| 2010-11-18 12:03:33 |
dogsrgr8 |
As we wait for others, where is everyone from? |
| 2010-11-18 12:03:48 |
steph199 |
Florida |
| 2010-11-18 12:04:09 |
diannef |
Hawaii |
| 2010-11-18 12:04:16 |
lczaplewski |
Wisconsin |
| 2010-11-18 12:04:19 |
mad |
Kentucky |
| 2010-11-18 12:04:40 |
dogsrgr8 |
Nice representation |
| 2010-11-18 12:05:48 |
jluquette |
Is this the virtual journal club for compassion fatigue? John |
| 2010-11-18 12:06:50 |
dogsrgr8 |
I can begin with talking a bit about Compassion fatigue. We define it as the traumatization of helpers through their efforts at helping others. When we saw problems within our outpatient infusion center, we thought our nurses would benefit from a CF intervention program. We did not have resources. So we approached the project from a research perspective to get funding. We began by surveying our staff on CF and burnout. |
| 2010-11-18 12:07:40 |
jluquette |
What tools to you use to assess? |
| 2010-11-18 12:08:09 |
dogsrgr8 |
We used the ProQol IV developed by Dr. Beth Stamm. It includes measures on CF, burnout and compassion satisfaction |
| 2010-11-18 12:08:31 |
diannef |
How did you get the tool? |
| 2010-11-18 12:08:36 |
jluquette |
Did you consider any others? |
| 2010-11-18 12:08:55 |
dogsrgr8 |
Easy, you can Google it and there is information about Beth. Contact her and she will mail out a users guide |
| 2010-11-18 12:09:28 |
lczaplewski |
Did the nurses respond favorably to participating in a survey? |
| 2010-11-18 12:09:43 |
dogsrgr8 |
Stamm has used the tool on approx 1000 emergency responders, social workers, some nurses, etc. We use her guidelines for establishing low and high risk cut offs so we could score our staff |
| 2010-11-18 12:09:59 |
diannef |
Would more respond if it was online? |
| 2010-11-18 12:10:01 |
dogsrgr8 |
We got a 34% response rate on our survey. We thought that was very good |
| 2010-11-18 12:10:24 |
dogsrgr8 |
online might get more responders - we were happy with what we obtained |
| 2010-11-18 12:10:51 |
jluquette |
Did you consider any others? |
| 2010-11-18 12:11:18 |
dogsrgr8 |
Any others?? Tools? We have since conducted a CF intervention pilot and we are also using Maslach |
| 2010-11-18 12:11:38 |
dogsrgr8 |
Maslach's burnout inventory |
| 2010-11-18 12:11:52 |
mad |
Logistically (and cost), did you have "drop off" places in the workplace for completed surveys or were they mailed. Also were the surveys numbered in any way to link to the demographics? |
| 2010-11-18 12:12:17 |
dogsrgr8 |
We distributed the surveys to their mailboxes, had staff meetings, posters. |
| 2010-11-18 12:12:49 |
dogsrgr8 |
Surveys were numbered so we could identify by units. We distributed to all inpatient and outpatient areas, included RNs, med techs, med assists and radiation techs |
| 2010-11-18 12:13:19 |
dogsrgr8 |
We analyzed demographics in the aggregate |
| 2010-11-18 12:14:20 |
diannef |
Any suggested references on designing a survey? |
| 2010-11-18 12:14:40 |
dogsrgr8 |
I would not design one. I think the ProQol IV is well validated and not very long |
| 2010-11-18 12:15:35 |
jluquette |
Did you analyze nurse responses apart from the other disciplines? |
| 2010-11-18 12:15:39 |
dogsrgr8 |
Since our first study we have been testing a CF intervention program. We use the ProQol IV, the Maslach burnout inventory and a staff satisfaction measure - collecting data post intervention and at 3 and 6 months out. Results are pending |
| 2010-11-18 12:16:03 |
dogsrgr8 |
We did not analyze nurse response apart from others. of the 153 respondents, 132 were RNs |
| 2010-11-18 12:16:15 |
jluquette |
What types of interventions? |
| 2010-11-18 12:17:08 |
dogsrgr8 |
We have developed a 4 week program (90 minutes each week) and a 4 hour retreat. Staff volunteered to participate. Our facilitators were trained on CF prevention by our consultant Dr. Erik Gentry (great resource). We have had two separate groups of staff take the program |
| 2010-11-18 12:17:24 |
mad |
I had thought the publication indicated that this was part of a quality initiative. With this in mind, did you use internal funding, external funding or both? What about funding for your follow up study (interventional study)? |
| 2010-11-18 12:18:29 |
dogsrgr8 |
The survey was done on our one initiative. Low cost. The CF intervention received internal funding - about $26,000 to pay for consultant, train facilitators, we paid staff to attend (their salary rate) and we paid for time spent by facilitators in the program |
