Self-care ‘critically important’ to avoid compassion fatigue, prevent burnout
FORT WORTH, Texas — Self-care is critically important for health care providers to avoid compassion fatigue and prevent burnout, according to a presenter at HOPA Ahead 2019.
“The work we do exposes us to tremendous amounts of suffering and ‘what-if’ questions,” Justin N. Baker, MD, FAAP, FAAHPM, Baker, MD, FAAHPM, FAAP, chief of the division of quality of life and palliative care, director of the hematology/oncology fellowship program and full member of the department of oncology at St. Jude Children’s Research Hospital, said during a presentation. “The personal and professional impact of chronic patient death is profound. If we don’t talk about self-care, and if we don’t contemplate what the impact of doing this work every day has on each of us, we won’t be able to help [our patients].”
Baker discussed the concept of passion fatigue, which — as described by Charles Figley in a 2002 paper in Journal of Clinical Psychology — reflects the “inevitable experience of the emotional exhaustion that comes from continuous compassion directed toward those in crisis.”
Research showed health care workers in general, and those who work in hematology/oncology specifically, have higher levels of compassion fatigue than trauma workers, Baker said.
“You all are asked every day to provide compassionate care to your patients and their families who are suffering,” Baker said. “You are, in part, taking that on yourself, and to think that has no effect is foolish.”
When compassion fatigue is persistent and not addressed, the risk for burnout increases.
“Burnout is the long-term consequence of not improving issues related to resilience and self-care,” Baker said.
One in 20 hospital pharmacists suffer from pronounced burnout, according to a paper published in 2007 in Journal of Pharmacy Practice and Research.
The authors reported no association between burnout level and sex, the role performed within the pharmacy, region or number of hours worked. However, individuals who had been in the field for 5 years or less appeared at greater risk for burnout.
“This underscores the importance of mentoring programs and making sure we have improved onboarding, training and check-ins,” Baker said.
Baker emphasized that burnout is preventable and treatable
Individual actions can include cognitive coping strategies (eg, accepting or normalizing death, and reframing your point of view to focus on positives), behavioral coping strategies (eg, vacations, sports, entertainment or hobbies), relational coping strategies (eg, accessing social support from colleagues, family members or friends), professional coping strategies (eg, compartmentalization), and spiritual coping strategies (eg, faith or religion).
Behaviors to avoid should include the continual loop of negative feedback, gossip, passive aggression and full detachment.
“If you are in the middle of being significantly affected by compassion fatigue, or perhaps even burned out, sometimes the only things that come out of it are these negative components,” Baker said. “It takes work and self-knowledge and institutional recognition of the importance of this.”
It also requires setting boundaries.
“In that moment I am with my patient and their family, I am fully present,” Baker said. “When I move to my next patient, that prior patient doesn’t follow along with me in my mind or on my emotional path.”
Baker also identified traits of clinicians who experience greater well-being. These include developing a philosophical attitude toward life, finding support in the workplace, engaging and finding meaning by developing a sense of self-worth and self-efficacy, developing healthy relationships personally and professionally, and taking care of themselves physically.
They also “grieve well,” Baker said. Steps could include ensuring adequate sleep, finding time to rest or rejuvenate throughout the work day, and speaking with colleagues to reinforce they are not alone in this experience.
“We may even want to develop rituals,” Baker said. “Whenever a patient I’m particularly close with dies, I think of a song that has some sense of meaning to me. When that song plays at a later date, I think of that patient and that family. ... It’s incredibly helpful to me, and it has been shown in literature that if you do develop rituals, it can help prevent much of what we are talking about.”
Actions at the institutional level can include additional training and education; acknowledgement and validation of grief; institutional psychosocial support; and opportunities for vacations or sabbaticals. Structural changes to training models also can be made to enhance support, lessen feelings of isolation and help alleviate the emotional burden associated with patient deaths.
Baker concluded by outlining a three-step plan to self-care. The first step is establishing an intention to give attention to your own well-being.
“Self-care is not selfish; rather, it is selfish to not do self-care,” he said.
The second step is conscious and mindful appreciation of what you already enjoy. The third is embracing practices that increase your moving from reacting to responding.
“When you have a very narrow emotional bandwidth and, if something negative happens to you, you can’t do anything but react,” Baker said. “When you expand your bandwidth by paying attention to these things, you’re able to respond. ...
“This is a personal call to action and an institutional call to action,” Baker added. “This is a crisis in our profession. We have a golden opportunity and an obligation. Your patients and families deserve better from you. If you do not take good care of yourself, you’re not giving all of you, so please take good care of yourself.” – by Mark Leiser
Baker J. Compassion fatigue, burnout and self-care: Self-care is not selfish. Presented at: HOPA Ahead 2019; April 3-6, 2019; Fort Worth, Texas.
Disclosure: Baker reports no relevant financial disclosures.