Meditation Program and Healthcare Providers’ Interoceptive Awareness, Compassion Fatigue, and Burnout

Research suggests that meditation can relieve stress, cultivate self-regulation skills, improve ability to focus, and modify risk for compassion fatigue (CF) and burnout in healthcare providers | Journal of Hospice & Palliative Nursing

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This pilot study examined a novel 6-week technology-assisted meditation program, coherently grounded in the system of yoga therapy that required minimal time. Five 10- to 12-minute meditations were offered via smartphone apps supported by biweekly e-mails. Hospice and palliative professionals at a Midwestern US healthcare network participated in the program (n = 36). Each meditation integrated attention, synchronized breath, gentle movements and a meditation focus. Weekly e-mails introduced a new meditation and reminded participants how and why to practice.

The participants used the meditations a mean of 17.18(SD, 8.69) times. Paired t tests found significant presurvey to postsurvey improvements for CF/burnout and interoceptive awareness. Participation significantly heightened perceived ability and propensity to direct attention to bodily sensations, increased awareness of physical sensations’ connections to emotions, and increased active body listening. The technology-assisted yoga therapy meditation program successfully motivated providers to meditate. The program required minimal time yet seemed to reduce CF/burnout and improve emotional awareness and self-regulation by heightening attention to present-moment bodily sensations.

Full reference: Heeter, C. et al. (2017) Effects of a Technology-Assisted Meditation Program on Healthcare Providers’ Interoceptive Awareness, Compassion Fatigue, and Burnout.Journal of Hospice & Palliative Nursing. Volume 19 (Issue 4) pp. 314–322

Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams

Maintaining a sense of self-care while providing patient centered care, can be difficult for practitioners in palliative medicine | BMC Palliative Care

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Background: We aimed to pilot an “on the job” mindfulness and compassion-oriented meditation training for interdisciplinary teams designed to reduce distress, foster resilience and strengthen a prosocial motivation in the clinical encounter.

Results: Significant improvements were found in two of three burnout components (emotional exhaustion and personal accomplishment), anxiety, stress, two emotional regulation competences and joy at work. Furthermore, 85% of the individual goals were attained. Compliance and acceptance rates were high and qualitative data revealed a perceived enhancement of self-care, the integration of mindful pauses in work routines, a reduction in rumination and distress generated in the patient contact as well as an enhancement of interpersonal connection skills. An improvement of team communication could also be identified.

Conclusions: Our findings suggest that the training may be a feasible, effective and practical way of reducing caregiver-distress and enhancing the resources of palliative care teams.

Full reference: Orellana-Rios, C.L. et al. (2017) Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program. BMC Palliative Care. Published: 6th July 2017

Continuous deep sedation until death & healthcare professionals’ emotional well-being

Ziegler, S. et al. BMC Palliative Care | Published online: 8 May 2017

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Background: The practice of continuous deep sedation is a challenging clinical intervention with demanding clinical and ethical decision-making. Though current research indicates that healthcare professionals’ involvement in such decisions is associated with emotional stress, little is known about sedation-related emotional burden. This study aims to systematically review the evidence on the impact of the inpatient practice of continuous deep sedation until death on healthcare professionals’ emotional well-being.

 

Conclusions: Current evidence does not suggest that practicing continuous deep sedation is generally associated with lower emotional well-being of healthcare professionals. Higher emotional burden seems more likely when professionals struggled with clinical and ethical justifications for continuous deep sedation. This appeared to be in part a function of clinical experience. Further research is needed to strengthen this evidence, as it is likely that additional studies will change the current evidence base.

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The experience of providing end of life care at a children’s hospice

McConnell, T. & Porter, S. BMC Palliative Care. Published online: 13 February 2017

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Background: More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children’s hospice.

Conclusions: Service and policy initiatives should encourage open, informal peer/organisational support among the wider children’s palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children’s hospices and hospital settings.

