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Compassion Fatigue, Compassion Satisfaction & Burnout among Pediatric Nurses
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2018 Air Medical Transport Conference Scientific Assembly Abstracts / Air Medical Journal 37 (2018) 291 298
Table 1. Quality Improvement Interventions ED physician activation of the Cath Lab – not required to consult Cardiology EMS pre notification of the EDs when transporting STEMI patients and Direct to Cath Lab process created Interventional Cardiology providers determining standard care paths, including medications, doses and other interventions to be done in the ED – this allowed for fewer Cardiology consults and faster times in the ED as significantly fewer clarifications, etc. were needed Creation of ED Acute Care Teams based on trauma care methodologies to provide the most efficient evaluation of EMS and “walk-in” STEMI patients Based on many of the streamlined and standardized processes, the team created a STEMI Safe Handoff Checklist to ensure that all components of care were completed prior to leaving the ED Collaboration with Critical Care Transport teams – auto launch for STEMI patients, additional collaboration with local EMS providers to share critical information as soon as possible, and CCT crew consistently educating, demonstrating and following the checklist Critical Care transport has also worked with local EMS, especially LifeNet, on shared early activation. This allows EMS to transmit directly to CCT putting the transport crews on standby even before the patient arrives in the ED. STEMI Rendezvous – regional ED’s have worked with CCT to set up specific transfer points and processes close to the helipads so that all caregivers, both transport and ED, are following standardized steps Dripless STEMI’s – drips in patients from outside ED’s are minimized in order to make handoff in the Cath Lab as seamless as possible
Results: Patients presenting to community hospital ED's experienced a 16 minute reduction in door-in-door-out time (now 44 minutes versus 60 minutes). Additionally the mean D2B times for all patients requiring transfer in the health system reduced to and remained at 90 minutes for 12 consecutive months in 2017. Reported mortality at the project start was below the 50th percentile and now exceeds the 90th percentile nationally. Conclusion: Our results show that improving and maintaining D2B times for patients needing interfacility transfer requires a systems level approach that must encompass the entire healthcare system from initial patient activation through to discharge. The interventions developed can be adapted and applied in other settings.
fatigue a = 0.81, burnout a = 0.65, and compassion satisfaction a = 0.88. Descriptive and frequency summaries were computed for all study variables. The effect of demographic factors on the study outcomes was studied using univariate analysis and multivariate analysis. Results: A total of 503 RNs participated. The results revealed overall low to average levels of compassion fatigue and burnout and generally average to high levels of compassion satisfaction. In multivariate analysis, younger nurses had statistically significant higher burnout (p = 0.04) and compassion fatigue scores (p = 0.01) and lower compassion satisfaction scores (p = 0.001) compared to nurses aged 40 years or older. In addition, nurses in the Critical Care and Emergency work clusters had statistically significantly higher burnout scores than those in Ambulatory, Perioperative and Medical/Surgical areas. Results also demonstrated nurses in the Emergency work cluster had significantly higher compassion fatigue scores than those in Ambulatory, Perioperative and Medical/Surgical areas. Conclusions/Relevance to Practice: Findings suggest younger nurses and those working in critical care areas have higher levels of compassion fatigue and burnout. Improving recognition and awareness of compassion satisfaction, compassion fatigue, and burnout may help to increase retention and identify interventions aimed at decreasing burnout and compassion fatigue. Different generation-specific strategies may be necessary to address the issues of compassion satisfaction, burnout, and secondary traumatic stress. These strategies should strive to ensure a positive work environment that promotes work satisfaction, retention and professional growth for nurses of all ages. https://doi.org/10.1016/j.amj.2018.07.020
https://doi.org/10.1016/j.amj.2018.07.019
Compassion Fatigue, Compassion Satisfaction & Burnout among Pediatric Nurses
Direct vs. Video Laryngoscopy in a Helicopter Emergency Medical Service (HEMS) Setting: A Retrospective Comparison Jens Olsen, MD; Timothy Lenz, MD; Medical College of Wisconsin
