• Transforms us

• Fragile (dependent on how you interpret ideas and events)

• Positivity Ratio• 3 to 1

10 Forms of Positivity (Frederickson 2009)

Joy Safe and familiar and require little effort on your part

Gratitude Appreciate something as a gift to be treasured

Serenity Like joy, but low-key, current circumstances are so comfortable, so right

Interest Feeling safe, something new draws your attention, creating sense of possibility

Hope When things are not going well, belief that things can change

Pride Blooming feeling after an achievement for which you can take credit

Amusement Unexpected happening that makes you laugh (safe and social)

Inspiration True human excellence, seeing better possibilities than usual

Awe Goodness on a grand scale, overwhelmed by greatness

Love Encompasses all of the above

Engage in an Upward Spiral (Frederickson 2009)

• Thinking makes it so• Stop for just a moment and ask yourself:

• What is right about my current circumstances?• What makes me lucky to be here?• What aspects of my current circumstances might I view as a gift to be

treasured?• How does it benefit me or others?

There’s a Facebook Group for that!!

Posture (Halfpenny 2015)

• Power pose• Improves confidence & demeanor• Increases testosterone 8%• Reduces cortisol up to 25%

www.codeofcharacter.com

Cultivate Compassionate Behaviors (Berg In Press and Unpublished)

• Caregiving is compassion in action

• Intentional behaviors can be practiced to increase a compassionate response

• Interpersonal (tones and gestures)• Clear communication• Team interaction

Health and Wellness• HEALTH

• Complete physical, mental and social well-being and not merely the absence of disease or infirmity

• WELLNESS• Quality or state of being healthy in body and mind, especially as the

result of deliberate effort

National Wellness Institute

• Ability to cope with intrinsic and extrinsic environmental stressors

• Moving along the life continuum toward biological death; we fluctuate between wellness and illness

Health and WellnessREQUIRES A PERSONAL CHANGE PROCESS

DEFINE YOUR

PURPOSE

FACE THE

TRUTH

TAKEACTION

Healthy Life Balance

Awareness Changes for Prevention• Change your inner voice• Change your perception of CF/BOS as a

challenge rather than a problem• Change your focus from negativity to

positivity

PreventionRESILIENCY• Capacity to recover quickly from difficulties;

toughness.

• Resiliency skills can be learned• Reactions to circumstances can be skillfully managed• Perspective of control

• Monitor progress

Key Principles of Resilience (Sieberg 2005)

Principle ActionLearnable skill Find resourcesDriven by attitude Commit to changeStrong self-esteem Change your inner talk/themeHabits have impact Practice resilient behaviorsProblem-focused coping Focus only on problem and good partFocus on what they can control Break it downAvoidance does not build resilience Face the challenge, get partnerTackling challenges leads to new strengths Recognize your growth

Prevention• Power in positive rituals to manage energy

• Energy expenditure and energy renewal balance• Reflect on current personal rituals

• Journal• Make lists

• Develop new rituals for stress-recovery balance• Intentional• Planned (precision & specificity)• Practiced (30-60 day acquisition)• Focus on new behavior, rather than old• Expect incremental changes

Loehr & Schwartz, 2009. Power of Full Engagement

Consider getting a coach or accountability partner

Building Resilience (Sieberg 2005)

• Change your theme song• Ask for support• Increase your positive experiences• Use the plan that fits you

• List what vitalizes you• Strategize on how to repeat, increase, or have new positive experiences• Develop plan to increase positive, revitalizing experienes• Do it

There’s a Website for that…….

Practice Compassion Toward Self• Active empathy and kindness to self• Reflect with purposeful mindfulness• Learn which activities promote self-healing• Sustainable self-care education

• Express needs• Clarify personal boundaries• Build positive relationships

My Revitalizations

Something to look forward to…..

It’s Not Just You

• 34% hospital nurses (higher in greater acuity)• 68% receptionists report patient verbal abuse• 2013

• 60% healthcare employees reported burnout• 34% looking for other jobs

• 2014• Across specialties• 68% family physicians• 73% general internists

http://www.brainenergysupportteam.org/tag/compassion-fatigue/

You as a LeaderHOW CAN YOU?:• Create a spirit of resiliency amid disruptive change• Invite others into resilient thinking and behaving

Positive Supportive Leadership• Improved

• patient mortality• nurses’ health

• Increased• job satisfaction• intent for nurses to remain in their current positions

(Spence-Laschinger et al., 2014)

Team Development Strategies (Berg 2016)

1. Acknowledge burnout and compassion fatigues exists2. Educate on how to recognize symptoms3. Embody stress relief coping skills as a team 4. Engage in team discussions about coping5. Make social support a priority6. Be proactive in response to high crisis situations (Berg 2014)

7. Emphasize positive aspects of work (patient care)8. Consider pre-employment screening for strong coping

Create a nurturing culture

Educate• Compassion Fatigue• Professionalism

• Professionalism Academy• Don’t Be an Ogre

• Nursing Lateral Violence

• Provider Wellness

Debriefings (Berg 2014)

• After Action Reviews• Level 1 resuscitations/Death/Bad

Experience

• Method• Standardized script

• (went well/didn’t go well/needs)

• Response• Positive, but time consuming• Positive benefit of discussing “what

went well”

Mortality Review

Play!• Mission: Provide compassionate care• Strategy: Refuel selves and team• Champion• Action: Play!

• Introduction games• Candy tosses• Give aways• Hot Potato• Team builders

ChallengeIs compassion fatigue……a. Unintended consequence of your workb. Intended consequence of your work

What is your obligation to provide compassionate and safe care?

More importantly….

• What kind of life do you want?

Wrapping up…• Make the decision to take care of yourself• Find support information/partner(s)/coach• Change your self-talk• Practice positive routines• Incorporate them in

• Family activities• Work practice

• Expect obstacles• Know that change takes time

2nd Disclaimer

• YOU MUST• not stop at listening to this talk• take action steps in your life

Everyday you should ask yourself,

“How can I improve?”Wesley Leadership Institute

Thank you

Gina M. Berg, PhD, MBAgberg@kumc.edu