Page 4 ONF SCHOLARSHIPS MESSAGE FROM ONF & GRANTS · Page 2 Ohio Nurse December 2017 OHIO NURSE The official publication of the Ohio Nurses Foundation, 4000 East Main St., Columbus,

current resident or

Non-Profit Org.U.S. Postage Paid

Princeton, MNPermit No. 14

Volume 11 | Number 1 | December 2017 Quarterly publication direct mailed to approximately 200,000 Registered Nurses in Ohio.

Inside this Issue

What’s inside this issue?Ohio’s “Support Nursing”

License PlatesPage 4

Nursing Management of Dementia (Alzheimer’s) Patients

Page 6

ONF SCHOLARSHIPS & GRANTS

Grant Program to Support Nursing Research

The Ohio Nurses Association already supports nursing research through its charitable arm – the Ohio Nurses Foundation. But did you know that ONA also offers a grant program to further support nursing research?

The grant program is a resource and one-stop-shop for any nurse to view available grant opportunities. ONA members will also have the added benefit of personalized assistance in finding and applying for specific opportunities.

Contact Lisa Walker, [email protected] or 614-448-1031 for more information.

MESSAGE FROM ONFDuring my term as the

President of the Ohio Nurses Association, the Ohio Nurses Foundation (ONF) was established. Since its inception, the ONF has awarded thousands of dollars to deserving nurses and nursing students to carry out their research or continue their nursing education. This was all made possible by your generous support. The recipients of this financial support have gone on to give back to ONA by serving in variety of leadership capacities.

You may have attended the Nurses Choice Awards luncheon which is held each spring in Columbus. That event gives us an opportunity to recognize the recipients of the scholarships and to learn more about the Nursing research that has been funded by ONF. In addition to being ONF’s major fundraiser, it’s always an uplifting event. The date and location of the Awards luncheon will be announced soon so you can mark your calendars!

This is an exciting time for ONF. We are poised to have an even larger impact on our profession in the state of Ohio. But we can’t do that without your support. As you consider your end of the year charitable contributions, please consider a gift that will support your Nursing colleagues and advance our profession.

Susan Stocker

__________________________________________

Appointed in 2001, Dr. Susan Stocker is the Dean and Chief Administrative Officer of Kent State University at Ashtabula. She holds the rank of Associate Professor at Kent State University and is the longest standing dean at Kent State University.

In addition to her duties on the Ashtabula Campus, Stocker currently serves as the Interim Dean and Chief Administrative Officer of Kent State University at Geauga, located in Burton, Ohio, and Kent State’s Regional Academic Center in Twinsburg.

Stocker led the capital campaign that raised $6 million dollars locally to help finance the Robert S. Morrison Health and Science Building (now Robert S. Morrison Hall). The state-of-the-art learning facility opened its doors to students in August 2009.

During her career as a registered nurse and educator, Stocker has served in a number of leadership capacities. She served as the President of the Ohio Nurses Association from 1997-2001 and was appointed to the Ashtabula County Medical Center Board of Trustees where she is currently the Chairperson.

Susan Stocker was also acknowledged as the 2016 Distinguished Alumni Award in recognition of her contributions to the field of nursing and nursing education.

Education• PhD, Curriculum and Instruction, Kent State

University• MSN, Nursing, Case Western Reserve University• BSN, Nursing, Villa Maria College• AAS, Nursing, Kent State University at Ashtabula• AAS, Medical Laboratory Technology, Trocaire

College in Buffalo, NY

Why reducing nurse fatigue has an economic benefit to hospitals . . . . . . . 2

Selfie Station . . . . . . . . . . . . . . . . . . . . 3

Editor’s Note . . . . . . . . . . . . . . . . . . . . . 4

Ohio Nursing License Plate . . . . . . . . . . 4

Continuing Education: Why? So What? . 5

Nursing Management of Dementia (Alzheimer’s) Patients . . . . . 6

Independent Study . . . . . . . . . . . 7-11

Page 2 Ohio Nurse December 2017

OHIO NURSEThe official publication of the Ohio Nurses

Foundation, 4000 East Main St., Columbus, OH 43213-2983, (614) 237-5414.

Web site: www.ohionursesfoundation.org

Articles appearing in the Ohio Nurse are presented for informational purposes only and

are not intended as legal or medical advice and should not be used in lieu of such advice. For specific legal advice, readers should contact

their legal counsel.

Ohio Nurses Foundation2015-2017 Board of Directors

CHAIR: To be appointed

TREASURER: To be appointed

DIRECTORS:To be appointed

PRESIDENT: Lori Chovanak, Columbus

The Ohio Nurse is published quarterly in March, June, September and December.

Address Changes: The Ohio Nurse obtains its mailing list from the Ohio Board of Nursing. Send address changes to the Ohio Board of Nursing:

17 South High Street, Suite 400Columbus, OH 43215614-466-3947www.nursing.ohio.gov

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. ONF and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Ohio Nurses Foundation of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this Foundation disapproves of the product or its use. ONF and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of ONF.

Lori Chovanak President, ONF

Why reducing nurse fatigue has an economic benefit to hospitals continued on page 3

Nurse fatigue is a major issue in health care. It is also a top contributor to nurse burnout. Burnout leads to some nurses leaving their employers and some leaving the profession altogether. There is an exhaustive list of how fatigue affects our wellbeing and practice and could be an entire article in itself. Yes, nurse fatigue has an impact on nurses. It also has an significant impact on patients and their care.

When a patient goes to the hospital, they may not realize that merely going to the hospital may be risky. According to a health risk appraisal conducted by the American Nurses Association, 58 percent of nurse respondents reported working beyond their shift hours in order to complete their work. Furthermore, according to the results of a separate study, after 12 hours of work, nursing errors or near misses nearly tripled in frequency. This demonstrates a direct correlation between preventable medical errors and nurse fatigue. Patients deserve to receive healthcare that helps their issues, not healthcare that could harm them.

In addition to impacting nurses and patients, nurse fatigue results in a large financial burden for hospitals. Almost two decades ago in the article “To Err Is Human: Building a Safer Health System” (IOM, 2000), it was estimated that preventable medical errors result in total costs of between $17 billion and $29 billion per year for hospitals nationwide. Furthermore, a May 2016 John Hopkins study suggests preventable medical errors are likely the third-leading cause of death in the United States. Information from respected sources like these demonstrate a responsibility to reduce nurse fatigue, and also supports that addressing this issue can be a significant economic benefit to the hospital.

I believe there are eight areas where preventing nurse fatigue can be of substantial benefit to patients and have an economic advantage to both our healthcare system and independent hospitals. These include retention and recruitment of talent, better patient outcomes, service reimbursement, safety and quality of care, reduction of infection rates, reduction of hospital readmission, minimizing litigation, and enhancing the organization’s reputation.

Each one of these economic benefits can be accomplished through equal contribution and cooperation between nurses and hospitals. If hospitals put the proper operating stucture in place, nurses will be able to better avoid fatigue and complete the responsibilities of providing care to the highest standard.

Recruitment and RetentionStudies show when nurses are happy, patients do

better. However, nurses who are dissatisfied in their work environment will not perform as well, or will leave their job. The Journal of the American Medical Association projects that by 2020 the U.S. will face a 20% deficit in the number of employed nurses versus projected needed. Recruitment and retention of experience is not only important in keeping costs down through avoiding on boarding of new staff. Additionally, studies show that nurse experience also contributes to improved patient outcomes and satisfaction.

In a Gallup study published in 2014, a strong, positive correlation was found between employee engagement with patients and patient outcomes. However, employees are unable to be fully engaged if they are fatigued. For instance, when mandatory overtime is utilized nurses become fatigued as well as experience dissatisfaction. This leads to a failure in work life balance, and eventually it will cause many nurses to leave their positions. The hospitals are then left with recruiting and on boarding new nurses.

On boarding new nurses is not a cost-effective endeavor. According to a Nursing Solutions 2016 staffing report, the average cost of turnover for a bedside registered nurse ranges from $37,000 to $58,400 per nurse. There are many different components that add up to the high cost of nurse turnover including advertising/recruiting, vacancy

Why reducing nurse fatigue has an economic benefit to hospitals

costs, hiring, orientation/training, decreased productivity, termination costs, potential patient errors, compromised quality of care, and loss of institutional knowledge. Thus, it’s more economical for hospitals to maintain their staff and keep them satisfied, than to lose nurses and have to recruit.

