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Compassionate Care in the
21st Century: Caring for Self
and Others
Virginia Organization of Nurse Executives and Leaders
“Cultivating Connections: Caring for You, Team, and Your
Consumers”
June 2, 2015
Dorrie Fontaine RN, PhD, FAAN
Dean and Professor
[email protected]
Agenda
Why is caring for self and others so critical
today?
Why is compassion and empathy needed
to improve the patient experience?
What are the benefits of compassion and
empathy for nurses to increase engagement with
self and others?
AACN Standards for
Establishing and Sustaining
Healthy Work Environments:
A Journey to Excellence
Essential Elements of a
Healthy Work
Environment (AACN 2005)
Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership
AACN studies on Healthy Work
Environments (with VitalSmarts)
Silence Kills
2005
Silent Treatment
(with AORN)
2011
Silent Treatment Study
5 year follow-up to Silence Kills
6500 OR and critical care nurses
Widespread disrespect present
Documented skills successful nurses use
Safety tools are not enough
GOOD NEWS: 20% vs 10% spoke up
Nurse Managers are Key
“Our
lives begin to end the day we
become silent about things that
matter.”
Martin Luther King, Jr.
Healing the Hospital
Hierarchy (New York Times March 17, 2013)
Theresa Brown RN
“When doctors
and nurses don’t
get along, it’s the
patient who
suffers.”
OMG…
(c) 2009 Debra Gerardi
All Rights Reserved
10
The Cost of Bad Behavior
Pearson, C. & Porath,
C. (2009) The cost of
bad behavior: How
incivility is
damaging your
business and what
to do about it. New
York: Penguin Group
Pearson & Porath (2009)
Among workers who’ve been on the receiving
end of incivility:
• 48% intentionally decreased their work effort.
•
•
•
•
38%
80%
63%
66%
intentionally decreased the quality of their work.
lost work time worrying about the incident.
lost work time avoiding the offender.
said that their performance declined.
“When it comes to managing the organization,
you should hire for civility, teach it, create
group norms, reward positive behavior, penalize
rudeness…”
In Pearson & Porath (2009)
Common in nurses and
physicians
Burnout
Post traumatic
Stress syndrome
Moral distress
Mealer et al 2009; Bruce et
al 2014
Healthy Work Environments?
Work force shortage
Moral distress
Lateral and vertical
violence such as
bullying
Quality & safety
issues
Working wounded
BURNOUT
Burnout
Emotional exhaustion
Emotionally overextended
and exhausted by work
Depersonalization
Negative, cynical, treating
others as objects
Personal accomplishment
(low)
Feeling inadequate,
incompetent, and inefficient
From: Maslach 1981
Association between Burnout and
Patient Outcomes
Hospitals with more
stressed nurses had higher
infection rates
When burnout reduced,
quality of care and cost
improved ….
30% decrease
over 6,000 fewer
infections and cost
savings of $69M
Cimiotti et al., 2012
Who burns out and why?
And…what about the ones who
don’t?
How to re-engage
Resilience in ICU Nurses
3500 nurses AACN
members
80 % experienced
burnout
22% highly resilient
and less likely to
develop burnout
Mealer, M et al (2012).
The presence of resilience is
associated with a healthier
psychological profile in ICU
nurses: Results of a national
survey. J Int Nurs Studies,
49:292-299.
Solutions/Opportunities
A call to action
Story of a surgeon
“the surgeon had 2 routes to the operating room---one
took him through a dark hallway filled with empty boxes.
The other more time consuming route took him through
the main hospital where he passed windows plants and
coworkers…
Powered by Feel: How individuals, teams and companies
excel (2008) Clawson, J. & Newburg, D.
Story of a surgeon
“…the latter gave him
energy, the former did not.
If he were your heart
doctor, ask yourself what
route you would want him
to take before he operated
on you! Fast and
discouraging or slow and
uplifting?”
Patient Satisfaction/John Dent, MD
Overall
4EAST
Displayed by Discharge Date
Inpatient Overall
From triple to quadruple aim:
Care of the patient requires
care of the provider
Bodenheimer, T. & Sinsky,
C. (2014) Ann Fam Med
12:573-576.
UVA School of Nursing
Creating
compassionate
nurses and
leaders
for the 21st Century
Reunion Weekend Yoga on
The Lawn June 7, 2014
What is compassionate care?
Why is it needed today?
The Compassionate Care
Initiative at UVA
Reducing human suffering by
cultivating compassionate
people and systems
What is compassion and
empathy?
Compassion
…experiencing a
trembling or
quivering of the
heart in response to
another’s pain
Sharon Salzburg
Empathy
Putting yourself in
the shoes of
another
A necessary
precondition for
compassion
Time to reclaim the
soul of health care
Cultivating Courage
Compassion starts with …
Awareness
and an
Open heart
Can empathy and compassion
be learned?
Editorial in the Daily Progress, January 6,
2013
Being Present…Fully Present
What do people see when they
see you?
Compassion is a
rigorous stance
We live in a time when
science is validating
what humans have
known throughout the
ages: that compassion
is not a luxury; it is a
necessity for our wellbeing, resilience, and
survival.
