Burnout, Compassion Fatigue and Moral Distress Flashcards

1
Q

Define burnout

A
  • Emotional exhaustion
  • Depersonalization
  • Low personal accomplishment (feeling ineffective)
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2
Q

Opposite of Burnout : Job engagement

A
  • energy, involvement and efficacy in workplace
  • sense of professional competence, pleasure and control
  • appropriate recognition/reward
  • supportive work environment
  • able to cope with challenges
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3
Q

List and describe three types of burnout

A
  • Frenetic
    • overinvested, works extremely hard to sacrifice of personal needs
    • lack of proportionate satisfaction
  • Under challenged
    • indifferent, lack of stimulation or meaning
  • Worn-out
    • overhwhelm from stress
    • lack of appropriate reward or appreciation
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4
Q

Individual Symptoms and signs of Burnout

A

Individual

  • overwhelming exhaustion
  • cynicism
  • detachment
  • sense of ineffectiveness
  • irritability
  • hypervigilance
  • interpersonal conflicts
  • perfectionism / rigidity
  • poor judgment
  • social withdrawal
  • numbness
  • difficulty concentration
  • questioning the meaning of life
  • sleep problems (intrusive thoughts, nightmares)
  • addictive behaviours
  • frequent illness
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5
Q

Team Symptoms and Signs of Burnout

A
  • Low morale
  • Conflicy
  • High job turnover
  • Impaired job performance
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6
Q

Factors that contribute to burnout

A
  • Workload
  • Control and training
    • intrinsic : lack on traning, competence
    • extrinsic: work conditions, scheduling, patient load, vertical hierarchy
  • Interprofessional team issues
    • strong hierrarchy
    • stifled expression of concern
  • Values
    • degree of congruity between personal values and values of work environment
  • Reward
  • Emotion work variables
    • ability to cope with grief, compassion fatigue, boundaries
  • Extrinsic factors
    • personal, family
  • Personality factors
    • over investment in work = burnout
    • low awareness of own physical and emotional needs
    • psychology of postponment
    • exaggerated sense of responsibility, doubt and guilt
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7
Q

Epidemiology of burnout

A
  • palliative care does not have more or less burnout that other health professionals
  • possibily lower burnout that other specialties
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8
Q

Consequences of burnout

A
  • poorer quality of care
  • lower empathy and compassion
  • lack of professionalism
  • increased risk of medical error
  • higher endorsement of euthanasia
  • depression
  • substance abuse
  • leave clinical practice
  • suicide
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9
Q

List factors that mitigate burnout

A
  • Attitudes and values
    • make the most out of life and relationships
    • forgiving of themselves and colleauges
    • flexibility and compromise
  • Strong team work
  • Resilience
  • Control
  • Training / competence
  • Use of wellness strategies
  • Spirituality and meaning
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10
Q

Define and describe components of resilience

A
  • Sense of commitment, control and readiness to meet and cope with challenges
  • Sense of coherence:
    • one’s life being comprehensible (cognitively meaningful and predictable)
    • manageable
    • meaningful (problems are inevitable challenges and not hindrances)
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11
Q

Personal wellness strategies to prevent burnout and compassion fatigue

A
  • sleep, nutrition, exercise
  • relaxation daily
  • non work related activities
  • develop relationships outside of work
  • balance between work and home
  • monitor for tendency to be over involved
  • personal time to grieve patients
  • mindful practice
  • reflective writing
  • develop specific coping skills
  • psychotherapy
  • attending to on’e spiritual needs
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12
Q

Professional development strategies for prevention of burnout

A
  • do not own patient’s suffering
  • conflict management
  • communication skills training
  • high level of knowledge with established clinical guidelines
  • Peer consultation
  • set limits, say no
  • set boundaries
  • diversifying one’s workload
  • continuing educational activties
  • finding and focusing on positive features of experiences
  • connecting regularly with respectful team of professionals
  • develop an approach/philosophy to dealing with end of life / death
  • identify 1-2 difficult scenarios and proactively plan responses
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13
Q

