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Oral Presentation Northcentral University Graduate Faculty of the School of Business

Exploring Compassion Fatigue in Long-Term Care Nursing Workers and Its Influence on Resident's Quality of Life. Oral Presentation Northcentral University Graduate Faculty of the School of Business in Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY.

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Oral Presentation Northcentral University Graduate Faculty of the School of Business

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  1. Exploring Compassion Fatigue in Long-Term Care Nursing Workers and Its Influence on Resident's Quality of Life Oral Presentation Northcentral University Graduate Faculty of the School of Business in Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY Presented by Voneece Luise Little, MBA Chair: Kenneth D. Gossett, Ph.D. Committee Member: Faisal, Aboul-Enein, Dr.P.H., December 26, 2013

  2. Agenda • Introduction • Background of the Problem • Statement of the Problem • Purpose of the Study • Theoretical Framework • Research Questions • Significance of the Study • Definitions • Review of the Literature • Summary • Methodology • Sample • Instruments • Demographic Questionnaire • Data Collection, Processing, and Analysis • Assumptions, Limitations, and Delimitations • Findings for the five research questions • Theoretical Framework Support Findings • Feedback Model of Study Findings • Implications • Recommendations • References • Discussion and Questions Voneece Luise Little-Candidate Dr. Kenneth Gossett-Chair Dr. Faisal Aboul-Enein-Committee Member

  3. Background of the Problem Many researchers have noted the prevalence of CF in nursing workers in various studies (Abendroth & Flannery, 2006; Beaupierre et al., 2012; Billhartz-Gregorian, 2012; Harrowing, 2011; Meadors & Lamson, 2008; Potter et al., 2010; Sabo, 2008; Ward-Griffin et al., 2011; Yoder, 2008). CF is a distinction frequently influencing nurses (Frandsen, 2010). Many LTC nurses enjoy providing care to their LTC residents (Frandsen, 2010). CF influences caregivers who constantly provide care for others in a compassionate manner and give too much of themselves emotionally resulting in fatigue of their body, mind, and spirit (Frandsen, 2010).

  4. Statement of the Problem • The problem is that many healthcare workers have been adversely influenced by symptoms of CF (Abendroth & Flannery, 2006; Beaupierre et al., 2012; Billhartz-Gregorian, 2012; Harrowing, 2011; Meadors & Lamson, 2008; Newell & MacNeil, 2011; Potter et al., 2010; Sabo, 2008; Ward-Griffin et al., 2011; Wilson, 2008;Yoder, 2008). • CF may influence LTC nursing worker’s overall work performance and their capacity to connect emotionally and compassionately with LTC residents. • In 2012, 1.3 million American elders lived in nursing facilities (George Washington University, 2012). • According to Chambers and Ryder (2009), a lack of compassion in care homes is a persistent problem, which can negatively influence LTC resident quality of care and QoL. • Need exists for educational and support services for workers with CF (Day & Anderson, 2011; Perry et al., 2010).

  5. Purpose of the Study The purpose of this qualitative exploratory case study was to explore how CF may be influencing LTC nurses and nursing assistants’ overall work performance and ability to connect emotionally and compassionately with LTC residents in one LTC facility in Western Kentucky.

  6. Theoretical Framework Nearly 30 years ago, Figley began studying CF, which he originally asserted was a type of burnout (Figley, 1995). Valenttheorized that CF and burnout culminate from distinct failed survival strategies (Yoder, 2008). MacRaewrote about compassion as having a reciprocal effect on both parties in the relationship and considers it a social construct (Perry, 2009). Jean Watson’s theoretical model of transpersonal caring is a holistic approach to engaging in a compassionate relationship (Watson, 2011).

  7. Research Questions Q1. How does CF influence the overall work of LTC nursing workers in a LTC facility? SQ1. What are the factors that contribute to CF for LTC nursing workers? SQ2. What are the factors that lessen CF for LTC nursing workers? SQ3. How does CF influence the ability of LTC workers to connect emotionally with their LTC residents? SQ4. How does CF influence the compassionate care of LTC nursing workers in a LTC facility?

