Compassion Fatigue: Prevalence among Oncology Nurses

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  • Missouri Oncology Society

    Spring 2015 Membership Meeting

    April 14, 2015

    Compassion Fatigue:

    Prevalence among

    Oncology Nurses

    Patricia Potter RN, PhD, FAAN

    Director of Research, Patient Care Services

    Barnes-Jewish Hospital

    St Louis, Mo 1

  • Burnout The chronic condition

    of perceived demands

    outweighing perceived

    resources*

    Secondary Traumatic Stress Emotional distress

    resulting from exposure to

    anothers trauma

    Compassion Fatigue

    2

  • 3

  • Impact on the Healthcare Environment

    o Burnout and Secondary Traumatic Stress are associated with: o Increased turnover or turnover intention o Absenteeism o Decreased work performance o Decreased patient satisfaction o Difficulty in recruiting and retaining staff

    Garman, Corrigan and Morris, 2002; Vahey, et al.,2004; Jones 2004; Yoder, 2010; Sung, Seo, Kim, 2012).

    o Both associated with patient satisfaction with nursing care - a significant predictor of overall patient satisfaction with hospital care

  • That which is to give light must endure burning. -Viktor Frankl

    5

  • 6

    2009 ________________________________________________2015

    Our Journey

  • Compassion Fatigue Oncology Nursing

    o 2009 -oncology nurse managers identified behaviors characteristic of compassion fatigue

    o Unknown concept o Surveyed RNs, Techs, MAs, Radiology Techs o ProQol IV 3 Constructs: compassion satisfaction,

    secondary traumatic stress, burnout. o Construct validity and reliability coefficients for the three

    subscales range from 0.710.9 (Aycock & Boyle, 2009; Boscarino, et al., 2004).

  • Study of Oncology Healthcare Staff

    o Participants (153) 34% response rate

    o Registered Nurses - 132

    o Patient Care Technicians - 6

    o Medical Assistants - 10

    o Radiology Technicians 5

    o Age: M = 39.9 years (Range 21-63)

    o Years in Healthcare: M = 14.8 years (Range 1-43)

    o Years in Oncology: M = 8.9 years (Range 1-33)

  • Results o Comp Satisfaction - 38.3/37

    o Burnout 21.5/22 o Comparable to average scores reported by Stamm

    (2005).

    o Secondary traumatic stress score 15.2/13 - higher than average score reported by Stamm (2005).

    o Staff working on inpatient nursing units had the highest percentage of high risk compassion satisfaction scores (p=.008)

    o High-risk scores for secondary traumatic stress were relatively

    equal among inpatient (37%) and outpatient staff (35%).

  • Build a Professional Resiliency Program for Oncology Staff

    o Trained 3 facilitators (pastoral care/MSW/PA) to present a compassion fatigue program for oncology nurses.

    o Dr. Eric Gentry consultant

    o Program Elements o Education about Compassion Fatigue components, including

    contributing factors

    o Compassion Fatigue Prevention & Resiliency

  • Course Design Oncology Staff

    o 5 wk program 90 minute sessions following day shift o 4th week 4 hr retreat off site o A mixed model repeated-measures design - compared

    outcome measures across four time points (before and immediately, 3-months, and 6-months after the program)

    o Adjusted for covariates (age, years in nursing, and years in oncology).

  • Outcome Measures

    o ProQol IV 30 item measure (Stamm, 2005)

    o Revised Impact of Events Scale (Beck et al., 2008) 22-items. Rates subjective distress caused by traumatic events experienced during the past week.

    o RN Satisfaction (Hinshaw & Atwood, 1983) 28 item scale (five-point Likert).

  • Table 4

    Pilot program outcomes (N=13)

    Instrument Pre (p) Post 0 mth (p) Post 3 mth (p) Post 6 mth (p)

    ProQOL-R-IV

    Compassion 39.53 39.92 (ns) 38.53 (ns) 40.76 (ns)

    Satisfaction

    Burnout 23.46 22.61 (ns) 23.69 (ns) 22.30 (ns)

    Secondary 19.76 17.61 (ns) 17.92 (ns) 16.23 (p 0.04)

    Traumatic Stress

    Impact of Events Scale R

    Avoidance 1.27 1.06 (ns) 0.57 (p.007) 0.90 (ns)

    Intrusive 1.79 1.34 (ns) 0.75 (p.000) 1.03 (p.004)

    Hyperarousal 1.38 0.80 (p.01) 0.58 (p.000) 0.74 (p.006)

    Total score 4.45 3.21 (p .04) 2.05 (p.000) 2.68 (p.005)

  • Staff Program Evaluation

    o It was most helpful to get together with a group and have discussions, to know other people have the same kind of day I do and experience the same things.

    o I learned how to relax a little bit about things. I learned to not take myself so seriously. I learned some relaxing techniques that kind of helped at home, too.

    o I have a tendency to take all the work on myself. I know now that it's okay to make patients wait, so I take time and don't make stupid mistakes.

    Potter P, Berger, J, Clarke M, Deshields T, Chen L: (2013). Evaluation of a Compassion Fatigue Resiliency Program for Oncology Nurses,

    Onc Nurs Forum, 40(2):180-187.

