Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse...

Compassionate Care in the 21st Century: Caring for Self

and Others

Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring for You, Team, and Your

Consumers”

June 2, 2015

Dorrie Fontaine RN, PhD, FAANDean and Professor

dkf2u@virginia.edu

Agenda

Why is caring for self and others so critical today?

Why is compassion and empathy needed to improve the patient experience?

What are the benefits of compassion and empathy for nurses to increase engagement with self and others?

AACN Standards for AACN Standards for Establishing and Sustaining Establishing and Sustaining Healthy Work Environments: Healthy Work Environments: A Journey to ExcellenceA Journey to Excellence

Essential Elements of a Essential Elements of a Healthy Work Healthy Work

Environment Environment (AACN 2005)(AACN 2005)

Skilled communication

True collaboration

Effective decision makingAppropriate staffing

Meaningful recognitionAuthentic leadership

AACN studies on Healthy Work Environments (with VitalSmarts)

Silence Kills2005

Silent Treatment(with AORN)

2011

Silent Treatment Study

5 year follow-up to Silence Kills6500 OR and critical care nursesWidespread disrespect presentDocumented skills successful nurses useSafety tools are not enough

GOOD NEWS: 20% vs 10% spoke upNurse Managers are Key

“Our lives begin to end the day we become silent about things that matter.”

Martin Luther King, Jr.

Healing the Hospital Hierarchy (New York Times March 17, 2013)

Theresa Brown RN“When doctors and nurses don’t get along, it’s the patient who suffers.”

(c) 2009 Debra Gerardi All Rights Reserved

10

OMG…

The Cost of Bad Behavior

Pearson, C. & Porath, C. (2009) The cost of bad behavior: How incivility is damaging your business and what to do about it. New York: Penguin Group

Pearson & Porath (2009)

Among workers who’ve been on the receiving end of incivility:

• 48% intentionally decreased their work effort.• 38% intentionally decreased the quality of their work.• 80% lost work time worrying about the incident.• 63% lost work time avoiding the offender.• 66% said that their performance declined.

“When it comes to managing the organization, you should hire for civility, teach it, create group norms, reward positive behavior, penalize rudeness…”

In Pearson & Porath (2009)

Common in nurses and physicians

Burnout

Post traumatic Stress syndrome

Moral distressMealer et al 2009; Bruce et al 2014

Healthy Work Environments?

Work force shortageMoral distress

Lateral and vertical violence such as bullying

Quality & safety issues

Working wounded

BURNOUT

Burnout

Emotional exhaustionEmotionally overextended and exhausted by work

DepersonalizationNegative, cynical, treating others as objects

Personal accomplishment (low)

Feeling inadequate, incompetent, and inefficient

From: Maslach 1981

Association between Burnout and Patient Outcomes

Hospitals with more stressed nurses had higher infection rates

When burnout reduced, quality of care and cost improved ….

Cimiotti et al., 2012

30% decreaseover 6,000 fewer infections and cost savings of $69M

Who burns out and why?

And…what about the ones who don’t?

How to re-engage

Resilience in ICU Nurses

3500 nurses AACN members80 % experienced burnout

22% highly resilient and less likely to develop burnout

Mealer, M et al (2012).The presence of resilience is associated with a healthier psychological profile in ICU nurses: Results of a national survey. J Int Nurs Studies, 49:292-299.

Solutions/Opportunities

A call to action

Story of a surgeon

“the surgeon had 2 routes to the operating room---one took him through a dark hallway filled with empty boxes. The other more time consuming route took him through the main hospital where he passed windows plants and coworkers… Powered by Feel: How individuals, teams and companies excel (2008) Clawson, J. & Newburg, D.

Story of a surgeon

“…the latter gave him energy, the former did not. If he were your heart doctor, ask yourself what route you would want him to take before he operated on you! Fast and discouraging or slow and uplifting?”

Patient Satisfaction/John Dent, MD

Displayed by Discharge Date

Overall

4EAST Inpatient Overall

From triple to quadruple aim: Care of the patient requires care of the provider

Bodenheimer, T. & Sinsky, C. (2014) Ann Fam Med 12:573-576.

UVA School of Nursing

Creating

compassionate

nurses and leaders

for the 21st Century

Reunion Weekend Yoga on The Lawn June 7, 2014

What is compassionate care?

Why is it needed today?

The Compassionate Care Initiative at UVA

Reducing human suffering by cultivating compassionate people and systems

What is compassion and empathy?

Compassion

…experiencing a trembling or quivering of the heart in response to another’s pain

Sharon Salzburg

Empathy

Putting yourself in the shoes of another

A necessary precondition for compassion

Time to reclaim the soul of health care

Cultivating Courage

Compassion starts with …

Awareness

and an

Open heart

Can empathy and compassion be learned?

Editorial in the Daily Progress, January 6, 2013

Being Present…Fully Present

What do people see when they see you?