Patient OutcomesIf hospitals are losing seasoned nurses and are

replacing them with new nurses that potentially have less experience, the quality and economics of care delivery can be compromised. When the care delivery is compromised, then patient outcomes are negatively impacted. When patient outcomes decline, hospitals realize a reduction in reimbursement from major payers such as Medicare and Medicaid.

An article released in 2014 by Health Leaders discusses the moral and financial implications of maintaining happy nurses and satisfied patients. In this article, a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is discussed. The scores of this survey concluded that in 2017, 2% of reimbursement dollars will be lost directly due to patient dissatisfaction.

In essence, hospitals have an obligation to prioritize optimal patient outcomes. This includes ensuring safe, quality care. According to the article about culture of safety titled “Navigating the Perfect Storm” by Ada Sue Hinshaw, strong positive work environments are crucial. This type of work environment not only makes the nurses more effective, but it substantially improves the safety and outcomes of the patient care delivered. Optimal outcomes will impact reimbursement. In order for optimal patient outcomes to be realized, nurses must be able to deliver the safe, quality care that patients deserve.

Patient Satisfaction As previously stated, at least 2% of the

reimbursement to hospitals is directly tied to patient satisfaction, based upon HCAHPS scores. High levels of staff engagement with patients are closely related to HCAHPS values. In a Gallup article published in 2014, it was estimated that Medicare payments for hospital readmissions cost the Centers for Medicare and Medicaid Service $17 billion per year.

Investments in employee satisfaction can pay off financially and lead to more satisfied patients who are likely to recommend the hospital to others. When nurses are able to provide safe, quality care, patients are overall much more satisfied with the care they receive. Reimbursement to hospitals is an important component of financial stability and success. As the outcomes of patients are consistently positive and patients display satisfaction with their care, reimbursement will consequently increase.

Safe, Quality CarePatients deserve safe, quality care. When nurses

are fatigued, studies have shown patients can have worse outcomes. When nurses aren’t satisfied or are fatigued, they can’t give their patients what they need and errors can increase. Errors occur when nurses have shorter attention spans, decreased memory, and impaired judgment. A fatigued nurse can result in a deterioration of the safety and quality of care provided.

As discussed in a Siemens Healthineers Global article published in 2016, open-minded and responsive staff heavily influences patient outcomes. Providing quality care is essential to patient safety. Studies show that nurses with more experience have less medical errors, and statistically demonstrate a higher level of quality in the care they deliver. Hospitals, nurses, and the entire healthcare team must work together for the best financial interest of the facility.

Infection Rates and Hospital Re-admission The significant economic consequences of

healthcare-associated infections in hospitals are detailed in the article, “The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention.” In these combined studies it is estimated that hospitals lose $28.4

December 2017 Ohio Nurse Page 3

ONA Members- Are You Prepared to Prevent Medication

Errors? – 1.3 CH- Running on Empty: Compassion

Fatigue in Nurses and Non-Professional Caregivers – 1.6 CH

- Developing a Nursing IQ – Part V – Practical Intelligence: Surviving in the Real World – 1.25 CH

FREE for ONA members at CE4Nurses.orgUntil February 28, 2018

Non-members may complete most studies at CE4Nurses.org for only $15

Why reducing nurse fatigue has an economic benefit to hospitals continued from page 2

to $45 billion annually due to hospital acquired infections. This means that decreasing infection rates could save U.S. hospitals billions of dollars. In order to prevent these hospital acquired infections, nurses must alert and rested. A reduction of infection rates is realized—as well as a decreased—in hospital re-admission rates in a healthy work culture. Nurses who are more satisfied and more competent are able to generate better patient outcomes and reduce infection rates. Reduced infection rates leads to less readmission, decrease length of stay, and greater reimbursement to the hospitals.

Litigation This concern over the lack of regulation in

scheduling nurses is highlighted in a study called “The Working Hours of Hospital Staff Nurses and Patient Safety.” This study finds that over 40% of the shifts worked by nurses extend over 12 hours, and the hours worked past the 12-hour shift consisted of significantly higher numbers of medical errors. Additionally, the previously cited 2016 John Hopkins study concludes that more than 25,000 people lose their lives annually due to preventable medical errors. If nurses are fatigued—leading to increased incidents of preventable medical errors—then there’s a higher possibility of litigation. This means hospitals potentially face more litigation from care that that is not up to standard and where preventable errors occurred. Nurses who are more focused and well rested perform their job with fewer medical errors, which significantly decreases the likelihood of an error that generates a legal complaint.

Reputation People are drawn to the hospitals that are close

to their communities, but also those of which they trust. Those who work in local hospitals are likely from these communities. Community members know the nurses working in the hospitals and are privy to their job satisfaction. With positive references from those nurses, community members are much more likely to think highly of their community hospitals. As discussed in the previously mentioned 2014 Gallup article about employee engagement with patients, it is crucial now more than ever to foster positive connections with patients. In a time when consumers are able to better compare healthcare options, hospitals must value the financial benefits of an excellent community reputation.

According to findings in a Becker’s Hospital Review article published in 2014, hospitals with high patient experience scores (HCAHPS scores) tended also score highly on reputation metrics. If community members know the hospital is a good employer, and that the nurses and healthcare staff are happy working there, then they’re going to choose to get their care there. This increases the patient’s likelihood of seeking healthcare in their community because those patients have heard that it’s a good hospital.

These economic benefits of reducing nurse fatigue are important for hospitals and for the healthcare system as a whole. Currently, if nurses are required to work mandatory overtime, it is difficult for them to address the issue. This is typically caused by fear of employer retaliation, leaving their co-workers in an understaffed situation, their worry that patients won’t get the care they need, or their fear of potentially losing their job or a license infraction.

However, with improved staffing plans, nurses are placed in a position to take better care of themselves in order to be better equipped to care for their patients. Nurses in acute care settings predominantly work twelve hours shifts. This means when they’re being directed to work mandatory overtime, their shifts expand to an unreasonable extended length of time. The Institute of Medicine report called “Keeping Patients Safe” recommends that nurses’ work hours be regulated to not more than 12 hours in a 24-hour period and not more than 60 hours in a 7-day work week. Currently, nurses will commonly work much longer.

The value of skilled, cognizant, and satisfied nurses should be heavily emphasized when considering the economic success of hospitals. Nurses should feel they are able to speak up when they are exhausted, not on their game, and uncomfortable to safely continue working. Allowing nurses to use their professional judgment as to whether or not they are safe to work additional hours is in the best interest of the patients for which they care, the nurses and the entire healthcare team, and equally as important to the economic health of the hospital.

http://www.odh.ohio.gov


EDITOR'S NOTE

The Ohio Nurses Association and the Ohio Nurses Foundation are excited to announce that the official nursing-themed Ohio license plate was released on July 3, 2017 and since then over 320 plates have been purchased. Proceeds from the license plate will help fund nursing scholarships and research grants from the Ohio Nurses Foundation – the charitable arm of the Ohio Nurses Association whose mission is to advance nursing through education, research and scholarships.

“We’re thrilled that the Ohio Nurses Foundation has a nursing-themed license plate in Ohio which will fund educational scholarships and research in nursing. It’s specifically designed for not only nurses, but for all who support nurses. Anyone can purchase the plate to benefit nursing and its future advancement, “stated Lori Chovanak, CEO of the Ohio Nurses Association and President of the Ohio Nurses Foundation.

“I was pleased to work with the Ohio Nurses Foundation to get this measure introduced and enacted into law,” State Representative Jim Hughes, the sponsor of the license plate legislation, said. “Nurses are a critical component to our national healthcare system and are always ready to aid Ohio residents whether it is a simple procedure or a grave diagnosis.”

“I am very happy to learn that the monies raised from the sale of these license plates will go directly to the Ohio Nurses Foundation to fund scholarships for those who want to become a nurse, one of the oldest and most highly regarded professions in the country,” Hughes added.