  • Hospital Wide Class Design

    o Offered twice a month

    o 8 hour class participatory, small groups

    o 2-3 facilitators clinical and non-clinical

    o Prior to class complete ProQol IV 3 dimensions

    o Post class evaluation ranges from 3 to 12 months

    o YTD > 660 attended

  • Compassion Satisfaction

    0.0%

    10.0%

    20.0%

    30.0%

    40.0%

    50.0%

    60.0%

    70.0%

    80.0%

    90.0%

    100.0%

    21.3%

    13.0% 14.7% 18.2% 18.4% 19.1% 21.3% 21.3%

    22.6% 23.8% 30.3% %

    At

    Ris

    k

    Low Compassion Satisfaction - Risk by Specialty

  • Burnout

    0.0%

    10.0%

    20.0%

    30.0%

    40.0%

    50.0%

    60.0%

    70.0%

    80.0%

    90.0%

    100.0%

    21.6%

    9.1% 10.2% 11.8% 13.2% 14.8%

    17.0% 23.4%

    28.1% 31.5% 33.3% %

    At

    Ris

    k

    Burnout - Risk by Specialty

  • Secondary Traumatic Stress

    0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

    100.0%

    37.3%

    14.3% 20.8%

    27.7% 34.8% 38.2%

    42.6% 42.6% 47.6% 48.3%

    % A

    t R

    isk

    Secondary Trauma - Risk by Specialty

  • Time on Unit

    0.0%

    10.0%

    20.0%

    30.0%

    40.0%

    50.0%

    60.0%

    70.0%

    80.0%

    90.0%

    100.0%

    Compassion Satisfaction

    Burnout Secondary Trauma

    24.1% 20.5%

    42.9%

    24.6% 28.0%

    44.0%

    18.7% 18.3%

    32.1% % A

    t R

    isk

    ProQOL Scores by Time on Unit

    1 Year or Less (n=115) 1-5 Years (n=209) 5+ Years (n=306)

  • Follow-Up Evaluation

    o Linked Surveys: n=130; 22%

    o Time Since Class o 6 months ago: 35% (29%)

    o Demographics o Female: 94.6% (91.0%) o Male: 5.6% (8.7%) o Average age: 43.2 (42.0) o Average number of years on

    unit: 10.0 (8.3) o Average number of years at

    BJH: 11.9 (9.9)

    Roles Nurse: 69.2% (69.2%)

    Physician: 0% (0.3%)

    Allied Health: 7.7% (7.9%)

    Tech/clerical: 8.5% (8.4%)

    Interpreters/Other: 14.6% (14%)

    Service ED: 8.5% (8.3%)

    IP Services: 30.8% (29.6%)

    Oncology: 7.7% (14.0%)

    Surgery/OR: 16.2% (14.0%)

    Educ/Support: 11.5% (8.5%)

    Radiology: 4.6% (5.4%)

    OP Services: 8.5% (7.4%)

  • Linked Follow-up Surveys

    37.0 37.7

    22.3

    20.3 16.7

    14.0

    0.0

    5.0

    10.0

    15.0

    20.0

    25.0

    30.0

    35.0

    40.0

    Average Score: Baseline (n=130) Average Score: Followup (n=130)

    Me

    an S

    core

    ProQOL scores from PreTest to PostTest: Linked Surveys

    Compassion Satisfaction Burnout Secondary Trauma

    ns

    t(129)=4.53; p

  • Course Evaluations

    1 2 3 4 5 6

    ...in your daily work

    ...in your personal life

    5.45

    5.41

    Unlikely (1) to Very Likely (6)

    Likelihood Will Practice... (n=659)

    1 2 3 4 5

    Would recommend to a co-worker

    4.69

    Unlikely (1) to Very Likely (5)

    Would Recommend to a Co-Worker

    (n=653)

    1 2 3 4 5 6

    Average facilitator rating

    Overall rating

    Relevance to your daily

    5.74

    5.65

    5.60

    Lowest (1) to Highest (6)

    Compassion Fatigue Course Ratings

    (n=660)

  • Is your job stressful?

    If so, what are some of the causes?

    What are some of the effects?

    23

  • CAUSE AND EFFECT

    Past learning

    Perceived threat

    Sympathetic dominance

    CAUSES of Stress

    Insufficient staff

    Angry collegue or patient

    Poor access to supplies

    Unreasonable time frame

    Bad Coffee

    EFFECTS of Stress

    Frustration

    Sense of failure

    Cannot sleep

    Angry

    Sad

    Very tired

    Anxious

  • High Anxiety Increased basal ganglia activity

    Normal Note the lessened activity

    of the basal ganglia

    25

    http://www.amenclinics.com/bp/atlas/viewlargeimage.php?img=ANX1.jpghttp://www.amenclinics.com/bp/atlas/viewlargeimage.php?img=ACTUND.jpg

  • 26

  • Physiological Brain Mechanics Other Effects

    Heart Rate Basal Ganglia & Thalamic Fx Obsession

    Breathing Rate Neo-cortical Fx Compulsion

    Breathing Volume Frontal Lobe activity

    Executive Fx

    Fine motor control

    Emotional regulation

    Speed & Agility

    Centralized Circulation

    Muscle Tension Temp