  8. Significance of the Study This study was important because it will bring new awareness of the influence CF can have on LTC nurses and nursing assistants who provide care for elderly residents on a daily basis. The ultimate significance and contribution of this study was to reveal unknown intricacies about CF present in LTC nursing workers and to reveal how CF influences their overall work. It is important to understand how CF influences LTC nursing worker’s overall work.

  9. Definitions Compassion. Compassion is the capacity to be attracted and moved by the fragility, weakness, and suffering of another (Downey, 1993). Compassion Fatigue (CF). CF is comprised of the state of tension and preoccupation with the traumatized by (a) Re-experiencing the traumatic events; (b) Avoidance/numbing of reminders, and (c) Persistent arousal; and is a natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by another (Figley, 2004a). Compassion fatigue process model. The CF process model is comprised of exposure to suffering, motivation to respond to the suffering and an aptitude for noticing pain in others. Quality of life (QoL). QoL is defined by the World Health Organization (WHO) as a person’s QoL is influenced by multiple factors to include physical well-being, psychological well-being, social relationships, and degree of independence, personal beliefs and their connection to significant features of their environment (1997).

  10. Review of the Literature • Several studies have been conducted to ascertain if healthcare workers have CF, and CF was present in many cases (Harrowing, 2011; Meadors & Lamson, 2008; Newell & MacNeil, 2011; Ward-Griffin et al., 2011; Yoder, 2008). • Healthcare workers with CF may become distressed with their patients and may not be able to provide the best care for patients (Showalter, 2010). • According to the HHS/AoA (2011), the American elderly population will rise to 72.1 million by 2030 from a population of 39.6 million in 2009. • LTC certified nurse assistant (CNA) turnover was as high as 67% in 2007 (LeRoy et al., 2010). • Chambers and Ryder (2009) noted a lack of compassion in care homes as a problem. • It is vital that LTC nursing workers recognize their symptoms of CF.

  11. Summary CF was initially named secondary traumatic stress (STS) (Figley, 1995). In diverse healthcare settings, some researchers have reported healthcare workers have CF. The literature reviewed focused on how CF may have influenced healthcare workers ability to provide compassionate care to their patients and how this influenced their QoL. These study findings will add to existing research on CF.

  12. Methodology Research Design • Face to face interviews were conducted with 11 long-term-care (LTC) nursing workers using a questionnaire consisting of 19 open ended questions. • Qualitative exploratory case study design. Sample • The sampling method was purposive as the researcher selected only LTC nursing workers who provide regular hands on caregiving. • Eleven LTC nursing workers from one Western Kentucky LTC facility participated. Instrument • The researcher conducted a thorough review of the literature on CF to compose the 19 open-ended interview questions. • Demographic Questionnaire Data Analysis • The interview data transcripts were analyzed using a qualitative data analysis involving a hand-coding method called in-vivo coding to identify common key words and phrases. • Thick Descriptions were helpful to identify themes (Mills et al., 2010).

  13. Sample The criteria for the participant sample was to recruit participants who were 18 years of age and older, were a LTC nursing worker, were willing to answer the 19 interview questions about their lived caregiving experiences, and were willing to participate in a 60 minute face-to-face conversation with the researcher. Eleven participants agreed to participate. Ages of participants ranged between 21 to 65 years old. Ten participants were female and one was male.