The Ohio Nurses Association and the Ohio Nurses Foundation began the journey of securing a license plate in 2015. The groups presented three possible images for the license plate and had the public vote for their favorite, with the winning image unveiled May 6, 2015 – the first day of National Nurses Week. The groups also collected well over 500 petition signatures, with many more nurses calling in asking how they could support the passage of this bill.

A Grateful 2017Happy Holidays! Happy New Year! Happy stress that comes with it all! You’re

likely reading this at the beginning of December, right when all of the madness of the holidays is starting to happen: the family; the parties; the shopping; the last minute shopping; the whirlwind of it all. All of that rushing around and chaos keeps us energized to make it through the rest of the year. Then all of the sudden it’s over. You’re left sitting there saying, “Well, now what?”

You’re “now what” may roll into a list of motivating New Year Resolutions – some you’ll actually accomplish and some that will fall by the wayside in less than a week’s time. I won’t sit here and give you a list of resolution tips and tricks or advice on how to stay on track; there’s plenty of articles already written on that subject that many of us have already read a dozen times or so.

What I will give you is a proposal for an alternative list: one that makes us feel instantly good and doesn’t leave us hoping to feel better in the future.

Ohio nurses – I propose we make a Grateful List for 2017 rather than a Resolution List for 2018. Yes, you may be rolling your eyes and saying, “how cheesy,” but don’t you think it’s time we start focusing on what’s going right instead of what’s going wrong?

Let’s make a list of our unique set of strengths that makes us “us” and celebrate those! Let’s thank our legs for carrying us through the day, our shoulders for being strong enough to carry the weight of the world and our hearts for ability to care deeply for others. Let’s be grateful for the ability to read this paper, and that we are still breathing and able to experience love and laughter. Let’s recognize the beauty of the simple things and the lessons in the more complex. Let’s sit in gratitude for all that is right, rather than focus on all that is wrong.

Here are a few things making my Gratitude List for 2017:• Another year with both of my parents and both of my in-laws• Great friends who have grown even closer through a trying year• A growing brood of fur-babies• Finally caving and watching Game of Thrones • A body that functions well and allows me to be active

What’s on your Gratitude List for 2017? Share on Facebook, Instagram or Twitter by using #GratitudeList2017

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Continuing Education: Why? So What?Pam Dickerson, PhD, RN-BC, FAAN

Why do you get contact hours? Because they’re required for your license renewal? Because they’re required for your certification renewal? Because you see a topic that sounds interesting? Because you’ve identified some areas of needed growth for yourself? Because you’ve identified an opportunity for your team to perform better?

Why do licensure and certification bodies think continuing education is important? It’s not about the contact hours!! The focus is evidence – when you relicense or recertify, what is the evidence that you are keeping up-to-date? What is the evidence that you know current best practice in your area of expertise? If you’ve been out of your academic educational environment for more than 18 months, your knowledge is already outdated! In order to be safe in our practice, it is critical that all of us keep up-to-date. Bottom line – it’s about professional development.

Continuing education is defined by the American Nurses Credentialing Center’s (ANCC) Accreditation Program and by the Association for Nursing Professional Development as “learning activities intended to build upon the educational and experiential bases of the professional RN for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the pubic and RNs’ pursuit of their professional career goals.”

For those of us who develop continuing education activities that support your professional development, our job is to identify the “holes” that can create pitfalls in practice or opportunities for improvement. You can help by letting us know the issues that are creating challenges for you and members of your team. Increasingly, we are seeing the importance of focusing on team-based education involving more than nursing. Since healthcare is provided by a team of healthcare professionals, it makes sense that our continuing professional development opportunities should also focus on team-based learning and practice. The Joint Accreditation program (nursing, medicine, and pharmacy) defines interprofessional continuing education as “education that occurs when members from two or more professions learn with, from, and about each other to enable effective collaboration and improve health outcomes.”

In order to improve practice, whether for an individual professional group or for an interprofessional team, a nursing professional development practitioner guides the educational planning process. He/she might ask you questions like “What is the biggest challenge you have in performing this skill?” “What additional information do you need to know in order to practice more efficiently or effectively?” “What would be helpful for you to learn to do in order to take better care of yourself?” or “Who are the people on your team that would benefit from education about the topic?” Based on a clear understanding of the issues that need to be addressed to improve practice or support your professional development, the nursing professional development practitioner determines what

outcome should be achieved by those who participate in the educational activity. Just as practitioners at the bedside are charged with the responsibility of improving outcomes for patients, those of us who develop educational activities are responsible for improving outcomes for learners.

We want to help you! Please be thoughtful in considering your own professional development needs, and reach out to the nursing professional development practitioner in your organization or association who can help in developing an activity that will be meaningful and relevant to you. Seek educational experiences that will help you learn and grow, not just earn contact hours!

Pamela S. Dickerson, PhD, RN-BC, FAANDirector of Continuing Education

Montana Nurses Association

Dr. Dickerson has been actively engaged in the practice of nursing for over 40 years and involved in continuing education for healthcare professionals since the early 1990’s. The focus of her work relates to developing, implementing, and

evaluating educational activities to achieve quality outcomes in professional practice and delivery of care. In her current role, she serves as leader of the Montana Nurses Association’s accredited approver and provider units, where she is accountable for management of educational activities enhancing the professional development of nurses and other healthcare team members, as well as approval of educational activities provided by other organizations. Dr. Dickerson is originally a graduate of a diploma school of nursing and has earned baccalaureate and master’s degrees in nursing and a doctorate in health administration. She has been actively involved with the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation since 1995, where she currently serves as Commissioner. Dr. Dickerson serves as associate editor of the Journal of Continuing Education in Nursing, is author of numerous articles in peer-reviewed nursing journals, and served as editor and chapter author of a book on women’s health. She is a member of several professional associations, including the American Nurses Association, the Association for Nurses in Professional Development, Sigma Theta Tau International, and the Alliance for Continuing Education in the Health Professions. She was inducted into the Cornelius Leadership Congress of the Ohio Nurses Association in 2005, received the prestigious ANCC President’s Award in 2010, and was inducted as a fellow in the American Academy of Nursing in 2013.

Wellness Conference March 9-10, 2018Location: OSU James Cancer Hospital Columbus, Ohio

Nurses Day at the StatehouseMarch 14, 2018Location: Ohio StatehouseDowntown Columbus

13th Annual Nursing Professional Development Conference

April 20, 2018Location: TBD

Becoming an Approved ProviderApril 24, 2018Virtual Learning9:00 am – 3:00 pmCost: $65.00

APRN Pharmacology ConferenceDates: TBDVirtual Learning

A Night at the Museum with Florence NightingaleMay 16, 2018Location: Ohio History Connection Columbus, Ohio

The Retired Nurses Forum of the Ohio Nurses Association

June 5-6, 2018 Location: OCLCDublin, Ohio

Becoming an Approved ProviderJune 14, 2018Virtual Learning9:00 am – 3:00 pmCost: $65.00

Tentative: Transition into Practice Summer Camp June 29 to July 1, 2018Location: TBD

The Ohio Nurses Association is accredited as a provider of continuing Nursing education by the

American Nurses Credentialing Center’s commission on Accreditation. (OBN-001-91)

Please visit: www.ohnurses.org For all updated event information

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AD is a progressive and debilitating neuropathological disease that affects the brain. The cause is unknown, but AD progression cannot be prevented, cured or halted. It alters memory, judgment, thought processes, reasoning, speech, fine and gross motor skills, and causes neuropsychiatric symptoms (such as irritability, apathy, disinhibition or hallucinations)and may result in death. Other forms of dementia are just as debilitating.

As they decline, patients with AD or dementia may be placed in nursing homes under the responsibility of nursing staff as their burden on the family becomes too much to handle. Nurses provide holistic care, attending to all aspects of patients’ wellness, so consideration must be placed beyond

simply maintaining patients. Quality of life is of vital importance, and new research is attempting to discern the best ways to enhance that for those in residential care.

