Cultivating Self-Compassion to Protect Nurses From Burnout and Secondary Traumatic Stress.

Nursing burnout, a result of prolonged occupational stress, has always been a challenge in health care, but recently the COVID-19 pandemic made this issue into a national priority. In fact, burnout among health care workers is one of the four priorities of the U.S. Surgeon General. Health care leaders and organizations are eager to implement strategies to improve nurses' well-being and, thus, enhance their mental health. Much of the literature has focused on the antecedents and consequences of nursing burnout, but there is limited information on strategies that protect perinatal nurses from burnout. Self-compassion is emerging as one strategy that has a positive correlation with nurse well-being and a negative association with burnout, depression, and anxiety. In this article, we identify and translate strategies to promote self-compassion in perinatal nurses.

Zentangle® Pilot Study: A Mindfulness Exercise for Oncology Nurses.

BACKGROUND: This study introduced Zentangle®, which involves drawing simple, repetitive lines and shapes to create patterns, as a tool to promote wellness for oncology nurses in a clinical practice setting. OBJECTIVES: The purpose of this study was to determine whether Zentangle used as a meditative activity in an acute time frame decreased stress, fatigue, and burnout while increasing professional quality of life and well-being in oncology nurses. METHODS: Twenty-six oncology nurses participated in a two-hour Zentangle class and received materials to complete art over four weeks. The Perceived Stress Scale, the Warwick-Edinburgh Mental Wellbeing Scale, the Patient-Reported Outcomes Measurement Information System-29, and the Professional Quality of Life measure were administered at selected periods. Twenty-four participants completed the study. FINDINGS: Nurses' well-being, socialization, anxiety, fatigue, secondary traumatic stress levels, and stress levels improved significantly. Most participants noted they would continue using Zentangle after the study. Zentangle is another tool to advance nurses' wellness by encouraging self-care.

Compassion Fatigue Resiliency Program Effects on Oncology-Hematology Nurses' Professional Quality of Life, Stress Levels, and Patients' Care Satisfaction: Nurse, Nurse Manager, and Patient Perspectives, a Mixed-Methods Study.

OBJECTIVES: This study aimed to evaluate the effects of the Compassion Fatigue Resiliency Program applied to oncology-hematology nurses on the professional quality of life and stress levels of nurses, on the satisfaction of cancer patients, and on the perspectives of nurse managers. DATA SOURCES: An experimental embedded mixed-methods design was conducted between December 20, 2022, and February 20, 2023. The study included 15 oncology-hematology nurses, 19 cancer patients, and 6 nurse managers. Qualitative interviews were conducted with patients and pre-tests were applied to patients and nurses. The Compassion Fatigue Resiliency Program was implemented for the nurses. Then qualitative interviews were repeated with the same patients; focus group interviews were conducted with the nurse managers; post-tests were applied to patients and nurses who participated in the training; and narrative feedback was collected. Quantitative data analysis was carried out using the Wilcoxon signed-rank test. Qualitative data were processed using an inductive approach to thematic analysis. CONCLUSION: Compassion satisfaction decreased after the Compassion Fatigue Resiliency Program. Qualitative results showed that the training program improved nurses' effective communication skills and ability to cope with stress. The program improved nurses' approach to patients and communication, and patients' care satisfaction levels increased. IMPLICATIONS FOR NURSING PRACTICE: The Compassion Fatigue Resiliency Program should be included in hospital in-service training programs and implemented and sustained. With this, compassion fatigue of nurses can be reduced or prevented, which will help to avoid the nurse shortages that already existing and increasing.

Nurses' Professional Quality of Life and Self-Care: A Mixed-Methods Study.

