Compassion After Harm: Caring for Our Own

Transcription

1 Compassion After Harm: Caring for Our Own Cynda Hylton Rushton PhD, RN, FAAN Bunting Professor of Clinical Ethics Professor of Nursing & Pediatrics Johns Hopkins University Berman Institute of Bioethics, School of Nursing

2 Gratitude: Joan Halifax, Roshi Michael Williams Albert Wu Janelle Sexton Lori Paine Members of the JHH Second Victim Committee

3 Remembering

4 Shared Commitments Clinicians intend to help others not harm them want to do their best to serve those in their care have high expectations of themselves and others are human beings-imperfect and fallible

5 Bring into your awareness An event involving your role, recent or past, when your action or inaction harmed another. As you recall this event, notice the feelings that arise, the physical sensations, and your thoughts.

6 Debrief What did you notice? What did you learn?

7 Suffering Defined An anguish experienced as a threat to our composure, our integrity, and the fulfillment of our intentions, and more deeply as a frustration to the concrete meaning that we have found in our personal experience. It is the anguish over the injury or threat to the injury to the self and thus the meaning of the self that is at the core of suffering. Reich, 1989

8 Suffering: Defined Suffering is a form of change that a person experiences; it is a mode of becoming (Soelle, 1975) The persistence of painful feelings long after they were provoked (Tattlebaum, 1989) When an incident is unprocessed or unresolved, the response to it will likely reappear whenever similar experiences of suffering or grief reoccur (Tattlebaum, 1989)

9 Suffering It is our suffering that is the most basic element that we share with others; the factor that unifies us with all living creatures HH Dalai Lama HHDL & Cutler, H (19981) Art of happiness, Hodder- Stoughton, London, p. 177

10 Feeling guilty, afraid and alone Delbanco and Bell, 2007 Suffering in Silence

11 Outcomes of clinician suffering Burnout Secondary trauma Moral Distress Medical errors Decreased morale and productivity & job satisfaction Higher turnover & absenteeism Decreased empathy West, Huschka, Novotny, et al, 2006; Willaims, Manwell,Konrad, Linzer, 2007; Shanafelt, Bradley, Wipf, et al, 2002;Firth-Cozens, Greenhalgh, 1997

12 When we are out of integrity~ we suffer

13 What is the proper response to suffering?

14 Responses Thrown under the bus ABC s Accuse Blame Crucify Deny/Suppress Project Strong emotions Normal reactions to abnormal events (J. Shapiro)

15 Compassion

16 What is compassion? (J. Halifax, 2013) Compassion considered to be: the capacity to attend to the experience of others to feel concern for others to sense what will serve others potentially or actually to be able to be of service Compassion has been more simply defined as the emotion one experiences when feeling concern for another s suffering and desiring to enhance that person s welfare (Leiberg, Klimecki, & Singer, 2011). Used with permission J Halifax

17 Empathy and compassion are not the same Empathy: a step in a complex of responses leading towards feelings of empathic concern and compassion. Empathy: feeling into vicariously sharing the same feeling with another. emotional & cognitive resonance (Empathic Distress Fatigue rather than Compassion Fatigue? Integrating Findings from Empathy Research in Psychology and Social Neuroscience; Olga Klimecki and Tania Singer: Laboratory for Social and Neural Systems Research, University of Zurich, Zurich) Used with permission J Halifax

18 Gathering Attention Recalling intention Attuning to self and other G.R.A.C.E (Joan Halifax, 2012) Considering what would really serve Ethically enacting, ending

19 Fear In response to the 3 U s Activates the reptilian brain Fight, flight, freeze Higher brain functions go off line Autopilot Become more rigid Focus narrows Judgment, blame, self doubt surface Reactivity; paralysis

20 How mindfulness helps Oriented to the present moment Cultivates stability of mind and emotion Reduces reactivity Helps focus attention Enhances insight and clarity Supports flexibility and resilience Jon Kabat-Zinn, 2000; Halifax, 2009; Krasner, et al, 2009

21 Befriending suffering Recognize our own suffering Engage with our suffering Bear witness to our process Embrace emotions rather than silence them Understand the sources of our suffering Learn to grieve Potentially release the grip of our suffering The role of forgiveness Adopt strategies for self stewardship Use our experiences as fuel for good

22 Forgiving Ourselves (Fred Luskin,2002) Failing at an important task Hurting someone else Failing to take action that was necessary Selfdestructive acts

23 Forgiving Ourselves Being aware of our humanness None of us are perfect Feeling the pain we cause others Developing new patterns Letting go of the old stories Sending compassion to ourselves

24 Moral Resilience the capacity of an individual to sustain or restore integrity in response to moral adversity. (adaped Rushton, C., (2016) It is not complacency, acquiescence or a positive spin

25 Compassion elevates you and others too! Seeing someone help another creates a state of elevation that inspires one to do the same. (J Haidt)

26 Organizational responsibility Healthcare leaders have a moral and ethical responsibility to support clinicians who were directly or indirectly involved in a medical error (James Conway & Saul Weingart, 2009)

27 Integrity starts with I Walk the talk be your values in each moment even when noone is watching Discern alignment with personal/professional values, commitments Be responsible and accountable for one s actions & inactions Act with courage; embody compassion in actions, decisions & communication

28 Organizational Code of Ethics Code of Conduct Ethical Framework for Safety Systems approach Diffuses naming, blaming and shaming Early warning systems Creates integrity preserving processes and structures Enacts norms of safety to report LISTENS Seeks to identify root causes that produce errors Implements solutions Invests in support systems

29 5 Rights of Second Victims (Denham, CR, J Patient Saf & Volume 3, Number 2, June 2007) T Treatment that is Just R Respect U Understanding & Compassion S Supportive Care T Transparency & Opportunity to contribute to learning

30 The human soul does not want to be fixed; It wants simply to be seen and heard Parker Palmer, 1998

31 I m so sorry you are going through this right now I ll listen I ll be with you wherever the road takes you I ll support you I ll be kind as you journey through this time AJN 205: 105 (9).

32 Safety Mantra What can I do to harm my patient today? What systems fail you on a consistent basis and are likely to harm the next patient? How will the next patient in your work area likely be harmed? What personal interventions would make your work more safe, effective and efficient? Can you think of recent events resulting in a patient safety hazard? What patient safety concerns do you have?

33 Moral Courage Our capacity to befriend our fear and stand up for our core values or principles. Confidence to act in accordance with ones values/commitments Courage is a choice that requires action

34 Notice Name Inquire Moral Courage Leverage possibility Appreciate effort Let go of what no longer serves

35 Strong back (Equanimity) Soft Front (Compassion)

36 Live the Questions Be patient toward all that is unsolved in your heart and try to love the questions themselves Do not now seek the answers, which cannot be given you because you would not be able to live them Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer. Rainer Maria Rilke, 1903, German Poet Letters to a Young Poet

37 Pause & Recall

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