Compassion Fatigue in Health Workers Eva Quirion NP

Compassion Fatigue in Health Workers Eva Quirion NP, Ph. D St. Joseph Internal Medicine

Disclosures I am crazy about my granddaughter! I have no other disclosures

What is Compassion Fatigue? A type of burnout related to empathic responses among caregivers to the trauma stories/experiences of patients (Joinson, 1992). A state of tension and preoccupation with the tramatized patient by re-experiencing the traumatic events, avoidance/numbing of reminders, persistent arousal (e. g. , anxiety) associated with the patient. It is a function of bearing witness to the suffering of others (Figley, 2002).

Who is Vulnerable to CF? Anyone providing care for others. This can be related to personal or professional life. Think physicians, nurses, medical assistants, support staff. Anyone involved in care.

What are the Symptoms of CF? Lack of energy to care about things that were important in the past. Removing oneself from contact with others Abuse of alcohol or drugs Reliving of trauma (re-playing conversations, etc. ) Lack of self-care and hygiene Emotionally labile

What are the Consequences of CF Decreased ability to provide a therapeutic relationship Feeling of not being able to do one’s job Relationship troubles Employment problems

Background In fact, Florence Nightingale may have had one of the first documented cases of CF. Parker (2006) stated, “Miss Nightingale slipped home quietly…after ceaseless work; and after witnessing suffering, death, and despair that would haunt her for the remainder of her life” (p. 45 ).

A Study: The Risk of Compassion Fatigue Among Nurse Practitioners in Maine

Problem Statement CF, a potential risk for all healthcare clinicians, had not been described for nurse practitioners. The risk for compassion fatigue (CF) among NPs, as well as the levels of compassion satisfaction, burnout, and secondary traumatic stress that exist for this population has not been described. Additionally, the NP characteristics of perceived stress, length of time in practice, gender, and job setting potentially predict higher risk of CF and needed examination.

Purpose of the Study Primary purpose To describe the risk of CF among NPs Will also provide measured levels of compassion satisfaction (CS), secondary traumatic stress (STS), and burnout Secondary purpose To determine if higher risk of CF can be predicted based on perceived stress, gender, job setting, and length of time in practice.

Significance There are 155, 000+ NPs practicing in the US today There are 1, 300+ NPs practicing in Maine NPs fulfill many roles, many times in rural and underserved areas The study of CF is potentially important to the retention of NPs

Nature of the Study Cross-Sectional Descriptive Correlational DV is higher risk of CF IV are perceived stress, job setting, gender, and length of time in practice Instrumentation

Research Questions What is the occurrence of STS, CS, and burnout among NPs in Maine? What is the level of risk for CF among NPs in Maine? What NP characteristics (i. e. job setting, gender, stress, or time in practice) predict higher risk of CF in NPs in Maine?

Multivariate Hypothesis H 0: The independent variables of job setting, gender, stress, and time in practice do not predict higher risk of CF Ha: At least one of the independent variables of job setting, gender, stress, and time in practice predict higher risk of CF

Theoretical Framework Jean Watson – Theory of Human Caring Science Nursing theory The nursing ideal Stress Response Sequence Model Psychological theory STS Burnout C F Compassion Fatigue Process Psychological theory CS

Assumptions, Limitations, Delimitations Assumptions Participants are who they say they are Honesty Instrumentation Limitations Cannot be generalized to the nation Study relates to RISK of CF, not actual CF Risk of CF is ordinal (low, medium, high) and the analysis is limited to that Delimitations NPs only, with active licenses

Review of the Literature Figley first studied CF in psychological research related to posttraumatic stress disorder beginning 4 decades ago Figley and Stamm produced the first instrument used to measure CF Figley and Stamm later parted ways and Stamm is now credited with the latest measurement instrument for CF (Professional Quality of Life Scale – Pro. QOL) Joinson mentioned CF first in the NURSING literature in 1992 There is a dearth of literature relating to CF among NPs, very little related to physicians, and moderate amounts related to RNs

Review of the Literature Are there things (characteristics, environments) that can predict risk of CF? Do the implications of CF matter? Would patients be impacted by CF in NPs? Are NPs satisfied with their work? How might CF fit in with NP job satisfaction?

