Compassion Fatigue in ER Nurses

Compassion Fatigue in ER Nurses
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Abstract
For this project, the identified problem is compassion fatigue and burnout amongst emergency nurses. Incidences of compassion fatigue (CF) amongst emergency nurses have increased very much over the past few years (Li et al., 2014). This particular problem is observed in the emergency department of hospitals. Compassion fatigue has a negative and adverse impact on nurse work environments and patient outcomes. Yoder (2010) reported that compassion fatigue (CF) impacts negatively on nurses, and therefore, interventions to deal with CF should be addressed so as to improve patient outcome and avoid burnout among nurses. The proposed solution entails providing nursing education with aim of improving knowledge on recognizing the symptoms of CF early on as this would encourage early treatment to avoid negative health outcomes on nursing staffs. Melvin (2012) pointed out that intervention of professional CF is critical for nurses to continue caring for patients. This project is expected to cost $20,000, which would cater for the provision of training and education. To obtain support from the employees and senior management of the hospital, it would be important to inform them of the benefits of the proposed solution as well as involving and consulting them during the implementation process so that they feel a sense of ownership to the project. Evaluating the effectiveness of the project will involve using structured, closed-ended questionnaires which would be distributed to the participants. To disseminate the findings, various strategies would be used such as websites; publication in nursing journals such as JAMA and New England Journal of Medicine; media coverage in newspapers, radio, and television; and well as holding and attending conferences to discuss the findings.
Keywords: compassion fatigue, burnout, education program, patient satisfaction
Compassion Fatigue in ER Nurses
1.0 Problem Description
The number of patients in emergency departments is increasing while there is also increased demand on nurses to improve their service in spite of support resources being constrained (Allender, Rector & Warner, 2013). As such, the pressure to improve performance and patient satisfaction has put a strain on nurses as they are more likely to suffer compassion fatigue (CF) and burnout while reporting low levels of patient satisfaction (Hunsaker et al., 2015). Given the need to also recruit and retain the most competent staff, nurse managers also face the challenge of making sure that there is quality health care provision (Lombardo & Eyre, 2011). Cases of compassion fatigue (CF) among emergency nurses have increased tremendously over the past few years (Li et al., 2014). Compassion fatigue includes mental, emotional, spiritual as well as physical effects experienced due to constant exposure to patients going through pain, sufferings and death (Adriaenssens et al., 2011).
The setting in which the identified problem – compassion fatigue among emergency nurses – is observed is the emergency department of hospitals. It is within emergency departments that nurses care for patients with emergency conditions and get to experience compassion fatigue (Hooper et al., 2010). Compassion fatigue has a negative and adverse impact on work environments and patient outcomes. A close association exists between compassion fatigue among the nurses and outcomes of negative patient satisfaction which includes increased nurse turnover, increased nursing absenteeism and poor quality nursing care as well as a higher dependence and over reflection of financial burdens to healthcare organizations (Fetter, 2012; Coetzee & Klopper, 2010).

CF is one of the elements that regularly affect nurses, since they witness the turmoil that patients go through. At the same time, the problem of burnout affects the normal operations of hospitals, while effective nurses also experience CF (Allender, Rector & Warner, 2013). Even though nurses typically show empathy towards the patients, burnout and CF limits the extent to which the nurses show caring tendencies because of the high stress levels. The notion that nurses are nurturing means that when there is CF this affects the nurse negatively taking a toll on the emergency department, nursing staff, patients as well as families hence there is a need to focus on compassion satisfaction as a way to deal with CF after recognizing and combating the condition.
The PICOT question is:
In emergency nurses (P), do the nurses treated for compassion fatigue (I), portray higher levels of patient satisfaction in their work (O) in comparison to those nurses not treated for compassion fatigue (C) after a period of 2 weeks?
