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Burnout and Compassion Fatigue in Research Coordinating Jessica Francis, CCRC University of Utah

Presenter Disclosure Jessica Francis, CCRC There are no relationships to disclose related to this presentation.

About Jessica Began as a lab tech in pulmonary medicine at the U Started working part-time as an RC for the Cystic Fibrosis team in July 2013 Hired full-time in December 2014 with the first ARC award Works on both adult and pediatric studies

Objectives Define burnout and identify its causes, signs, and symptoms Define compassion fatigue and identify its causes, signs, and symptoms Discuss strategies for preventing and treating burnout and compassion fatigue Explore how this relates to research coordinating Explore prevention and treatment options

What is burnout? Burnout is a psychological syndrome of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment (Maslach, 1996) Some experts believe other conditions such as depression and anxiety disorders can be represented by the term “burnout” Physical illnesses may cause burnout-like symptoms, it’s important to learn your own personal barometer NOT trauma related

Causes of burnout Cumulative process typically involving: Increased workload Increased institutional stress, i.e. situations outside of your control Decreased satisfaction and enjoyment at work Decreased sense of meaning and purpose in your work

Recognizing burnout Maslach Burnout Inventory has been the standard for years, it measures: Emotional exhaustion: feelings of being emotionally overextended and exhausted by one’s work Depersonalization: an unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction Personal accomplishment: feelings of competence and successful achievement in one’s work

The OLdenburg Burnout Inventory (OLBI) Developed more recently than the Maslach Burnout Inventory Measures both burnout and disengagement in the workplace Designed to be used in all professions, whether or not the employee interacts directly with other people Also used to measure academic burnout The higher the score, the more burned out you may be See syllabus for a copy!

What is compassion fatigue? The natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person (Figley 2002) Also called “vicarious traumatization” or “secondary traumatization” May be referred to as the “cost of caring” Can be defined as a caregiver’s reduced capacity or interest in being empathic or bearing the suffering of clients/patients More acute than burnout, potentially easier to reverse

Causes of compassion fatigue Typically the result of one or two specific events Events can be personal or professional In Cystic Fibrosis research specific causes can relate to particular patient incidents including illness and death

Symptoms of compassion fatigue Exhaustion Reduced ability to feel sympathy and empathy Anger and irritability Increased use of alcohol and drugs Dread of working with certain clients/patients Diminished sense of enjoyment of career Heightened anxiety or irrational fears Difficulty separating work life from personal life Impaired ability to make decisions and care for clients/patients

Professional Quality of Life Scale (ProQOL) Considered the most effective screening tool for compassion fatigue to date Measures Compassion Satisfaction, Burnout, and Secondary Traumatic Stress See syllabus for a copy!

Burnout vs. Compassion Fatigue Similarities Emotional exhaustion Reduced sense of personal accomplishment or meaning in work Mental exhaustion Decreased interaction with others Physical exhaustion Differences Burnout emerges over time and can take longer to reverse Compassion fatigue has a rapid onset and faster recovery if recognized and managed early

How does this relate to research coordinating? Clinical trials are: Intense: generally with pressure to start-up and enroll as fast as possible regardless of other responsibilities Time consuming: hours spent on start-up and other paperwork add up and study visits can range anywhere from 4-12 hours in a single day Detailed: among other pressures a good RC must manage more details than many other jobs Personal: RCs spend hours with their study participants and get to know them as much as or better than other CF team staff members 24/7: RCs must be available to their PIs, participants, and sponsors outside of normal work hours Life or death: whether or not we regularly acknowledge it our positions are unique in their relationship to our participants’ health and safety

Prevention and treatment of burnout and compassion fatigue Be open and honest with those in your life about what you need Cultivate mindfulness both personally and professionally Strive for wellness Practice stress reduction and stress resilience Develop a self-care plan Treatment Take time away from work Practice the ABCs of mindfulness Practice stress relief Implement your self-care plan Adjust as needed for specific situations Revise your self-care plan with what you’ve learned

Different types of stress Stress Relief Activities that provide acute decrease in feelings of stress Examples include crying, drinking alcohol, eating “comfort” food, listening to music Stress Reduction Activities that decrease the overall burden of stress in one’s life Examples include vacations, exercising, eating well Stress Resilience Activities that increase one’s capacity to cope with stress Examples include meditation, mindfulness

Stress Relief

Stress Reduction

Stress Resilience

Mindfulness Mindfulness is the gentle effort to be continuously present with experience ABCs of Mindfulness A is for awareness: becoming more aware of what you are thinking and doing, what’s going on in your mind and body B is for “just Being” with your experience: avoiding the tendency to respond on auto-pilot and feed problems by creating your own story around them C is for seeing things and responding more wisely: by creating a gap between the experience and our reaction it it, we can make better choices

Benefits of mindfulness The ability to recognize, slow down, or stop automatic and habitual reactions The ability to respond more effectively to complex or difficult situations The ability to see situations more clearly Ultimately you hope to achieve balance and resilience at work and at home, i.e. the “work/life balance”

Ways to practice mindfulness Meditation: Can be as simple as counting your breaths for 30 seconds, as involved as using apps, books, CDs, going to classes Mindful walking: Don’t just rush from place to place, try to walk with intention noticing everything your senses are telling you Mindful eating: Focus on your meal away from distractions Mindful speaking: Convey your thoughts intentionally and with purpose Mindful listening: Don’t interrupt, don’t talk about yourself, give feedback on what you heard Exercise: The more physically aware we are the easier it is to be mentally aware

Wellness: The Ultimate Goal Complex and multifaceted nature of a person’s physical, mental, and emotional health and well being Goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life (Wallace 2009, Shanafelt 2002) Challenges to wellness Denial and avoidance as coping strategies Heavy workload and fatigue Being involved with others’ suffering, fear, illness, and death Not prioritizing self care

Promoting wellness at work Promote a healthy environment: standing desks, healthy snacks, pedometers/step challenges, weight loss challenges Taking advantage of resources provided including social workers, other counseling, free yoga classes, wellness retreats Dividing up work when possible Building teams both inside and outside work Using PTO as much as possible Moving on when it’s not a good fit

Team building outside of work

Team building at work

Goofing off Team building at work

Promoting wellness outside of work Create a morning routine Dedicate time to be completely away from work (this includes email on your phone, etc) Make time for yourself outside of your personal obligations Do things you enjoy even if they’re not “productive” Practice good sleep hygiene Avoid caffeine after lunch Finish eating at least three hours before bed Limit technology use before bed Create an evening routine to wind down and trigger your sleep habit

Develop a Self-Care Plan

Self-Care plan outline Identify what you need in the following categories to achieve positive self-care: Physical, Emotional, Personal, Psychological, Spiritual, Professional Write down what you envision as your work/life balance Describe what things might get in the way Explain what negative strategies you need to avoid that may have affected you in the past Imagine how you’ll feel if you implement this plan Revise as necessary

Thank you! Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom. Author Unknown (Often falsely attributed to Victor K. Frankl)