Roshi Joan Halifax
Compassion as a Global Remedy
His Holiness the Dalai
Lama, October 2012
Susan Bauer-Wu
Tussi and John Kluge Endowed Professor
“The science of finding focus…”
Resiliency Initiative
The Architecture of
Resilience
“…resilient practices -- things like
meditation, yoga, reflective writing, deep
breathing, even physical exercise -- make
for happier, stronger, more centered
clinicians.”
D. Fontaine, S. Bauer-Wu, & D. Germano (2014)
http://www.huffingtonpost.com/dorrie-k-fontaine/thearchitecture-of-resil_b_4560762.html
Compassionate Care Initiative
Jonathan Bartels RN, BSN
The Pause
Bartels, J. (2014). The
pause. Critical Care
Nurse, 30:74-75.
Compassion and the need for
Kindness
Kindness
“is not just about
being nice, it’s
about recognizing
another human
being who deserves
care and respect”
Compassionate Care
Contemplative Practices
Awareness—Presence—Resilience
Mindfulness is a way of being and relating to
ourselves, our circumstances, one another, and the
world around us.
Susan Bauer-Wu (2011)
Invites an attitude of openness and curiosity.
It is being awake to the fullness of our lives right
now, through engaging the five senses and noticing
the changing landscapes of our minds without
holding on or pushing away any of it.
-S. Bauer-Wu (2011)
What are you willing to notice in
your world?
Mindful clinicians associated with
better patient care
• Multi-center, observational study
(MD, NP, PA)
• Measures:
– Patient ratings of quality of care (n=437)
– Clinician (n=45) encounters recorded and coded
into high and low mindfulness
• High mindfulness clinicians associated with:
– Patient-centered communication
– Positive emotional tone
(Beach et al., 2013)
UVA Compassionate Care
Initiative Vision
To have safe and high
functioning healthcare
environments with
healthy and happy
nurses, physicians and
other health care
workers and where
heart and humanness
are valued and
embodied
What are we doing at UVA?
Integrating into the Schools
of Nursing and Medicine, all
of UVA and the Health
System
Built a resilience room and
contemplative classroom
Free yoga and meditation 5
days a week
What are we doing at UVA?
Formal courses and
ones sprinkled
throughout curriculum
Resiliency retreats (for
every nursing student
and those “in the
field”)
Compassionate Care
“ambassadors”
If we truly practiced with compassion and
empathy, what would the health care system
look like? How would we be transformed? How
might this change the outcomes for patients and
families…
From Fontaine, D. K., Rushton, C.H., & Sharma, M. (2014). Cultivating
compassion and empathy. In M. Plews-Ogan & E. Beyt (Eds.). Wisdom
leadership in academic health care centers: Leading positive change.
London: Radcliffe Publishing, 92-110.
…invite stillness and inquiry
Take a breath
Our focus includes
Interprofessional Education
To create understanding
of each other’s roles by
training all 3rd year
nursing and medical
students together
3 C’s
3 C’s for cultivating a Pause in
Your Life and Resiliency
First
Consider a
contemplative
practice
3 C’s for cultivating a Pause in
Your Life and Resiliency
Next
Carve out time
for gratitude. Start
a gratitude journal of
just writing down 3
things you are grateful
for every night… do it
for 21 days and it is a
habit.
Third
Cultivate a practice of kindness
towards yourself and others
“Above all else reach
out and put your arm
around your nearest
colleague…
we are all in this
together.”
Dr. C Farmer
Resources
American Association of Critical-Care Nurses. (2005). AACN
standards for establishing and sustaining healthy work
environments: A journey to excellence. American Journal of
Critical Care, 14, 187-197. Available at:
http://www.aacn.org/hwe
Bartels, J. (2014). The pause. Critical Care Nurse, 30:74-75.
Cimiotti, J.P., Aiken, L.H., Sloane, D.H., & Wu, E.S. (2012).
Nurse staffing, burnout, and health care–associated infection.
AJIC, 40(6): 486-490.
Fontaine, D. K., Rushton, C.H., & Sharma, M. (2014).
Cultivating compassion and empathy. In M. Plews-Ogan & E.
Beyt (Eds.). Wisdom leadership in academic health care
centers: Leading positive change. London: Radcliffe
Publishing, 92-110.
Resources
Fontaine, D. K. Can empathy and compassion be learned?
Editorial, Daily Progress, January 6, 2013.
Fontaine, D. K., Bauer-Wu, S. & Germano, D. (2014) The
architecture of resilience.
http://www.huffingtonpost.com/dorrie-k-fontaine/thearchitecture-of-resil_b_4560762.html
• Mealer, M et al (2012).The presence of resilience is associated
with a healthier psychological profile in ICU nurses: Results of
a national survey. Int J of Nurs Studies, 49:292-299.
• Ulrich, B. T. et al Critical care nurse work environments 2013:
A status report. Critical Care Nurse;34:64-79
• Zwack, J. & Schweitzer J. If every fifth physician is affected by
burnout, what about the other four? Resilience strategies of
experienced physicians. Acad Med 2013;88:382-38