Download Joanne Goldbort, PhD, RN - Indiana's AWHONN section

Joanne Goldbort, PhD, RN
Burnout, Compassion Fatigue, STSD
Intrapartum Setting
• General belief of “this is a happy place to
work.”
• Bringing life into the world is a miraculous
event, met with joy and awe
• However, there are risks and challenges
Inherent Challenges:
• Situations similar to any life altering event
that occurs in an ER
• Occasions when joy is replaced with
sadness
• The entire health care team and the
family can be affected by distressing
events
Emergency Birthing Situations
• Can be devastating for the woman/family
• Literature replete with reports of women
who develop post-traumatic stress
disorder after a traumatic birth experience
•
Ayers & Pickering, 2001; Soet, Brack, & Dilorio, 2003; Beck, 2004a, 2004b;
Leeds & Hargreaves, 2008.
One Woman’s Story
I really think part of it was the position, all
these people in there, and the total lack of
connection that there was a human being
on the table going through this! It’s like, I
was a body, I was a piece of meat that
needed to have a procedure done to get
this child out and when that was over then
it’s fine, and it’s done. But to me who was
going through it, nobody was talking to me.
It’s not a natural position to be laid, filleted
opened naked in front of all these men and
people that didn’t, that really don’t even
know your name.
Burnout
• Evolves when expectations of the individual and the
organization are in conflict (Aycock & Boyle, 2010)
• Cumulative stress from the demands of daily life—a
state of physical, emotional, & mental exhaustion (Potter,
et al 2010)
• Arises when assertiveness goals are not met in the work
place (Boyle, 2011)
• Associated with high work loads, unsupportive work
settings, & failure to achieve personal goals (Yoder,
2010)
Symptoms of Burnout
• Physical: Rapid pulse, fatigue, hypertension,
head, back or muscle aches
• Behavioral: Chemical abuse, medication errors,
poor record keeping, cynicism
• Emotional: Critical of others, apathy, depression,
hopelessness, irritability
• Spiritual: Doubt concerning beliefs, urgency to
change job, marriage, relocation
(Aycock & Boyle, 2009)
Compassion Fatigue
• Compassion—Latin means “co-suffering”
• Deep physical, emotional, & spiritual
consumption accompanied by significant
emotional pain (Aycock & Boyle, 2009)
• Emerges suddenly & without warning and
includes a senses of helplessness and
confusion (Potter, et al 2010)
CF-cont’
• Stems from emotional engagement &
interpersonal intensity associated with
witnessing tragedy within the work setting
• Occurs when rescue-caretaking strategies
are not met
• Similar to Secondary Traumatic Stress
Disorder (STSD)
(Boyle, 2010; Lester, 2010)
Risk Factors CF
• First Responders
• Soldiers
• Noted in caring professionals whose
personal identity is closely associated with
their professional role
• Inability to rescue patients
Symptoms of CF
Work Related:
• Avoidance or dread of working with certain
patients; Dread going to work
• Reduced ability to feel empathy towards
patients or families
• Frequent sick days
• Lack of joyfulness
• Error rate an issue
Symptoms of CF
Emotional:
• Mood swings, restlessness, anxiety
• Depression, anger, and resentment
• Poor concentration, focus & judgment
• Oversensitivities
• Memory issues
(Lombardo, 2011; Douglas, 2010; Potter et al, 2010)
Symptoms of CF
Physical:
• Headaches
• Digestive problems
• Sleep disturbances
• Fatigue
• Cardiac—chest pain, palpitations
• Increase susceptibility to illness
(Lombardo, 2011; Douglas, 2010)
More than one symptom must be present
plus an assessment of the RN to include:
• Description/evaluation of the work setting
and working conditions
• Tendency to become overinvolved
• Usual coping strategies
• Replenishing strategies
• Openness for learning new skills
(Lombardo, 2011)
Secondary Traumatic Stress Disorder
(STSD)
The natural consequent behaviors and
emotions resulting from knowing about a
traumatizing event experience by a
significant other [or] the stress resulting
from helping or wanting to help a
traumatized or suffering person (Figley,
1995)
STSD
• A natural consequence of caring between
two people, one of whom has been initially
traumatized and the other whom is
affected by the first’s traumatic
experiences (Figley, 1999)
• Figley redefined CF as STSD
• Symptoms nearly identical to PTSD
(Devilly, et al 2009)
STSD symptoms
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Recurrent recollections
Distressing dreams
Psychological distress—anxiety
Reminders of the events
Anger, depression, hopelessness
Feeling on the edge
Irritability, difficulty concentrating, and
insomnia
Qualitative Phenomenological Study
• What effect, if any, does participating in
and/or witnessing a traumatic birth have
on the intrapartum nurse caring for the
woman?
