Agenda. Logging/ Signing in Welcome Housekeeping Presentation Questions & Discussion. National Standards Assessment Program

Transcription

1 Agenda Logging/ Signing in Welcome Housekeeping Presentation Questions & Discussion

2 Housekeeping Mute phone: Background noise/mobile phone Questions: unmute phone raise hand chat room talking mention name and Service work at Participants introductions Evaluation

3 Self Care for Staff Standard 13 CQI webinar 27 th November 2014 Presenters: Helen Vaz NSAP Quality Manager John Cavengah -Senior Staff Specialist

4 Purpose of Session Explore some self care strategies Tips on making change to provide self care for staff - Standard 13

5 Standard 13 Staff and volunteers reflect on practice and initiate and maintain effective self care strategies. Intent: Self care needs to be part of the palliative care service culture and structure as provision of palliative care is emotionally draining

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7 Standard 13 NSAP Quality Elements 13.1 There are procedures in place to identify and respond to critical incidents. Critical incident procedures focus on system enhancements, not on blame for individuals. IIMS Incident Information Management System 13.2 Employee assistance programs and/or counselling services are available to staff and volunteers to meet their identified needs. Psychologist - CMN has an independent Psychologist who is available to see staff confidentially. This system tends not to be used very commonly 13.3 There are education programs in place to enable staff and volunteers to develop effective coping strategies. Monthly Multidisciplinary Education Program SELF CARE 13.4 The service encourages staff and volunteers to make use of available supports, whether formal or informal. SELF CARE Regular Disciplinary Meetings / Multidisciplinary Team members support of each other / Pastoral Care / Social Work / Staff undertake various self care strategies e.g. Meditation; Spiritual Direction; Mentoring support; Cycling; Touch Football; Jogging ; Walking Groups; Music Activities; Arts and Theatre

8 Why is Self Care so Important? Key Articles (in my view!! Or somewhere to get started) 1. Kearney, M. K., R. B. Weininger, M. L. Vachon, R. L. Harrison and B. M. Mount. "Self-Care of Physicians Caring for Patients at the End of Life: "Being Connected... A Key to My Survival"." JAMA 301, no. 11 (2009): , E1. 2. Bloemhard, A. Self-Care for Health Professionals. Coffs Harbour: The Mid North Coast Division of General Practice, Coffs Harbour, March 2009, Jones, S. H. "A Self-Care Plan for Hospice Workers." American Journal of Hospice and Palliative Medicine 22, no. 2 (2005): Radwany, S., D. Hassler, N. Robinson, M. Soltis and R. Myerscough. "Poetry as Self-Care and Palliative Care." J Palliat Med 15, no. 12 (2012): Wakefield, A. "Nurses' Responses to Death and Dying: A Need for Relentless Self- Care." Int J Palliat Nurs 6, no. 5 (2000): Vachon, M. L. "Staff Stress in Hospice/Palliative Care: A Review." Palliative Medicine 9, no. 2 (1995):

9 Kearney s Article.. Burnout mental distress manifested in normal individuals who experience decreased work performance resulting from negative attitudes and behaviours. It arises from stresses that arise from a clinician s interaction with the work environment. Individual: Physical and emotional exhaustion / cynicism / sense of ineffectiveness & lack of accomplishment / over identification / over involvement / irritability and hypervigilance / sleep problems / social withdrawal / professional and personal boundary violations / poor judgment / perfectionism and rigidity / questioning the meaning of life / questioning prior religious beliefs / interpersonal conflicts / avoidance of emotionally difficult clinical situations / addictive behaviours / numbness and detachment / concentrating difficulty / frequent illness (sick days) Team: Low morale / High job turnover / impaired job performance / staff conflicts Kearney, M. K., R. B. Weininger, M. L. Vachon, R. L. Harrison and B. M. Mount. "Self-Care of Physicians Caring for Patients at the End of Life: "Being Connected... A Key to My Survival"." JAMA 301, no. 11 (2009): , E1

