Friday, 22 February 2019
Oncology care is advancing at a rapid pace, enabling treatment of more complex diagnoses, more elderly patients, and a growing number of patients. For the oncology nurse, this is both an exciting time but also strenuous with the increasing level of patient acuity and numerous learning demands as treatment develops. These are factors that can lead to compassion fatigue, generally defined as an exhaustion result from caring for patients experiencing various degrees of suffering. Negative effects of compassion fatigue include physical symptoms such as nausea, headaches, and insomnia, to psychological distress such as depression or anxiety. Studies have demonstrated that oncology nurses are at increased risk for compassion fatigue compared to other specialties. Poor working conditions (increased worked hours, less break time or inability to care for own personal needs) with secondary traumatic stress and burnout. However, these experiences can be ameliorated by a supportive environment. A strong need to combat compassion fatigue exists, and nurse managers must understand the implications and barriers to creating supportive work environments for oncology nurses. First, assessing or compassion fatigue and compassion satisfaction is crucial, which can be done by using the Professional Quality of Life (ProQOL®) scale. This project used this tool implemented in two phases with the goal of providing a Compassion Fatigue Toolkit for oncology nurses working on two units at an urban teaching hospital. The ability to perform self-care or self-compassion can reduce burnout, but must be facilitated and supported by nurse managers to enable nurses to provide compassionate care. Creating an environment that ameliorates high-risk satisfaction scores is crucial in preventing nursing burnout. This project was implemented in two phases with the goal of providing a Compassion Fatigue Toolkit for oncology nurses working on two units at an urban teaching hospital in Pittsburgh, Pennsylvania. Four surveys were used to assess compassion fatigue and satisfaction, self-care practices, and barriers to self-care. The first tool used was the ProQOL®, the second was a unique to this project, the third assessed use of the toolkits, and the fourth was a free-response focus group questionnaire. Nurses completed surveys on self-care practices and work environment to create personalized toolkits. These included unique resources available to each unit, suggestions for self-care, as well as institutional resources within the hospital organization. The toolkits were freely available and located in the nurses station. The project received a total of 12 responses from Unit 1 (N= 35) and 20 responses from Unit 2 (N= 38) for the ProQOL® survey, 19 responses from Unit 1 and 23 responses from Unit 2 for the second survey, and 8 responses from Unit 1 and 12 responses from Unit 2 for the third survey. Due to low response rates, statistical analysis was not carried out. The low response rate and low utilization rates yielded from the third survey prompted the open discussion questions completed by a focus group of 10 staff nurses. These responses were analyzed thematically. Responses to the open discussion questions fell into four main categories: Leadership, Work Schedule, Acuity and Staffing, and Personal Barriers. Respondents felt that a lack of support for off-shifts and time off work negatively impacted self-care. Self-care activities were limited by difficulty accessing services if it required significant ravel from home, in addition to balancing working long, rotating shifts. High acuity and poor staffing required nurses to work additional hours, leaving little time for self-care or toolkit utilization. Most often, nurses reported feeling guilty for performing self-care and self-compassion activities that impacted their time with their friends and loved ones. Although the initial goal of this project, to create a self-compassion toolkit that could improve compassion fatigue scores among oncology nurses, was unsuccessful, it did create relevant insights into challenges that oncology nurses face. The main barrier categories, leadership, work schedule, acuity and staffing, and personal life, prevented nurses from accessing the toolkit and utilizing the available resources. The results of the project are limited by poor response rate and small sample, but the topics yielded during the focus group present implications for oncology nurse leaders, from managers to charge nurses, and even preceptors. Combatting compassion fatigue and burnout must incorporate the input and opinions of the frontline staff, who can create a positive atmosphere and positive change through shared decision making. Nurse managers must balance goal setting with relationship building to understand staff needs. They also can enlist the help of informal leaders to role model positive coping, work-life balance, and professional practice. This project demonstrates that top-down solutions that are not implemented through a consensus with the staff are not easily adopted. Future interventions to improve satisfaction should be developed with an engaged team with goals to have safe workloads and clear expectations, enhance the sense of community in the unit, recognize staff achievement, and transparent decision making.