Teresa Merk; Cincinnati Children's Hospital Medical Center Problem/Background: Nurses caring for very ill or dying children are frequently exposed to highly stressful and emotional situations. Over time and with repeated exposures, nurses can develop compassion fatigue and burnout. In addition to placing nurses at increased risk for significant emotional and physical health issues, compassion fatigue also contributes to nurse burnout, medical errors and low patient satisfaction. Research Question or Hypothesis: The study aimed to answer two research questions: "What is the prevalence of compassion fatigue, burnout, and compassion satisfaction among registered nurses at a large academic pediatric health care facility located in the Midwest?" "Is there an association between compassion fatigue, burnout, and compassion satisfaction and age, years of nursing experience, and nursing specialty?" Theoretical Framework: Stamm's Theory of Compassion Satisfaction and Compassion Fatigue serves as the theoretical framework for the study. Whereas burnout is associated with feelings of hopelessness and apathy, compassion fatigue describes the feelings of physical, emotional, and spiritual exhaustion from absorbing the problems and suffering of others. Compassion satisfaction describes nurses' satisfaction when caring for patients and feeling competent and supported by colleagues. Method and Study Design: The study was a cross-sectional descriptive design that used convenience sampling. Data were collected via computer using the Professional Quality of Life Scale (ProQOL), a 30-item instrument designed to assess professional quality of life for those in helping professions. The ProQOL is comprised of three subscales, each comprised of 10 items and measured using a 5-point Likert type scale. Reliability for each subscale is as follows: compassion
Introduction: In the prehospital setting, when caring for critically ill patients, the ability to quickly and effectively secure a definitive airway can be a matter of life of death. As such, all helicopter emergency medical service (HEMS) providers must be able to safely perform this procedure with speed and efficacy. Video laryngoscopy (VL) was invented and introduced as an improved technique for performing orotracheal intubation, and its use has become widespread amongst pre-hospital and HEMS organizations. Despite this, little information is available regarding the efficacy of VL when compared to standard direct laryngoscopy (DL) in this pre-hospital setting. As such, there is sparse evidence to guide the HEMS provider's decision on which to use when attempting to secure the airway of a critically ill patient. Provider preference often comes into play in this situation. In a preliminary survey, Nolen and Pokorney found that while the majority of Wisconsin Flight For Life (FFL) HEMS providers choose VL, variation does exist between providers in regards to VL vs DL preference. Selfreported success rates by providers suggested 100% first pass success with DL and 87.5 success with VL. This survey relied on provider recall, and further review of records is required to evaluate the accuracy of these reports. Currently, there is no protocol regarding which laryngoscopy modality to employ in the HEMS setting. This research aims to improving the quality of care received by patients who require orotracheal intubation by HEMS providers. To do this, we investigate whether the use of VL or DL increases successful orotracheal intubations by HEMS providers. We hypothesized that the first pass and overall success would be greater with VL and the overall complications would be less with VL when compared to DL. Methods: A retrospective chart review was performed of all intubated patients transported by HEMS providers from January 2015 to July 2017.
2018 Air Medical Transport Conference Scientific Assembly Abstracts / Air Medical Journal 37 (2018) 291 298
Table 1. Quality Improvement Interventions ED physician activation of the Cath Lab – not required to consult Cardiology EMS pre notification of the EDs when transporting STEMI patients and Direct to Cath Lab process created Interventional Cardiology providers determining standard care paths, including medications, doses and other interventions to be done in the ED – this allowed for fewer Cardiology consults and faster times in the ED as significantly fewer clarifications, etc. were needed Creation of ED Acute Care Teams based on trauma care methodologies to provide the most efficient evaluation of EMS and “walk-in” STEMI patients Based on many of the streamlined and standardized processes, the team created a STEMI Safe Handoff Checklist to ensure that all components of care were completed prior to leaving the ED Collaboration with Critical Care Transport teams – auto launch for STEMI patients, additional collaboration with local EMS providers to share critical information as soon as possible, and CCT crew consistently educating, demonstrating and following the checklist Critical Care transport has also worked with local EMS, especially LifeNet, on shared early activation. This allows EMS to transmit directly to CCT putting the transport crews on standby even before the patient arrives in the ED. STEMI Rendezvous – regional ED’s have worked with CCT to set up specific transfer points and processes close to the helipads so that all caregivers, both transport and ED, are following standardized steps Dripless STEMI’s – drips in patients from outside ED’s are minimized in order to make handoff in the Cath Lab as seamless as possible
Results: Patients presenting to community hospital ED's experienced a 16 minute reduction in door-in-door-out time (now 44 minutes versus 60 minutes). Additionally the mean D2B times for all patients requiring transfer in the health system reduced to and remained at 90 minutes for 12 consecutive months in 2017. Reported mortality at the project start was below the 50th percentile and now exceeds the 90th percentile nationally. Conclusion: Our results show that improving and maintaining D2B times for patients needing interfacility transfer requires a systems level approach that must encompass the entire healthcare system from initial patient activation through to discharge. The interventions developed can be adapted and applied in other settings.