A study to improve quality of life for all nursing home residents was conducted by Husebo and Flo (2015) and aimed at improving staff competency via the acronym COSMOS – COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety. They wanted staff to be able to meet these basic human rights of all the residents, keeping them “informed about his or her disease…to consider future plans, be out of pain, receive proper medical treatment, and be involved in meaningful activities.” (p. 2). Their research findings suggested that COSMOS improved the quality of life for nursing home residents while respecting patient rights. However, no matter the situation, it is essential the nurse provides respect and compassion in any way possible, and provides all the aforementioned rights of COSMOS so the patient may have the highest quality life possible while in the nursing home.

One aspect of COSMOS that is of importance to consider is medication review. A different study, focused on neuropsychiatric symptoms (NPS) in dementia patients. They found that 91.7% of participants had at least one form of NPS over the course of the study. They documented the incidence, persistence, and resolution of each. They also evaluated psychotropic drug use, recording the percentages of study participants prescribed various categories of psychotropic drugs and the amount of time that they were continued.

Later studies would provide further evidence that psychotropic drugs are not particularly efficient at treating many of the symptoms of dementia while causing various adverse side effects. This is what makes medication review so important, the nurse must evaluate if the benefits of the drug (or drugs) given outweigh their adverse effects on the patient. If there is a concern, it is the nurse’s responsibility as an advocate for the patient to discuss it with the physician.

Questions on the efficiency of psychotropic drugs has spurred research into alternative, non-pharmacological treatments. There have been a multitude of studies on the effectiveness of various non-pharmacological interventions for dementia patients with problematic behaviors or NPS. Further studies divided the strategies into environmental, caregiver, and behavioral approaches.

Research on behavioral approaches have been sparse. Case studies and anecdotal reports are most common. Researchers agree more investigation of this type of therapy is needed, including feasibility and efficacy in different types and severities of dementia.

In contrast, there is strong evidence about the benefits of non-pharmacological strategies for caregivers in order to cope with or reduce behavioral problems. Some listed interventions included educating the caregiver on effective communication skills, matching activity demands to patient’s ability, and addition education and support for the caregiver (when dementia patient is cared for at home), about home safety, disease physiology, problem solving, stress reduction, and health promotion.

Alternative approaches include environmental, and may be the most effective at preventing problematic behaviors. The researchers discussed how deficits in processing and interpreting their environment may lead dementia patients to become irritable, aggressive or overwhelmed resulting in acting out and undesirable behavior. Altering the environment so that it is less stimulating, with normal lighting, moderate sound, and a small number of people and appropriate cueing were more likely to decrease behavioral symptoms. Also, providing for all of their sensory needs such as hearing, vision, warmth, and comfort, even when they cannot be communicated is important; one study found that by simply implementing hearing aids to residents of their community, they saw an improvement of behavioral symptoms from all participants.

Various non-pharmacological interventions and comparing them showed that there are multiple options that are often very effective in managing patients with dementia or AD, so much so that the researchers included that several professional organizations have suggested that drug therapy should be used only after the failure of non-pharmacological strategies or in cases of grave danger or distress. Further techniques could be found to be beneficial as well. It is good to be aware of these techniques as a nurse, so that they may be attempted before moving onto medications for behavioral problems.

A diagnosis of Alzheimer’s disease and dementia is absolutely menacing, for both elders and their loved ones. It causes uncertainty of the future, and fear of slow debilitation and loss. However, an educated nursing staff can help reduce anxiety and help these people manage their diseases in order to provide them with the highest quality of life possible for as long as possible. A true understanding of what people are going through cognitively may be difficult to discern, but no matter what stage they are at, they are still people. And no matter how far they have declined they are still as deserving of every right as any other patient, even if it takes special accommodations in order to care for them. We as nurses would do well to improve our care tactics as understanding of dementia continues to grow to ensure more holistic and conscientious care improves the quality of life for those afflicted with these terrible debilitating diseases._____________________________________________________________________

Heidi Shank MSN, RN, DNP (c) is the Undergraduate Program Director and Instructor at the University of Toledo College of Nursing with 31 years of nursing and progressive administrative nursing and organizational leadership experience. Specialty areas include nursing leadership, organizational design, joint commission accreditation, and critical care with a specialty in stroke-related care initiatives and patient safety. Heidi also serves as the American Association of Critical-care Nurses, as the Region 9 Chapter Advisor for all of Ohio & Indiana. She is also a member and committee member of the Zeta Theta Chapter of Sigma Theta Tau.

Jessica Pierce is a senior nursing student at The University of Toledo, and will be graduating with her BSN at the end of 2017. She has had the chance to work with numerous senior and dementia patients at her current and previous job at nursing homes as a Certified Nursing Assistant since 2014, as well as at a personal level earlier in life. She has experienced both a grandmother and great-grandmother progressing through AD and hospice, where she was introduced to the nursing profession and helped spur her career choice. Her plans are to become a hospice nurse, and hopes to combine her personal experiences and empathy with her training and knowledge to help guide her patients and their families through what is often the most difficult periods of their lives.

Nursing Management of Dementia (Alzheimer’s) PatientsHeidi Shank, DNP, MSN, RN &

Jessica Pierce, senior nursing student

With multitudes of research studies and technological advancements in the past century, health care has reached new heights in its ability to protect human life and extend longevity. People are living longer and the oldest “old” population, those over the age of 80, are the fastest growing age group according to the 2009 US Census Bureau. One unique challenge faced by “seniors” is the prevalence of dementias, in particular Alzheimer’s disease (AD).

When working with geriatric patients, it is essential to be educated on these diseases and their progression, and the effects they have not only on the patient themselves, but to their loved ones and families. How the nurse interacts with a patient will vary depending on the stage and severity of their disease. Nurses must be comfortable using therapeutic skills, which includes reorientation. Evidence based research has identified the best ways to assist dementia patients in managing their lives, and more recent research has begun to identify new ways to further improve the quality of life for these seniors as they combat these debilitating diseases.

There are several possible types of dementia, but AD is the most common. AD affects an estimated 5.5 million adults (aged 65 and up) in the United States and is expected to affect 13.8 million by 2050. AD was determined to be the sixth leading cause of death in 2014.

Jessica PierceHeidi Shank


Running on Empty: Compassion Fatigue in Nurses and Non-Professional Caregivers

This independent study was developed by Jan Lanier, JD, RN. Revisions to this study were made by Barbara Brunt,

MA, MN, RN-BC, NE-BC.

DESCRIPTION: This independent study has been developed to help nurses better recognize compassion fatigue in nurses and non-professional caregivers and how to manage it. OUTCOME: The nurse will be able to apply strategies to deal with compassion fatigue personally and with non-professional caregivers. 1.6 contact hours will be awarded. The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91). Expires 7/24/19 © 2011, 2013, 2015, 2017 Ohio Nurses Association DIRECTIONS1. Please read carefully the attached article

entitled, “Running on Empty: Compassion Fatigue in Nurses and Non-Professional Caregivers.”

2. Then complete the post-test.3. The next step is to complete the evaluation

form and the registration form.4. When you have completed all of the

information, return the following to the Ohio Nurses Association (4000 East Main Street, Columbus, OH 43213).1. The post-test; completed registration form;

$15.00 fee; and evaluation form. The authors and planning committee members have declared no conflict of interest. Disclaimer: Information in this study is intended for educational purposes only. It is not intended to provide legal and/or medical advice. The post-test will be reviewed. If a score of 70 percent or better is achieved, a certificate will be sent to you. If a score of 70 percent is not achieved, a certificate will not be issued. A letter of notification of the final score and a second post-test will be sent to you. We recommend that this independent study be reviewed prior to taking the second post-test. If a score of 80 percent is achieved on the second post-test, a certificate will be issued. If you have any questions, please feel free to call Sandy Swearingen at 614-448-1030 ([email protected]).

STUDY

The phone rang at 6:30 that morning. It was the nurse calling to say she would not be able to be at my house by seven because she didn’t have any gas in her car. In fact, she wouldn’t be there at all. Now what was I to do? My eight-year-old daughter who is severely disabled has significant care needs that only a licensed nurse can meet. I couldn’t take another day off from work and expect to continue to have that job. All I could do was sit in the middle of my floor and cry uncontrollably. Eight years of multiple life threatening emergencies, as well as day-to-day care giving expectations, had taken their toll on my coping skills. I was tired. I was done, but I couldn’t take the day off.

