COMPASSION FATIGUE: THE ROAD LEADING TO BURNOUT HH- /media/Grand...آ  2017-08-23آ  6/14/2017 1 COMPASSION

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    COMPASSION FATIGUE: THE ROAD LEADING TO BURNOUT

    Richard Miller, MD FACS Professor of Surgery

    Chief, Division of Trauma, Surgical Critical Care and Emergency Surgery

    Vanderbilt University Medical Center Grand Rounds

    St. Charles Health System Bend, Oregon

    June 16th , 2017

    Disclosure

    • None • All patients or their families have given

    permission to show photos • Vanderbilt: Spire Health and Wellness

    Collaborative

    HH- 1992 • 18 y/o Clemson student hydroplaned her VW on

    Interstate, crashed into schoolbus • ISS 65 • Transected aorta, bilateral hemoptx, multiple rib

    fxs • Ruptured spleen, Grade IV liver laceration • Complex pelvic, extremity fractures • Arrived moribund with BP 50P

    SS

    • 29 y/o/w/f 38 cal. GSW to abdomen • BP 80 / P • through central portion of liver, stomach, pancreas,

    spleen • expl. lap, L thoracotomy, cross clamp aorta for

    massive hemoperitoneum • splenectomy, distal 2/3 pancreatectomy, partial

    hepatorrhaphy and packing, gastric repair • ISS 25 • > 50 units blood / blood products

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    Have you heard of Compassion Fatigue?

    • Discussions regarding nurses and counselors • First diagnosed in nurses in 1950s • First described in literature in 1980s (Figley) • Also called Secondary Traumatic Stress

    Disorder (STSD)

    • Work with populations who experience traumatic events

    • Work in a highly stressful environment • Jam packed schedule- yet need to be

    compassionate EVERY DAY!!

    Have you heard of Compassion Fatigue?

    Compassion Fatigue

    • Phenomenon that occurs when caregiver feels overwhelmed by repeated empathetic engagement with distressed patients/families

    • Precursor of Burnout- manifests itself as – Physical – Emotional – Spiritual

    EXHAUSTION

    Compassion Fatigue

    • Delivering too much bad news or prolonged periods of time dealing with difficult issues – Terminal illness – Critically ill/injured – Angry patient/family – Psychopathology – Permanent lifestyle changes

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    TW

    • 28 y/o female • Banking executive • First date • Passenger on MCC vs 18-Wheeler • Impaled by back bumper and thrown • Avulsion of perineum/abdominal wall

    MG

    • 47 y/o male • Train car hitch manager • Crush injury left pelvis/groin/leg • Hemipelvectomy/open abdomen • Multiple operations leading to STSG

    to flank, abdomen, remaining pelvis

    Cost of Caring •Charles Figley, co-author •Compassion Fatigue: Coping with STSD in those who treat traumatized patients and their families •“There is a cost to caring… Those who have enormous capacity for feeling and expressing empathy tend to be more at risk for compassion stress”

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    KH • 4 y/o/w/f run over by minivan • BP 60 / 0 • flail chest / severe bilateral PC • femur fx • hemoperitoneum • ISS 50 • exploratory laparotomy - splenectomy, repair liver lac,

    bilateral CT’s • 7˚later - tense abdomen unable to oxygenate / ventilate

    oliguric • ICU decompression / Silo • MUSC

    Incidence of Compassion Fatigue • Up to 85%!! • Feel they no longer had any compassion

    left to give • Even after “restful” time off • CF take toll

    – Decrease productivity – More sick days – Higher turnover

    Warning Signs of CF • Diminished sense of

    personal accomplishment • Exhaustion (physical and

    emotional) • High self-expectations • Inability to maintain

    balance of empathy and objectivity

    • Less ability to feel joy

    • Low self-esteem • Sleep disturbances • Workaholism • Anger/blaming • Abusing drugs, alcohol or

    food • Depression

    Burnout vs Compassion Fatigue • Compassion Fatigue:

    – Continue give themselves FULLY but find it difficult to maintain healthy balance of empathy and objectivity

    – Sucked into vortex that pulls you slowly downward – Can’t stop downward spiral – Work harder/continue to give to others until

    completely tapped out • Burnout: adapt to exhaustion by becoming less

    empathetic and more withdrawn/desensitized

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    Burnout: What Is It? • A syndrome of psychological (and physical) exhaustion and

    diminished efficiency resulting from overwork or prolonged exposure to stress*

    * Encarta Dictionary: English (North America)

    Depersonalization

    Emotional exhaustion

    Low personal accomplishment

    BURNOUT

    Burnout Eventually Becomes a Vicious Cycle

    Futility, disappointment, and guilt

    Interpersonal problems and depression Health problems

    Diminished performance

    Lethargy, depleted motivation MALAISE OF THE SPIRIT

    Symptoms of Burnout

    • Health problems • Substance abuse • Chemical dependency • 6% exhibit suicidal

    ideation • Most surgeons unable to

    recognize they need help

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    Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout - Carol Peckham/January 11, 2017

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    VANDERBILT SURGERY

    Work Unit Strategies

    Gathering MD

    Organizational Strategies to Protect Well-

    Being

    Recommendations and Approvals

    Implementation

    Communications

    Evaluation Strategies to

    Support High-Risk Individuals

    Vanderbilt Task Force for Empowerment & Well-being

    Identification of Strategies

    Compassion Fatigue/Burnout Therapy

    • PREVENTION!! • 1st learn to recognize when you are wearing down • Come to terms with suppressed feelings of anger, fear,

    self-doubt since early medical/nursing/EMS education • Take care of yourself

    – Get into habit of doing something EVERYDAY that will replenish you

    • Not easy: old habits comfortable even when bad for us • Real lifestyle changes take time, energy and desire

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    Compassion Fatigue/Burnout Therapy

    • Understand that emotional pain you feel is NORMAL!!! • Will dissipate once start caring for your physical and

    emotional needs • Find someone to talk to: a GOOD LISTENER

    – Connection – Spouse or friend listen without judgment – Colleague with first hand knowledge of CF – Senior mentor – Clergy – Support group

    Develop your own SELF-CARE PLAN

    • Spend quiet time alone – Learn mindfulness meditation (being in the moment) – Reconnect with a spiritual source – Help achieve inner balance/miraculous turnaround

    • Recharge your batteries daily – Commit to eating better/regular exercise regimen/adequate

    sleep

    • Hold one focused, connected and meaningful conversation each day – Time with family and close friends feeds the soul

    Finding Community Support

    • Building a culture of support at work is vital • Explore resources provided by your organization • Social support affects everything from length of

    life to incidence of many diseases • It’s okay to start small • One example:

    The Spire Story @ Vanderbilt

    • Background: CF in the Trauma Unit • September 2013: Introducing the program … and staff cuts • December 2013: Excited employees, improved morale • Spring 2014: Expansion, throughout VUMC

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    • Website and apps • Sharing

    Accomplishments • Points and Peer-Support • Custom Rewards • Challenges and

    Competitions

     RESULTS!

    Implementing Spire

    • An important complement to external support

    • Very well researched • Different levels • Example: Search Inside

    Yourself – Chade-Meng Tan, Google software engineer and motivator

    • Calm your mind, focus on being present

    Mindfulness

    Words of wisdom from someone who has suffered from Compassion Fatigue:

    Find things that give your life joy and meaning

    Take A Moment To

    Appreciate The Beauty Around You

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    Develop emotional awareness

    Prioritize personal wellness

    Find meaning in work

    Connect with others

    Personal Wellness

    Physical Well-being • Fitness • Nutrition • Sleep • Healthcare

    Mental Well-being • Hobbies/interests • Kinship • Alone/down time-

    Mindfulness – Yoga – Meditation – Appreciate life’s blessings – Etc.

    Burnout (ICD-10) = Z73.0, a state of vital exhaustion

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