Burnout, Compassion Fatigue and Moral Distress Flashcards
1
Q
Define burnout
A
- Emotional exhaustion
- Depersonalization
- Low personal accomplishment (feeling ineffective)
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
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
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
5
Q
Team Symptoms and Signs of Burnout
A
- Low morale
- Conflicy
- High job turnover
- Impaired job performance
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
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
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
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
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)
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
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
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
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
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
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
- Ability to notice and observe sensations, thoughts and feelings even if unpleasant
- Ability to lower tendency to respond reactively
- Enhanced ability to react with awareness and intention
- 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