This scenario and others like it are played out daily sometimes with devastating consequences (Lanier, 2013). The idea that nurses and other professional caregivers are susceptible to what has come to be known as “compassion fatigue” (CF) has received wide-spread acceptance; however, the long-term effect of CF on non-professional caregivers has received far less focus. As more and more emphasis is placed on home or community-based care venues as the preferred location for meeting health care needs, the stress experienced by the non-professional caregivers will take on even greater significance. The purpose of this study is to define CF, distinguish it from burnout, and identify strategies for ameliorating its symptoms. Secondarily, the study will explore the role of nurses dealing with non-professional individuals who care for loved ones over a prolonged period and who are experiencing CF. Finally, the study will look at the implications of CF relative to the health care delivery system.

Compassion Fatigue vs. BurnoutCaring is a cornerstone of nursing. Eric Gentry, a

leading traumatologist, has suggested that “people who are attracted to care giving often enter the field already compassion fatigued. They come from a tradition where they are taught to care for the needs of others before caring for themselves” (Smith, 2013c, p. 1). With that idea in mind, it should not be surprising that something called “CF” might be especially prevalent among nurses and others in the helping professions.

Webster defined the compassion that goes hand-in-hand with caring as “sorrow for the sufferings or trouble of another or others, accompanied by an urge to help; deep sympathy” (Agnes, 2006, p. 229). Compassion is the therapeutic alliance between the patient and the nurse to achieve the desired outcome (Figley, 2014). Despite the importance of compassion to effective nursing practice, it can become a deterrent to good care when it overwhelms the nurse’s ability to function effectively in a professional caregiver capacity.

The term “CF” was first used in 1992 by Joinson, a nurse, to describe a syndrome that occurred when nurses were caring for a patient facing life-altering or life-threatening changes as a result of an illness or accident. She identified CF as a unique form of burnout that affects individuals in caregiving roles (Lombardo & Eyre, 2011).

As more attention was focused on the concepts embodied in that early description, experts began to distinguish burnout from compassion fatigue and vicarious trauma or secondary trauma stress. The latter now refers to traumatic stress reactions that occur following critical or emergent experiences in which the initial traumatizing event suffered by one person becomes

CONTINUING EDUCATION

a traumatizing event for another. In other words, the nurse caregiver internalizes the PTSD experienced by a patient. This vicarious trauma is the emotional response to a single acute traumatic event (Lanier, 2013).

Burnout is a broad-based syndrome that develops gradually as a person interacts with his or her workplace. It can be associated with an imbalance of demand and resources along with the fact that the ideal and the real often differ to the extent that one is frequently chasing rainbows that dissipate when approached (Todaro-Franceschi, 2013). Burnout is associated with a situation rather than an individual. If you can trace the stress in question to work conditions, time pressures, or personalities, it is most likely burnout.

Todaro-Franceschi (2013) identified 12 phases of burnout, which may not occur in any particular order, and do not all have to manifest for someone to be experiencing burnout. These phases are:

1. The compulsion to prove oneself2. Working harder3. Neglecting one’s needs4. Displacement of conflicts5. Revision of values6. Denial of emerging problems7. Withdrawal8. Obvious behavioral changes9. Depersonalization10. Inner emptiness11. Depression12. Burnout syndrome

Nurses experiencing burnout are at greater risk for CF. It should be noted that nurses must possess compassion to experience the fatigue of it. In contrast, those experiencing burnout need not have the prerequisite of compassion (Harris & Quinn Griffin, 2015).

CF is not a character flaw. Rather, it is defined as a syndrome that individuals may develop when they internalize pain or anguish related to other people in their work environment (Todaro-Franceschi, 2013). It is a chronic lack of self-care; unless nurses find ways to continuously renew themselves from the drain associated with their nursing practice, they not only lose energy but also enthusiasm for their work.

Compassion fatigue is the physical, emotional, and spiritual result of chronic self-sacrifice and/or prolonged exposure to difficult situations that renders a person unable to love, nurture, care for, or empathize with another’s suffering. (Harris & Quinn Griffin, 2015). Such fatigue causes the sufferer to lose the ability to experience satisfaction or joy professionally or personally. CF is not pathological in the sense of mental illness, but is considered a natural behavior and emotional response that results from helping or desiring to help another person suffering from trauma or pain (Todaro-Franceschi, 2013).

Independent Study continued on page 8

Steps to complete the independent study:

• Read the article• Go to www.ce4nurses.org• Click “Course Categories” then click

“Course Catalog A-Z”• Scroll down till you see this issues

independent study• Click on course and complete the post-test

and evaluation.ONA members can use their free code for this course.

Non-Members the course is $15.00.

Certificates are emailed after a passing scored is achieved.

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CONTINUING EDUCATIONBurnout Compassion FatigueAnyone who works in difficult work environments is at risk

Health care professionals who regularly observe or listen to experiences of fear and pain and suffering are at risk

Adapt to exhaustion by becoming less empathetic and more withdrawnReduced personal achievement

Continue to give but cannot maintain a healthy balance between empathy and objectivity

Response to work situation Response to people. Personally identify with patient and personally absorb patient’s trauma or pain

Results from being busy Results from giving high levels of energy and compassion over a prolonged period of time.

Evolves gradually when differences between the expectations of the individual and the organization are in conflict

Those experiencing CF give from a state of depletion. They never fill themselves because they have never accepted that sustainable self-care is an essential ingredient in the care-giving equation.

Identifying Compassion FatigueAccording to Michael Kearney, MD, lead author of

a report on CF published in the Journal of the American Medical Association, approximately 6-8% of nurses and physicians suffer CF (Kearney, et al., 2009). The number of non-professional caregivers who experience the condition is not known, however the lack of hard data should not be interpreted as an indication that the problem is confined to professionals. Rather, it suggests that more attention should be given to the spouses, parents, siblings and others who are being relied upon more and more often to take on long-term care giving roles and responsibilities in our evolving health care system.

Some postulate that CF is more common today among professional caregivers because of increased patient loads, a shortage of nurses and other health care personnel, and financial constraints/budgetary realities that force difficult economic choices to be made. Regardless of the cause, the result is costly both from a personal perspective as well as from a financial one.

Some of the most inclusive work about CF has been written by trauma study pioneer Charles Figley, who believes that CF is a more user-friendly term than secondary traumatic stress, which is closely aligned with post-traumatic stress disorder. He thinks the modern-day description of this syndrome is equivalent to his early depiction of secondary victimization as well as the similar concept of “emotional contagion.” When caregivers become preoccupied with another’s experience (of being traumatized), we too are traumatized (Todaro-Franceschi, 2013).

Not only can individuals experience CF, but entire organizations may also evidence the condition. Organizational signs of compassion fatigue are high absenteeism; constant changes in co-worker relationships; inability for teams to work well together; desire among staff to break company rules; outbreaks of aggressive behavior among staff; inability of staff to complete assigned tasks; inability of staff to respond and meet deadlines; lack of flexibility among staff; negativism toward management; strong reluctance to change; inability of staff to believe improvement is possible; and a lack of vision for the future. Chronic absenteeism, growing Worker’s Compensation costs, high turnover rates, and friction in the workplace are some of the effects of compassion fatigue that can and do impact an organization’s bottom line (Smith, 2013b).

CF should be addressed at the organizational level as well. To offset and reduce the risk of CF in staff members, organizations and managers can: • Create an open environment where employees have a

venue for mutual support. Encourage employees to talk about how they are affected by their work.

• Offer training that educates employees about burnout and CF and how to recognize the symptoms.

• Share the caseload among team members, particularly the most difficult cases.

• Make time for social interactions among teams. Social events and a yearly retreat away from the workplace can build cohesion and trust.

• Encourage healthy self-care habits such as good nutrition, sleep, taking work breaks.