2.0 Solution Description
Ideally, promoting teamwork at the workplace will improve the social support for nurses and enhance emotional attachment. However, nurses may not identify the signs of CF and burnout, and there is a need to improve nursing education about the condition. The education program will be undertaken with a view of improving knowledge on recognizing the symptoms of CF early on as this encourages early treatment to avoid negative health outcomes on nurses and slow down in hospital operations. In other words addressing the symptoms of CF then encourages treatment.
The education sessions are emphasized even before there is a recovery program to reduce CF and burnout as it will be easier to accelerate recovery when the participants have prior knowledge about causes of burnout. As such, the implementation of accelerated recovery programs can be undertaken following the success of the education sessions. The nursing participants are able to identify CF among themselves and in others while working together, and this encourages the nurses to seek professional help. The education program highlights on implementing an intervention plan to influence nurses, with the organizational leadership providing approval to support the program in order to improve how organization utilizes resources. Since the intervention focuses also on the organization, other underlying issues that may result from CF including patient satisfaction and nurse’s turnover are addressed.
2.1 Rationale for selecting proposed solution
Early recognition of CF will make it easier to use resources more efficiently. As such, nursing education will be highlighted as an intervention, while also assessing the level of knowledge attained as this is associated with implementing changes. In particular, recognizing CF among the nurses will minimize burnout while also allowing timely interventions, and the nurses can also point out if they find evidence that there is a likelihood that other nurses are suffering from burnout (Allender, Rector & Warner, 2013). Lack of adequate knowledge on how to recognize CF stalls interventions and this has a negative impact on the work rate of nurses and their ability to build caring relationships with patients. The education will incorporate the stakeholders, with emphasis on nurses who engage with patients more often than the other health practitioners. As such, informing the management about the progress of the training sessions facilitates monitoring and taking into account positive changes associated with the implementation process.
3.0 Incorporating evidence from review of literature
According to Yoder (2010), CF impacts negatively on nurses, and as such interventions to deal with CF should be addressed so as to improve patient outcome and avoid burnout among nurses. In any case, Wentzel and Brysiewicz, (2014), highlight that the work environment may influence the onset of CF and trauma. As such, the need to undertake intervention that involves all stakeholders would be beneficial in improving the working environment to address some of the stressors. Burnout has different effects on nurses, and timely intervention is necessary by identifying the factors that influence compassion satisfaction.
Nurses proving end-of-life care are particularly at risk of CF, having witnessed loss over time in any case; nursing care can place undue pressure on nurses since there is a need for exquisite symptom management. According to Melvin (2012), nurses are constantly faced with trauma, suffering and pain, meaning that despite their best efforts to care for patients they may experience distress associated with their experiences. Melvin (2012) also mentions that intervention of professional CF is critical for nurses to continue caring for patients. The researcher further highlights two study participants who mentioned the benefit of nurse managers facilitating interventions for nurses who suffer distress as a result of exposure to family and patient trauma.
4.0 Implementation Plan
Obtaining necessary approval: Relying on evidence-based practice (EBP) would increase the likelihood that the project would help reduce trauma and CF at the workplace and improve health outcomes. Seeking approval for the proposed solution will also integrate staff support, since nurses and physicians are tasked with improving the quality of care. To begin with, the implementation plan there will be a need to consult the nurses to ensure they understand the benefits of the proposed solution. Additionally, other staff working in the critical care department will be informed on the proposal as this makes it likely that all staff will be directly involved in the implementation process.
Nursing managers oversee the implementation of changes, while the hospital administrators approve changes. As such, the administrators will need to give their approval for the proposal, which will highlight on the changes to be undertaken based on EBP and assessment of the current situation. Hence, the objectives of the proposal will be clearly laid out, highlighting the benefits of the project as this will likely influence the administrator’s decision on accepting and approving the proposal. Typically, there is skepticism when implementing changes, and there is need to bring on board all stakeholders.
