Compassion Fatigue & Debriefing: An acute-care evidence based education program
Summary
CHEO is a specialized acute-care hospital that helps more than 500,000 children and youth every year from Eastern Ontario, western Quebec, Nunavut and Northern Ontario. It takes 3,200 doctors, nurses and other allied heath professionals and staff to care for these children and youth. Between April 2018 and February 2019, these same staff and employees experienced 51 code whites, 269 SPOT activations (Critical Care Response Team) and 6 code blues. Occupational Health and Safety data for 2018 show a total of 3653 missed days of work, up from 3113 in 2017. Mental health is the leading cause for claims above all others at CHEO. In June and July of 2019 Critical Care Services Ontario (CCSO) conducted a 1-Measure Burnout Survey to front-line critical care staff in Ontario hospitals, and CHEO's staff were above the provincial average.
To date, compassion fatigue and burnout education have not been specifically addressed at CHEO. While there are a number of resources available to hospital staff, uptake is limited to a small consistent group, with relatively small uptake from frontline care providers. As a RN in the PICU I know that critical care practitioners are at particularly high risk of burnout due to the unique demands present in an intensive care unit, and I bear witness to these consequences including exhaustion, worry, stress, poor decision-making, pessimism, and feeling disconnected. The CCSO states the risk of burnout impact on a team is reduced team morale, poor communication, and negative emotional contagion. I was encouraged to join the Debriefing Taskforce by Ann Lynch, Chief Nursing Executive & VP Acute Care, to help identify improvement strategies for individuals and teams at CHEO.
The overall focus of this ACPF Fellowship was to increase my knowledge and understanding of how to design and implement an educational strategy to address compassion fatigue for individuals employed in an acute care setting. Corporate strategies were already in alignment with this objective with a CHEOWorks Debriefing Taskforce having been struck in December 2018 under Mary MacNeil (Director, Nursing Practice & Education), therefore the work of this Fellowship sought to join the existing Debriefing Taskforce and further engage in the subject matter.
My own learning objectives for this ACPF Fellowship included conceptual analysis and clarity regarding compassion fatigue, burnout, resilience and debriefing in an acute care setting. I engaged multiple subject matter experts internally and externally to CHEO, completed training by the TEND Academy and the CHEO Research Institute, and read key literature to develop my knowledge, skills and expertise. I conducted a site visit to Alberta Children's Hospital and learned about other peer-to-peer support programs in Canada and the US. These learnings helped me to understand how to identify, organize, and collect relevant data pre/post implementation of a compassion fatigue and debriefing education program for individuals in an acute are setting. I collaborated to design and implement a multidisciplinary QIP of peer responders trained to provide immediate support in terms of debriefing and defusing.
Outcomes
A pilot Peer Emotional Empowerment Program of Support (PEEPS) will be launched in April 2020 in PICU and Hematology- Oncology & Medical Day Unit at CHEO in response to the existing needs and the works of this Fellowship. The QIP, conducted in partnership with both units, has the potential to be an indicator of staff wellness and to assess the value of PEEPS and the availability of the program. Grounded in the processes of Critical Incident Stress Management (CISM) the aim of this program is to provide timely support to staff and employees who have been involved in critical incidents that leave them emotionally and/or physically affected by those incidents (International Critical Incident Stress Foundation, 2020). The design of PEEPS has been further informed by emergent themes from Fellowship interviews of healthcare providers at Alberta Children's Hospital and their experiences implementing CISM. CHEO is in a unique position to study the implementation of PEEPS, and prepare the QIP for publication. The study will use a prospective, multi-method survey design aimed to address two questions: 1) Is the PEEPS program an effective program of support for emotional debriefing?, and 2) Does implementation of the PEEPS program address burnout rates among the two units in the pilot? For the program evaluation, two surveys were designed during the ACPF. In addition to surveys, the program will also be evaluated by reviewing activity such as usage data. Preliminary discussions about PEEPS have been extremely positive with multiple units and disciplines requesting early access to the program.
Overall experience
I am grateful to the RNAO for funding this opportunity and I would like to thank my Primary Mentor Jennifer Ellis, RN, PhD (Director, Quality and Safety, CHEO) for her support and guidance. A very special thank-you to my fellowship team: Brennah Holley (Nurse Educator, CHEO), Megan Sloan (Project Coordinator, CHEO), Anna Pevreal (Director, CHEO), Erin Larmer (Clinical Manager, CHEO) and Renee Kampman (RN, ACH) for facilitating my fellowship activities. A special thank-you also to the RNAO and Alberta Children's Hospital for supporting this exciting learning opportunity. It is my hope that there will be opportunities to sustain my Fellowship work through presentations and conferences. I am especially hopefully that PEEPS will prove to be a valued solution for staff and employees at CHEO. It is inspiring to work with these individuals every day, and it is time to take care of our caregivers too.
#Utakecare2, #PEEPSforYOU
