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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
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