| 2010-11-18 12:19:16 |
dogsrgr8 |
The program |
| 2010-11-18 12:19:44 |
dogsrgr8 |
The program emphasizes interactive activities and group discussion. Emphasis on self-regulation and self-care principles |
| 2010-11-18 12:20:17 |
lczaplewski |
In my experience working in a few different oncology clinics, the primary complaint is lack of staff. In the current economic environment, there are hiring freezes making hiring improbable. I have seen horrible burnout among these nurses. |
| 2010-11-18 12:20:48 |
dogsrgr8 |
Just remember burnout and CF are not the same thing. I am sure you should see burnout with poor staffing. Very common |
| 2010-11-18 12:21:20 |
lczaplewski |
Compassion fatigue plays a role in burnout. |
| 2010-11-18 12:21:38 |
dogsrgr8 |
They are related, but you cannot eliminate CF by simply adding staff |
| 2010-11-18 12:22:17 |
jluquette |
What is your understanding of the difference between CF and burnout? |
| 2010-11-18 12:22:54 |
mad |
How many individuals were able to participate in the intervention study and had all participated in the baseline assessment? Also, because your initial data was from multiple units, are there any plans to follow attendees or collective staff retention rates? |
| 2010-11-18 12:23:11 |
dogsrgr8 |
CF is related to the relational connection you have with the "victims of trauma" - your patients, who undergo rigorous therapies, often repeatedly. Burnout deals with the stresses from the work environment - staffing, work relationships, even the way the work setting is set up |
| 2010-11-18 12:24:00 |
dogsrgr8 |
We have had 16 participate in the intervention pilot. all were RNs from our outpatient infusion areas |
| 2010-11-18 12:24:28 |
jluquette |
So it is the origin, empathy or workplace variables that make the difference, not the symptoms or the interventions? |
| 2010-11-18 12:24:31 |
dogsrgr8 |
We are not following retention because the program is not large scale yet. That is our long term goal |
| 2010-11-18 12:25:02 |
dogsrgr8 |
yes as to empathy vs. workplace. Research has shown that RNs with high CF cannot be empathetic |
| 2010-11-18 12:26:35 |
jluquette |
So the principle symptom is loss of empathic abilities? ) Please pardon my questions, I am trying to get a handle on this.) |
| 2010-11-18 12:27:32 |
dogsrgr8 |
CF is broader than that - after seeing patients loss, grief, symptoms, etc nurses begin to feel the same symptoms. There are four levels of symptoms with CF - physical, psychological, emotional, spiritual and professional |
| 2010-11-18 12:28:29 |
dogsrgr8 |
The typical nurse with CF is tired, misses work, is cynical and pessimistic, has poor relations with workers and talks about leaving her job. At home the person is sleepless, appetite changes, relations are poor |
| 2010-11-18 12:28:57 |
jluquette |
Are we talking chronic exposure or single trauma, as per Figley (I think)? |
| 2010-11-18 12:29:20 |
dogsrgr8 |
A person with burnout has a sense of disconnection, feels trapped by work, is also exhausted and feels bogged down by the system, but the cause is the work environment |
| 2010-11-18 12:30:05 |
dogsrgr8 |
Figly is a great resource. In the case of nursing it is chronic. A major single trauma could certainly start it but it tends to be chronic, from what I know |
| 2010-11-18 12:31:37 |
dogsrgr8 |
Is anyone else trying any interventions |
| 2010-11-18 12:32:55 |
jluquette |
lczaplewski: What role does CF play in burnout? Is this why the symptoms seem so alike? |
| 2010-11-18 12:33:36 |
mad |
I work in a small, community outpatient facility and the economic constraints make an approach like this difficult. I would think if we could target the More "at risk" individuals, it might be more feasible. Your initial study attempted to describe the at risk population at your facility with a statistically significant result for inpatient units nurses at risk for less compassionate satisfaction. Is there a plan to target the inpatient side for intervention? |
| 2010-11-18 12:33:46 |
dogsrgr8 |
Well if a nurse is working in an environment where there is inadequate staffing, poor relations with colleagues and docs, - then he or she, if they are also dealing with CF will have a great deal of stress affecting them |
| 2010-11-18 12:35:03 |
dogsrgr8 |
