Using Personal Reflective Debrief To Promote Resilience from Compassion Fatigue Madeline Schmidt, MSN, APNP Marquette University Hi I’m Madeline Schmidt I’m here to present my Capstone project on using personal reflective debrief to promote resilience from compassion fatigue

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Presentation Objectives Problem in healthcare-Compassion fatigue Literature synthesis My capstone project Implications for future projects

Compassion Fatigue Occupational hazard of providing empathetic, relationship-based care is compassion fatigue Comprised of compassion satisfaction, secondary traumatic stress and burnout Nurses are at high risk of development based on internal and external stresses as well as compassionate care (Berg, Harshbarger, Ahlers-Schmidt, & Lippoldt, 2016; Duffy, Avalos, & Dowling, 2014)

Literature Synthesis Repeated exposure to chaos, high acuity patients, workplace violence, trauma and death can be challenging and emotionally draining All healthcare providers should receive prevention and treatment and support should be normal and not a weakness “Millennial” generation more likely to experience burnout than “baby boomers” Professional Quality of Life (ProQOL) survey was most widely way to assess compassion fatigue in nurses (Flarity, Gentry, Mesnikoff, 2013; Hinderer, et al, 2014; Hunsacker, Chen, Maughan & Heaston, 2014; Kelly, et al., 2015; Sacco, Ciurzynski, Harvey & Ingersoll, 2015).

Coping Strategies in Literature Education, meditation and debrief have all been discussed in the literature as ways to prevent the emotions of compassion fatigue Resilience is the ability to cope successfully despite adversity; it is a dynamic and modifiable process (Earvolino-Ramirez, 2007; Flarity, Gentry, Mesnikoff, 2013; Hevezi, 2015; Polk, 1997; Potter, et al., 2013)

Stress process model (Pearlin, 1989) Theory: Stress process model (Pearlin, 1989) http://www.bjmp.org/content/psychological-distress-carers-people-mental-disorders (Pearlin, 1989)

Theory of Resilience (Polk, 1997)

Personal Reflective Debrief Structured debrief Proactively Personal Goals Personal reflection Learning about self Coping mechanisms Social support Supporting and learning as a team (Earvolino-Ramirez, 2007; Flarity, Gentry, Mesnikoff, 2013; Hevezi, 2015; Polk, 1997; Potter, et al., 2013)

International Association of Trauma Professionals (IATP) Certified Compassion Fatigue Professional (CCFP)

DNP project proposal: Objectives and goals Evaluate levels of compassion fatigue Implement personal reflective debrief sessions Reassess levels of compassion fatigue Analyze and disseminate findings

Site Information Level 2 trauma center 25 bed emergency department Midwestern hospital Urban environment High acuity/high volume 62 nurses (both Full and Part time)

Key Stakeholders Manager Director Charge nurses Staff nurses

Resources and Budget Creation of intervention- part of course work International Review Board- in kind Staff time-in kind Conference room space Access to unit manager Fliers- $25 Food-$200 Statistician- in kind

DNP Project: Methods IRB approval (December 2016) Create survey link (December 2016) Set up dates for personal reflective debrief sessions (January 2017) Advertise through emails and fliers (January 2017) Send out initial ProQOL survey (January 2017)

Generate: Baseline Needs Assessment Professional Quality of Life Scale (ProQOL) Validated and Reliable Balance between symptoms of: compassion satisfaction secondary traumatic stress burnout Gives overall compassion fatigue score. (Stamm, 2016)