Description of implementation logistics: Implementation logistics play a vital role in the success of the proposed plan, while relying on EBP provides guidelines on the best ways to integrate changes to achieve the set objectives. As such, there will be an assessment of the resources required as well as readiness to accept changes in order to improve implementation of the proposal. There will be evaluation of changes, with nurse managers tasked with ensuring that the sessions are relevant. In any case, when the nurses are well informed about the proposed solution they are more likely to be actively involved to oversee its implementation. It is assumed that nurses will understand how to identify CF symptoms, to facilitate intervention and the training will also identify duties to be carried out to improve intervention and reduce burnouts.
Involving various stakeholders and disseminating information to them encourages resources and time to be invested and improve the nurses’ morale as such, the nurse managers and leaders supervise the project implementation with a view of identifying the opportunities available as well as the challenges that are likely to hinder the project’s implementation. With each team of nurses given their report on how distress affects their work experience, it will be possible to compare results with different teams during the education sessions. It is through active learning that the training session’s best impart knowledge. Overall, the hospital staff are all to be orientated on the impending changes in order to minimize resistance to change and integrate them, but nurses and nurses manager will play a more proactive role to facilitate assessment on the effects of CF on the study participants.
Resources required for implementation: To facilitate the education training, power points (see appendix A), handout (see appendix B), and pre/post tests (see appendix C) will be applicable. There is a need for the participants to identify CF and burn out and hence while working in teams they can give their personal experiences with regards to various interventions. As such, the allocated time will be considered in the training session to avoid clashing with other schedules, with the nursing staff all in attendance. After the sessions, surveys will then be administered as pre and post test (see appendix C). The education sessions pre/post tests are to understand if the participants learned anything new and the extent to which the sessions were valuable. Nurse perceptions about the training sessions are also important as shown by feedback and their enthusiasm towards implementing changes.
The respondents would be educated about compassion fatigue and nurse burnout and how nurses are affected by this problem. They would also be enlightened about the proposed solution, the project (see Appendix A). Personal computers will be relied upon to store information that can easily be accessed at any time, with information also sent to each nurse via e-mail after the close of the education sessions. Sharing the information in nursing education is vital to provide evidence on the viability of an intervention. In any case, for easier referencing, retrieving information is necessary, making it possible to assess areas, and more opportunities to improve the implementation plan. The full cost of the training session and related expenses is expected to be $ 20,000.
5.0 Incorporating theory
Watson’s theory of human caring was introduced between 1975 and 1979. Watson’s theory emerged as a result of her views in the nursing field. The theory was meant to enhance a meaning in nursing and portray the practice as an emerging sector and distinct profession with certain values, practices, ethics and mission in the world (Watson, 2010). Some of the core principles of Watson’s theory include the practice of equanimity and kindness, enhancing and playing part in the caring-healing settings, giving chances to miracles and ensuring belief of others (Watson, 2010).
The rationale for selecting Watson’s theory is founded under the premises that nurses in the emergency center deal with critical issues of patients and failure to ensure full attention can ruin intervention (Lukose, 2011). Watson’s theory has been grounded in the emphatic association between nurses and patients, which is the core focus of this project. Watson’s theory works to provide a solution for compassion fatigue among the nurses. Watson’s theory advocates for one of the most crucial parts of nursing that is the relationship-based nursing (RBN). That way, RBN encourages empathy along with communication to patients and families. Watson’s theory also encourages nurse relationship and collaborations with other colleagues and self (Sabo, 2006).
This project aims at determining if the nurses who have been treated for compassion fatigue tend to deliver greater satisfaction than those who have not been treated for the same. Watson’s theory will be used in the project by illustrating that the disorder is encountered by nurses who assist patients who are in distress. In return, the nurses will become traumatized after empathy and showing compassion (Herron, 2010). Owing to the provisions in the theory, the practices of empathy and compassion will lead to insufficient care traits and self-sacrifice on the side of the nurses (OkumuÅŸ & Lash, 2015). Watson’s theory can be concluded that Watson’s theory of human caring is the best one to conduct the project. Watson’s theory tends to incorporate core concepts including a transpersonal caring association, caring moments, several working ways and relational caring among others. Watson’s theory provides the most basic ways of mitigating compassion fatigue.
