The Advanced Clinical Practice Fellowship (ACPF) program has provided me with a unique opportunity to learn about program design and development processes. This fellowship was completed full time in the fall and winter of 2015-2016 under the guidance and supervision of my mentoring team from Kingston General Hospital, (Joanna Noonan, manager of Occupational Health, Safety and Wellness; Theresa Richard, Return to Work Specialist; and Mary Myers, Lead Advisor of Leadership and Learning). Through this experience, I have learned how I can contribute to have a more positive impact on the mental wellbeing of all of those who provide and support patient care. The topic I decided to focus on for program design and development was an educational program plan for compassion fatigue awareness and resiliency. It is important to acknowledge that compassion fatigue can affect not only health care professionals, but also allied health and family caregivers, therefore this educational program plan is for all individuals in an acute care setting.

The mission of The Compassion Fatigue Educational Program is to focus on three areas:

1. raising awareness,
2. teaching strategies for resilience to compassion fatigue, and,
3. providing the necessary emotional supports to individuals when needed.

The competencies of the Institute for Performance and Learning were used as a framework to assess performance needs in a structured manner. For the purpose of this fellowship, the following competency categories and subcategories were explored: (1) assessing performance needs, (2) identifying performance gaps, (3) identifying solutions for the gaps, and (4) validating next steps and measures. Future work for the program will include (1) designing training, (2) conducting design analysis, (3) establishing learning objectives and evaluation, and (4) create detailed design.

Through my learning objectives, I was exposed to a variety of learning opportunities including a literature search and written review on compassion fatigue and existing educational programs/plans. Using search terms such as compassion fatigue, burnout, educational programs/plans, nurse fatigue, physician burnout, caregiver burnout, I was able to collect an extensive amount of information and research material on my topic. This included a variety of articles, books, YouTube videos, websites, and research papers, RNAO best practice guidelines recommendations such as Healthy Work Environments and Preventing and Mitigating Nurse Fatigue in Health Care Healthy Work Environments. I also had the opportunity to visit other hospitals (i.e., Mount Sinai, Toronto East General Hospital, and North York General Hospital) to learn about existing educational programs on compassion fatigue.

My literature search included the work of pioneers and experts in the field of compassion fatigue to further understand the current findings on compassion fatigue and I had the opportunity to meet with and interview several experts including Francoise Mathieu (Compassion Fatigue Specialist and Co-Executive of Tend), Dr. Melissa Andrew (Director of Resident Affairs at Queen’s University), Dr. Thomas Ungar (Chief of Psychiatry and Medical Director of the Mental Health Program at North York General Hospital), Florence O’Connor (Account Executive, Homewood Health Services, Ottawa), Dr. Claude Barraud (Psychotherapist and Clinical Manager, Crisis Management Services, Homewood Health), Melissa Barton (Director of Organizational Development and Healthy Workplace at Mount Sinai, Toronto), Nathalie Peladeau ( Interim Director, Nursing Education and Development at Mount Sinai, Toronto), Christine Devine (Wellness Specialist, Toronto General East, Toronto), and Katherine Victorio (Wellness Coordinator, North York General Hospital). I have future plans to meet with Dr. Heather Stuart (epidemiologist, Queen’s University, expert on stigma, and chair of Bell Let’s Talk). Other expert input through email correspondence included Dr. Frank Ochberg (Clinical Professor of Psychiatry, Michigan State University, Former Associate Director, National Institute of Mental Health, Former Director, Michigan Department of Mental Health, as well as founder of Gift from Within, a website for PTSD Resources for Survivors and Caregivers), Joyce Boaz (Director of Gift from Within), and Dr. Charles R. Figley (a pioneer in compassion fatigue and traumatology, Past President and Founder, Green Cross Academy of Traumatology, Director, Tulane University Traumatology Institute).

The literature review was completed in written format and integrated into the learning objectives of sample modules as part of the proposed educational program plan for KGH. The literature review can be a reference for staff and components of it can be used for the KGH’s wellness website as a tool for raising awareness. The completed online Prezi samples of compassion fatigue educational presentations that were designed and developed through this RNAO fellowship include the following:

1. a 45 minute “lunch and learn” module on compassion fatigue for a general audience that can be used for new hires, peer partners, and adapted for a nursing and/or physician audience, and
2. wo 20-minute modules, entitled Compassion Fatigue Fundamentals and The Stress Factors, were also developed for front line employees and key stakeholders.

There are further plans to develop all seven modules of the compassion fatigue educational program plan, including modules on trauma, stigma, personal resources, KGH resources, and resiliency. As well, there are further plans to develop a training session specifically for leaders (i.e., managers, charge nurses, and supervisors) to foster champions within the organization.

Through this fellowship, I learned the steps and components for the development of an adult education program, and learned how to critically assess and use evidence-based research to prepare a literature review on compassion fatigue awareness and compassion fatigue programs. By learning how to conduct a needs assessment, which included internal and external environmental scans, and to perform a gap analysis, I was able to garner a good understanding of the current internal and external status related to this topic, and able to identify any gaps and suggestions for improvement. The gap analysis compared the recommendations found in the literature search and interviews to what was in place in our hospital, and considered the various barriers to overcome in order to meet the recommendations for a robust compassion fatigue program. Through one-to-one interviews and focus group interviews, I strengthened my ability to collect and synthesize descriptive data in a meaningful way. These interviews took place in person, by telephone, through email, at KGH and at other hospital and organization sites. Conducting interviews was my favorite component of this learning experience. Data and materials gained from the internal and external reviews/interviews were shared with my mentoring team, and I was able to learn how to integrate these findings into the KGH Compassion Fatigue Awareness & Resiliency Program.

The needs assessment process involved eliciting relevant information from a variety of sources as mentioned, analyzing that data, and recommending a solution. This helped me to determine the most effective approach to take in developing the program for optimal dissemination and uptake by program participants. This assessment also helped me to pre- strategize on program implementation and resulted in our team deciding that management, charge nurses, and supervisors play a critical role and therefore need to be one of the target audiences. A presentation specifically for them will be developed with a focus on the fundamentals of what Compassion Fatigue is and why it matters, how to recognize compassion fatigue in their employees, and the specific actions they can take to support their teams to minimize and possibly prevent compassion fatigue. In addition, information on existing supports available to them as leaders, such as the Key Person Advice Line and Crisis Management Services from our EFAP provider, will be included. A newly developed critical debriefing algorithm will be provided in order to assist leaders in determining when and how to efficiently access such services.

Overall, this ACPF program has been the most rewarding learning experience of my career. I have developed a variety of new skill sets that I can apply to have a positive impact on others and my organization. This fellowship has allowed me to lay the foundation for a sustainable compassion fatigue program that will eventually be completed with all 7 modules for implementation.

I wanted to thank the RNAO for this amazing opportunity to learn, flourish and grow in my nursing career, as well as Kingston General Hospital and my mentoring team who were supportive right from the onset. This being the best experience of my entire career, I strongly encourage anyone who has a learning interest to explore the ACPF program.