BACKGROUND: Improving retention of nurses working in critical care is an urgent priority. Ideas on how to do this abound, but actual data are inconclusive. One common theory is that simply increasing nurse resiliency will minimize turnover. OBJECTIVE: To determine whether knowledge and application of compassionate self-care practices can significantly improve nurses' professional quality of life and thereby promote their retention. METHODS: This pilot study had a mixed-methods design. A training program in self-care techniques was implemented in a level IV trauma care secondary hospital, with data collected before and after the intervention by means of written surveys. Study participants were 40 nursing professionals working in an intensive care unit and a medical/surgical unit. The underlying theory was Jean Watson's framework of human caring. RESULTS: The study results showed that, although the participants evaluated the training program positively and reported improved work-life balance, they did not experience a statistically significant change in professional quality of life from before the intervention to after the intervention. CONCLUSIONS: The study findings are consistent with current literature indicating that prevention of compassion fatigue and burnout cannot be achieved by the efforts of individuals alone but requires collaboration between professionals and their institutions, with special attention to 3 elements: (1) a healthy work environment, (2) organizational support, and (3) nurse resiliency.

Compassion fatigue and compassion satisfaction in pediatric and neonatal care nurses during the COVID-19 pandemic in Sweden.

PURPOSE: Quality of care and the mental and physical health of nurses are interlinked. The COVID-19 pandemic has imposed an extremely high burden on health care. This study aimed to: 1) describe professional quality of life of registered nurses (RN) working in the pediatric and neonatal care units during the COVID-19 pandemic in Sweden, 2) compare professional quality of life between RNs with and without a Master's degree in specialist nursing pediatric care (MSc), and 3) compare differences in professional quality of life associated with the nursing experience (years). DESIGN AND METHODS: This study adopted a cross-sectional survey design. The PROQoL®-5-questionnaire was administered as a web survey to 160 RNs at four pediatric wards and two neonatal units of two hospitals in Sweden. RESULTS: Seventy-one RNs responded to the survey. Overall, they reported a sufficient professional quality of life. RNs with an MSc suffered significantly lower secondary traumatic stress levels. Experienced RNs reported significantly higher compassion satisfaction and lower occupational burnout. CONCLUSION: Higher education and longer experience are beneficial for nurses' professional quality of life when working in pediatric care units. PRACTICAL IMPLICATIONS: Results from this study highlights the importance of offering RN education in pediatric care at master level and supporting novice nurses, to prevent negative professional well-being outcomes in pediatric care, because the health of nurses is of utterly importance when crisis such as a pandemic hits the world. The findings also suggest that the conditions for professional quality of life could improve through activities such as self-care, time for reflection, better working hours, competence-adjusted salary, and educational opportunities.

Compassion Fatigue in Nurses Providing Palliative Cancer Care and Coping Strategies to Prevent and Manage it.

OBJECTIVES: End-of-life care for cancer patients is one of the most challenging experiences encountered by nurses. Cancer nurses providing end-of-life care may experience compassion fatigue due to prolonged exposure to the suffering and intense emotional reactions of patients, death and the dying, and grieving families. However, the development of resilience and effective coping skills can decrease nurse turnover rates and increase the quality of palliative cancer care. This article discusses the concept of compassion fatigue, how it develops, compassion fatigue experienced by nurses providing palliative cancer care, and the Compassion Fatigue Resiliency Program (CFRP) coping method. DATA SOURCES: Author experience and journal articles were used. CONCLUSION: Compassion fatigue can occur from secondary traumatic stress and burnout after nurses' prolonged and intense exposure to helping suffering patients, resulting in decreased ability to care, expend energy, or exhibit empathy and compassion. The CFRP is a structured, comprehensive training program designed to educate nurses about compassion fatigue and enable them to develop a support network, strengthen their coping skills, and improve resilience. IMPLICATIONS FOR NURSING PRACTICE: It is recommended that the CFRP be included in in-service training in institutions and be applied to oncology nurses at regular intervals in a block program format (1-2 days). Newly recruited oncology nurses in particular should be supported with such training in orientation programs. Institutional managers play an important role in organizing such programs and screening for the risk of compassion fatigue in nurses who provide end-of-life care.

Piloting a Mindfulness App for Use by Nursing Staff at Work.

