Using Personal Reflective
Debrief To Promote
Resilience from
Compassion Fatigue
Madeline Schmidt, MSN, APNP
Marquette University
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Presentation Objectives
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Problem in healthcare-Compassion fatigue
Literature synthesis
My capstone project
Implications for future projects
Compassion Fatigue
• Occupational hazard of providing empathetic,
relationship-based care is compassion fatigue
• Comprised of compassion satisfaction, secondary
traumatic stress and burnout
• Nurses are at high risk of development based on internal
and external stresses as well as compassionate care
(Berg, Harshbarger, Ahlers-Schmidt, & Lippoldt, 2016;
Duffy, Avalos, & Dowling, 2014)
Literature Synthesis
• Repeated exposure to chaos, high acuity patients, workplace
violence, trauma and death can be challenging and
emotionally draining
• All healthcare providers should receive prevention and
treatment and support should be normal and not a weakness
• “Millennial” generation more likely to experience burnout
than “baby boomers”
• Professional Quality of Life (ProQOL) survey was most widely
way to assess compassion fatigue in nurses
(Flarity, Gentry, Mesnikoff, 2013; Hinderer, et al,
2014; Hunsacker, Chen, Maughan & Heaston, 2014;
Kelly, et al., 2015; Sacco, Ciurzynski, Harvey &
Ingersoll, 2015).
Coping Strategies in Literature
• Education, meditation and debrief have all been
discussed in the literature as ways to prevent the
emotions of compassion fatigue
• Resilience is the ability to cope successfully
despite adversity; it is a dynamic and modifiable
process
(Earvolino-Ramirez, 2007;
Flarity, Gentry, Mesnikoff, 2013; Hevezi, 2015; Polk,
1997; Potter, et al., 2013)
Theory:
Stress process model (Pearlin, 1989)
http://www.bjmp.org/content/psychologicaldistress-carers-people-mental-disorders
(Pearlin, 1989)
Theory of Resilience
(Polk, 1997)
Personal Reflective Debrief
• Structured debrief
o Proactively
o Personal Goals
• Personal reflection
o Learning about self
o Coping mechanisms
• Social support
o Supporting and learning as a team
(Earvolino-Ramirez, 2007;
Flarity, Gentry, Mesnikoff, 2013; Hevezi, 2015;
Polk, 1997; Potter, et al., 2013)
International Association of
Trauma Professionals (IATP)
• Certified Compassion Fatigue Professional (CCFP)
DNP project proposal:
Objectives and goals
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Evaluate levels of compassion fatigue
Implement personal reflective debrief sessions
Reassess levels of compassion fatigue
Analyze and disseminate findings
Site Information
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Level 2 trauma center
25 bed emergency department
Midwestern hospital
Urban environment
High acuity/high volume
62 nurses (both Full and Part time)
Key Stakeholders
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Manager
Director
Charge nurses
Staff nurses
Resources and Budget
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Creation of intervention- part of course work
International Review Board- in kind
Staff time-in kind
Conference room space
Access to unit manager
Fliers- $25
Food-$200
Statistician- in kind
DNP Project:
Methods
• IRB approval (December 2016)
• Create survey link (December 2016)
• Set up dates for personal reflective debrief sessions
(January 2017)
• Advertise through emails and fliers (January 2017)
• Send out initial ProQOL survey (January 2017)
Generate:
Baseline Needs Assessment
• Professional Quality of Life Scale (ProQOL)
• Validated and Reliable
• Balance between symptoms of:
o compassion satisfaction
o secondary traumatic stress
o burnout
• Gives overall compassion fatigue score.
