Patricia Potter

Compassion Fatigue and Burnout

This descriptive, cross-sectional survey was conducted in inpatient nursing units and outpatient clinics in a cancer center in the midwestern United States. The sample of 153 healthcare providers included RNs, medical assistants, and radiology technicians. The fourth revision of the 30-item Professional Quality of Life (ProQOL R-IV) scale was used for measuring compassion fatigue, compassion satisfaction, and burnout. A series of cross tab analyses examined the relationship between participant demographics and three ProQOL R-IV subscales. The study sample scored similarly on compassion satisfaction and burnout when compared with participants who used the ProQOL R-IV in previous studies. Value exists in analyzing the prevalence of burnout and compassion fatigue among oncology healthcare providers. Understanding the needs of distinct demographic groups offers valuable direction for intervention program development. Applying internal evidence in the design of a relevant stress-reduction program will better equip healthcare providers to recognize and manage compassion fatigue and burnout.

Understanding the Cognitive Work of Nursing in the Acute Care Environment

Objective To combine human factors engineering techniques with qualitative observation of nurses in practice to analyze the nature of nurses cognitive work and how environmental factors create disruptions that pose risks for medical errors. Background Few researchers have examined the nature of nurses cognitive work while in practice with patients. Researchers have described the broad range of thinking processes required in the acute care work setting, but have failed to examine how such processes are conducted and influenced by the complex care environment. A combined research methodology enables researchers to better understand how the nursing process becomes disrupted and the potential influence of this disruption on the safe and effective care of patients. Methods An ethnographic study, using mixed-methodological approaches, involved 7 staff registered nurses. The quantitative and qualitative data collection included field observation and summarative interviews. Findings A high number of cognitive shifts and interruptions, and a nurses cumulative cognitive load, create the potential for disrupting a nurses attention focus during care of patients. A majority of interruptions occurred as nurses performed interventions, particularly medication preparation. Conclusion New attention must be given to how care systems and work processes complement or interfere with nurses cognitive work.

Describing Nurses' Work: Combining Quantitative and Qualitative Analysis

Objective: To better understand nursing activities and working conditions. Background: Nursing practice involves astute clinical decision making and the competent delivery of nursing care procedures. To complete nursing procedures, nurses must simultaneously organize and reorganize priorities and manage changing clinical information for multiple patients. Few researchers have examined the specific nature of nurses activities and the effect of the environment on their work. Methods: Quantitative and qualitative methods were used to collect data on 7 nurses engaged in nursing activities. Examples of methods include link analysis, subject matter expert, task analysis, cognitive pathway, and “stacking.” Data collection focused on how nurses managed priorities, changing clinical information, and interruptions. Results: The “cognitive pathway” graphically depicts the nature of nurses work. Specifically, it reveals the shifting of the nurses attention from patient to patient and the occurrence of interruptions. “Stacking” shows the number of tasks a nurse must balance at any one time. On average, nurses had 10 or more activities waiting to be performed and experienced 3.4 interruptions/hr. Conclusion: These methods provide unique insight into the dynamic nature of patient care and nursing work. Application: Extension of the methods demonstrated here may be useful in guiding efforts to change the work of nursing to better provide quality care and less stressful work environments.

Mapping the Nursing Process A New Approach for Understanding the Work of Nursing

The work of nursing is nonlinear and involves complex reasoning and clinical decision making. The use of human factors engineering (HFE) as a sole means for analyzing the work of nursing is problematic. Combining HFE analysis with qualitative observation has created a new methodology for mapping the nursing process. A cognitive pathway offers a new perspective for understanding the work of nursing and analyzing how disruptions to the nursing process may contribute to errors in the acute care environment.