This article discusses the findings of a 5-week pilot using a mindfulness app among medical-surgical nursing staff in an acute care setting during a 12-hour shift. Informational sessions on compassion fatigue, mindfulness, and the process were implemented with leadership providing daily support. The postimplementation survey demonstrated increased calmness and reduced stress. Barriers identified involve perceived time constraints. Awareness is needed on compassion fatigue, interventions to combat, and modifications to promote the culture of self-care.

Establishing Music Therapy as an Alternative to Reducing Compassion Fatigue among Health Workers.

Compassion fatigue is a condition that occurs in individuals who are continuously involved in providing care or emotional support to others who are experiencing suffering or difficulties. This condition can affect the physical, emotional, and psychological well-being of health professionals. The results of a literature review show that music therapy can effectively reduce stress levels, emotional exhaustion, and burnout symptoms associated with compassion fatigue. This article proposes the use of music therapy as an effective alternative to reduce compassion fatigue.

The Impact of Loving-Kindness Meditation on Compassion Fatigue of Nurses Working in the Neonatal Intensive Care Unit: A Randomized Clinical Trial Study.

Compassion fatigue is a common complication in nurses, which can lead to burnout, job dissatisfaction, and a decline in the quality of patient care. This study aimed to investigate the impact of loving-kindness meditation on compassion fatigue of nurses working in the neonatal intensive care unit (NICU). This cluster-blinded randomized clinical trial study was conducted on 66 NICU nurses in 2 educational hospitals selected. The intervention group received a 1-month online program for daily training and practice of loving-kindness meditation. The control group received miscellaneous files on mental health during the COVID-19 pandemic period. The Nursing Compassion Fatigue Inventory (NCFI) was filled out by the 2 groups, before and after the intervention. The results showed that the mean scores of the NCFI in the intervention group decreased significantly compared with before the intervention (P = .002). In comparison with the control group, there was a significant difference between the mean scores of the 2 groups after the intervention (P = .034). Among nurses working in NICU, loving-kindness meditation significantly reduces compassion fatigue after 1 month. These findings support the use of this intervention for nurses.

Self-Compassion Interventions to Target Secondary Traumatic Stress in Healthcare Workers: A Systematic Review.

Healthcare professionals' wellbeing can be adversely affected by the intense demands of, and the secondary traumatic stress associated with, their job. Self-compassion is associated with positive wellbeing outcomes across a variety of workforce populations and is potentially an important skill for healthcare workers, as it offers a way of meeting one's own distress with kindness and understanding. This systematic review aimed to synthesise and evaluate the utility of self-compassion interventions in reducing secondary traumatic stress in a healthcare worker population. Eligible articles were identified from research databases, including ProQuest, PsycINFO, ScienceDirect, Google Scholar, and EBSCO. The quality of non-randomised and randomised trials was assessed using the Newcastle-Ottawa Scale. The literature search yielded 234 titles, from which 6 studies met the inclusion criteria. Four studies reported promising effects of self-compassion training for secondary traumatic stress in a healthcare population, although these did not use controls. The methodological quality of these studies was medium. This highlights a research gap in this area. Three of these four studies recruited workers from Western countries and one recruited from a non-Western country. The Professional Quality of Life Scale was used to evaluate secondary traumatic stress in all studies. The findings show preliminary evidence that self-compassion training may improve secondary traumatic stress in healthcare professional populations; however, there is a need for greater methodological quality in this field and controlled trials. The findings also show that the majority of research was conducted in Western countries. Future research should focus on a broader range of geographical locations to include non-Western countries.

Debriefing After Critical Events Is Feasible and Associated With Increased Compassion Satisfaction in the Pediatric Intensive Care Unit.