Qualitative cont’
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Nine intrapartum nurses recruited
8 female, 1 male
Age range: 31-60 years
Mean age: 46 years
27 stories shared
Occurred at different stages of the nurses’ career
Similar in impact regardless of the stage of their career
STSD expressed
• “And it was very traumatic for [me]. I didn’t
know what to do. I was brand new. The
only thing I knew was that I wasn’t
supposed to have a cord in my hand. And
so I started yelling for other nurses to
come help me. “
STSD expressed
• “I had nightmares for several weeks after that,
wondering about . . . how that could happen and
what it was . . . It was very difficult from the first
few weeks afterwards to come to work.”
• “But it took me years of seeing that visualization
over and over and over again before I could
finally move on and not continue to think about
it every minute of every day. . .”
Makes you want to withdraw. Makes you
not want to deal with things. I can
remember how we all kept talking . . . to try
to find out, ‘is there anything else
we could have done? Could we have done
anything differently? Could we have had a
different outcome?’ But as a woman, as a
nurse, it still makes you feel like you failed.
Unexpected Consequences
• Directly correlated to nurse retention and
turnover, to patient satisfaction, and to
patient safety
(Potter et al, 2010)
Remen (1996)
The expectation that we can be immersed in
suffering and loss daily and not be touched
by it is as unrealistic as expecting to be able
to walk on water without getting wet.
Interventions
Provision 5 of the ANA Code of Conduct
states:
The nurse owes the same duties to self
as to others.
Resilience
• The ability to cope with or recover from the
impact of stress and turn it into a positive
learning experience.
• Latin—”to leap back” or “to spring back”
• A dynamic process that can be learned
• A cyclic process of uncovering, using, and
developing the innate self, motivating life
force, human spirit
(Grafton et al, 2010)
Resilience cont’
• Emotional intelligence—the ability to
sense, perceive, use, understand and
effectively manage emotions
• Reflective thinking
• Quiet Rooms
• Guided teaching
• Techniques for relaxation
(Sabo, 2011)
Interventions cont’
• Work life balance—Practicing responsible
selfishness—diet, exercise, journaling,
meditation, counsel for marital and child
issues, adequate sleep, yoga, tai-chi
Interventions cont’
Education to:
• Improve communication skills
• Identify personal coping strategies
• Develop caring communication styles
• Establish boundaries with patients and
families
• Reframe “difficult” interactions
(Lombardo, 2011)
Interventions cont’
• Resolve interpersonal relationship
problems in the workplace
• Cope with ethical conflict & dilemmas
• Utilize meditation and mindfulness
• Attend a conference
Interventions cont’
Work setting strategies:
• On-site counseling—EAP
• Seek out a mentor
• Staff support groups—retreats
• Debriefing
• Art Therapy
• Massage
Teamwork
“
Afterwards, the nurses that were involved, I think
were really effected by the situation because it was
a bad outcome. And luckily I was on a unit where
we could all talk together, cry together, debrief
together and get through it together and it was
really supportive.”
Interventions cont’
• Bereavement interventions—sympathy
cards, attending funerals, memorial
services
• Become involved in a project of interest
• Meet own spiritual needs
Interventions cont’
Develop Nurse Residency Program
• One year for new graduates
• Monthly meetings with focused topics and
to “reflect”
• Develop critical thinking skills
• Share thoughts and feelings
• Develop effective decision making skills
For the Love of OB
• “So you have to be able to have a personal satisfaction
to want to keep doing it…we love what we do.”
• “Makes you feel so insignificant. So small and humble to
be a part of that, to help these people out . . . but it’s, it’s
been a blessing in my life...This lady and the people I
work with, are all of them, are part of what makes it work
and worthwhile.”
LET’S DO IT FOR OUR MOTHERS AND FOR OUR NEWBORNS!
THEY NEED US TO BE HEALTHY TOO.