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Stress And The Professional Caregiver 0.8


2nd Draft version of Presentation for 11/19/2009 - KU Palliative Care Fellowship Lecture Series. Uploaded to show the evolution of creating a slide presentation

2nd Draft version of Presentation for 11/19/2009 - KU Palliative Care Fellowship Lecture Series. Uploaded to show the evolution of creating a slide presentation

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  • OHPPC – 5,6,75,8,9
  • OHTPPC10,11Discuss the difference between distress and eu-stress, can pressure be a good thing. Can challenge or being presented with more than you can feasibly deal with be and advantage. Yes in the short term stress can make you more productive, collect more resources to do the task at hand
  • Table 16.1 form OHPPC
  • 69


  • 1. Stress and Burnout in the Professional Caregiver in Hospice & Palliative Care
    Christian Sinclair, MD, FAAHPM
    Kansas City Hospice & Palliative Care
  • 2. Objectives
    1. Identify risk factors associated with stress and burnout for professional caregivers in hospice and palliative care
    2. Define the psychological and relationship characteristics which can prevent or accelerate caregiver stress
    3. Perform a self-assessment of professional caregiver burnout
  • 3. Overview
    Death and dying
    “That must be depressing?!”
    ≈25% of palliative care staff *
    report symptoms leading to psychiatric morbidity and burnout
    Lower than that of other specialties†
    Like oncology and critical care
    Emotionally charged environment
    *Ramirez 1995; Turnipseed 1987, Woolley 1989
    †Mallett 1991, Bram 1989
  • 4. Definitions
    Compassion fatigue
  • 5. Stress
    Demands from the work environment exceed the employee’s ability to cope with or control them
    Relationship between employee and environment
    Consider stress at multiple levels
    Team (formal or ad hoc)
  • 6. Burnout
    Progressive loss of idealism, energy and purpose experienced by people in the helping professions as a result of the conditions of their work
    Related to our need to believe in meaningful work/life
    Chronic interpersonal stressors
    Lack of accomplishment
  • 7. Signs and Symptoms of Burnout
    Physical exhaustion
    Emotional exhaustion
    GI disturbances
    Weight loss
    Low morale
    Job turnover
    Impaired job performance
    decreased empathy
    increased absenteeism
  • 8. Maslach
    Burnout as a psychological syndrome
    Exhaustion – individual
    Cynicism – relationship
    Lack of accomplishment – self-eval
    Not due to an individuals disposition
  • 9. Maslach
    Burnout associated with:
    No gender diff
    Personal char
    Low hardiness
    Lo self-esteem
    Strongest association with job characteristics
    Chronically difficult job demands
    Imbalance of high demands, low reources
    Presence of conflict (people, roles, values
  • 10. Kumar et al - psychiatrists
    Work cond
    Violence with pts
    Suicidal patients
    On call duties
    How one perceives and responds to stress
  • 11. Is burnout just depression
    Overlapping constructs
    If you have severe burnout higher risk of major depressive disorder
    If you have major depressive disorder higher risk of burnout
  • 12. Compassion Fatigue
    Secondary traumatic stress disorder
    Identical to post-traumatic stress disorder
    Except the trauma happened to someone else
    Bystander effect
    No energy for it anymore
    Emptied, no
  • 13. Countertransference
    Alchemical reaction between patient and caregiver at themost vulnerable time in ones life – thru the experience both can be transformed
    Whole person care
    The social brain is wired to help others in distress
  • 14. Study 5 -age
    UK study of phsyicians - #5
    Burnout associated with being under age 55
    Increased job satisfaction with older age
    Emotional sensitivity increases with age-37-38
    Married with children mixed results
  • 15. Hardiness 42-43-44
    Sense of commitmment, control and challenge
    Helps perception, interpretation, successful handling of stressful events
    Prevetns excessive arousal
    Oncology docs and nurses 46
  • 16. resilience
    Not avoidance of stress
    But stress that allows for self-confidence thru mastery and appropriate responsibility
    Hardiness versus coherence
  • 17. Emotional Sensitivity
    Hospice Nurses 38
    Group oriented
    Cautious with new ideas
    Potentially naïve in dealing with those more astute
