Compassion Fatigue Interventions in Pediatric Hematology/Oncology Nurses: Caring for Yourself So You Can Care for Others Barbara Morris, BSN, RN, CPHON, CPN
Jessica Cooper, BSN, RN, CPN
BACKGROUND
METHODS
Compassion is a fundamental aspect of nursing. Compassion related to nursing is identified as an awareness of a patient’s vulnerability and the desire to nurture and support the patient. Two major components of compassion:
Design: quasi-experimental approach Participants: were recruited from the inpatient oncology/hematology/bone marrow transplant unit through a convenience sample Intervention: participants will be shown a 20-minute PowerPoint presentation on what compassion fatigue is, signs and symptoms, and common triggers of compassion fatigue among pediatric oncology nurses; education will also be given describing tools and resources available at PCH; handouts will be provided Measurements/Assessments:
– –
Compassion satisfaction: the joy, purpose, and pleasure one receives from doing his/her job well Compassion fatigue: loss of work-related satisfaction and is usually associated with providing prolonged continuous care to patients, can negatively impact the wellbeing, health, and performance of employees • Burnout: environmental and interpersonal stressors such as non-supportive work environment, high workload, increasing workplace demands, and lack of resources • Secondary traumatic stress: result of being exposed to people who have experienced stressful traumatic events during patient care
Pediatric oncology nurses face stressful situations based on the care demands of this unique population, about 40% to 60% of pediatric oncology nurses experience some degree of compassion fatigue and burnout. Compassion fatigue can impact a nurse emotionally, intellectually, physically, socially, and spiritually and can impact a nurse’s quality of life. Nurses who do not address compassion fatigue may become depersonalized which in turn contributes to decreased job satisfaction, performance, and patient satisfaction At Phoenix Children’s Hospital, we were seeing a high turnover with many of the nurses expressing different descriptions of compassion fatigue as reasons for leaving. As the organization does not currently have a program in place specifically to deal with this issue, we wanted to explore how to decrease compassion fatigue on our floor.
Demographic survey including number of sick days in the last six months, and if they have ever thought about leaving pediatric oncology or the nursing profession. It will also ask if there are mental health issues so we can account for variables that may increase a person’s compassion fatigue. The Compassion Fatigue Pre/Post Test Survey consists of 12 questions that will assess if nurses are able to better define compassion fatigue and describe common symptoms after an educational intervention. It additionally will measure identification of common triggers for developing compassion fatigue, and any plans to utilize the resources available at PCH. To measure compassion satisfaction and compassion fatigue, the ProQOL scale will be used as a pre and one month post-test survey. The ProQOL scale consists of 30 questions (ranging from 1-never to 5- very often) about work related behaviors, feelings, and thoughts that they have experienced in the last 30 days. The ProQOL scale measures three subscales: 1)compassion satisfaction and compassion fatigue is broken down into 2)burnout and 3)secondary traumatic stress. The ProQOL surveys will be scored and the results interpreted to identify if someone ranks low, average, or high on compassion satisfaction, burnout, and secondary traumatic stress.
–
–
–
Potential Benefits:
Emotional Symptoms
Physical Symptoms
• • • •
• Fatigue/Insomnia • Hypertension • Accident prone
Desensitization Irritability Overwhelmed Hopelessness
Social Symptom • • • •
Loss of interests Overeating Risky behaviors Isolation
Mental Health Symptoms • Depression • Anxiety
7 Main Peace Room Employee Assistance Program Team Lavender Head Space – paid for by PCH 7 Main Debriefing Patient’s “Where are we now” Updates
Keep Calm Be Kind campaign Team Bonding Events Rainbow Kids Events Remembrance Journal Keep calm be kind campaign Puppy Adoption for Units
Prevent/Treat Compassion Fatigue
OBJECTIVES Design and implement an IRB approved, evidence-based, educational intervention among pediatric oncology nurses and identify if increased knowledge about compassion fatigue and utilization of resources decreases compassion fatigue and improves compassion satisfaction. Increase understanding of the signs, symptoms, and triggers of compassion fatigue in the population of 7 Main Hematology/Oncology/Bone Marrow Transplant nurses. Create two Peace Rooms for our 46 bed unit for staff to have a safe place to go to breathe, cry, debrief, and refresh themselves. Introduce the nursing staff to hospital and floor resources and tools available to them for preventing and treating compassion fatigue
“A new nurse was crying in our supply room and kept being interrupted, so I was able to bring her to the Peace Room and give her some time to herself.” “I was having a rough day, so I sat in the Peace Room with my lunch in the dark with the fairy lights on. It was really helpful.”
Unexpected: increased recognition and involvement from the organization with implementation of numerous resources.
AVAILABLE TOOLS AND RESOURCES
Work Symptoms • Suboptimal patient care • Self-reported medical errors • Absenteeism • Desire to quit
IRB study approved, after numerous delays, in August 2018. Results pending. Implementation of two Peace Rooms on 7 Main with positive feedback from staff:
Improved knowledge about compassion fatigue How to prevent and treat compassion fatigue Reduce compassion fatigue and increase compassion satisfaction
– – –
Symptoms of Compassion Fatigue
CONCLUSIONS
Mindfulness Peace Room Head Space
Activity
Rest
Bonds
Physical
Proper Sleep
Family/
Debriefing
Personal Time
Friends CoWorkers
REFERENCES Boyle, D. A. (2011). Countering compassion fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, 16(1). Bramley, L., & Matiti, M. (2014). How does it really feel to be in my shoes? Patients’ experiences of compassion within nursing care and their perceptions of developing compassionate nurses. Journal of Clinical Nursing, 23(19-20), 2790-2799. Harris, C., & Griffin, M. T. Q. (2015). Nursing on empty: Compassion fatigue signs, symptoms, and system interventions. Journal of Christian Nursing, 32(2), 80-87. Henry, B. J. (2014). Nursing burnout interventions: What is being done?. Clinical Journal of Oncology Nursing, 18(2), 211. Moody, K., Kramer, D., Santizo, R. O., Magro, L., Wyshogrod, D., Ambrosio, J., ... & Stein, J. (2013). Helping the helpers: Mindfulness training for burnout in pediatric oncology—a pilot program. Journal of Pediatric Oncology Nursing, 30(5), 275-284. Potter, P., Deshields, T., Berger, J. A., Clarke, M., Olsen, S., & Chen, L. (2013). Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncology Nursing Forum, 40(2), 180-187. Stamm, B. H. (2010). The concise ProQOL manual (2nd ed). Pocatello, ID: ProQOL.org. Zadeh, S., Gamba, N., Hudson, C., & Wiener, L. (2012). Taking care of care providers: A wellness program for pediatric nurses. Journal of Pediatric Oncology Nursing, 29(5), 294-299.
CONTACT Barbara Morris, BSN, RN, CPN, CPHON Phoenix Children’s Hospital
[email protected]
Jessica Cooper, BSN, RN, CPN Phoenix Children’s Hospital
[email protected]