BACKGROUND: Repeated exposure to death and dying increases health care professionals' risk for burnout and secondary traumatic stress. Pediatric critical care providers are at particularly high risk because the death and dying of children are associated with even greater psychological impact. LOCAL PROBLEM: A charge nurse in the pediatric intensive care unit identified a need for additional staff support after critical patient events. METHODS: The aim of this quality improvement project was to design and implement a debriefing process, the Rapid Review of Resuscitation, in a 40-bed, high-acuity pediatric intensive care unit at an urban children's hospital in the midwestern United States. A preintervention-postintervention survey used the Professional Quality of Life Scale, version 5, to evaluate staff members' compassion satisfaction, burnout, and secondary traumatic stress before and 1 year after implementation. The debriefing process was designed and implemented on the basis of interview data and literature review. RESULTS: Preimplementation (104 of 222 staff members [47%]) and postimplementation (72 of 184 staff members [39%]) survey responses were compared. Compassion satisfaction scores (mean [SD] T scores: preimplementation, 54.10 [7.52]; postimplementation, 56.71 [6.62]) were significantly higher (P = .02) 1 year after implementation. Burnout (P = .69) and secondary traumatic stress (P = .06) scores were not significantly different. After implementation, 74% of respondents reported that the debriefing process was "very helpful" or "somewhat helpful" after critical patient events. CONCLUSIONS: Compassion satisfaction improved and burnout and secondary traumatic stress did not change with implementation of the debriefing process after critical patient events.

Effect of a Compassion Fatigue Resiliency Program on Nurse Managers' Professional Quality of Life, Stress, and Resilience: A Mixed-Methods Study.

BACKGROUND: Compassion fatigue, stress, and burnout have an adverse impact on nurse managers. PURPOSE: To evaluate the impact of a compassion fatigue resiliency program on nurse managers and to obtain their views of the program. METHODS: This mixed-methods study was conducted with 16 nurse managers. The compassion fatigue resiliency program was implemented; compassion fatigue, compassion satisfaction, burnout, perceived stress, and resilience were assessed before and after implementation of the program. RESULTS: The mean compassion fatigue and perceived stress scores of nurses decreased significantly after the intervention. Four themes were identified from qualitative analysis, including awareness, coping with stress, effective communication skills in team management, and recommendations. CONCLUSIONS: The current study shows the training program reduced nurse managers' compassion fatigue and stress and enabled nurse managers to improve their coping skills and awareness.

The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life.

BACKGROUND: Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS). PURPOSE: To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL. METHODS: Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit , for 3 weeks. RESULTS: Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low ( P = .003), while their low BO scores ( P = .12) and moderate CS scores ( P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased ( P =.01). The hypothesis was partly supported. IMPLICATIONS FOR PRACTICE AND RESEARCH: Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.

A multi-method quasi-experimental study to assess compassion satisfaction/fatigue in nurses, midwives and allied health professionals receiving a narrative medicine intervention.

AIMS: To: (1) measure the impact of a narrative medicine intervention on compassion fatigue and compassion satisfaction of nurses, midwives and allied health professionals; (2) explore participants' working experiences and (3) their impressions of the intervention. DESIGN: Multi-methods, quasi-experimental before-after intervention design. METHODS: The intervention consisted of 20 narrative medicine sessions (60 h). Healthcare providers (N = 48) from a mother-and-child hospital in Italy completed the 'Professional quality of life' questionnaire before and after the intervention (January 2020-April 2021). Baseline scores served as internal controls. Open-ended questions explored participants' touching experiences at work and their evaluation of the intervention. A thematic content analysis was performed. Reporting followed the TREND and SRQR guidelines. RESULTS: The differences before-after intervention in compassion satisfaction or fatigue scores were not statistically significant. Three themes emerged from participants' touching experiences: "Witnessing death and sufferance"; "Witnessing violence" and "Organizational stressors during COVID-19". A statistically significantly higher median score for post-intervention compassion satisfaction was found among participants who reported at least one touching experience compared to those who had no touching experience. Four themes emerged from the reported strengths of the program: "Learning to exteriorize feelings"; "Team building"; "Useful to rework personal/professional journey" and "Develops professional empowerment". Two themes emerged from reported weaknesses: "Programme organization" and "Participants' difficulties in sharing experiences". CONCLUSION: A time-limited narrative medicine intervention is not sufficient to produce significant changes in satisfaction or compassion fatigue, especially if implemented during a pandemic. However, such an intervention holds promise for supporting nurses and midwives' professional empowerment and promoting continuity of compassionate care. IMPACT: For those at risk of compassion fatigue, policymakers need to invest in training in narrative medicine, which promotes team building, and employee well-being and thus favours compassionate care. Such programmes should be offered to undergraduate students to nurture compassion and attention to self. PATIENT OR PUBLIC CONTRIBUTION: Does not apply as the study only includes health care providers.

