Self-care Flashcards
1
Q
Burnout syndrome
A
- Loss of enthusiasm for work (emotional exhaustion), sense of being overextended and depleted
- Treating people as if they were objects (depersonalization), callous, cynical, or detached responses to work
- Loss of sense that work is meaningful (Low personal accomplishment), sense of being ineffectual and underachieving
Often arises when individuals are under constant pressure
2
Q
Types of burnout
A
Frenetic
- Overinvested
- Working very hard to the sacrifice of personal needs
- Frustrated and distressed by lack of proportionate satisfaction (success, reward, or appreciation)
Under-challenged
- Indifferent as a result of insufficient challenge, stimulation, or meaning from work
Worn-out
- Neglectful due to being overwhelmed by too much work stress and lack of proportionate satisfaction (success, reward, or appreciation)
3
Q
Symptoms and signs of burnout
A
Individual
- Overwhelming physical/emotional exhaustion
- Feelings of cynicism or detachment
- Sense of ineffectiveness and lack of accomplishment
- Avoidance of emotionally difficult clinical situations
- Irritability and hypervigilance
- Interpersonal conflicts - overidentification or overinvolvement
- Perfectionism and rigidity
- Poor judgment (boundary violations)
- Social withdrawal
- Numbness and detachment
- Difficulty in concentrating
- Questioning the meaning of life
- Questioning prior religious beliefs
- Sleep problems, intrusive thoughts, nightmares
- Addictive behaviours
- Frequent illness (often non-specific)
Team
- Low morale
- High job turnover
- Impaired job performance (decreased empathy, increased absenteeism)
4
Q
Contributors to burnout
A
- Workload
- Control and training
- Sense of personal control over patient care, team dynamics
- May be particularly exacerbated by clinicians with inadequate training particularly around interpersonal skills, specific palliative care skills, and management of compassion fatigue
- Extrinsic factors include work conditions, scheduling, etc. - Interprofessional/Team conflict and issues
- Values
- Greater burnout seen in oncologists who do not value psychosocial aspects of care and relief of physical/psych/spiritual distress (as opposed to curative treatments)
- Moral distress when duties conflict with values
- Distress from an unattainable standard - Reward
- Limited or inadequate financial rewards, or institutional recognition/respect - Emotion-work variables
- Clinicians must be able to emotionally engage while at the same time, not being overwhelmed by suffering or grief - Extrinsic factors (family, financial, social, etc.)
- Personality factors
- Overinvested, highly motivated individuals at higher risk - Age
- Younger caregivers more likely to be burned out - Gender
- Conflicting results
5
Q
Measures to prevent burnout and compassion fatigue: Personal wellness strategies
A
- Adequate sleep, nutrition, exercise
- Relaxation built into the day (meditation, massage, deep breathing, etc.)
- Engaging regularly in a non-work related activity
- Supportive and enjoyable relationships with friends/family
- Good work-life balance to defuse work-related tensions
- Monitor oneself for tendency to become overinvolved
- Finding and allowing adequate personal time to grieve losses that come with losing a patient
- Self-awareness techniques (mindful communication or reflective writing)
- Specific set of coping skills, stress management, etc. to deal with daily challenges
- Psychotherapy or spiritual care as needed, particularly in the case of strong emotional reactions or if reminded of personal losses frequently
- Attending to one’s spiritual needs and developing a philosophy of care that provides personal meaning and purpose
6
Q
Measures to prevent burnout and compassion fatigue: Professional Development Strategies
A
- Remember who own’s the problem (don’t make the patient’s problems your own)
- Learn to handle conflict effectively
- Training in communication skills
- Maintain a high level of clinical competence and familiarity with guidelines
- Engaging in peer consultation
- Assertiveness skills (set limits, say no, ask for what you need)
- Clear and consistent to maintain boundaries around vacations, time on call, sustainable workload
- Diversifying one’s workload so that not all professional time involves care to the most distressed patients
- Con ed
- Focusing on positive aspects of one’s own and patient’s experiences
7
Q
Measures to prevent burnout and compassion fatigue: Organizational strategies
A
- Adequate resources for the job (supervision, con ed, days off, benefits, positive work environment)
- Scheduling that accommodates work/life balance
- Comforting/soothing physical settings
- Encouraging and supporting choice and control, promoting fairness/justice in the workplace
- Appropriate recognition and reward
- Supportive work community
- Adequate supervision and mentoring
- Respect for the work performed by PC clinicians
- Regular discussions of challenging cases where all team members are encouraged to contribute in a safe, supportive environment
- Mindfulness-based stress reduction for team
8
Q
Compassion Fatigue
A
- Emotional impact of working with people involved in traumatic life events
- May be a form of PTSD
9
Q
Symptoms of Compassion fatigue
A
- Strong emotions (guilt, sadness, anger)
- Intrusive thoughts/nightmares
- Avoidance
- Feeling numb or frozen
- Feeling isolated or personally responsible
- Mistrust of others
- Increased or decreased sense of power or control
- Cynicism
- Withdrawal from the larger treatment team or personal relationships
- Detachment from emotional situations
- Irritability
- Overidentifying with others distress
10
Q
Strategies to mitigate compassion fatigue
A
- Exquisite empathy (highly present, attuned, well-boundaried, heartfelt empathic engagement)
- Resilience (post traumatic growth and finding the positive in others experiences of trauma)
- Grieving strategies (departmental memorial services, journalling, attending a funeral)
- Mindfulness
- Wellness
11
Q
Moral distress
A
- Stress reaction characterised by frustration, anger, anxiety
- Occurs when someone knows what is ethically correct but is constrained in acting in accordance with their convictions
Examples:
- Clinical decisions (continued life support when not in the best interest, Full Code requests by terminally ill patients. etc.