Are plan is to get funds so that we can offer our program to our inpatient nurses. The only reason they were not in the pilot is that we wanted to reward our managers on the outpatient side who brought the issue to our attention. For a pilot we knew we would have a small number so we started outpatient. We hope to grow but will need funds |
| 2010-11-18 12:35:25 |
jluquette |
Does anyone know if Eye Movement Desensitization and Reprocessing (EMDR) effective? |
| 2010-11-18 12:35:39 |
dogsrgr8 |
I do not |
| 2010-11-18 12:36:39 |
ssalatskvarn |
I feel many of us look at CF similar to Post Traumatic Shock-it is there all the time once it reaches the point of CF..Many of the s/s of CF are similar to PTSD. |
| 2010-11-18 12:36:55 |
dogsrgr8 |
The most fascinating part of our program that I did not know about was the self regulation piece. Learning how to switch from sympathetic to parasympathetic stimulation through relaxation techniques. |
| 2010-11-18 12:37:32 |
dogsrgr8 |
Absolutely CF is a form of PTSD but it is secondary to someone else feeling a traumatic event, it is not primary |
| 2010-11-18 12:38:17 |
jluquette |
I found it interesting the study found BSNs were higher risk for CF and Graduate prepare nurse were higher for burnout. |
| 2010-11-18 12:39:23 |
dogsrgr8 |
Yes that was confirmed in another study as well - the reference is mentioned in the article. I think the premise is that the nurse with advanced education has high expectations for what she or he hopes to do for patients. When that is unmet it adds to a sense of feeling ineffective, which is part of CF |
| 2010-11-18 12:39:46 |
jluquette |
ssalatskvarn - I too thought it was more like PTSD-type phenomenon. |
| 2010-11-18 12:40:06 |
dogsrgr8 |
It is but again it is secondary traumatization - watch the trauma of others |
| 2010-11-18 12:41:31 |
jluquette |
dogsrgr8 - that makes sense about the expectations. |
| 2010-11-18 12:42:01 |
jluquette |
Could you say more about the interventions? |
| 2010-11-18 12:42:08 |
dogsrgr8 |
Research by Keidel (2002) showed that persons who are overly conscientious and perfectionist are more susceptible to CF |
| 2010-11-18 12:44:04 |
dogsrgr8 |
The intervention program involves having participants review their professional and personal goals. Lot of 1:1 pairing up and small group discussions. They review the secondary traumatic situations that triggered their stress. We talk about the issue of fear - fear of being inept, not providing the support we need to - etc. We teach them self regulation exercises and talk a lot about ways to get involved in more self care in the work place. Finding peers who are supportive and can talk through difficult times |
| 2010-11-18 12:45:48 |
dogsrgr8 |
Any other questions? |
| 2010-11-18 12:46:00 |
ssalatskvarn |
Has anyone looked at the factor that many nurses are so caring-that they have a general feeling of not being able to do enough? We have many objects that limit our care to pt's-especially the cost and the insurance co.'s |
| 2010-11-18 12:46:30 |
diannef |
I have to log out, but I thank you for your help and advice here. |
| 2010-11-18 12:46:45 |
dogsrgr8 |
I believe there is a lot of literature on co-dependency - I think that has a bit to do with what you are describing |
| 2010-11-18 12:48:38 |
jluquette |
No, just that I am impressed with the study. I was wondering if there are other personal or professional variables that make a nurse more likely to experience CF. |
| 2010-11-18 12:49:58 |
dogsrgr8 |
Well it is interesting. I spoke with a group about CF as it may affect family caregivers. Lot of our nurses deal with caring for someone in the home. Can you imagine that cumulative effect? No one is studying that |
| 2010-11-18 12:51:35 |
jluquette |
Were there any interventions, personal or systemic, to increase compassion satisfaction? |
| 2010-11-18 12:52:23 |
ssalatskvarn |
I have benefited from our chat-I must leave now. Thanks! |
| 2010-11-18 12:52:41 |
dogsrgr8 |
Not targeted. overall the interventions are designed to reduce CF and increase compassion satisfaction. We will have data next year |
| 2010-11-18 12:53:47 |
jluquette |
I look forward to it. And to see what funding might be available to fund it. |
| 2010-11-18 12:54:10 |
dogsrgr8 |
Best of luck to you - any other questions? |
| 2010-11-18 12:55:25 |
jluquette |
Thank you. This is important to discuss. |
| 2010-11-18 12:56:07 |
dogsrgr8 |
If you have no further questions, I think we can log out |