fatigue a = 0.81, burnout a = 0.65, and compassion satisfaction a = 0.88. Descriptive and frequency summaries were computed for all study variables. The effect of demographic factors on the study outcomes was studied using univariate analysis and multivariate analysis. Results: A total of 503 RNs participated. The results revealed overall low to average levels of compassion fatigue and burnout and generally average to high levels of compassion satisfaction. In multivariate analysis, younger nurses had statistically significant higher burnout (p = 0.04) and compassion fatigue scores (p = 0.01) and lower compassion satisfaction scores (p = 0.001) compared to nurses aged 40 years or older. In addition, nurses in the Critical Care and Emergency work clusters had statistically significantly higher burnout scores than those in Ambulatory, Perioperative and Medical/Surgical areas. Results also demonstrated nurses in the Emergency work cluster had significantly higher compassion fatigue scores than those in Ambulatory, Perioperative and Medical/Surgical areas. Conclusions/Relevance to Practice: Findings suggest younger nurses and those working in critical care areas have higher levels of compassion fatigue and burnout. Improving recognition and awareness of compassion satisfaction, compassion fatigue, and burnout may help to increase retention and identify interventions aimed at decreasing burnout and compassion fatigue. Different generation-specific strategies may be necessary to address the issues of compassion satisfaction, burnout, and secondary traumatic stress. These strategies should strive to ensure a positive work environment that promotes work satisfaction, retention and professional growth for nurses of all ages. https://doi.org/10.1016/j.amj.2018.07.020
https://doi.org/10.1016/j.amj.2018.07.019
Compassion Fatigue, Compassion Satisfaction & Burnout among Pediatric Nurses
Direct vs. Video Laryngoscopy in a Helicopter Emergency Medical Service (HEMS) Setting: A Retrospective Comparison Jens Olsen, MD; Timothy Lenz, MD; Medical College of Wisconsin
Teresa Merk; Cincinnati Children's Hospital Medical Center Problem/Background: Nurses caring for very ill or dying children are frequently exposed to highly stressful and emotional situations. Over time and with repeated exposures, nurses can develop compassion fatigue and burnout. In addition to placing nurses at increased risk for significant emotional and physical health issues, compassion fatigue also contributes to nurse burnout, medical errors and low patient satisfaction. Research Question or Hypothesis: The study aimed to answer two research questions: "What is the prevalence of compassion fatigue, burnout, and compassion satisfaction among registered nurses at a large academic pediatric health care facility located in the Midwest?" "Is there an association between compassion fatigue, burnout, and compassion satisfaction and age, years of nursing experience, and nursing specialty?" Theoretical Framework: Stamm's Theory of Compassion Satisfaction and Compassion Fatigue serves as the theoretical framework for the study. Whereas burnout is associated with feelings of hopelessness and apathy, compassion fatigue describes the feelings of physical, emotional, and spiritual exhaustion from absorbing the problems and suffering of others. Compassion satisfaction describes nurses' satisfaction when caring for patients and feeling competent and supported by colleagues. Method and Study Design: The study was a cross-sectional descriptive design that used convenience sampling. Data were collected via computer using the Professional Quality of Life Scale (ProQOL), a 30-item instrument designed to assess professional quality of life for those in helping professions. The ProQOL is comprised of three subscales, each comprised of 10 items and measured using a 5-point Likert type scale. Reliability for each subscale is as follows: compassion
Introduction: In the prehospital setting, when caring for critically ill patients, the ability to quickly and effectively secure a definitive airway can be a matter of life of death. As such, all helicopter emergency medical service (HEMS) providers must be able to safely perform this procedure with speed and efficacy. Video laryngoscopy (VL) was invented and introduced as an improved technique for performing orotracheal intubation, and its use has become widespread amongst pre-hospital and HEMS organizations. Despite this, little information is available regarding the efficacy of VL when compared to standard direct laryngoscopy (DL) in this pre-hospital setting. As such, there is sparse evidence to guide the HEMS provider's decision on which to use when attempting to secure the airway of a critically ill patient. Provider preference often comes into play in this situation. In a preliminary survey, Nolen and Pokorney found that while the majority of Wisconsin Flight For Life (FFL) HEMS providers choose VL, variation does exist between providers in regards to VL vs DL preference. Selfreported success rates by providers suggested 100% first pass success with DL and 87.5 success with VL. This survey relied on provider recall, and further review of records is required to evaluate the accuracy of these reports. Currently, there is no protocol regarding which laryngoscopy modality to employ in the HEMS setting. This research aims to improving the quality of care received by patients who require orotracheal intubation by HEMS providers. To do this, we investigate whether the use of VL or DL increases successful orotracheal intubations by HEMS providers. We hypothesized that the first pass and overall success would be greater with VL and the overall complications would be less with VL when compared to DL. Methods: A retrospective chart review was performed of all intubated patients transported by HEMS providers from January 2015 to July 2017.