• Reward effort and offer flexible work hours.• Offer training that focuses on self-care and life balance

to build resilience to stress. (Portnoy, 2011). The signs of CF appear over time, not overnight. It is

not a matter of one day an individual is fine and the next they are not. Symptoms may include irritability, disturbed sleep, outbursts of anger, intrusive thoughts, and a desire to avoid anything having to do with the patient’s struggle. An individual experiencing CF may be tired before the workday begins. There is a lack of enjoyment in leisure activities. Difficulty focusing, excessive blaming, and excessive complaints about one’s job and co-workers could indicate CF.

Other classical signs are a decreased sense of personal satisfaction in professional accomplishments; a sense of underlying and generalized anger; free floating anxiety and restlessness; depression, low self-esteem; loss of enjoyment at work and at home; sense of hopelessness and loss of control over one’s destiny; denial of negative feelings; physical complaints of migraine headaches, GI distress, and exhaustion; abuse of food and/or drugs or alcohol; disruption in sleep cycle and mood swings. Caregivers experiencing CF may find themselves working longer to compensate for the negative feelings. The result is a caregiver who is unable to meet personal or workplace expectations. There is a decline in job performance and efficiency. Errors may increase. CF, if not addressed, can destroy an individual’s personal life (Todaro-Franceschi, 2013).

Because CF is progressive, it is possible and desirable to identify relatively early when a nurse is at risk for the condition, and take the steps needed to lessen the consequences. To do so, however, requires awareness of the factors at play that are leading to an increased risk for CF. The Compassion Fatigue Awareness Project (www.compassionfatigue.org) provides on its website two self-assessment tools, the Professional Quality of Life Scale (PROQOL) and the Life Stress Self-Test, that could be utilized as screening devices to determine whether CF

may be causing the symptoms and behaviors that are being exhibited either by a professional caregiver or by a non-professional one. By responding to the early signs one could prevent the loss of valuable human resources and the attendant costs associated with filling nursing staff vacancies. For the non-professional caregiver, it could mean the difference between continuing to provide care at home and being forced to resort to a more formalized institutional setting—typically a costly and less desirable alternative.

Dealing with Compassion FatigueGenerally, caregivers are by nature compassionate

individuals; therefore, the thought of being unable to meet care giving expectations adds to their sense of hopelessness. Accepting that these feelings are not a character flaw is essential if one is to halt the CF juggernaut and begin the healing process. Not surprisingly, self-awareness is the first step in combating the debilitation associated with CF. Along with self-awareness comes the need to engage in self-care—something that may be foreign to the typically overwhelmed caregiver experiencing CF.

Self-reflection, finding balance in daily activities, and setting boundaries (saying “no”) are all components of caring for oneself. Todaro-Franceschi (2013) described this as the ART Model: Acknowledging feelings, Recognizing choices and reexamining intentions, and Turning Outward to reconnect with self and others. Other coping strategies include:

• Changing one’s personal engagement level with a patient or situation if possible;

• Changing the nature of the work involvement by transferring or going to part-time work or changing shifts;

• Taking extra days off;• Seeking help from colleagues for informal

debriefing;• Recharging at a retreat or creating a “stress-free zone”;• Developing a career plan and sticking to it; and• Nurturing positive relationships at work and at home. (Lombardo & Eyre, 2011)

12 Self-Care Tips (Mathieu, 2007))1. Take stock. What’s on your plate? List demands

on your time and energy—family, work, volunteer—then determine what stands out. What would you like to change? Can you talk about it with someone?

2. Start a self-care idea collection. Brainstorm with friends, make a list, then pick three ideas that seem to resonate with you. Commit to implementing them within the next month.

3. Find time for yourself every day. Rebalance your workload. Do you work through lunch and spend days off running errands? Try taking ten minute breaks to listen to music or simply do nothing.

4. Delegate. Learn to ask for help at home and at work.

5. Have a transition from work to home. Find a transition ritual such as changing clothes immediately upon arriving home or going for a short walk.

6. Learn to say “no” (or “yes”) more often. Think of one thing you could say “no” to more often or say “yes” to self-care tactics.

7. Assess your trauma input. Recognize the amount of trauma information unconsciously absorbed each day through TV news, etc. There is a lot of extra trauma input outside of working with patients, so create a trauma filter to protect yourself from extraneous material.

8. Learn more about compassion fatigue.9. Consider joining a supervision/peer support

group.10. Attend workshops/professional training regularly.11. Consider part time work (at this type of job).12. Exercise.

Independent Study continued from page 7

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Physical Emotional Work Related

▪ Headaches▪ Digestiveproblems:diarrhea,

constipation, upset stomach▪ Muscletension▪ Sleepdisturbances:inability

to sleep, insomnia, too much sleep

▪ Fatigue▪ Cardiacsymptoms:chest

pain/pressure, palpitations, tachycardia

▪ Moodswings▪ Restlessness▪ Irritability▪ Oversensitivity▪ Anxiety▪ Excessiveuseofsubstances:

nicotine, alcohol, illicit drugs▪ Depression▪ Angerandresentment▪ Lossofobjectivity▪ Memoryissues▪ Poorconcentration,focus,and

judgment

▪ Avoidanceordreadofworkingwith certain patients

▪ Reducedabilitytofeelempathytowards patients or families

▪ Frequentuseofsickdays▪ Lackofjoyfulness

The Compassion Fatigue Awareness Project was established by Patricia Smith in response to the realization that, while CF was relatively common, widespread recognition of its prevalence or its devastating consequences was rare. Appropriate support systems and effective networks were in short supply. To serve as a resource for the entire gamut of CF sufferers, the web-based Project developed a series of materials it calls the “Ten Laws.” They highlight the various approaches needed to effectively deal with CF on various fronts.

The Ten Laws Governing Healthy Caregiving(Smith, 2013a)

1. Sustain your compassion.2. Practice authentic, sustainable self-care daily.3. Build a support system.4. Create a work/life balance.5. Apply empathic discernment.6. Recognize the humor.7. Learn to let go.8 Acknowledge your successes.9. Remain optimistic.10. Elevate levels of compassion satisfaction.

The Ten Laws Governing Healthy Change(Smith, 2013a)

1. Create systemic change as opposed to systematic change.

2. Understand the vision for change.3. Stay focused.4. Practice patience with others.5. Ask the right questions.6. Pay no attention to rumor or gossip.7. Recognize when you need help and ask for it.8. Collaborate with management.9. Take time away to re-energize, when necessary10. Breathe deeply as often as possible.

The Ten Laws Governing Authentic, Sustainable Self Care (Smith, 2013a)

1. By validating ourselves, we promote acceptance.2. By validating others, we elevate ourselves.3. By meeting our own mental, physical, and

spiritual needs, we provide care from a place of abundance, not scarcity.

4. By practicing self-goodwill, we manifest it throughout our lives.

5. By honoring past traumas and hurts, we allow ourselves freedom from the pain that controls us.

6. By naming and taking ownership of the core issues that limit our growth, we create authenticity.

7. By “doing the work,” we reclaim the personal power that is rightfully ours.

8. By defining our personal boundaries, we teach others how to respect us.

9. By creating a Personal Mission Statement, we define ourselves.

10. By managing our self-care, we welcome happiness into our lives.

The Ten Laws Governing a Healthy Workplace(Smith 2013a)

1. Employer provides debriefing for staff following any traumatic event.

2. Employer provides continuing education for staff.3. Employer provides benefits to aid staff in practicing

authentic, sustainable self-care.4. Employer provides management and staff with

tools to accomplish their tasks.5. Employer directs management to monitor

workloads.6. Employer provides positive team-building

activities to promote strong relationships between colleagues.

Symptoms of Compassion Fatigue (Lombardo & Eyre, 2011, p 3)

7. Employer encourages “open door” policies to promote good communication among staff.

8. Employer translates the organization’s mission statement into action.

9. Employer allows management to empower staff.10. Employer promotes transparency in all

communications and dialogues. Individuals serving in a care-giving capacity are

frequently at risk for CF. It cannot be cured but the symptoms and manifestations can be managed. Many of the management strategies are targeted toward the professional caregiver. The non-professional caregivers typically have fewer options available to them. They cannot “change the nature of their work involvement” or go from full time to part time status. For that reason, it is important for nurses and others involved in caring for individuals with chronic conditions to be cognizant of the needs of the caregivers as well as the immediate medical needs of their patients. If non-professional caregivers are experiencing CF, the patients’ care needs may not be met leading to complications and possible unanticipated hospital stays.