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BMA: Doctors caring for dying patients need more support

British Medical Association’s call comes as poll highlights impact treating patients at end of their life has on doctors | The Guardian

marseille-142394_960_720.jpgThe British Medical Association has called for more support for doctors caring for dying patients after a survey found fewer than one in five physicians feel they get sufficient assistance. The poll highlighted the deep-seated effect that treating patients at the end of their life has on doctors, with 93.9% saying it has an emotional impact on them.

More than a third (37.2%) of the 457 doctors who responded to the online poll said they cared for dying patients frequently or all the time. A similar proportion (34.6%) said they occasionally cared for people at the end of their life, with 28.2% saying they never did. Only 14.7% said they had accessed formal or informal support networks, either locally or nationally.

Read the full news story here

Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions

Hill, R.C. et al. (2016) Palliative Medicine. 30(9). pp. 825-833

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Background: Staff in palliative care settings perform emotionally demanding roles which may lead to psychological distress including stress and burnout. Therefore, interventions have been designed to address these occupational risks.

Aim: To investigate quantitative studies exploring the effectiveness of psychosocial interventions that attempt to improve psychological wellbeing of palliative care staff.

Design: A systematic review was conducted according to methodological guidance from UK Centre for Reviews and Dissemination.

Data sources: A search strategy was developed based on the initial scans of palliative care studies. Potentially eligible research articles were identified by searching the following databases: CINAHL, MEDLINE (Ovid), PsycINFO and Web of Science. Two reviewers independently screened studies against pre-set eligibility criteria. To assess quality, both researchers separately assessed the remaining studies using the Quality Assessment Tool for Quantitative Studies.

Results: A total of 1786 potentially eligible articles were identified – nine remained following screening and quality assessment. Study types included two randomised controlled trials, two non-randomised controlled trial designs, four one-group pre–post evaluations and one process evaluation. Studies took place in the United States and Canada (5), Europe (3) and Hong Kong (1). Interventions comprised a mixture of relaxation, education, support and cognitive training and targeted stress, fatigue, burnout, depression and satisfaction. The randomised controlled trial evaluations did not improve psychological wellbeing of palliative care staff. Only two of the quasi-experimental studies appeared to show improved staff wellbeing although these studies were methodologically weak.

Conclusion: There is an urgent need to address the lack of intervention development work and high-quality research in this area.

Read the abstract here

Tidying rooms and tending hearts: An explorative, mixed-methods study of hospital cleaning staff’s experiences with seriously ill and dying patients

Jors, K. et al. Palliative Medicine. Published online:  May 9 2016

11559-2Background/aim: Palliative care is based on multi-professional team work. In this study, we investigated how cleaning staff communicate and interact with seriously ill and dying patients as well as how cleaning staff cope with the situation of death and dying.

Design: Sequential mixed methods, consisting of semi-structured interviews, focus groups, and a questionnaire. Interviews and focus group discussions were content analyzed and results were used to create a questionnaire. Quantitative data were submitted to descriptive analysis.

Setting: Large university clinic in southern Germany.

Participants: A total of 10 cleaning staff participated in the interviews and 6 cleaning staff took part in the focus group discussion. In addition, three managerial cleaning staff participated in a separate focus group. Questionnaires were given to all cleaning staff (n = 240) working at the clinic in September 2008, and response rate was 52% (125/240).

Results: Cleaning staff described interactions with patients as an important and fulfilling aspect of their work. About half of participants indicated that patients talk with them every day, on average for 1–3 min. Conversations often revolved around casual topics such as weather and family, but patients also discussed their illness and, occasionally, thoughts regarding death with cleaning staff. When patients addressed illness and death, cleaning staff often felt uncomfortable and helpless.

Conclusion: Cleaning staff perceive that they have an important role in the clinic—not only cleaning but also supporting patients. Likewise, patients appreciate being able to speak openly with cleaning staff. Still, it appears that cleaning staff may benefit from additional training in communication about sensitive issues such as illness and death.

Read the abstract here