• (Stamm, 2016)
Survey Demographics
Sample demographics of nurses who completed ProQOL survey
Variable
Pre % (n=32)
Age
20-25
15.63% (n= 5)
26-30
21.88% (n=7)
31-35
15.65% (n=5)
36-40
31.25% (n=10)
41-45
6.25% (n=2)
46 or older
9.38% (n=3)
Post% (n=18)
16.67% (n=3)
22.22% (n=4)
11.11% (n=2)
44.44% (n=8)
0% (n=0)
5.56% (n=1)
Gender
Male
Female
15.63% (n=5)
84.38% (n=27)
27.78% (n=5)
72.22% (n=13)
Years worked in the ED
0-5 years
6-10
11-15
Over 15
46.88% (n=15)
25.0% (n=8)
18.75% (n=6)
9.38% (n=3)
61.11% (n=11)
11.11% (n=2)
27.78% (n=5)
0% (n=0)
Highest degree completed
ADN
BSN
MSN
18.75% (n=6)
78.13% (n=25)
3.13% (n=1)
33.33% (n=6)
61.11% (n=11)
5.56% (n=1)
Implement:
Personal Reflective Debrief
• Implement the personal reflective debrief sessions
(February 2017)
• Debrief
o Individual story, group support
• Reflection
• Coping mechanisms
• Thank you to nurses
Reassess:
Pre- and Post- Intervention Results
Mean Scores Pre-Test
Mean Scores Post-Test
Secondary
Compassion Traumatic
Satisfaction Stress
Burnout
High
(Over 42)
Average
(23-41)
Low
(22 or
below)
37.0
Secondary
Compassion Traumatic
Satisfaction Stress
Burnout
High
(Over 42)
Average
(23-41)
23.2
22.0
37.4
Low
(22 or
below)
23.4
24.8
(Stamm, 2010)
Survey Results:
Compassion Satisfaction
20-25
46+
26-30
31-35
36-40
41-45
Survey Results:
Secondary Traumatic Stress
20-25
46+
26-30
31-35
36-40
41-45
Survey Results:
Burnout
20-25
46+
26-30
31-35
36-40
41-45
Results:
Narrative Notes - Themes
• Leadership support
o Break room (aromatherapy)
o Praise and recognition
• Co-Worker support
o Smaller group sessions
o After shift intervention
• Individual coping mechanisms
o Positive praise
o Support at work and at home
Outcomes
• Strengths
o Ease of implementation
o Social support
o Individualized approach
o Leadership facilitated
• Barriers
o Time: staff and
facilitator
o Participation
o Location
o Short time of project
o Project design
o Self report
Implications
• Evaluation
o Impact
• Findings are consistent
with other studies that
used the ProQOL with
trauma nurses
• APN leadership
o Application
• Next steps
o Longer follow-up
o More time between
interventions
o Different measurement
tool
o Other nursing subsets
• Dissemination
• Sustainability
(Berg, 2016; Flarity et al, 2013; Hinderer et al., 2014; Hevezi, 2015;
Hunsacker,2015; Potter et al., 2013).
Questions
References
• Berg, G., Harshbarger, J., Ahlers-Schmidt, C., & Lippoldt, D. (2016).
Exposing compassion fatigue and burnout syndrome in a trauma team: A
qualitative study. Journal of Trauma Nursing, 23(1), 3-10. doi:
10.1097/JTN.0000000000000172
• Duffy, E., Avalos, G., Dowling, M. (2014). Secondary traumatic stress among
nurses: a cross sectional study. International Emergency Nursing, 23,53-58.
doi: 10.1016/j.ienj.2014.05.001
• Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing
Forum, 42(2), 73-82.
• Flarity, K., Gentry, J., & Mesnikoff, N. (2013). The effectiveness of an
educational program on prevention and treating compassion fatigue in
emergency nurses. Advanced Emergency Nursing Journal, 35(3), 247-258.
doi: 10.1097/TME.0b013e31829b726f
• Hevezi, J. (2015). Evaluation of a meditation intervention to reduce the
effects of stressors associated with compassion fatigue among nurses.
Journal of Holistic Nursing, XX (X), 1-8. doi: 10.1177/0898010115615981
References cont.
•Hinderer, K., VonRueden, K., Friedmann, E., McQuillan, K., Gilmore, R.,
Kramer, B. (2014). Burnout, compassion fatigue, compassion satisfaction, and
secondary traumatic stress in trauma nurses. Journal of Trauma Nursing,
21(4), 160-169. doi: 10.1097/JTN.0000000000000055
•Hunsacker, S., Chen, H., Maughan, D., & Heaston, S. (2014). Factors that
influence the development of compassion fatigue, burnout, and compassion
satisfaction in emergency department nurses. Journal of Nursing Scholarship,
47(2), 186-194. doi: 10.1111/jnu.12122
•Pearlin, L. (1989). The sociological study of stress. Journal of Health and
Social Behavior, 30(3), 241-256.
•Potter, P., Deshields, T., Allen, J., Clarke, M., Olsen, S., Chen, L. (2013).
Evaluation of a compassion fatigue resiliency program for oncology nurses.
Oncology Nursing Standard, 40(2), 180-187.
•Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID:
ProQOL.org.