    Lacking objectivity
  • 18. Genetics
    5-HTT short alleles
  • 19. Social Support
    Early identified as important
    Similar to critical nurses
    Buffer to stress in workplace and assoicated with optimism
    Lack of social support predicted anxiety and psychosomatic complaints
  • 20. Attachment Style
    84 UK nurses
  • 21. Stressful life events
  • 22. MD comparisons
    Htable 16.2
    Deporsonilzation associated with work overload
  • 23. Religiosity, Spirituality, Meaning making
    Hospice staff more deeply religious (1984)
    Religious associated with decr risk of burnout in onc staff (2000) 44
    230 NZ MD correlation between religion and vicarious traumitzation higher compassion fatigue but a negative one with spirituality and burnout 11
  • 24. Engagement v. Burnout
    Workload – associated with deprsonalization
    Control – performing without training/outside epxertise
    Reward – Intrinsic and extrensic
    Money, care, touch, stories, love
    Lo ,though I walk through the valley of the shadow of death, it is never my turn
    Community – group v. team
    Values – individual moral agent, professional role and team
    Engagement: nrg, involvement, efficiency
    Compassion satisfaction
  • 25. Emotional Work Variables
    Closenss vs. distance
    Controlled closeness
    Patient rotation
    Choosing when and where closeness
    Rational reflection of internal process
    Concentrating on one’s own role
    Anticipating patient death
    Maintaining appropriate composure
    “No, within love” avoid being destroyed in the process of caring
  • 26. Inability to live up to one’s own standards
    Good or better death haunt our field
    Expectation of an unattainable ideal
    No pain therapy, symptom control support in psycho social and spiritual dimension can take the horror away from death. Avoid dramatisation of ideals and practice modesty and humbleness
  • 27. Death acuity/volume
    Rarely studied
  • 28. Evidence Based Interventions
    Few studies
    Poorly powered
    Mindfulness fully present without judgement
    Narrative driven workshops
    Dot theory
    Abcd of dignity conserving care
    Attitude, behavior, compassion dialogue
  • 29. Bibilography
    Vachon MLS. The stress of professional caregivers. Oxford Textbook of Palliative Medicine 3rd edition (2004). p992-1004.
    Vachon MLS, Muller M. Burnout and symptoms of stress in staff working in palliative care. Oxford Handbook of Psychiatry in Palliative Care (2009). p236-264.
    Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Leaning MS, Snashall DC, Timothy AR. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995 Jun;71(6):1263-9.
    TurnipseedDL Jr. Burnout among hospice nurses: an empirical assessment. Hosp J. 1987 Summer-Fall;3(2-3):105-19.
    Woolley H, Stein A, Forrest GC, Baum JD. Staff stress and job satisfaction at a children's hospice. Arch Dis Child. 1989 Jan;64(1):114-8.
    MallettK, Price JH, Jurs SG, Slenker S. Relationships among burnout, death anxiety, and social support in hospice and critical care nurses. Psychol Rep. 1991 Jun;68(3 Pt 2):1347-59.
    Bram PJ, Katz LF. A study of burnout in nurses working in hospice and hospital oncology settings. OncolNurs Forum. 1989 Jul-Aug;16(4):555-60.
    Gambles M, Wilkinson SM, Dissanayake C. What are you like?: A personality profile of cancer and palliative care nurses in the United kingdom. Cancer Nurs. 2003 Apr;26(2):97-104.
    KobasaSC. Stressful life events, personality, and health: an inquiry into hardiness. J Pers Soc Psychol. 1979 Jan;37(1):1-11.
    KobasaSC, Maddi SR, Kahn S. Hardiness and health: a prospective study. J Pers Soc Psychol. 1982 Jan;42(1):168-77.
    KashKM, Holland JC, Breitbart W, Berenson S, Dougherty J, Ouellette-Kobasa S, Lesko L. Stress and burnout in oncology. Oncology (Williston Park). 2000 Nov;14(11):1621-33; discussion 1633-4, 1636-7.
    PapadatouD, Anagnostopoulos F, Monos D. Factors contributing to the development of burnout in oncology nursing. Br J Med Psychol. 1994 Jun;67 ( Pt 2):187-99.
    AmentaMM. Traits of hospice nurses compared with those who work in traditional settings. J Clin Psychol. 1984 Mar;40(2):414-20.
    Sinclair S, Raffin S, Pereira J, Guebert N. Collective soul: the spirituality of an interdisciplinary palliative care team. Palliat Support Care. 2006 Mar;4(1):13-24.
    Hawkins AC, Howard RA, Oyebode JR. Stress and coping in hospice nursing staff. The impact of attachment styles. Psychooncology. 2007 Jun;16(6):563-72.