Method Quantitative, descriptive, and correlational The research questions ask if there is a correlation between variables The goal is to determine if there are predictors for CF among NPs Other methods such as qualitative or descriptive only would be used to answer questions dissimilar to the present study This is non-experimental as no treatments are being applied to the research subjects

Population and Sampling Population is all NPs in Maine – about 1300 people Formula for logistic regression sample size estimate is 10 x the number of independent variables / the smallest proportion of negative or positive cases (10 x 4)/. 10 = 400 Alpha of. 05, medium effect size, power of. 80 Actual sample size of 368, Nagelkerke R Square was statistically significant with P<. 001 and indicated that the variance in the DV was predicted by IV of time in practice and perceived stress

Data Analysis of descriptive research questions Analysis of correlational, bivariate and multivariate hypotheses Binomial regression analysis was used to determine answer to the correlational research questions These variables in this study are binomal, categorical, ordinal Testing of assumptions in order to run the logistic regression analysis

Validity & Reliability External Sending research surveys to ALL NPs in Maine Generalizable to Maine NPs, but not all NPs Subject reactivity to questions could affect validity Reliability is good for both the Pro. QOL and PSS Internal Several tests were run to assure internal validity related to the instruments Selection bias is minimized by all potential subjects having the opportunity to participate Adequate sample size was planned and obtained

Results Very little missing data, replaced by using multiple imputation N=368 Gender Job Setting Mean Time in Practice (years) Male Female Primary Care Outpatient Specialty Inpatient Specialty Other 12. 39 24 344 155 123 38 52 Minimum 1 Maximum 50 6. 5% 93. 5% 42. 1% 33. 4% 10. 3% 14. 2%

Results RQ 1: What is the occurrence of STS among NPs in Maine? Average High Frequency 132 236 Percent 35. 9 64. 1 RQ 2: What is the occurrence of CS among NPs in Maine? Low Average High Frequency 43 162 163 Percent 11. 7 44. 0 44. 3

Results RQ 3: What is the occurrence of burnout among NPs in Maine? Low Average High Frequency 32 230 106 Percent 8. 7 62. 5 28. 8 RQ 4: What is the level of risk of CF among NPs in Maine? Lower Moderate Risk Higher Moderate Risk* Frequency 212 156 Percent 57. 6 42. 4

Results RQ 5: What NP characteristics (job setting, gender, perceived stress, time in practice) predict higher risk of CF among NPs in Maine? Job setting and gender did NOT predict higher risk of CF Higher perceived stress DID predict higher risk of CF Shorter time in practice DID predict higher risk of CF

How can findings be utilized Perceived Stress When NPs perceived more stress, the risk for CF was higher Stress reduction practices could help retain NPs and prevent the development of CF, but more study is needed Length of time in Practice Points toward improving mentorship for new NPs and supports newer internships that are cropping up in the U. S.

Stress Busters Different for different people Treating each other well, even when we don’t behave well Assume the best of your co-workers until proven otherwise Speaking up for others and for yourself in the workplace Management is key and can create or decrease workplace stress

Where is the Fun? Joy in the Workplace, form a committee Food days Taking care of the garden/grounds Plan outings/ways to be active Be inclusive to family and pets Highlight an employee of the month

Do’s and Don’ts of Recovery Do Don’t Find someone to talk to Blame others Understand that the pain you feel is Look for a new job, buy a new car, NORMAL get a divorce, or have an affair Start exercising and eating well Fall into the habit of complaining Get enough sleep Hire a lawyer Take some time off Work harder and longer Develop interests outside your work Self-medicate Identify what’s important to you Neglect your own needs and interests

What to do If you think that you are in trouble or you think that someone else is in trouble Talk to someone you can trust EAP, management, counselor Remember CF does not go away if you change jobs CF needs to be treated with therapy and is similar to treating PTSD Consider the length of time symptoms are present

Thank You