- Communication issues (false hope, inadequate information)
- Resources (Interests of the organization override that of the patient due to limited resources or availability)
- Lack of staff time (staff time spending time on admin activities rather than patient care)
- Rules and regulations (When rules constrain a clinician in acting in their best judgment)
12
Q
Management of moral distress
A
- Forums to discuss ethically troubling situations
- Open and interactive approach to moral conflict
- Careful attention to team dynamics
- Evaluation of whether constraining factors can be changed and how one might engage with these
- Flexibility in re-conceptualizing a problem to maintain a sense of control and understand the differences in reasoning through ethical dilemmas (e.g. patient has a right to be a no code)
- Insight that compromising comes from a place of strength
13
Q
Mindfulness skills
A
- Notice and observe sensations, thoughts, and feelings (even if unpleasant)
- Ability to lower one’s tendency to respond reactively to emotionally charged experiences
- Enhanced ability to react with awareness and intention rather than being on reactive autopilot
- Focussing on the experience, not the labels or judgments we apply to them (feel the feeling, don’t label right or wrong)
14
Q
Mindful practice in medicine (four qualities)
A
- Attentiveness
- Observe without making judgments that distort ability to understand - Critical curiosity
- Ability to open up to possibilities, rather than premature closure - Informed flexibility (‘beginner’s mind)
- Adopt a fresh perspective of consider more than one perspective simultaneously rather than taking a single fixed view - Presence
- Being there physically, mentally, and emotionally for patients
15
Q
Reflective writing
A
- Diarize challenging/rewarding clinical encounters
- Record personal thoughts and objective clinical data - Share and explore narratives in small group discussions or in one on one debriefing
- Focus upon a reflective/evaluative approach to understanding one’s thoughts, thought processes, feelings, and responses
Aim - foster better self understanding and mindfulness skills
16
Q
Human rights laws relevant to Palliative Care
A
- Right to health
- Right to dignity (promotion of dignity of the individual patient)
- Right not to be subjected to inhuman or degrading treatment (promotion of appropriate treatment, pain management with opioids, etc.)
- Right to non-discrimination and equality (equal access to palliative care services to all)
- Right to seek, receive, and impart information (access to information on palliative care, palliative treatments, etc.)
- Rights of all children to access health care
- Right to health in older persons
17
Q
Counter arguments to pain management and palliative care being basic human rights
A
- Individual human rights do not supersede that of the collective
- A right to palliative care cannot be separated from a general right to health - many aspects of health are inadequately addressed and palliative care must be implemented along with other public health measures (adequate food, housing, etc.)
18
Q
Practical application of a human rights perspective of palliative care:
A
- Does the nation have pain/palliative care policies?
- To what extent are opioids available and accessible for those receiving palliative care?
- Does the nation report their annual opioid requirements for medical purposes to the International Control Board, and are these reports commensurate with need?
- Are health professionals educated in management of patients with life-limiting illness and safe/appropriate use of opioids?
- Are palliative care services integrated across all levels of healthcare?
19
Q
Confidentiality: Definition
A
- Goal is to maintain confidence/trust in the relationship between patient and provider
- Confidentiality is practices and behaviours strengthening the trust and confidence between patients and HCPs, with special attention to the use of any and all information disclosed by/obtained from patients during their care
20
Q
Benefits of respecting confidentiality
A
- Patient has more trust and confidence, more likely to adhere to treatments
- Disclosures are more likely to be honest when a patient can trust the care provider, leading to optimal patient outcomes and improved patient safety
- Respects integrity and personhood
