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Compassionate Care in the 21 st 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, FAAN Dean and Professor [email protected]

Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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Page 1: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

[email protected]

Page 2: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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?

Page 3: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 4: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 5: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

AACN studies on Healthy Work Environments (with VitalSmarts)

Silence Kills2005

Silent Treatment(with AORN)

2011

Page 6: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring
Page 7: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 8: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Martin Luther King, Jr.

Page 9: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.”

Page 10: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

(c) 2009 Debra Gerardi All Rights Reserved

10

OMG…

Page 11: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 12: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.

Page 13: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

“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)

Page 14: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Common in nurses and physicians

Burnout

Post traumatic Stress syndrome

Moral distressMealer et al 2009; Bruce et al 2014

Page 15: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Healthy Work Environments?

Work force shortageMoral distress

Lateral and vertical violence such as bullying

Quality & safety issues

Working wounded

BURNOUT

Page 16: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 17: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 18: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Who burns out and why?

And…what about the ones who don’t?

How to re-engage

Page 19: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.

Page 20: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Solutions/Opportunities

A call to action

Page 21: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.

Page 22: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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?”

Page 23: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Patient Satisfaction/John Dent, MD

Displayed by Discharge Date

Overall

4EAST Inpatient Overall

Page 24: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.

Page 25: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

UVA School of Nursing

Creating

compassionate

nurses and leaders

for the 21st Century

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Reunion Weekend Yoga on The Lawn June 7, 2014

Page 27: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

What is compassionate care?

Why is it needed today?

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Page 29: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

The Compassionate Care Initiative at UVA

Reducing human suffering by cultivating compassionate people and systems

Page 30: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

What is compassion and empathy?

Page 31: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Compassion

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

Sharon Salzburg

Page 32: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Empathy

Putting yourself in the shoes of another

A necessary precondition for compassion

Page 33: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Time to reclaim the soul of health care

Page 34: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Cultivating Courage

Page 35: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Compassion starts with …

Awareness

and an

Open heart

Page 36: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Can empathy and compassion be learned?

Editorial in the Daily Progress, January 6, 2013

Page 37: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Being Present…Fully Present

Page 38: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 39: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Compassion as a Global Remedy

His Holiness the Dalai

Lama, October 2012

Page 40: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Susan Bauer-WuTussi and John Kluge Endowed Professor

Page 41: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

“The science of finding focus…”

Page 42: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Resiliency Initiative

Page 43: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

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Compassionate Care Initiative Jonathan Bartels RN, BSN

The Pause

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

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Page 46: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Compassion and the need for Kindness

Page 47: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 48: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Compassionate CareContemplative Practices

Awareness—Presence—Resilience

Page 49: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Susan Bauer-Wu (2011)

Page 50: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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)

Page 51: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

What are you willing to notice in your world?

Page 52: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring
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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)

Page 58: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 59: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 60: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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”

Page 61: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.

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…invite stillness and inquiry

Take a breath

Page 63: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

Our focus includes Interprofessional Education

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

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3 C’s

Page 65: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

First

Consider a contemplative practice

Page 66: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.

Page 67: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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

Page 68: Compassionate Care in the 21 st Century: Caring for Self and Others Virginia Organization of Nurse Executives and Leaders “Cultivating Connections: Caring

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.

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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