10 Factors mitigating AGAINST Burnout Mindful Meditation Reflective Writing Adequate supervision and mentoring Sustainable workload Promotion of feelings of choice and control Appropriate recognition and reward Supportive work community Promotion of fairness and justice in the workplace Training in communication skills Development of self awareness skills Practice of self care activities Continuing educational activities Participation in research Mindfulness based stress reduction for team Meaning centred intervention for team Kearney, M. K., R. B. Weininger, M. L. Vachon, R. L. Harrison and B. M. Mount. "Self-Care of Physicians Caring for Patients at the End of Life: "Being Connected... A Key to My Survival"." JAMA 301, no. 11 (2009): , E1

11 Kearney s Article.. Compassion Fatigue Described as the cost of caring for others in emotional pain that has led helping professionals to abandon their work with traumatized persons. It evolves specifically from the relationship between the clinician and the patient.? Similar to PTSD except that it applies to those emotionally affected by the trauma of another. In contrast to burnout, the clinician with compassion fatigue can still care and be involved albeit in a compromised way. Compassion fatigue can lead to burnout. Symptoms of Compassion Fatigue parallel 3 domains of PTSD Hyperarousal (disturbed sleep, outbursts of anger, hypervigilance) Avoidance ( not wanting to go there again, desire to avoid thoughts, feelings and conversations Re-experiencing (intrusive thoughts / dreams, psychological or physiological distress in response to reminders of work with those dying) Kearney, M. K., R. B. Weininger, M. L. Vachon, R. L. Harrison and B. M. Mount. "Self-Care of Physicians Caring for Patients at the End of Life: "Being Connected... A Key to My Survival"." JAMA 301, no. 11 (2009): , E1

12 Factors mitigating AGAINST Compassion Fatigue Exquisite empathy highly present, sensitively attuned, well boundaried, heartfelt empathic engagement invigorates rather than depletes the clinician, and protects against compassion fatigue and burnout. This idea is called BIDIRECTIONALITY and refutes the idea that in some of us being empathic to dying patients must lead to emotional depletion. Self awareness involves a combination of self knowledge and and the development of dual awareness. This stance allows the clinician to attend to the needs of the Patient, the work environment and his/her own subjective experience. Self Awareness can be enhanced by a) Becoming involved in education projects, b) Involvement in peer support activities c) Mindfulness Meditation the intentional, accepting and non-judgmental focus of one's attention on the emotions, thoughts and sensations occurring in the present moment d) Reflective Writing reflecting on what happened, what did I feel, how did I respond, what might I do differently? Kearney, M. K., R. B. Weininger, M. L. Vachon, R. L. Harrison and B. M. Mount. "Self-Care of Physicians Caring for Patients at the End of Life: "Being Connected... A Key to My Survival"." JAMA 301, no. 11 (2009): , E1

13 Decision to focus on Self Care for 2014:- Incorporate Self Care Education into the usual professional activity and Education Sessions Make Self Care matter of fact / routine Highlight Self Care at every opportunity

14 Organisational Structure: Medical and Nursing (Various) Staff Meetings weekly Multidisciplinary Team Meetings Weekly Clinical Audit Reviews Weekly Hospital Grand Rounds Hospice Review Meeting (Review of all Inpatients about 10mins discussion each) Student Teaching (All Disciplines) Nursing Mentoring Compassion and Presence Seminars Sessions (Supported Financially by Department)

15 Monthly Education Programme (Multidisciplinary Team CMN) 1. Indigenous Health Aspects of Medicare Local 2. Survivorship 3. Update on Palliative Care Research 4. Poetry as Self Therapy 5. Caregivers and Us 6. Meditation and Reflective Practice 7. Compassion and Presence 8. Diogenes Syndrome 9. Medical Marihuana 10. Perceptions of the Value in Medical Training (Jensen and Robertson) (Denham, Radiation Oncologist) (Clark, Pall Care Dir) (Wand, Psychologist) (Cain & Cavenagh) (Carmel Moore RSJ) (Harris SW, Ringstad Past Care) (Dullard) (Mather) (Cameron-Taylor)

