The Effect of an Educational and Self-Care Intervention on Compassion Fatigue Among Oncology Nurses Jeannie Wirth, RN, MSN, AOCN, CNS Cindy Hallman, RN, BSN, CMSRN Kelly Kuhns, PhD, RN

Problem statement Oncology nurses are eyewitness to patients’ experience of physical, psychosocial, and spiritual distress Develop long-term and close relationships with patients and families and may not anticipate the negative consequences to self that may emerge from repeated exposure to patient distress and death (Aycock 2009; Walton 2010)

Definition Figley (1995) described CF as a form of post- traumatic stress disorder in which caregivers develop a secondary trauma by becoming affected during repeated care of patients experiencing a traumatic event. Boyle (2011) defined the difference from burnout in that burnout arises when assertiveness-goal achievement intentions are not met, while compassion fatigue evolves when rescue-caretaking strategies are unsuccessful leading to caregiver feelings of distress and guilt.

Measuring Compassion Fatigue Professional Quality of Life tool (Pro-QOL) has been found to have strong reliability and validity Three subscales Compassion Satisfaction Burnout Secondary Traumatic Stress

Summary of Existing Literature Strong evidence that oncology nurses experience compassion fatigue as measured by the Professional Quality of Life (Pro QOl) Scale. The ProQOl scale is the most commonly applied measure of the effects of suffering and trauma on nurses.

Summary of Existing Literature Lack of high quality experimental studies that investigate the effectiveness of specific interventions in preventing and treating compassion fatigue. Experimental research is needed to validate the effectiveness of interventions in preventing and relieving compassion fatigue in oncology nurses.

Self Care Plans for the Caregivers

Study Design Randomized controlled trial Oncology nurses from a single institution were recruited and consented to participate Subjects were randomly assigned to the treatment or control groups Treatment group received two 3.5 hour education sessions, eight weeks apart Control group engaged in a single one hour discussion All subjects completed the Pro-QOL and demographic tool at the start of their initial session All subjects completed the Pro-QOL eight weeks after their initial session

Overall Goals of the Educational Session Acknowledge risk for compassion fatigue. Develop and enact (with intention) self- identified self-care interventions for a minimum of 30 minutes, three times per week for eight weeks.

Specific Learning Objectives Compare and contrast CF and burnout Discuss characteristics of oncology nurses that put them at risk for CF Identify interventions to manage CF Develop a “self care plan” with specific interventions Implement “self care plan”

Sessions: Tell Your Story – 2 purposes: to help participants get to know each other and to help participants remember why they became an oncology nurse Sessions were specifically designed to encourage interaction and discussion Included reflection exercises, participation in relaxation exercises and watching motivational videos (Simple Truths)

Why are Oncology Nurses’ Risk for CF Empathy and caring are the foundation for Oncology Nursing! Empathic listening is a “Way of Being”. “The capacity for compassion and empathy seems to be at the core of our ability to do the work and at the core of our ability to be wounded by the work” (Stamm 1999; Figley, 1999)

Discussion of Oncology Nurses Risk for CF 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 through water without getting wet. This sort of denial is no small matter (Rachel Naomi Remen M.D. Kitchen Table Wisdom: Stories That Heal).

How Do I Know if I Have Compassion Fatigue? Frustration and impatience with family, friends and/or issues not deemed as ‘life threatening’ (kicking the dog) Unhealthy life choices Feel fatigued Cranky Picking at each other

Identify the Need for Self-Care Majority of nurses perceive themselves as giving, caring people but find it hard to nurture themselves (Boyle, 2011). May subconsciously feel that taking time for self- care is selfish if it takes away from work-related projects or valuable time with family and friends. Double edged sword – a person who gives selflessly but is vulnerable to the point of self-starvation (Larson and Bush, 2006).

Review of Self-Care Strategies Self Care Strategies for the Physical Body Self Care Strategies for the Social Being Self Care Strategies for the Psychological Self Self Care Strategies for the Spiritual person Resiliency Intentionality & Mindfulness

Self-Care Plan Development Assessment - I am at risk for CF as E/B: ___________________________________________ Intervention – I choose as my intervention ______________________________________________ Implementation - I will use “intention” to perform my self identified interventions. I promise that I will practice my intervention at least 3 times per week by (give specifics) ______________________________________________

Demographics n=33 Primarily female No significant difference between experimental and control groups

Compassion Satisfaction GroupPre- Intervention Post- Intervention Experimental Control ANOVA analysis No significant difference in pre-intervention scores (.895) Significant difference in post-intervention scores (p =.002)

Burnout GroupPre- Intervention Post- Intervention Experimental Control ANOVA analysis No significant difference in pre-intervention scores (p=.662) No significant difference in post-intervention scores (p=.0670)

Secondary Trauma GroupPre- Intervention Post- Intervention Experimental Control ANOVA analysis No significant difference in pre-intervention scores (p=.777) Significant difference in post-intervention scores (p=.010)

Discussion Intervention was successful in improving compassion satisfaction and decreasing secondary trauma but had no effect on burnout Burnout may be influenced by many other factors beyond compassion fatigue

Discussion Participants in the experimental group anecdotally reported that they did not engage in the suggested purposeful self-care May suggest that just acknowledging the existence of compassion fatigue may help to mitigate

Future Directions Significant interest from other units for the compassion fatigue sessions No randomization but will collect pre- and post- intervention data

Jeannie Wirth Contact Info

Selected References Aycock, N. (2009), Interventions to Manage Compassion Fatigue in Oncology Nursing. Clinical Journal of Oncology Nursing, 13,(2) Gentry, E. (2004), Training-as-Treatment: Effectiveness of the Certified Compassion Fatigue Specialist Training. International Journal of Emergency Mental Health, 6(3), Najjar, N. 2(2009) Compassion Fatigue: A Review of Research to Date and Relevance to Cancer-care Providers. Journal of Health Psychology, 14(2), Neville, K. PhD, RN The Relationships Among Health Promotion Behaviors, Compassion Fatigue, Burnout, and Compassion Satisfaction in Nurses Practicing in a Community Medical Center. The Journal of Nursing Administration, 43 (6), Perry, B. (2011), An Exploration of the Experience of Compassion Fatigue in Clinical Nurses. Canadian Oncology Nursing Journal, 21(2), Potter, P. (2013) Developing a Systemic Program for Compassion Fatigue. Nursing Administration Quarterly, 37(4), Yoder, E. (2008) Compassion Fatigue in Nurses. Applied Nursing Research, 23,