1. 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

2. Disclosure Information for this presentation
There are no relevant financial relationships related to this presentation/program.
There is no sponsorship/commercial support of this presentation/program.
The content being presented will be fair, well-balanced and evidence-based.
Learners must have signed the attendance roster at registration this morning and will need to complete the on-line evaluation after the conference to successfully complete this program and receive the contact hours certificate.

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

4. 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)

5. 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).

6. 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)

7. Stress process model (Pearlin, 1989)
Theory:
Stress process model (Pearlin, 1989)
(Pearlin, 1989)

8. Theory of Resilience
(Polk, 1997)

9. 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)

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

11. 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

12. 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)

13. Key Stakeholders
Manager
Director
Charge nurses
Staff nurses

14. 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

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

16. 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)

17. 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)

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

19. 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)

20. Compassion Satisfaction
Survey Results:
Compassion Satisfaction

21. Secondary Traumatic Stress
Survey Results:
Secondary Traumatic Stress

22. Survey Results:
Burnout

23. 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

24. 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

25. 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).

26. Questions

27. 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), doi: /JTN
Duffy, E., Avalos, G., Dowling, M. (2014). Secondary traumatic stress among nurses: a cross sectional study. International Emergency Nursing, 23, doi: /j.ienj
Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing Forum, 42(2),
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), doi: /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), doi: /

28. 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), doi: /JTN
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), doi: /jnu.12122
Pearlin, L. (1989). The sociological study of stress. Journal of Health and Social Behavior, 30(3),
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),
Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org.