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TRANSCRIPT
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COMPASSION FATIGUE: THE ROAD LEADING TO BURNOUT
Richard Miller, MD FACSProfessor of Surgery
Chief, Division of Trauma, Surgical Critical Care and Emergency Surgery
Vanderbilt University Medical CenterGrand Rounds
St. Charles Health SystemBend, Oregon
June 16th , 2017
Disclosure
• None• All patients or their families have given
permission to show photos• Vanderbilt: Spire Health and Wellness
Collaborative
HH- 1992• 18 y/o Clemson student hydroplaned her VW on
Interstate, crashed into schoolbus• ISS 65• Transected aorta, bilateral hemoptx, multiple rib
fxs• Ruptured spleen, Grade IV liver laceration• Complex pelvic, extremity fractures• Arrived moribund with BP 50P
SS
• 29 y/o/w/f 38 cal. GSW to abdomen• BP 80 / P• through central portion of liver, stomach, pancreas,
spleen• expl. lap, L thoracotomy, cross clamp aorta for
massive hemoperitoneum• splenectomy, distal 2/3 pancreatectomy, partial
hepatorrhaphy and packing, gastric repair• ISS 25• > 50 units blood / blood products
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Have you heard of Compassion Fatigue?
• Discussions regarding nurses and counselors• First diagnosed in nurses in 1950s• First described in literature in 1980s (Figley)• Also called Secondary Traumatic Stress
Disorder (STSD)
• Work with populations who experience traumatic events
• Work in a highly stressful environment• Jam packed schedule- yet need to be
compassionate EVERY DAY!!
Have you heard of Compassion Fatigue?
Compassion Fatigue
• Phenomenon that occurs when caregiver feels overwhelmed by repeated empathetic engagement with distressed patients/families
• Precursor of Burnout- manifests itself as– Physical– Emotional– Spiritual
EXHAUSTION
Compassion Fatigue
• Delivering too much bad news or prolonged periods of time dealing with difficult issues– Terminal illness– Critically ill/injured– Angry patient/family– Psychopathology– Permanent lifestyle changes
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TW
• 28 y/o female• Banking executive• First date• Passenger on MCC vs 18-Wheeler• Impaled by back bumper and thrown• Avulsion of perineum/abdominal wall
MG
• 47 y/o male• Train car hitch manager• Crush injury left pelvis/groin/leg• Hemipelvectomy/open abdomen• Multiple operations leading to STSG
to flank, abdomen, remaining pelvis
Cost of Caring•Charles Figley, co-author •Compassion Fatigue: Coping with STSD in those who treat traumatized patients and their families•“There is a cost to caring… Those who have enormous capacity for feeling and expressing empathy tend to be more at risk for compassion stress”
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KH• 4 y/o/w/f run over by minivan• BP 60 / 0• flail chest / severe bilateral PC• femur fx• hemoperitoneum • ISS 50• exploratory laparotomy - splenectomy, repair liver lac,
bilateral CT’s• 7˚later - tense abdomen unable to oxygenate / ventilate
oliguric• ICU decompression / Silo• MUSC
Incidence of Compassion Fatigue• Up to 85%!!• Feel they no longer had any compassion
left to give• Even after “restful” time off• CF take toll
– Decrease productivity– More sick days– Higher turnover
Warning Signs of CF• Diminished sense of
personal accomplishment• Exhaustion (physical and
emotional)• High self-expectations• Inability to maintain
balance of empathy and objectivity
• Less ability to feel joy
• Low self-esteem• Sleep disturbances• Workaholism• Anger/blaming• Abusing drugs, alcohol or
food• Depression
Burnout vs Compassion Fatigue• Compassion Fatigue:
– Continue give themselves FULLY but find it difficult to maintain healthy balance of empathy and objectivity
– Sucked into vortex that pulls you slowly downward– Can’t stop downward spiral– Work harder/continue to give to others until
completely tapped out• Burnout: adapt to exhaustion by becoming less
empathetic and more withdrawn/desensitized
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Burnout: What Is It?• A syndrome of psychological (and physical) exhaustion and
diminished efficiency resulting from overwork or prolonged exposure to stress*
* Encarta Dictionary: English (North America)
Depersonalization
Emotional exhaustion
Low personal accomplishment
BURNOUT
Burnout Eventually Becomes a Vicious Cycle
Futility, disappointment, and guilt
Interpersonal problemsand depression Health problems
Diminished performance
Lethargy, depleted motivationMALAISE OF THE SPIRIT
Symptoms of Burnout
• Health problems• Substance abuse• Chemical dependency• 6% exhibit suicidal
ideation• Most surgeons unable to
recognize they need help
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Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout - Carol Peckham/January 11, 2017
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VANDERBILT SURGERY
Work Unit Strategies
Gathering MD
Organizational Strategies to Protect Well-
Being
Recommendations and Approvals
Implementation
Communications
EvaluationStrategies to
Support High-Risk Individuals
VanderbiltTask Force for Empowerment & Well-being
Identification of Strategies
Compassion Fatigue/Burnout Therapy
• PREVENTION!!• 1st learn to recognize when you are wearing down• Come to terms with suppressed feelings of anger, fear,
self-doubt since early medical/nursing/EMS education• Take care of yourself
– Get into habit of doing something EVERYDAY that will replenish you
• Not easy: old habits comfortable even when bad for us• Real lifestyle changes take time, energy and desire
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Compassion Fatigue/Burnout Therapy
• Understand that emotional pain you feel is NORMAL!!!• Will dissipate once start caring for your physical and
emotional needs• Find someone to talk to: a GOOD LISTENER
– Connection– Spouse or friend listen without judgment – Colleague with first hand knowledge of CF– Senior mentor– Clergy– Support group
Develop your ownSELF-CARE PLAN
• Spend quiet time alone– Learn mindfulness meditation (being in the moment)– Reconnect with a spiritual source– Help achieve inner balance/miraculous turnaround
• Recharge your batteries daily– Commit to eating better/regular exercise regimen/adequate
sleep
• Hold one focused, connected and meaningful conversation each day– Time with family and close friends feeds the soul
Finding Community Support
• Building a culture of support at work is vital• Explore resources provided by your organization• Social support affects everything from length of
life to incidence of many diseases• It’s okay to start small• One example:
The Spire Story @ Vanderbilt
• Background: CF in the Trauma Unit• September 2013: Introducing the program … and staff cuts• December 2013: Excited employees, improved morale• Spring 2014: Expansion, throughout VUMC
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• Website and apps• Sharing
Accomplishments• Points and Peer-Support• Custom Rewards• Challenges and
Competitions
RESULTS!
Implementing Spire
• An important complement to external support
• Very well researched• Different levels• Example: Search Inside
Yourself – Chade-MengTan, Google software engineer and motivator
• Calm your mind, focus on being present
Mindfulness
Words of wisdom from someone who has suffered from Compassion Fatigue:
Find things that give your life joy and meaning
Take A Moment To
Appreciate The Beauty Around You
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Develop emotional awareness
Prioritize personal wellness
Find meaningin work
Connect with others
Personal Wellness
Physical Well-being• Fitness• Nutrition• Sleep• Healthcare
Mental Well-being• Hobbies/interests• Kinship• Alone/down time-
Mindfulness– Yoga– Meditation– Appreciate life’s blessings– Etc.
Burnout (ICD-10) =Z73.0, a state of vital exhaustion