The Role of the Nurse in Addressing Compassion Fatigue in Non-Professional Caregivers

By definition, nursing practice encompasses more than direct hands-on care of the individual patient. Nurses also provide care to communities and groups. Indeed, the law regulating nursing practice (Chapter 4723 of the Ohio Revised Code) defines the practice of nursing as a registered nurse as “providing to individuals and groups nursing care requiring specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences.” (Section 4723.01 (B) ORC emphasis added). Similarly, the law defines the practice of licensed practical nurses to include, “providing to individuals and groups nursing care requiring the application of basic knowledge of the biological, physical, behavioral, social, and nursing sciences...” (Section 4723.01 (F) ORC emphasis added)

In other words, the entire family unit may be the recipient of a nurse’s care and expertise. The concept of “holism” is reflected in these definitions. Holistic nursing means caring for the physical, emotional, social, family, and the overall environment to achieve the optimal health outcomes for all.

Applying the principles embodied in holistic care when a family member or loved one is serving as the primary caregiver means the nurse, who may only be intermittently involved with the patient, must be alert to the likelihood of CF within the family unit. Indeed, non-professional caregivers are the largest group at risk for CF and the most difficult to identify and treat because of their personal, emotional connection to the patient.

While the term “CF” is becoming more commonplace among professional caregivers, it is less frequently recognized per se in the non-professional realm. These caregivers manifest the same signs and symptoms, but no one has put the “CF” label on what they are experiencing. Providing the “diagnosis” is reassuring and helps the caregiver realize that his/her symptoms are not unusual nor are they a character flaw. Putting a name on the feelings helps start the processes needed to manage the emotional and physical reactions the caregiver is experiencing.

A nurse should consider asking the family member caregiver to complete a self-assessment tool (such as the Professional Quality of Life Scale [PROQOL]) and provide a list of resources and other information the caregiver could use should CF be an issue. Ideally, this should be a routine component of the plan of care a nurse develops whenever care needs will be met for a prolonged period of time by family members or loved ones.

In addition to proactively anticipating CF, a nurse should also guard against unwittingly adding to the stress that contributes to CF. When a nurse is caring for a patient in a home health environment, he/she should be aware of the ramifications that accompany failure to keep a commitment or visit as scheduled. Family members may have been counting on that time as an opportunity to get away, even briefly, to engage in self-care. The loss of the promised respite can be as devastating as the actual additional care demands that the family member must shoulder in the absence of the nurse. Nurses should be sensitive to the important role they fill in meeting these needs. When that insight is lost or ignored, the implications for the family member can be excruciating and ultimately affect the health of the patient.

Joe’s story

“I’ve been caring for my husband Joe for several years. He suffers from Parkinson’s and recently had a stroke. He is unsteady on his feet and has trouble eating. He is incontinent. I can’t leave him alone for fear he might hurt himself. We can’t go anywhere because I have trouble getting him into and out of the car by myself. Neighbors have been helpful and so have my children, but they all have lives of their own. I don’t mind caring for my husband. It is what I want to do, but I miss not being able to go to church or play cards with my friends occasionally.” When asked, this non-professional caregiver had never

heard of the phrase “CF” nor had she considered that her own physical health might be compromised by her care giving duties. Not surprisingly, she eventually had a myocardial infarction that severely limited her ability to be the caregiver she had been for so long. Ultimately, a nursing home placement became the only option for Joe.

What might have been done?

Nurses caring for Joe could anticipate the implications of the 24/7 care-giving responsibilities the wife had assumed. Strategies for engaging in regular self-care activities could be presented to her early in the process and routinely stressed during subsequent encounters. Referrals to community support systems such as adult day care and similar respite opportunities, meals on wheels, and transportation options should be initiated. In other words, a care plan for the family unit should be developed and modified as needed and communicated to all involved in Joe’s care not just once but throughout the time Joe’s care needs are being met at home (Lanier, 2013).

Patty’s insights

“I’ve been the primary caregiver for my daughter for over eight years and only recently learned about CF from a parent support group. None of the nurses, social workers or physicians who have been involved with us has ever mentioned it, even though they know I am a single parent. It was reassuring to

Independent Study continued on page 10


CONTINUING EDUCATIONIndependent Study continued from page 9

me to learn that what I am experiencing is actually a formalized concept, and that I am not alone in these feelings. It made sense to me when I finally put a name to it, but I would not have been able to do that by myself. I am too close to the situation.

Although I appreciate how important self-care is in dealing with my CF, I think sometimes the nurses who are in our home don’t fully understand or appreciate how important they are in helping me meet my own self-care goals. We’ve never talked about it, and I would feel funny bringing it up myself. When the nurses are meeting my daughter’s health care needs, it allows me to just be her mom. When my daughter thrives, so do I.”

What might be done?This mom, while recognizing she is experiencing

what she calls “chronic grief,” continues to minimize her own self-care needs. Her statement “When my daughter thrives so do I” is evidence she continues to place a low priority on her own very legitimate and separate care needs. A nurse could help legitimize these needs and help identify ways she could begin to meet them. While the circumstances of the family make this mother a likely candidate for CF, she has not been afforded an opportunity to raise her concerns with the professionals who are frequently involved with her daughter’s care. The mother was reluctant to bring the issues up on her own initiative; therefore, without nurses being willing to do so, the family unit ‘s health is not optimized (Lanier, 2013).

Compassion Fatigue and the Health Care System in General

Sorenson, Bolick, Wright, and Hamilton (2017) conducted a review of current literature on CF in healthcare providers. They found that CF and related concepts were pervasive and affected a wide variety of health care providers (HCPs). They noted that advanced practice registered nurses, and other therapists (respiratory, physical, and occupational) were not well represented in the literature. They concluded more research is needed to evaluate CF for HCPs in a variety of settings and the degree to which it affects personal and professional well-being, including interactions with patients, patient outcomes, and the quality of professional life.

An organizational program to address CF was described by Potter, Deshields, & Rodriquez (2013). They outlined a hospital-wide residency program designed to help professional caregivers understand CF, recognize the physical, mental, and emotional effects of stress, and adopt resiliency strategies. Developing an institutional culture of recognition and support for CF is critical. CF training allows professional caregivers to reconnect to their personal mission and then truly begin to connect with an organization’s values and mission.

CF left unrecognized and untreated can have significant ramifications not only for the individuals involved, but also for the health care system. Nurses who are unable to effectively manage their CF are more likely to leave the nursing profession, thereby contributing to the already critical nursing shortage. Replacing these individuals is costly from an organizational perspective given the expenses associated with recruiting and orienting new nurses. Further, CF may manifest itself through frequent absenteeism or other disruptive behaviors that add tangible and intangible costs to the employer and the health care system as a whole.

Retention issues impact not only nurse availability at the bedside, but also the availability of educators and mentors for novice nursing staff, particularly in the development of critical thinking and problem solving. Even with tenured staff lack of skill development to manage CF may impact retention and staff engagement in the work setting. (Aycock & Boyle, 2009, p. 185)

Ultimately, a workforce that is not able to safely and effectively meet productivity expectations adds costs to an already financially overburdened system.

The need to control the ever-increasing cost of health care has led to greater reliance on non-institutional settings and non-professional caregivers. That means more family members will take on the responsibility for meeting the health care needs of their loved ones in informal settings without the resources needed to safeguard their own personal, physical and emotional health. People are living longer with chronic conditions that require skilled nursing care for prolonged periods of time.

The ever-growing aging population will put further strain on the health care delivery system that is already unable to cost effectively meet care needs or expectations. CF is one complication of long-term care giving that, if better understood, identified early and appropriately managed, could be minimized to everyone’s advantage. Doing so could enable non-professional caregivers to avoid the emotional trauma and other debilitating behaviors that limit their care giving effectiveness. It would also allow patients to be more appropriately cared for in non-institutional settings. If our system of health care is to look to home and community-based care as the lynchpin of cost containment, the need to proactively address the side effects associated with that approach, such as CF, cannot be ignored. Not only is it the right thing to do from a personal or societal perspective, it is also the economically prudent thing to do as well.

