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Stress And The Professional Caregiver 0.8

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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
  • Transcript

    • 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
      Stress
      Burnout
      Compassion fatigue
      Countertransference
    • 5. Stress
      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
      Individual
      Team (formal or ad hoc)
      Organizational
    • 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
      Exhaustion
      Cynicism/detachment
      Lack of accomplishment
    • 7. Signs and Symptoms of Burnout
      Fatigue
      Physical exhaustion
      Emotional exhaustion
      Headaches
      GI disturbances
      Weight loss
      Sleeplessness
      Depression
      Boredom
      Frustration
      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:
      Demographics
      Single
      Younger
      No gender diff
      Personal char
      Neuroticism
      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
      Predisposing
      Personality
      Work cond
      Precipitating
      Violence with pts
      Suicidal patients
      On call duties
      Perpetuating
      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
      Extroverted
      Empathic
      Trusting
      Open
      Expressive
      Insightful
      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
      Secure
      Preoccupied
      Fearful
      Dismissing
    • 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
      Fairness
      Values – individual moral agent, professional role and team
      Engagement: nrg, involvement, efficiency
      Compassion satisfaction
    • 25. Emotional Work Variables
      Closenss vs. distance
      Controlled closeness
      Strategies:
      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.