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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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!

11. 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

12. 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

13. 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

14. 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!

15. 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

16. 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

17. 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

18. 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

19. Stress Relief

20. Stress Reduction

21. Stress Resilience

22. 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

23. 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”

24. 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

25. 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

26. 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

27. Team building outside of work

28. Team building at work

29. Goofing off Team building at work

30. Promoting wellness outside of work
Create a morning routine
Dedicate time to be completely away from work (this includes 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

31. Develop a Self-Care Plan

32. 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

33. 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)