Organizational strategies for preventing burnout and compassion fatigue

A
  • adequate resources
  • scheduling
  • physical work spaces adequate
  • supporting choice and control
  • promoting fairness and justice in workplace
  • appropriate recognition and reward
  • supportive work community
  • adequate supervision and mentoring
  • space for personal items that anchor clinicians to lives outside of work
  • atmosphere of respect
  • open discussion of compassion fatigue
  • ethos of colaborative care
  • regular discussion of challenging cases
  • mindfulness stress reduction practices
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14
Q

What is Compassion Fatigue?

A
  • Emotional impact of working with people who have traumatic life events
  • “cost of caring”
  • secondary or vicarious traumatization
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15
Q

Symptoms of compassion fatigue

A
  • similar to PTSD
  • hyperarousal
  • disturbed sleep
  • hypervigilance
  • avoidance
  • anger, strong emotions
  • cynicism
  • somatic complaints
  • instrusive thoughts
  • detachment or over involvement
  • splitting “good-bad” polarization
  • increased sense of personal responsibility
  • mistrust of others
  • withdrawal
  • saviour syndrome
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16
Q

Strategies to mitigate compassion fatigue

A
  • good professional boundaries not enough
  • exquisite empathy
    • highly present, heartfelt empathic engagement
    • self boundaried
    • self awareness, mindful communication skills
  • Resilience
    • compassion satisfaction
    • post traumatic growth
    • expanded world view
  • grieving strategies
  • mindfulness strategies
17
Q

Post traumatic growth

A
  • positive changes in sense of self, philosophy of life
  • subsequent to direct experiences of traumatic event that shakes the foudnation of individual’s worldview.
  • own life is enriched, deepened by witnessing patient’s / family’s post traumatic growth
  • healing connections by involvement in patient’s experience of meaning and peacefulness relating to death.
18
Q

Describe moral distress

A
  • stress reaction
  • frustration, anger, anxiety
  • individual has conviction of what is ethically correct, but is constrained from acting in accordance with their convictions.
19
Q

Sources of moral distress in palliative care

A
  • Clinical decisions
    • over aggressive interventions, continued life support, nihilistic care, inadquate sedation or pain relief
  • Communication issues
    • false hope, poor communication
  • Resources
  • Lack of staff time
  • Rules and regulations
20
Q

Management of moral distress

A
  • Organizational
    • norms
    • support resources
    • team work
  • Individual
    • training to recognize moral distress
    • training in ethical decision making
    • coping and flexibility
    • more than one way
21
Q

Self awareness strategies for prevention of burnout, compassion fatigue and moral distress

A
  1. Ability to notice and observe sensations, thoughts and feelings even if unpleasant
  2. Ability to lower tendency to respond reactively
  3. Enhanced ability to react with awareness and intention
  4. Focus on experience, not labels or judgment
22
Q

Describe 4 qualities of mindful practice

A
  • attentiveness
  • critical curiosity
  • informed flexibility (beginner’s mind)
  • Presence

Allows clinicians to respond to challenging situations with more flexibility, sensitivity and less reactivity, more forgiving of themselves and others, greater empathy.

23
Q

Self awareness practices

A
  • reflective writing
  • sensation awareness
  • centring actions (breathing, meditation)
  • rewards after task completion
  • poem or reflection at rounds
  • check in with loved ones
  • multitask self care (treadmill while dictation)
  • deliberately make connections
  • field notes on meaningful or traumatic encounters and events, share this material at rounds
  • role-shedding ritual at the end of the day.
24
Q

Reflective writing

A
  • diary of challenging or rewarding clinical encounters
  • record thoughts
  • objective clinical data of narrative
  • can be shared in small group discussions or one-on-one supervision/debriefing
  • discussion facilitate reflective / evaluative approach to understanding one’s thoughts, processses, feelings and responses.
  • fosters self understanding
  • fosters mindfulness
  • Description, reflection, action