6.0 Evaluation plan
Several methods would be used to measure the effectiveness of the project. This project is about providing nursing education programme to nurses in the hospital’s emergency department as the intervention to reduce cases of nurse burnout as well as compassion fatigue. The intervention is also intended to improve nurse job performance and thereby improve patient satisfaction. The first method that would be used to measure the effectiveness of this project entails comparing the incidences of compassion fatigue and nurse burnout at the hospital before and after the implementation of this project. This means that the project would be considered as effective if incidences of nurse burnout and compassion fatigue reduce by a certain extent after the intervention has been provided to the emergency nurses. However, if incidences of CF and nurse burnout remain the same or increase two months following the implementation of the proposed solution, then the project would be considered to have been ineffective since it would not have served the purpose of its implementation. The second method for measuring the effectiveness of this project will entail comparing the levels of patient satisfaction before and after the implementation of the project. This project is expected to result in improved patient satisfaction due to reduced nurse burnout and CF. As such, if patient satisfaction two months after the project is implemented improves, then the project would be seen as effective, otherwise, it would be considered to have been ineffective and futile.
The variables that would be assessed when the project outcomes are evaluated include the perceptions and attitudes of staff members at the hospital – emergency nurses in particular. This is largely because it is the hospital’s emergency nurses who would receive the education intervention aimed at reducing their compassion fatigue and burnout. In essence, this project would only be successful if hospital staff members have a positive attitude and affirmative perception toward it. If they do not, then this project may be unsuccessful.
PowerPoint slides (see Appendix A) and handouts (see Appendix B) would be used to educate project participants. A hand out questionnaire (see Appendix D) is used to evaluate the outcomes of the project. The questionnaire contains a total of 6 structured, closed-ended questions which the respondents can answer in about 13 minutes. Closed-ended questions are used since it is easy to analyze the data obtained from quantitative questionnaire. It will be handed out to nurses working in the emergency department who would have been treated for compassion fatigue.
7.0 Dissemination Plan
Other than conducting the research in the field of nursing, there is also the aspect of presenting the results to the nursing community and the key stakeholders (Strategiesfornursemanagers.com, 2015). This is a crucial aspect as it is the start of the practical application of the research in the real world. The nursing community has to understand the content of the research in their context, for them to appreciate the importance of the findings and their applicability. As such, the strategies used in the dissemination of the results are the most crucial aspects. One of the strategies that are going to improve the level of understanding and increased acceptance is through publication of the findings of this project in reputable scholarly journals such as New England Journal of Nursing or JAMA. Publication of the findings in scholarly journals will not only increase the credibility of the research findings, but will also make the findings available to the academicians and the nurses as well through a formal forum.
The other strategy for disseminating the findings of this project to the stakeholders and the greater nursing community will involve the presentation of the results through the national and local professional conferences that are held in the various counties across the country. The presentations can also be extended to the local and national journal clubs, to tap into the huge base of professionals and stakeholders that grace these events. Putting up a website where the stakeholders and the nursing communities can interact with the findings is also important as they will have a firsthand experience, through the portals to interact with the authors as well (Strategiesfornursemanagers.com, 2015).
Moreover, conferences and forums would be held at the local and national level and national level attended by the nursing community and the stakeholders attend such events. In these forums and conferences, the project and the findings obtained would be discussed. Making presentations at hospital committees is also a quite significant strategy for disseminating the findings to the stakeholders and the greater nursing community. Making presentations is a direct means of meeting with the nursing community and helping them to understand the meaning and significance of the research in reference to improving their well-being and that of their patients with close reference to health care delivery and quality.
8.0 Review of literature
Adriaenssens, J., De Gucht, V., Van Der Doef, M., & Maes, S. (2011). Exploring the burden of emergency care: Predictors of stress-health outcomes in emergency nurses. Journal of Advanced Nursing, 67(6), 1317-1328.
In the report Adriaenssens et al. (2011) bring out the comparison of the general nurses to emergency nurses with reference to characteristics of the organizations and the jobs. The report further gives an insight into the way these chara...