Emotional Hazards of Oncology Nursing Practice Debi i Boyl oyle M MSN, R RN, AOCNS™, F FAAN AAN
GO GOAL AL • Platform • Problem • Portfolio • Promise
PLATFORM
Increased turnover Decreased patient satisfaction Inadequate teamwork U.S. . Department o of L Labor Adverse health outcomes • 12 million healthcare workers in U.S. Excessive workload • Nurses are the largest segment = 3 million Lack of support Moral distress Lack education in EOL care, communication skills Absence of team skills 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.
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 • Compassion Fatigue • Stresses experienced within, • Stresses related to the and related to, the work relationships between nurses environment 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 o … • 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 Moral al A Ang nguish sh • 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 Cumulative Grief 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
Cumulative Gr e Grief/Unatten ended ed S Sorrow Inven entor ory • Monthly estimate of dying patients ___ • Yearly # dying patients ___ • Years in your role ___ • Cumulative estimate of death exposure ___
Po Portfo folio
IDEA EAL F FOCI 1 2 3 Self-Care Work Distress Coping Outside Reduction Enhancement Work
Analyze where you are spending your 24 hours On a scale of 1-10, how stressed are you? What’s on Then ask your family! your Assume personal responsibility for self-care plate? 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 onsib ibil ilit ity f y for or 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
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, ? Work k Distress R Reduction on
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.
Coping Enhancement Resilience Spirituality
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 RESILIENCE • Emotional Ability to recover from adversity • Physical Pursue and sustain growth Choose forward direction • Intellectual Introspection required • Spiritual • Work
Prom omise se
Historical Focus On Others The c e cen entral irony i in nursing is that t t the m majority ty o of 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
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 ort of of d denial is l is no o 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 of 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 o not ot – - 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
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. Sour urce: Mark Stebnicki (2008). Empathy hy Fa Fatigue . Springer Publishing: New York.
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