Survey Demographics Sample demographics of nurses who completed ProQOL survey Variable Pre % (n=32) Post% (n=18) Age   20-25 15.63% (n= 5) 16.67% (n=3) 26-30 21.88% (n=7) 22.22% (n=4) 31-35 15.65% (n=5) 11.11% (n=2) 36-40 31.25% (n=10) 44.44% (n=8) 41-45 6.25% (n=2) 0% (n=0) 46 or older 9.38% (n=3) 5.56% (n=1) Gender Male 15.63% (n=5) 27.78% (n=5) Female 84.38% (n=27) 72.22% (n=13) Years worked in the ED 0-5 years 46.88% (n=15) 61.11% (n=11) 6-10 25.0% (n=8) 11-15 18.75% (n=6) Over 15 Highest degree completed ADN 33.33% (n=6) BSN 78.13% (n=25) MSN 3.13% (n=1)

Implement: Personal Reflective Debrief Implement the personal reflective debrief sessions (February 2017) Debrief Individual story, group support Reflection Coping mechanisms Thank you to nurses

Reassess: Pre- and Post- Intervention Results Mean Scores Pre-Test Compassion Satisfaction Secondary Traumatic Stress Burnout High (Over 42) Average (23-41) 37.0 23.2 Low (22 or below) 22.0 Mean Scores Post-Test Compassion Satisfaction Secondary Traumatic Stress Burnout High (Over 42) Average (23-41) 37.4 23.4 Low (22 or below) 24.8 (Stamm, 2010)

Compassion Satisfaction Survey Results: Compassion Satisfaction 20-25 26-30 31-35 36-40 41-45 46+

Secondary Traumatic Stress Survey Results: Secondary Traumatic Stress 20-25 26-30 31-35 36-40 41-45 46+

Survey Results: Burnout 20-25 26-30 31-35 36-40 41-45 46+

Results: Narrative Notes - Themes Leadership support Break room (aromatherapy) Praise and recognition Co-Worker support Smaller group sessions After shift intervention Individual coping mechanisms Positive praise Support at work and at home

Outcomes Strengths Ease of implementation Social support Individualized approach Leadership facilitated Barriers Time: staff and facilitator Participation Location Short time of project Project design Self report

Implications Evaluation Impact Findings are consistent with other studies that used the ProQOL with trauma nurses APN leadership Application Next steps Longer follow-up More time between interventions Different measurement tool Other nursing subsets Dissemination Sustainability (Berg, 2016; Flarity et al, 2013; Hinderer et al., 2014; Hevezi, 2015; Hunsacker,2015; Potter et al., 2013).

Questions

References Berg, G., Harshbarger, J., Ahlers-Schmidt, C., & Lippoldt, D. (2016). Exposing compassion fatigue and burnout syndrome in a trauma team: A qualitative study. Journal of Trauma Nursing, 23(1), 3-10. doi: 10.1097/JTN.0000000000000172 Duffy, E., Avalos, G., Dowling, M. (2014). Secondary traumatic stress among nurses: a cross sectional study. International Emergency Nursing, 23,53-58. doi: 10.1016/j.ienj.2014.05.001 Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing Forum, 42(2), 73-82. Flarity, K., Gentry, J., & Mesnikoff, N. (2013). The effectiveness of an educational program on prevention and treating compassion fatigue in emergency nurses. Advanced Emergency Nursing Journal, 35(3), 247-258. doi: 10.1097/TME.0b013e31829b726f Hevezi, J. (2015). Evaluation of a meditation intervention to reduce the effects of stressors associated with compassion fatigue among nurses. Journal of Holistic Nursing, XX (X), 1-8. doi: 10.1177/0898010115615981

References cont. Hinderer, K., VonRueden, K., Friedmann, E., McQuillan, K., Gilmore, R., Kramer, B. (2014). Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. Journal of Trauma Nursing, 21(4), 160-169. doi: 10.1097/JTN.0000000000000055 Hunsacker, S., Chen, H., Maughan, D., & Heaston, S. (2014). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194. doi: 10.1111/jnu.12122 Pearlin, L. (1989). The sociological study of stress. Journal of Health and Social Behavior, 30(3), 241-256. Potter, P., Deshields, T., Allen, J., Clarke, M., Olsen, S., Chen, L. (2013). Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncology Nursing Standard, 40(2), 180-187. Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org.