16 Having a go at something different. Poetry Coulehan, J and P Clary. "Healing the Healer: Poetry in Palliative Care." Journal of Palliative Medicine 8, no. 2 (2005): Radwany, S., D. Hassler, N. Robinson, M. Soltis and R. Myerscough. "Poetry as Self-Care and Palliative Care." J Palliat Med 15, no. 12 (2012): ANN Ann died today Bright morning sunshine Loving Mother sad and joyous Her task so sacred Malodour conquered. Gentleness and dignity as life flowed Away from her Hoped for new life In a different and just way Where time ceases. Strong towering son, a vigil kept Loved her and keeps on loving She lives through him Strength in defending a nation Powerful yet powerless. We share our mutual vulnerability Wedding photo Tears Smiles Making sense of it Her life fully lived JC 13/12/2012

17 Self care Strategies Summary Incorporate into everyday activities Instigators to facilitate any discussion (e.g. SW and PC) Tips on how to implement Don t make a big issue of Self Care just start doing it!! Make it frequent focus

18 References 1. Bloemhard, A. (2009). Self-care for Health Professionals. Coffs Harbour: The Mid North Coast Division of General Practice, Coffs Harbour, March Cole, R. (1997). Meditation in palliative care--a practical tool for self-management. Palliat Med, 11(5), Fernando, A. T., 3rd, & Consedine, N. S. (2014). Development and initial psychometric properties of the Barriers to Physician Compassion questionnaire. Postgrad Med J, 90(1065), Goswami, D. C. (2013). Understanding self-awareness in palliative care. J Pain Palliat Care Pharmacother, 27(4), Harris, M., Bond, M., & Turnbull, R. (1990). Nursing Stress and Stress Reduction in Palliative Care. Palliat Med, 4, Irish Hospice Foundation. (2013). End-of-Life Care & Supporting Staff; a literature review (pp. 17). 7. Jones, S. H. (2005). A self-care plan for hospice workers. American Journal of Hospice and Palliative Medicine, 22(2), Kearney, M. K., Weininger, R. B., Vachon, M. L., Harrison, R. L., & Mount, B. M. (2009). Self-care of physicians caring for patients at the end of life: "Being connected... a key to my survival". JAMA, 301(11), , E1151. doi: /jama Kim, H. C., Rapp, E., Gill, A., & Myers, J. (2013). An innovative self-care module for palliative care medical learners. J Palliat Med, 16(6), Levine, S., Marschke, M., & Gorawara-Bhat, R. (2011). The Role of Self-Reflection in Palliative Care Education: A Pilot Study of Students Attitudes and Perspectives on End-of-Life Care (740). J Pain Symptom Manage, 41(1), Radwany, S., Hassler, D., Robinson, N., Soltis, M., & Myerscough, R. (2012). Poetry as self-care and palliative care. J Palliat Med, 15(12), Rose, J., & Glass, N. (2008). Enhancing emotional well-being through self-care: the experiences of community health nurses in Australia. Holist Nurs Pract, 22(6), Sanchez-Reilly, S., Morrison, L. J., Carey, E., Bernacki, R., O'Neill, L., Kapo, J.,... Thomas Jde, L. (2013). Caring for oneself to care for others: physicians and their self-care. J Support Oncol, 11(2), Teno, J. M. (2002). Palliative care teams: self-reflection - past, present, and future. J Pain Symptom Manage, 23(2), Vachon, M. L. (1995). Staff stress in hospice/palliative care: a review. Palliat Med, 9(2), doi: / Wakefield, A. (2000). Nurses' responses to death and dying: a need for relentless self-care. Int J Palliat Nurs, 6(5),

19 Questions Evaluation survey