Evaluation of a Compassion Fatigue Resiliency Program for Oncology Nurses

PURPOSE/OBJECTIVESnTo evaluate a resiliency program designed to educate oncology nurses about compassion fatigue.nnnDESIGNnDescriptive pilot study.nnnSETTINGnA National Cancer Institute-designated comprehensive cancer center in the midwestern United States.nnnSAMPLEn13 oncology nurses employed in an outpatient infusion center.nnnMETHODSnNurses attended a five-week program involving five 90-minute sessions on compassion fatigue resiliency. A pre- and post-test design, using repeated measures, was conducted over six months.nnnMAIN RESEARCH VARIABLESnScores on the Professional Quality of Life (ProQOL) IV, Maslach Burnout Inventory-Human Services Survey, Impact of Event Scale-Revised (IES-R), and the Nursing Job Satisfaction Scale.nnnFINDINGSnLong-term benefits were realized from the program. Secondary traumatization scores on the ProQOL IV declined immediately after the program, remained down at three months, and then dropped again at six months, with a statistically significant mean difference compared with baseline. The average IES-R total scores improved significantly overall and for each of the three postintervention time points. Participants evaluated the program positively with respect to their ability to apply and benefit from resiliency techniques.nnnCONCLUSIONSnThis is the first reported study to show benefits gained from a compassion fatigue intervention program. Participants received useful strategies for managing stress at work and home.nnnIMPLICATIONS FOR NURSINGnCompassion fatigue is a prevalent condition among healthcare providers. Development of resiliency to compassion fatigue may improve decision making, clarity of communication, and patient and nurse satisfaction.nnnKNOWLEDGE TRANSLATIONnSelf-regulation offers an approach to reduce stress during a perceived threat. Working by intention reduces reactivity in the workplace and makes communication more intentional and, therefore, effective.

The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year.

PurposeThe purpose of this longitudinal study was to track the symptom experience in a sample of cancer patients, determine the persistence of cancer symptoms and symptom burden, and examine the relationship between symptoms and QOL over time.MethodsFive hundred forty-two patients provided longitudinal data, completing surveys over a 12-month period. Patients had breast, colorectal, gynecologic, lung, or prostate cancer with stage 1, 2, or 3 disease. Surveys included the Memorial Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General Scale and were administered every 3xa0months. Demographic and clinical information and comorbidities were collected from the tumor registry.ResultsThe number and type of symptoms experienced by patients varied by cancer type, but about 90xa0% of patients reported one or more symptoms—with prostate cancer patients reporting fewer symptoms and colorectal patients, more symptoms. Prostate patients also had the lowest symptom burden at every time point. Overall, symptom burden decreased over time, as did the Physical subscale for the MSAS. Quality of life was stable over time, except for physical well-being, which improved. Quality of life was negatively correlated with symptom burden at every time point.ConclusionsThe differences in symptom experience by cancer type suggest that assessment and management of symptoms must be individually tailored or at least adjusted by cancer type. While symptom burden decreased over time, residual symptom burden was still noteworthy. As quality of life was persistently negatively correlated with symptom burden, the results suggest the need for comprehensive symptom assessment and management.

Psychosocial aspects of caregiving: perceptions of cancer patients and family caregivers.

PurposeThe care of cancer patients involves collaboration among health care professionals, patients, and family caregivers. As health care has evolved, more complex and challenging care is provided in the home, usually with the support of family members or friends. The aim of the study was to examine perceived needs regarding the psychosocial tasks of caregiving as reported by patients and caregivers. We also evaluated the association of demographic and clinical variables with self-reported caregiving needs.MethodsConvenience samples of 100 cancer patients and 100 family caregivers were recruited in outpatient medical and radiation oncology waiting areas—the patients and caregivers were not matched dyads. Both groups completed a survey about their perceptions of caregiving tasks, including how difficult the tasks were for them to do. Demographic information was also provided by participants.ResultsCaregivers reported providing more help in dealing with feelings than patients endorsed needing. Caregivers were also more likely than patients to report the psychosocial aspects of caregiving were more difficult for them. Lastly, caregivers were more likely to report helping with logistical issues in comparison with patients expressing this need. Race, length of time since diagnosis, and age were associated with patients’ expressed needs, while only number of hours spent providing care was associated with the caregivers’ reporting of care activities.ConclusionsOur results suggest that patients may underestimate how difficult caregivers perceive the psychosocial aspects of caregiving to be. Also, it seems that caregivers tend to take on the psychosocial aspects of caregiving, although patients do not tend to report this need. Caregiving needs were only minimally associated with demographic variables, as was participation in caregiving tasks.

