Compassion and Empathy - UWCNE 1 Compassion Fatigue A presentation for nurses 1 Created by Amy O’’Leary MN, OCN Why should we as nurses be concerned about compassion fatigue?

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  • 3/14/2012

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    Compassion FatigueCompassion FatigueA presentation for nursesA presentation for nurses

    11

    pp

    Created by Amy OCreated by Amy OLeary MN, OCN Leary MN, OCN

    Why should we as nurses be concerned about Why should we as nurses be concerned about compassion fatigue?compassion fatigue?

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    Can be emotionally and professionally Can be emotionally and professionally devastatingdevastating66

    Causes are unavoidable in nursingCauses are unavoidable in nursing66

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    Difficult to recognize unless aware of Difficult to recognize unless aware of compassion fatiguecompassion fatigue66

    Lack of recognition inhibits effective treatmentLack of recognition inhibits effective treatment66

    ObjectivesObjectives

    Define the concepts of compassion fatigue (CF), Define the concepts of compassion fatigue (CF), burnout, and compassion satisfactionburnout, and compassion satisfaction

    List the possible causes and contributing factors List the possible causes and contributing factors for compassion fatig efor compassion fatig e

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    for compassion fatiguefor compassion fatigue Propose strategies to reverse and reduce Propose strategies to reverse and reduce

    compassion fatiguecompassion fatigue

    Presentation OverviewPresentation Overview

    Exploration of relevant concepts with further Exploration of relevant concepts with further explanation through case reportsexplanation through case reports

    Discussion of contributing factorsDiscussion of contributing factors

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    Signs of compassion fatigueSigns of compassion fatigue

    Interventions for compassion fatigueInterventions for compassion fatigue

    Compassion and EmpathyCompassion and EmpathyIsnIsnt this why we went into nursing?t this why we went into nursing?

    Compassion: Compassion: Sympathetic consciousness of otherSympathetic consciousness of others distress, s distress,

    together with a desire to alleviate ittogether with a desire to alleviate it44

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    Empathy: Empathy: An emotional engagementAn emotional engagement55 Highly presentHighly present77 Sensitively attunedSensitively attuned77 HeartfeltHeartfelt77

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    Compassion SatisfactionCompassion Satisfaction

    The pleasure derived from the work of helpingThe pleasure derived from the work of helpingothersothers77

    Symbiotic relationship between nurse and Symbiotic relationship between nurse and patientpatient77

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    patientpatient77

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    CF is progressive and cumulative

    Compassion discomfort (temporary, Compassion discomfort (temporary, removable by rest) removable by rest) Compassion stress Compassion stress

    (Stress level increases and endurance (Stress level increases and endurance d )d ) C i f iC i f i 33

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    decreases) decreases) Compassion fatigueCompassion fatigue33

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    The Cost of CaringThe Cost of Caring77

    Compassion fatigue is a state where the Compassion fatigue is a state where the compassionate energy that is expended has compassionate energy that is expended has surpassed restorative processes.surpassed restorative processes.

    (C 2010 237)(C 2010 237)33

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    (Coetzee, 2010, p. 237)(Coetzee, 2010, p. 237)33

    Secondary Traumatic Stress DisorderSecondary Traumatic Stress Disorder

    State of exhaustion and dysfunctionState of exhaustion and dysfunction33

    Directly related to traumatic patient experiencesDirectly related to traumatic patient experiences22

    Manifest symptoms similar to PTSDManifest symptoms similar to PTSD33; ;

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    -- depressiondepression-- generalized anxietygeneralized anxiety-- avoidanceavoidance-- hyperhyper--arousal arousal

    BurnoutBurnout

    Burnout = Burnout = mental distress andmental distress and work performancework performance77

    Related toRelated to77::F iF i

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    FrustrationFrustration Powerlessness Powerlessness Inability to achieve work goalsInability to achieve work goals

    Frequent/inappropriate anger

    Apathy/Indifference

    Unresponsiveness

    Irritability

    CF r/t: Patient Contact & Use of Self

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    Burnout r/t: Work Environment

    STSD r/t:Traumatic events

    Hyper-arousal

    Avoidance

    Intrusion

    Powerlessness

    Cynicism

    Detachment

    Irritability

    Depression

    Sleep difficulty

    Concentration

    Energy

    Absences

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    Case Report 1Case Report 1

