Compassion Fatigue and Dialysis Care

Compassion Fatigue and Dialysis Care
4 hours ago 0 Comments
Posted in Articles, Administrators, Nurses, Nephrologists, Practice Management, Stress
Print

Part 1: Why It's Important to Understand Stress and Burnout

By Mark Meier, MSW, LICSW

Imagine for just a moment what it would be like to deliver a dialysis treatment in a perfect world. You know the world where the dialysis patients in your clinic routinely follow their diet, fluid, exercise, and medication recommendations. The world where your patients smile when they arrive, they thank you for the care you provide them, and they are always on time and never skip a treatment. And the people you work with; they are always polite, they don’t gossip about one another, they don’t complain about their pay or how much work they have to do, and they always show up on time and with a big smile on their faces.

Okay the dream is over Dorothy, and this isn’t Kansas. The truth is our patients (and many of our colleagues) come to us with complex social, emotional, practical, and physical needs. Individuals on dialysis have high rates of depression, which negatively impacts their adherence to medical recommendations. Many dialysis patients have lost hope about the future, many are angry, and many are frightened. These emotions often lead to individuals who lash out at others or simply retreat into themselves and ignore the pressing issue of managing their kidney disease.

Individuals with kidney disease live with chronic pain, nausea, diarrhea, fatigue and other medical issues which impact their quality of life, overall mood, and level of happiness and satisfaction. In other words, when you expect your patient to show up smiling and ready to do all that you want them to do you shouldn’t be surprised or angered when their attitude and behavior doesn’t meet your expectations.

Beyond the technical aspects of providing a dialysis treatment and your ability to empathize with your patient’s needs, several other factors influence the quality of care that is provided. For example the level of professionalism demonstrated by the dialysis clinic staff has a major impact on the quality of care provided. The overall functioning and health of the “team” working in the clinic is critical to excellent dialysis.

And perhaps most importantly the emotional well-being of each individual practitioner working in the dialysis clinic is absolutely related to the quality of care being provided. Professionals who are suffering from issues such as “burnout”, “compassion fatigue” or depression are not likely to be operating in an effective and compassionate manner.

In this two-part series we are going to take a close look at the health of those who provide dialysis treatments and look at ways in which we can better cope with the stress of working in dialysis and in turn provide better care for our patients. The delivery of excellent dialysis (not adequate!) is a complex proposition and it should be what all of us as professionals strive to provide. Not to forget, excellent dialysis is what our patients deserve and what ESRD Conditions for Coverage demand.

Working in Healthcare is Difficult

In the 12 years I have trained, educated, and supported those who work in dialysis I have noticed an underlying theme that complicates their ability to effectively manage the stress of working in dialysis. Namely, that providing dialysis care is easy. We have somehow tried to convince ourselves that the delivery of a treatment that is required to maintain a person’s life when performed in an emotionally charged, fast-paced, constantly changing environment is going to be easy. Let’s just clarify for a moment; an easy day in the dialysis center is going to be a rare occasion and a challenging day is likely to be the norm.

This is an important first step in coping with the stress of working in dialysis for many reasons. First, when you show up to work and expect things to go smoothly you are often angered at the first part of the day that doesn’t go well, which usually occurs about 15 minutes after you open your doors.

Second, the professional who doesn’t truly grasp what it means to be a dialysis patient are going to be constantly frustrated with the behavior and attitudes of their patients. Let’s look at the frustration often associated with patient non-adherence. To begin, individuals who perfectly manage conditions such as their diabetes, hypertension, weight, etc., generally do not end up on dialysis. For a multitude of reasons, the individuals who survive CKD Stage 4 and make it to dialysis have most likely not managed their disease states effectively. .

This isn’t to say we blindly and willingly accept a patient’s nonadherence and let them go about the business of systematically destroying themselves. Rather, it means we as renal professionals accept that nonadherence is part of this disease state and something the vast majority of our patients will present with. It also means we need better interventions (repeatedly lecturing a patient is not an intervention) and greater understanding (blaming patients or labeling them is not adequate) of why patient’s are nonadherent.

The Role of Stress

It is pretty evident to anyone who has ever worked in dialysis that it can be very stressful. It can be stress inducing to work with patients who are medically fragile and who need vigilant oversight during their treatment. It can be stressful working with patients who are angry, argumentative, or who challenge you about the way you are doing your job. It can be very stressful when one of your patient’s dies or is hospitalized. And of course lately there has been a tremendous amount of stress associated with issues such as the recently released conditions for coverage and the case-mix adjusted bundled prospective payment system.