Delegation practices between registered nurses and nursing assistive personnel.

AIMnTo understand registered nurses (RNs) and nursing assistive personnels (NAP) perceptions of delegation practices in delivery of oncology patient care.nnnBACKGROUNDnNo research to date describes how RNs and NAP communicate and interact during the delegation process. An understanding of the nature of communication during delegation offers direction for how RNs and NAP can improve collaboration.nnnMETHODnQualitative descriptive study.nnnRESULTSnParticipants described conflict as a central theme during delegation. Sources of conflict varied between RNs and NAP. Successful delegation is characterised by effective communication, teamwork and initiative.nnnCONCLUSIONnSuccessful delegation depends on the quality of RN and NAP working relationships, timely ongoing communication, initiative and a willingness to collaborate.nnnIMPLICATIONS FOR NURSING MANAGEMENTnNurse managers play a key role in the facilitation of delegation practices. Developing clear guidelines for RN and NAP patient reporting and providing opportunities to discuss conflict-related issues is essential. RNs would benefit from acquiring competency in how to conduct reports, resolve conflicts, and how to convey their role in patient care management. Nursing assistive personnel would benefit from developing competency in using effective communication skills for giving feedback, clarifying tasks and patient status and resolving conflict.

Documenting the Symptom Experience of Cancer Patients

BACKGROUNDnCancer patients experience symptoms associated with their disease, treatment, and comorbidities. Symptom experience is complicated, reflecting symptom prevalence, frequency, and severity. Symptom burden is associated with treatment tolerance as well as patients quality of life (QOL).nnnOBJECTIVESnThe purpose of this study was to document the symptom experience and QOL of patients with commonly diagnosed cancers. The relationship between symptoms and QOL was also explored.nnnMETHODSnA convenience sample of patients with the five most common cancers at a comprehensive cancer center completed surveys assessing symptom experience (Memorial Symptom Assessment Survey) and QOL (Functional Assessment of Cancer Therapy). Patients completed surveys at baseline and at 3, 6, 9, and 12 months thereafter. This article describes the studys baseline findings.nnnRESULTSnSurveys were completed by 558 cancer patients with breast, colorectal, gynecologic, lung, or prostate cancer. Patients reported an average of 9.1 symptoms, with symptom experience varying by cancer type. The mean overall QOL for the total sample was 85.1, with results differing by cancer type. Prostate cancer patients reported the lowest symptom burden and the highest QOL.nnnLIMITATIONSnThe sample was limited in terms of racial diversity. Because of the method of recruitment, baseline data were collected 6-8 months after diagnosis, meaning that participants were at various stages of treatment.nnnCONCLUSIONSnThe symptom experience of cancer patients varies widely depending on cancer type. Nevertheless, most patients report symptoms, regardless of whether or not they are currently receiving treatment. Patients QOL is inversely related to their symptom burden.

Developing a systemic program for compassion fatigue.

The effort in hospitals to improve the patient experience has yielded a new impetus to address compassion fatigue (CF), a combination of secondary traumatic stress and burnout. Over the last 3 years, Barnes-Jewish Hospital has developed a systemic program for CF resiliency. An initial evaluation of the extent to which CF was affecting the hospitals oncology staff led to the formal implementation of a resiliency program for oncology registered nurses. The success of that program ultimately led to the implementation of a hospital-wide resiliency program, designed to help professional caregivers understand CF, recognize the physical, mental, and emotional effects of stress, and adopt resiliency strategies. The voluntary program has been very well received by participants, and a formal evaluation shows promising results with a decline in secondary traumatic stress and burnout among participants. Developing an institutional culture of recognition and support for CF is critical for health care organizations. Establishing such a culture may help managers proactively create work environments that provide opportunities for connection and support among staff. Compassion fatigue training allows professional caregivers to reconnect to their personal mission and then truly begin to connect with an organizations values and mission.