January 3, 2012

Contact:
Kathyrn Holleman
314-286-0303
[email protected]

ST. LOUIS - Caring for others has a cost.

“Oh, yeah. That’s why I got out of it,” says a former oncology nurse at Barnes-Jewish Hospital. The nurse, who remained anonymous, worked on an inpatient oncology floor. Many of her patients fought aggressive, relentless cancers during multiple hospital admissions.

“You’d become attached to them and you knew what their outcome was likely to be,” she said. “They’d deteriorate and die and it would break your heart. It happened over and over again. It was very stress-producing.”

The nurse eventually moved to another position in the hospital that didn’t involve direct patient care.

A new program at Barnes-Jewish Hospital aims to reduce stories like this one by helping staff alleviate “compassion fatigue.” The program, developed specifically for the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine by a pioneer in the field of compassion fatigue, is unique in the U.S., say program coordinators.

After a successful pilot program for oncology nurses, staff in other areas such as the emergency department and intensive care units, began attending compassion fatigue classes this fall. Classes will be available for staff throughout the hospital in 2012, says Patricia Potter, RN, PhD, FAAN, director of research for patient care services.

The initiative grew out of concerns from nurse managers of several oncology units that staff, especially nurses, were becoming chronically stressed and burned out. Turnover on the units was high. Three nurse managers approached Potter and Teresa DeShields, PhD, for help in 2009.

Potter and Deshields, manager of psycho-oncology services, started by surveying nurses, managers, patient care technicians and respiratory therapists on those oncology units. A little more than 150 people responded.

The survey measured burnout and secondary traumatic stress. Secondary traumatic stress, says Potter, comes from caring for people who are experiencing trauma. Repeated exposure to patients’ loss, pain and suffering can lead to similar feelings in the care providers. It’s a built-in job hazard for care providers, she says.

“There’s a quote by [Holocaust survivor and psychologist] Viktor Frankl: ‘What is to give light must endure burning,”’ she says. “I think people who care for others understand. Caregiving is painful.”

The problem comes when the pain manifests itself in symptoms that include feelings of inadequacy as a caregiver, the inability to let go of work-related issues, loss of hope, lack of energy and irritability. If unchecked, symptoms may even encroach into the caregiver’s private life and result in physical and emotional problems.

But it’s not just the individual staffer who suffers from compassion fatigue, says Potter. Burnout and secondary traumatic stress can lead to high turnover, absenteeism, difficulty retaining staff and decreased work satisfaction. This in turn is associated with decreased patient satisfaction.

Results from the oncology staff survey indicated that burnout and secondary traumatic stress was high enough to warrant an intervention.

Formulating a program

With approval from Barnes-Jewish Hospital administration, Potter, DeShields and a committee of nurse managers and others worked with Dr. Eric Gentry to develop a pilot compassion fatigue program. Gentry, a certified traumatologist, is a pioneer in the field of compassion fatigue and does ongoing work with caregivers and first responders to victims of incidents such as the Oklahoma City bombing and 9/11, says Potter.

Working with Gentry, the committee devised a compassion fatigue pilot program for a small group of oncology staff. The first group of 14 went through the program in 2010.

Based on participant evaluation, the program results were very encouraging. The committee then proceeded to approach the Foundation for Barnes-Jewish Hospital to fund development of a compassion fatigue program for the entire hospital staff, beginning with a special “train the trainer” session.

A number of factors – being a large academic medical center caring for high acuity patients; being a regional time-critical diagnosis referral center, being near an underserved urban population – make Barnes-Jewish a prime site for compassion fatigue among staff members throughout the facility, says Potter.

The Foundation for Barnes-Jewish Hospital agreed and granted funding for the initiative. The initial “train the trainer” course was held in summer 2011. Sessions for emergency department and other clinical units is underway now to the end of the year with bi-monthly sessions open to all staff throughout 2012.

The course formulated by Gentry and the committee for the Barnes-Jewish staff endeavors to teach participants the skills they need to alleviate physical, mental and emotional stress and reconnect or rediscover the reasons they became caregivers.

Where “once-in-a-lifetime” is every day

Chaplain Cheryl Palmer, manager of Barnes-Jewish spiritual care services, participated in the “train the trainer” session.

The sessions offer techniques that might seem simple, but are rooted deep in each participant’s physiology and identity, Palmer says.

For instance, participants are taught to recognize when they feel tense and how to relax their body while engaged in the activities that cause them stress. Learning to totally relax their body is a way to achieve self regulation.

“When you’re angry or scared, you defensively tighten up,” Palmer says. “Learning to relax helps you move to a different place.”

That place, she says, is one in which participants learn they can be more intentional and make better decisions about their work and their relationships with others.

Participants also engage in an exercise that involves sharing the reasons they went into healthcare or chose to work at Barnes-Jewish.

“It’s a reminder of what brought you here in the first place,” she says. “It’s about sharing your fundamental values. That you’re doing this to relieve suffering, or to give hope. It’s powerful. As they remember, people can get teary.”

The compassion fatigue program is not just for clinical people, but all staff, including chaplains, housekeepers, security personnel, even public relations people – anyone who interacts with patients, families or other caregivers regularly.

Because of the size, location and services offered at Barnes-Jewish, an abnormally large proportion of intense experiences – birth, death, trauma, dire illness, dramatic procedures – happen here in disproportionately large numbers. What some people may experience only once or twice in lifetime happens at Barnes-Jewish daily, Palmer says.

“What happens here can really fry you,” she says. “And that’s for anyone who witnesses it.”

But at the same time, being able to help a patient through one of these stressful times, to help them recover, to comfort their family, to change lives and to witness people lives being changed can be immensely moving and fulfilling, she says.

“It’s more than a job. It’s a calling for some people to work in healthcare,” she says. “To feel so bad they have to leave the profession they love is like an injury to the mind and spirit.”

With buy-in from hospital leadership and a commitment to sustain the initiative and extend it to all employees, the compassion fatigue program has the potential to prevent situations like that of the oncology nurse who gave up patient contact, Palmer says.

“I’m so happy we’re doing this as an institution,” she says.