The Role of Compassionate Care in Medicine: Toward Improving Patients' Quality of Care and Satisfaction.

INTRODUCTION: Despite its description as a cornerstone of a healthcare provider's professional identity, the impact of compassionate care on various aspects of medicine has been poorly defined. In this review, we aimed to elucidate the role of compassionate care in various aspects of medicine and healthcare delivery. METHODS: Four databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol for a literature review regarding compassionate care and its intersection with medical education, patient-provider communication, patient care, and clinical outcomes, patient and provider characteristics, telemedicine and artificial intelligence, caregiver compassion fatigue, and cost of care. RESULTS: Twenty-two articles met the inclusion criteria. Analysis revealed that clinical outcomes are correlated with the degree of patients' perception of empathy and compassion from their providers. Along with enhanced patient outcomes, compassionate care was shown to reduce the costs of care, compassion fatigue and burnout, and the number of malpractice claims. However, compassion can be perceived differently among patients of various cultural and ethnic backgrounds. Compassion training sessions can be implemented among residents in surgical and nonsurgical medical specialties to improve perceived compassion. Furthermore, the use of telehealth modalities may positively or negatively impact compassionate care, requiring further exploration. CONCLUSIONS: Compassionate care plays a crucial role in improving patient care and clinical outcomes while reducing caregiver burnout and the risk of malpractice litigation. However, a lack of compassion training and caregiver compassion fatigue may detract from the delivery of effective compassionate care.

Becoming an inner ally: the compassionate minds approach to self-compassion - an online programme.

A rapidly growing body of evidence indicates the enormous psychological burden of working in health care on nurses and other health professionals that is resulting in high levels of psychological problems. These will have profound effects on individuals and long-term ramifications for healthcare systems. Effective interventions that can counter the adverse psychological effects of caring during the COVID-19 pandemic and beyond are urgently required. With this in mind, the authors have created an online self-compassion programme to advance the health and wellbeing of the nursing workforce through developing proactive evidence-based preventive teaching and learning strategies to promote compassion satisfaction and prevent compassion fatigue by improving self-compassion. The online programme is underpinned by compassionate minds theories and research.

Resilience, Insight, Self-Compassion, and Empowerment (RISE): A Randomized Controlled Trial of a Psychoeducational Group Program for Nurses.

BACKGROUND: Nurses tend to be vulnerable to burnout and compassion fatigue due to constant workplace stressors. There is a need to provide advocacy, education, programming, and resources in the areas of positive coping and self-care to reduce burnout symptoms and promote well-being. RISE is an 8-week psychoeducational group intervention for nurses with four themes: resilience, insight, self-compassion, and empowerment. AIMS: This randomized controlled trial examined the effects of RISE on mental well-being. METHODS: The sample included 75 registered nurses who work in a hospital-based setting. Outcomes included resilience, insight, self-compassion, empowerment, stress mind-set, perceived stress, and burnout. Independent-samples t tests were conducted to compare outcomes between intervention and wait-list control groups at baseline and 1-month follow-up, as well as at 3-month follow-up. Supplemental analyses included paired-samples t tests and linear mixed models to compare the outcomes of the intervention group participants at baseline to 1-month follow-up, as well as at 3-month and 6-month follow-ups. RESULTS: Participants in the intervention group showed improved levels of insight (i.e., engagement in self-reflection), perceived stress, and burnout (i.e., emotional exhaustion) when compared with the control group and improved levels of resilience, self-compassion, stress mind-set, and perceived stress when compared with their baseline. CONCLUSIONS: This study informs how RISE affects nurse well-being and may be an effective intervention for reducing burnout and stress. This type of whole-person intervention can support nurses to improve their well-being and ability to cope amid the complex interplay of factors at the individual, unit, and organizational levels.