EVALUATION

1. Do you think that the outcome was met? OUTCOME: The nurse will be able to

apply strategies to deal with compassion fatigue personally and with non-professional caregivers.

______ Yes _______ No

2. Was this independent study an effective method of learning?

______ Yes _______ No

If no, please comment:

3. What one strategy will you be able to use in your work setting?

4. How long did it take you to complete the study, the post-test, and the evaluation form?

______________

5. What other topics would you like to see addressed in an independent study?

REGISTRATION FORM

Name: ______________________________ (please print clearly)

Email address: _______________________

Address (Street/City/State/Zip):

____________________________________

____________________________________

____________________________________

Day phone number: ( ____ ) ______________

_____ RN _____ LPN Please return:- Completed Post-test and Evaluation Form- Registration Form- $15.00 Fee TO: Ohio Nurses Association 4000 East Main Street Columbus, OH 43213

Offering Excellent Shift and Weekend Differential!Excellent Benefits!

Also seeking:Licensed Practical Nurse, State Tested

Nurse Assistant, Resident Assistant and more

Apply Online: www.otterbein.org/careersQuestions: 419-798-8203

Otterbein-Northshore9400 North Shore Blvd. | Lakeside-Marblehead, OH 43440

Registered Nurses


1. Compassion fatigue is best defined as:a. A condition experienced

only by nurses and other professional caregivers.

b. A character flaw that arises when a caregiver does not have the resources needed to provide care to patients.

c. A syndrome that includes physical, emotional, and spiritual exhaustion that affects an individual’s desire and ability to care for others.

2. Burnout is a sense of frustration or

tiredness associated with a situation rather than an individual.a. True b. False

3. Learning about compassion fatigue is

one method to engage in self-care.a. True b. False

4. Individuals experiencing burnout

exhibit all twelve phases.a. True b. False

5. Compassion is a critical component

of good nursing care and can never be a deterrent to good care..a. True b. False

6. Nurses experiencing burnout are at

greater risk for compassion fatigue.a. True b. False

7. A nurse is providing skilled

care to a patient in the patient’s home, and visits him every other morning. The patient’s wife has been caring for her husband for over a year and she is reluctant to leave the home even when the nurse is there. Which statement best describes the nurse’s responsibilities in this scenario:a. The nurse is hired to care for

the gentleman so the wife’s needs are outside her areas of responsibility.

b. The wife is an amazing caregiver and as such the nurse can rely on her to meet the patient’s care needs.

c. Because the wife is at risk for compassion fatigue, the nurse should discuss the syndrome with her and suggest some strategies for managing it.

8. A nurse who is experiencing

unresolved compassion fatigue is at greater risk for errors in the workplace.a. True b. False

9. The costs of compassion fatigue

include:a. Replacement costs to fill nursing

staff vacanciesb. Worker’s compensation claimsc. Organizational disruptiond. All of the above

10. The first step in dealing with

compassion fatigue is self-awareness.a. True b. False

11. Engaging in self-care means setting boundaries and saying “no”.a. Trueb. False

12. Dealing with compassion fatigue

at the organizational level entails systematically developing policies and creating conditions to promote healthy, more effective workers.a. Trueb. False

13. The practice of registered nursing

is defined as:a. Providing skilled care in a

clinical setting to individuals experiencing an alteration in their health status requiring the rendering of treatments and administration of medications at the direction of a physician

b. Providing medical care to individuals or groups that entails the use of special skills learned in nursing education programs.

c. Providing to individuals and groups nursing care requiring specialized knowledge, judgment, and skill.

14. A nurse can contribute to a family

member caregiver’s compassion fatigue by failing to keep commitments to visit the patient at a set time.a. Trueb. False

15. Caring for a patient experiencing

post-traumatic stress disorder (PTSD) could result in the nurse developing vicarious trauma.a. Trueb. False

16. The Compassion Fatigue

Awareness Project is a web-based resource that provides support for nurses and others experiencing compassion fatigue.a. Trueb. False

17. Which of these statements is

accurate?a. Family member caregivers are

seldom at risk for compassion fatigue because of their emotional connection to the patient.

b. Family member caregivers will readily accept that compassion fatigue is an issue affecting them both physically and emotionally.

c. Family member caregivers may experience compassion fatigue but are unlikely to be aware that it has a label and can be managed.

d. None of the above. 18. A nurse experiencing compassion

fatigue:a. Is at risk for substance abuseb. Is more likely to make

medication errorsc. May avoid intense patient

situationsd. All of the abovee. None of the above

Post TestDIRECTIONS: Please complete the post-test and evaluation form. There is only one answer per question.

The evaluation questions must be completed and returned with the post-test to receive a certificate.

19. A nurse working in a rehabilitation center has been caring for a patient who suffered life-altering injuries as a result of a fire that destroyed his home. The patient also lost his two young children because he was unable to rescue them from the burning house. The nurse has two children who are the same ages as the patient’s children. She has begun to try to avoid this patient and has complained to her co-workers that she is unable to sleep. Her irritability and short temper make others go out of their way to avoid her as much as possible. This nurse is most likely experiencinga. Burnoutb. Vicarious traumac. Stagnationd. Post-traumatic stress disorder

20. A nurse manager who believes one

of her staff nurses is experiencing compassion fatigue should:a. Initiate a discussion with this

nurse about the possibility of compassion fatigue.

b. Inquire as to what might be done to help this nurse deal with the kinds of patient situations he/she is encountering.

c. Provide opportunities for the nurses on the unit to attend continuing education programs on compassion fatigue.

d. None of the above because compassion fatigue is an inevitable result of being a nurse in a busy hospital and it cannot be effectively managed.

e. a, b, & c are correct 21. Non-professional family caregivers

should be encouraged to:a. Make caring for themselves a

priorityb. Exercisec. Limit exposure to traumatic

events shown on the mediad. All of the abovee. Only a & b are correct

22. It is better to create systematic

change rather than systemic change.a. Trueb. False

23. A home health nurse who regularly

visits a severely disabled child notices that the mother who is the child’s 24/7 caregiver is tense and quick to criticize. She appears angry and is neglecting her own appearance. The child’s care needs are being met without fail; however, efforts to find respite care have been unsuccessful. The nurse should:a. Be aware that the mother is

likely experiencing compassion fatigue that, if left unaddressed, could affect the child’s health status.

b. Talk with the mother about compassion fatigue and suggest they work together to develop self-care strategies.

c. Be concerned but realize that her responsibilities extend only to the child and not the mother.

d. a & b are correct

24. In a healthy workplace, the employer provides tools for managers and staff to accomplish their tasks.a. Trueb. False

25. The increased prevalence of

compassion fatigue could be due in part to staffing issues and economic concerns.a. Trueb. False

26. Compassion fatigue can affect

the overall health care delivery system if:a. Nurses who experience

compassion fatigue decide to leave nursing for another less stressful occupation.

b. Experienced nurses are not available to mentor new graduates and help them adapt to the demands of patient care.

c. Families or non-professional caregivers are unable to meet the demands of their loved ones’ care needs and consequently turn to institutionalized settings for that care.

d. All of the above are correcte. Only b and c are correct

27. The ART model stands for:

a. Acting on feelings, recognizing others, and trying different strategies

b. Acknowledging feelings, recognizing choices, and turning outward

c. Acting on feeling, recharging, and taking stock

d. Acknowledging feelings, recognizing choices, and turning inward

28. Which statement is accurate?

a. Policy makers are looking to non-institutional settings and non-professional caregivers to control rising health care costs

b. Family caregivers always have the resources they need to meet the health care demands of their loved ones.

c. The nursing shortage and the growing aging population are not factors to consider when analyzing the impact of compassion fatigue on health system needs.

29. If you can trace the stress being

experienced by a caregiver to work conditions, time pressures, or personalities it is probably as result of compassion fatigue rather than burnout.a. Trueb. False

30. Compassion fatigue is best

defined as a pathological condition that results from a caregiver’s inability to manage his/her emotional responses to caring for patients.a. Trueb. False


Name: _______________________________

Final Score: ___________

Please circle or otherwise indicate the correct answer.

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