Stress And The Professional Caregiver 0.5


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First 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
  • OHTPPC 10,11
  • Table 16.1 form OHPPC
  • Stress And The Professional Caregiver 0.5

    1. 1. Stress and the Professional Caregiver<br />Christian Sinclair, MD, FAAHPM<br />Kansas City Hospice & Palliative Care<br />Nov 19, 2009<br />
    2. 2. Objectives<br />
    3. 3. Overview<br />25% of palliative care staff report symptoms<br />Indicates psychiatric morbidity and burnout<br />Lower than that of other specialties<br />Like oncology<br />
    4. 4. Definitions<br />Stress<br />Relationship between employee and work environment<br />Demands from the work environment exceed the employee’s ability to cope with or control them<br />Burnout<br />Progressive loss if idealism, energy and purpose experienced by people in the helping professions as a result of the conditions of their work<br />Related to our need to believe in meaningful work/life<br />Chronic interpersonal stressors<br />Exhaustion<br />Cynicism/detachment<br />Lack of accomplishment<br />
    5. 5. Signs and Symptoms of Burnout<br />Fatigue<br />Physical exhaustion<br />Emotional exhaustion<br />Headaches<br />GI disturances<br />Weight loss<br />Sleeplessness<br />Depression<br />Boredom<br />Frustration<br />Low morale<br />Job turnover<br />Impaired job performance (decreased empathy, increased absenteeism<br />
    6. 6. Maslach<br />Burnout as a psychological syndrome<br />Exhaustion – individual<br />Cynicism – relationship<br />Lack of accomlishment – self-eval<br />Not due to an individuals disposition<br />
    7. 7. Maslach<br />Burnout associated with:<br />Demographics<br />Single<br />Younger<br />No gender diff<br />Personal char<br />Neuroticism<br />Low hardiness<br />Lo self-esteem<br />Strongest association with job characteristics<br />Chronically difficult job demands<br />Imbalance of high demands, low reources<br />Presence of conflict (people, roles, values<br />
    8. 8. Kumar et al - psychiatrists<br />Predisposing<br />Personality<br />Work cond<br />Precipitating<br />Violence with pts<br />Suicidal patients<br />On call duties<br />Perpetuating<br />How one perceives and responds to stress<br />
    9. 9. Is burnout just depression<br />Overlapping constructs<br />If you have severe burnout higher risk of major depressive disorder<br />If you have major depressive disorder higher risk of burnout<br />
    10. 10. Compassion Fatigue<br />Secondary traumatic stress disorder<br />Identical to post-traumatic stress disorder<br />Except the trauma happened to someone else<br />Bystander effect<br />No energy for it anymore<br />Emptied, no<br />
    11. 11. Countertransference<br />Alchemical reaction between patient and caregiver at themost vulnerable time in ones life – thru the experience both can be transformed<br />Whole person care<br />The social brain is wired to help others in distress<br />
    12. 12. Study 5 -age<br />UK study of phsyicians - #5<br />Burnout associated with being under age 55<br />Increased job satisfaction with older age<br />Emotional sensitivity increases with age-37-38<br />Married with children mixed results<br />
    13. 13. Hardiness 42-43-44<br />Sense of commitmment, control and challenge<br />Helps perception, interpretation, successful handling of stressful events<br />Prevetns excessive arousal <br />Oncology docs and nurses 46<br />
    14. 14. resilience<br />Not avoidance of stress<br />But stress that allows for self-confidence thru mastery and appropriate responsibility<br />Hardiness versus coherence<br />
    15. 15. Emotional Sensitivity<br />Hospice Nurses 38<br />Extroverted<br />Empathic<br />Trusting<br />Open<br />Expressive<br />Insightful<br />Group oriented<br />Cautious with new ideas<br />Potentially naïve in dealing with those more astute<br />Lacking objectivity<br />
    16. 16. Genetics<br />5-HTT short alleles<br />
    17. 17. Social Support<br />Early identified as important<br />Similar to critical nurses<br />Buffer to stress in workplace and assoicated with optimism<br />Lack of social support predicted anxiety and psychosomatic complaints<br />
    18. 18. Attachment Style<br />84 UK nurses<br />Secure<br />Preoccupied<br />Fearful<br />Dismissing<br />
    19. 19. Stressful life events<br />
    20. 20. MD comparisons<br />Htable 16.2<br />Deporsonilzation associated with work overload<br />
    21. 21. Religiosity, Spirituality, Meaning making<br />Hospice staff more deeply religious (1984)<br />Religious associated with decr risk of burnout in onc staff (2000) 44<br />230 NZ MD correlation between religion and vicarious traumitzation higher compassion fatigue but a negative one with spirituality and burnout 11<br />
    22. 22. Engagement v. Burnout<br />Workload – associated with deprsonalization<br />Control – performing without training/outside epxertise<br />Reward – Intrinsic and extrensic<br />Money, care, touch, stories, love<br />Lo ,though I walk through the valley of the shadow of death, it is never my turn<br />Community – group v. team <br />Fairness<br />Values – individual moral agent, professional role and team<br />Engagement: nrg, involvement, efficiency<br />Compassion satisfaction<br />
    23. 23. Emotional Work Variables<br />Closenss vs. distance<br />Controlled closeness<br />Strategies:<br />Patient rotation<br />Choosing when and where closeness<br />Rational reflection of internal process<br />Concentrating on one’s own role<br />Anticipating patient death<br />Maintaining appropriate composure<br />“No, within love” avoid being destroyed in the process of caring<br />
    24. 24. Inability to live up to one’s own standards<br />Good or better death haunt our field<br />Expectation of an unattainable ideal<br />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<br />
    25. 25. Death acuity/volume<br />Rarely studied<br />
    26. 26. Evidence Based Interventions<br />Few studies<br />Poorly powered<br />Mindfulness fully present without judgement<br />Narrative driven workshops<br />Dot theory<br />Abcd of dignity conserving care<br />Attitude, behavior, compassion dialogue<br />
    27. 27. Bibliography<br />Vachon MLS. The stress of profesisonal caregivers. Oxford Textbook of Palliative Medicine 3rd edition (2004). p992-1004.<br />Vachon MLS, Muller M. Burnout and symptoms of stress in staff working in palliative care. Oxford handbook of Psychoatry in Palliative Care (2009). p236-264.<br />