    Sarah has worked as a nurse for a medical Sarah has worked as a nurse for a medical surgical unit for 7 years. She takes care of many surgical unit for 7 years. She takes care of many different patients with different needs throughout different patients with different needs throughout her work week. The unit is very busy. In addition, her work week. The unit is very busy. In addition, the patients on Sarahthe patients on Sarahs unit are very sick, s unit are very sick, terminally ill or dying and need intense emotional terminally ill or dying and need intense emotional support.support.O i h i l i f hO i h i l i f h

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    Over time the emotional strain of her Over time the emotional strain of her patientpatients pain and anguish leads to compassion s pain and anguish leads to compassion discomfort, and her enthusiasm and sensitivity discomfort, and her enthusiasm and sensitivity towards patienttowards patients needs begins to diminish.s needs begins to diminish.She eventually becomes emotionally She eventually becomes emotionally overwhelmed, evoking the desire to stay overwhelmed, evoking the desire to stay uninvolved and disconnected from patientuninvolved and disconnected from patients s suffering. She no longer cries over the loss of a suffering. She no longer cries over the loss of a patient or provides emotional support. She has patient or provides emotional support. She has become compassion fatigued.become compassion fatigued.6,76,7

    Case Report 2: Letter from a patient

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    I felt a bit like this olI felt a bit like this ol dog; I had complete dog; I had complete faith and trust in you! Thank you for being my faith and trust in you! Thank you for being my night nurse during my recuperation from the night nurse during my recuperation from the splenectomy and hysterectomy. Isplenectomy and hysterectomy. Im getting m getting stronger. Tomorrow begins the second phase of stronger. Tomorrow begins the second phase of th h lith h li th h th T i ht Ith h th T i ht I

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    the healingthe healing-- the chemotherapy. Tonight, as I the chemotherapy. Tonight, as I prepare for this transition, I am prepare for this transition, I am soso grateful grateful to all to all the nurses who took such excellent postthe nurses who took such excellent post--op care op care of me. I am especially grateful to youof me. I am especially grateful to you-- for your for your willingness to calm me by talking with me. God willingness to calm me by talking with me. God bless you for your compassion and intelligence.bless you for your compassion and intelligence.

    CF and Compassion SatisfactionCF and Compassion Satisfaction

    Negative correlation between CF and Negative correlation between CF and compassion satisfactioncompassion satisfaction99

    le els of compassion satisfaction fo nd inle els of compassion satisfaction fo nd in

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    levels of compassion satisfaction found in levels of compassion satisfaction found in RNRNs with

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    Personal FactorsPersonal Factors

    Ethnicity?Ethnicity?88

    Experience?Experience?99

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    pp

    Coping strategies?Coping strategies?8,98,9

    Patient ConditionsPatient Conditions99

    Patients experiencing serious physical, Patients experiencing serious physical, emotional, financial threats, or imminent death emotional, financial threats, or imminent death

    Challenging behaviors such as confusionChallenging behaviors such as confusion

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    Challenging behaviors such as confusion, Challenging behaviors such as confusion, combative and aggressive behavior combative and aggressive behavior

    Futile care, aggressive medical care despite of Futile care, aggressive medical care despite of patient diagnosispatient diagnosis

    System IssuesSystem Issues

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    System Issues Associated with CF9

    8 hour shifts 8 hour shifts number of days worked number of days worked census census

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    acuity acuity Heavy patient assignmentsHeavy patient assignments

    Possible Signs of CFPossible Signs of CF33

    Physical Physical EmotionalEmotional Social Social

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    IntellectualIntellectual

    PhysicalPhysical

    Accident proneAccident prone1,3,61,3,6

    ExhaustionExhaustion1,3,61,3,6

    HeadachesHeadaches1,3,61,3,6

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    Difficulty in falling and staying asleepDifficulty in falling and staying asleep1,2,3,61,2,3,6

    Susceptibility to infectionSusceptibility to infection1,3,61,3,6

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    EmotionalEmotional

    Anger to frequent or intense for the Anger to frequent or intense for the situationsituation1,31,3

    ApatheticApathetic1,31,3

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    Desire to leave nursingDesire to leave nursing1,31,3

    DepressionDepression1,31,3

    IrritabilityIrritability1,31,3

    Social EffectsSocial Effects33

    Unresponsiveness Unresponsiveness Callousness Callousness Indifference Indifference

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    Avoidance of emotionally charged situationsAvoidance of emotionally charged situations IsolationIsolation

    IntellectualIntellectual

    Poor judgementPoor judgement33

    Disinterest in introspectionDisinterest