Emotional Hazards of Oncology Nursing Practice Debi i Boyl oyle M - - PowerPoint PPT Presentation

Emotional Hazards of Oncology Nursing Practice

Debi i Boyl

• yle M

MSN, R RN, AOCNS™, F FAAN AAN

GO GOAL AL

• Platform
• Problem
• Portfolio
• Promise

PLATFORM

U.S. . Department o

• f L

Labor

• 12 million healthcare workers in U.S.
• Nurses are the largest segment = 3 million
• Nurses working in high-intensity areas such as critical care,

pediatrics and oncology report high levels of stress.

• Burnout scores are significantly higher for hospital nurses than

for any other profession.

• Rushton C, Batcheller J, Schroeder K, Donohue P (2015). Burnout and resilience

among nurses practicing in high-intensity settings. American Journal of Critical Care Nursing, 25(5): 412-420.

 Increased turnover  Decreased patient satisfaction  Inadequate teamwork  Adverse health outcomes

• Excessive workload
• Lack of support
• Moral distress
• Lack education in EOL care,

communication skills

• Absence of team skills

Co Contemporary V Variables Influenc encing Nur urses’ ses’ W Work Stres ess

• Slow economic growth
• ‘Job lock’
• Two incomes required
• Single parent households
• ‘Sandwich Generation’
• Long work hours
• Delayed retirement
• Technology

PROBLEM BLEM

Di Differentiating C Compas assion F Fatigue ue F From B Burnout

• Burnout
• Stresses experienced within,

and related to, the work environment

• Compassion Fatigue
• Stresses related to the

relationships between nurses and their patients/families

Denver CF video

Th The D Double-Edged S Swo word

The capacity for compassion and empathy is at the core of our ability to do our work well, and at the core of our vulnerability to be wounded by our work.

• “First Responders”
• Stress acknowledgement:
• Availability of counselors
• Education & de-briefing
• Time away from trauma source

We e Are ‘First On Th The e Sc Scene’, Eyewit itnes ess s To

• …
• Unsettling and tenuous nature of shock, disbelief,

confusion, worry and despair

• Profound debility and incapacitation
• Significant disruption of family norms
• Consequences of physical and emotional loss
• Disfigurement and depression
• Considerable energy targeting avoidance of ‘bad

news’

• Deconstruction of the family’s future orientation
• Death -
• Tragic
• Unanticipated
• Intolerable
• Premature

A NEW DEFINITIONAL PARADIGM - NURSE EMPATHIC DISTRESS

Compassion On Overdrive

Witnessing Trauma

Intimate nature; daily; repeated; multiple; no ‘out’

Moral Anguish

Questioning care; remorse; guilt

Cumulative Grief

Unrecognized; unattended

• Questioning the nature of patient struggles and suffering

usually around EOL care

• Characterized by ‘dueling expectations’ between

disciplines R/T benefits of treatment and truth-telling

• Sense of moral outrage
• Anger, frustration, resentment, blaming
• Avoidance strategies
• Sub-standard interdisciplinary communication
• Team conflict
• Evolves from mourning deaths of patients with whom a strong

emotional connection evolved

• Cumulative loss; unattended sorrow
• Depression evidenced at home and work; rumination of how

patient died; guilt

• Apathy, lethargy, tearfulness out of context, suppressed

emotion

• Suppression of feelings; lack of interest in activities previously

enjoyed; withdrawal, disengagement at work

Moral al A Ang nguish sh Cumulative Grief

Cumulative Gr e Grief/Unatten ended ed S Sorrow Inven entor

• ry
• Monthly estimate of dying patients ___
• Yearly # dying patients

___

• Years in your role ___
• Cumulative estimate of death exposure ___

Po Portfo folio

IDEA EAL F FOCI

Self-Care Outside Work

1

Work Distress Reduction

2

Coping Enhancement

3

Analyze where you are spending your 24 hours On a scale of 1-10, how stressed are you? Then ask your family! Assume personal responsibility for self-care Consider introducing affirming rituals into your daily routine

• Analyze wh

wher ere y you s spen end y your 2 24 hours

• Rate y

te your s stress

• Confi

firm r rati ting wi with th your f family

• Assume personal

al r respon

• nsib

ibil ilit ity f y for

• r s

self-ca care re; negoti tiate/ e/del eleg egate h e help

• Consider

er p patter erns … … are y you s stuck?; s solicit hel elp t to es establish new n w norm

What’s on your plate?

Work k Distress R Reduction

• n
• Education
• Communication, EOL, conflict, emotional sequelae
• Address Emotion
• De-briefing, Schwartz Rounds, staff counselor, journaling, CAM, renewal retreat)
• Novel Approaches
• Patient/family focus groups, performance appraisal, ?

A Healthy Work Environment (HWE) is one that is safe, empowering and satisfying. Parallel to the World Health Organization’s definition of health, it is not merely the absence of real and perceived threats to health, but a place of “physical, mental and social well-being”, supporting optimal health and safety…. for both the patient and health care worker in any setting.

Resilience Spirituality

Coping Enhancement

Philoso sophical al S Shift R Required

• Practice responsible selfishness
• Reframe success
• Focus on your spiritual health

Domains of Wellness

(… a multidimensional construct that describes a positive state rather than simply the absence of illness.)

• Social
• Emotional
• Physical
• Intellectual
• Spiritual
• Work

RESILIENCE

Ability to recover from adversity Pursue and sustain growth Choose forward direction Introspection required

Prom

• mise

se

The c e cen entral irony i in nursing is that t t the m majority ty o

• f nurses c

consider t themselves to be e caring, g, n nurtu turing p peo eople but f find i it hard to n nurtu ture t themselves. – Boyle 2011

2011

Historical Focus On Others

The e e expectati tion t that w t we c e can b be e immersed i in suffering a and l loss d daily a and not b t be e touched by it y it, is is as as unreali listic as as e expectin ing t to b be ab able le to to walk t through gh water er w without ge getting g wet et. This is sor

• rt of
• f d

denial is l is no

• small m

ll matter.

Source: Rachel Naomi Remen M.D. Kitchen Table Wisdom: Stories That Heal

Some of t the b best c caregiving advi vice ce we’ e’ve e ever er hear heard c d comes es f from flight a attendants …

We must acknowledge the emotional labor of our nursing specialty.

Our work is soul work. It requires an enormous appreciation of the dynamics

• f human suffering – physical, social,

emotional, and spiritual.

This wor work wi will ta ll take it’ t’s toll on toll on us i if we we do n

• not
• t –
• Ack

Acknowl wled edge it’ it’s p pres esen ence

• Tal

alk ab about it’ ut it’s del elet eter erious ef effect ects

• Ask

k for for help

Sour urce: Mark Stebnicki (2008). Empathy hy Fa

• Fatigue. Springer Publishing: New York.

In traditional Native American teaching, it is said that each time you heal someone, you give away a piece of yourself until at some point, you will require healing.