But rather than openly acknowledging this stress, in healthcare we tend to ignore or minimize its impact on the care we provide. In fact, we place healthcare professionals into very challenging environments where conflict, death, staffing shortages, and threats of violence with little and in most cases no training on how to cope with this level of stress.

Physicians, nurses, social workers, and other renal professionals typically see themselves as “experts” and authority figures that are not impacted by the experience of working in stressful environments. In order to maintain this aura of invincibility, most healthcare professionals will go to great lengths to deny they are personally struggling and instead will act out in other harmful and destructive ways. Issues such as drug and alcohol abuse, divorce, and suicide actually impact professionals in healthcare at a greater rate than the general public. The reality is that healthcare professionals are not immune to stress and its impact.

Why This Matters

There is a growing body of evidence that has shown an association between stress and the development of problems such as anxiety, sleeplessness, irritability, burnout, compassion fatigue and depression. In addition, individuals experiencing a great deal of stress are less able to concentrate and more prone to making mistakes which in the delivery of a dialysis treatment can lead to very serious consequences.

We as healthcare professionals are trained to help other people and we traditionally have done a poor job of admitting our own vulnerabilities to the impact of stress. And when we are feeling the impact of stress we often assume that we are not impacting others, when in fact this is completely false.

For example do you find that you work with individuals who are routinely negative, pessimistic, argumentative, and in general draining to be around? Traits such as these are often associated with the notion of burnout and compassion fatigue and they can certainly be signs of depression.

These individuals will often mask their own pain and struggles by being unduly harsh to their patients or colleagues. The impact these people have on the team is significant and creates an environment of stress, mistrust, hostility, and this ultimately hurts patient care. In environments such as these, not only is the person struggling miserable, but they can take down whole teams or cause otherwise well functioning individuals to become negative and frustrated as well.

Stress Gone Awry!

Some level of stress can be beneficial when working in dialysis. A healthy sense of stress can keep you focused and alert to the needs of your patients. However, it is when the stress a person is experiencing begins to impact their lives that we need to be concerned. When stress levels start to impact your ability to sleep, eat, or engage in activities that used to be enjoyable to you we need to be concerned. When you find that your patients feel more like a burden and a hassle to you rather than individuals who are suffering and need your care you should be concerned and take a close look at what you are feeling and experiencing. Also when you find that you dread coming to work or you want to avoid work by calling in sick, or you do not fully attend to your duties that something deeper than just the stress of the job is occurring.

Three commonly described outcomes that are associated with stress that is not addressed are:

* Burnout
* Compassion Fatigue
* Depression

Burnout has been described as “the physical and emotional exhaustion that workers can experience when they have low job satisfaction and feel powerless and overwhelmed at work” (Stamm, 1995).

Compassion Fatigue refers to “the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate” (Mathieu, 2009).

And depression is a diagnosable condition that is associated with:

* Loss of interest in activities
* Feelings of sadness and loneliness
* Sleep difficulties
* Unintended weight gain or loss
* Difficulty concentrating
* Fatigue or loss of energy
* Psychomotor agitation or retardation
* Unexplained feelings of guilt
* Thoughts of suicide

In addition to these concepts, stress in healthcare professionals has been associated with PTSD, anxiety, and secondary traumatic stress. All of these issues have one thing in common and that is they cause you profound personal distress. Your ability to be an empathic, engaged, and effective clinician is essentially lost.

You are likely experiencing feelings of agitation, hopelessness, anger, frustration, and countless other negative emotions. You are likely experiencing physical difficulties such as difficulty sleeping, unexplained aches and pains, and GI distress to name a few. Further, your relationships and life outside of your work is also likely suffering.

Working in dialysis is stressful and even though we would like to think we are immune to the impact of this stress, we are not. When our stress gets the better of us we are not going to be functioning at the level that is needed in the dialysis center and the rest of your life is going to be impacted. One of the first steps you need to take in addressing your stress is recognition that you are human and it is alright to experience stress. Despite what our training and the culture of healthcare often communicates to us, you are not weak or somehow inadequate if you find yourself struggling.

Next month we are going to look at critical steps you can take to help cope and enjoy the work you do in a stressful environment.

Meier is the founder of Equalicare, LLC, a Minneapolis-based consulting firm focused on health and wellness. In the dialysis field he has worked as a social worker, patient care technician, and facility administrator. Mark led the first national data collection effort investigating involuntary patient discharge and helped develop online training for the American Nephrology Nurses’ Association (ANNA) regarding depression in the dialysis setting. Email Mark at markm@equalicare.com.

http://www.renalbusiness.com/articles/2010/10/compassion-fatigue-and-dialysis-care.aspx