Compassion is a rigorous stance

We live in a time when science is validating what humans have known throughout the ages: that compassion is not a luxury; it is a necessity for our well-being, resilience, and survival. Roshi Joan Halifax

Compassion as a Global Remedy

His Holiness the Dalai

Lama, October 2012

Susan Bauer-WuTussi and John Kluge Endowed Professor

“The science of finding focus…”

Resiliency Initiative

The Architecture of Resilience

“…resilient practices -- things like meditation, yoga, reflective writing, deep breathing, even physical exercise -- make for happier, stronger, more centered clinicians.”

D. Fontaine, S. Bauer-Wu, & D. Germano (2014)

http://www.huffingtonpost.com/dorrie-k-fontaine/the-architecture-of-resil_b_4560762.html

Compassionate Care Initiative Jonathan Bartels RN, BSN

The Pause

Bartels, J. (2014). The pause. Critical Care Nurse, 30:74-75.

Compassion and the need for Kindness

Kindness“is not just about being nice, it’s about recognizing another human being who deserves care and respect”

Compassionate CareContemplative Practices

Awareness—Presence—Resilience

Mindfulness is a way of being and relating to ourselves, our circumstances, one another, and the world around us.

Susan Bauer-Wu (2011)

Invites an attitude of openness and curiosity.

It is being awake to the fullness of our lives right now, through engaging the five senses and noticing the changing landscapes of our minds without holding on or pushing away any of it. -S. Bauer-Wu (2011)

What are you willing to notice in your world?

Mindful clinicians associated with better patient care

• Multi-center, observational study (MD, NP, PA)

• Measures: –Patient ratings of quality of care (n=437)–Clinician (n=45) encounters recorded and coded into high and low mindfulness

• High mindfulness clinicians associated with:–Patient-centered communication–Positive emotional tone

(Beach et al., 2013)

UVA Compassionate Care Initiative Vision

To have safe and high functioning healthcare environments with healthy and happy nurses, physicians and other health care workers and where heart and humanness are valued and embodied

What are we doing at UVA?

Integrating into the Schools of Nursing and Medicine, all of UVA and the Health System

Built a resilience room and contemplative classroom

Free yoga and meditation 5 days a week

What are we doing at UVA?

Formal courses and ones sprinkled throughout curriculum

Resiliency retreats (for every nursing student and those “in the field”)

Compassionate Care “ambassadors”

If we truly practiced with compassion and empathy, what would the health care system look like? How would we be transformed? How might this change the outcomes for patients and families…

From Fontaine, D. K., Rushton, C.H., & Sharma, M. (2014). Cultivating compassion and empathy. In M. Plews-Ogan & E. Beyt (Eds.). Wisdom leadership in academic health care centers: Leading positive change. London: Radcliffe Publishing, 92-110.

…invite stillness and inquiry

Take a breath

Our focus includes Interprofessional Education

To create understanding of each other’s roles by training all 3rd year nursing and medical students together

3 C’s

3 C’s for cultivating a Pause in Your Life and Resiliency

First

Consider a contemplative practice

3 C’s for cultivating a Pause in Your Life and Resiliency

Next

Carve out time for gratitude. Start a gratitude journal of just writing down 3 things you are grateful for every night… do it for 21 days and it is a habit.

ThirdCultivate a practice of kindness

towards yourself and others

“Above all else reach out and put your arm around your nearest colleague…we are all in this together.”Dr. C Farmer

ResourcesAmerican Association of Critical-Care Nurses. (2005). AACN standards for establishing and sustaining healthy work environments: A journey to excellence. American Journal of Critical Care, 14, 187-197. Available at: http://www.aacn.org/hwe

Bartels, J. (2014). The pause. Critical Care Nurse, 30:74-75.

Cimiotti, J.P., Aiken, L.H., Sloane, D.H., & Wu, E.S. (2012). Nurse staffing, burnout, and health care–associated infection. AJIC, 40(6): 486-490.

Fontaine, D. K., Rushton, C.H., & Sharma, M. (2014). Cultivating compassion and empathy. In M. Plews-Ogan & E. Beyt (Eds.). Wisdom leadership in academic health care centers: Leading positive change. London: Radcliffe Publishing, 92-110.

ResourcesFontaine, D. K. Can empathy and compassion be learned? Editorial, Daily Progress, January 6, 2013.Fontaine, D. K., Bauer-Wu, S. & Germano, D. (2014) The architecture of resilience. http://www.huffingtonpost.com/dorrie-k-fontaine/the-architecture-of-resil_b_4560762.html

• Mealer, M et al (2012).The presence of resilience is associated with a healthier psychological profile in ICU nurses: Results of a national survey. Int J of Nurs Studies, 49:292-299.

• Ulrich, B. T. et al Critical care nurse work environments 2013: A status report. Critical Care Nurse;34:64-79

• Zwack, J. & Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med 2013;88:382-38