  14. Instruments Instruments • The researcher conducted a thorough review of the literature on CF to compose the 19 open-ended interview questions. In addition, a field test was used to assure the 19 interview questions were appropriate for this study. • Demographic Questionnaire

  15. Demographic Questionnaire • Demographic data were obtained using a questionnaire designed for this study. Data gathered were: • Gender • Age • Race • Marital Status • Degree earned • Occupation • Work experience in years as a LTC nursing worker

  16. Data Collection, Processing, and Analysis Before data collection began, permission was obtained from the Institutional Review Board (IRB) of Northcentral University to conduct this study. All interviews were audio recorded and interview data was transcribed verbatim. Thick descriptions were utilized in analysis. Content analysis was used to derive themes in the collected data transcripts. Next, the analysis procedure involved listing and initial grouping of all common expressions pertinent to the research purpose. Six themes were identified from this content analysis process based on common key words, expressions, and experiences noted in the participants’ responses.

  17. Assumptions, Limitations, and Delimitations • Assumptions • The researcher assumed that all of the LTC nursing worker participants were open and truthful. • The researcher assumed that LTC nursing workers who have symptoms of CF may be adversely influencing the quality of care provided to their LTC residents. • The researcher assumed that CF symptoms in LTC nursing workers may have influenced their interactions with residents. • Limitations • Small sample size of 11 participants. • Participants more compassionate by nature. • Researcher bias. • The results may not be generalizable. • Delimitations • Included only LTC nursing workers who have provided regular hands on care to LTC residents.

  18. Findings

  19. Research Question 1 (Q1) Q1. How does CF influence the overall work of LTC nursing workers in a LTC facility? The data collected from participant responses to all 19 interview questions helped to answer the main research question, research Q1. The participant responses to interview question 19 had a major influence on answering research question one in this study.

  20. Research Sub-question 1 (SQ1) SQ1. What are the factors that contribute to CF for LTC nursing workers? The data collected from participant responses to interview questions 2, 5, 7, 8, 9, and 14 helped to answer research SQ1. Many factors that may contribute to CF were noted by the eleven participants in this study.

  21. Research Sub-question 2 (SQ2) SQ2.What are the factors that lessen CF for LTC nursing workers? The data collected from participant responses to interview questions 1, 11, 16, 17 and 18 helped to answer research SQ2: What are the factors that lessen CF for LTC nursing workers? Many factors that may lessen CF were noted by the eleven participants in this study.

  22. Research Sub-question 3 (SQ3) SQ3.How does CF influence the ability of LTC workers to connect emotionally with their LTC residents? The data collected from participant responses to interview questions 4, 10, 12, and 15 helped to answer research SQ3. Some of the participant’s ability to connect emotionally with their residents may have been influenced by CF.

  23. Research Sub-question 4 (SQ4) SQ4.How does CF influence the compassionate care of LTC nursing workers in a LTC facility? The data collected from participant responses to interview questions 3, 6, and 13 helped to answer research SQ4. Some of the participant’s ability to provide compassionate care to their residents may have been influenced by CF.

  24. Theoretical Framework Support Findings Figley’s CF model emphasized a caregiver is exposed to suffering, is driven to respond to the suffering, and has the propensity to recognize pain in others (Perry et al., 2010). Sabo (2011) argued that Figley’s CF model does not adequately address how nurses benefit from their relationships with patients or how the nurse-patient relationship might insulate the nurse from developing CF. Valenttheorized that CF occurs when a person is unable to rescue or save the suffering individual from harm and results in guilt and distress to the caretaker (Yoder, 2008). MacRaewrote about compassion as having a reciprocal effect on both parties in the relationship and considers it a social construct (Perry, 2009). Watson’s theoretical model is comprised of a relationship among the caregiver and patient who both search together for meaning and totality of being and becoming to improve comfort actions, pain control, a sense of well-being, wholeness, or even spiritual transcendence of suffering (Watson, 2011).

  25. Feedback Model of Study Findings

  26. Implications • Many of the participants interviewed in this study indicated they have experienced signs of CF. • Some participants reported becoming more emotionally numb or accepting of the emotional or physical pain their residents were experiencing. • Participants did note experiencing feelings of stress, sadness, numbness, and helplessness at times. • One factor that lessened CF for the participants was showing their residents love and compassion. • All of the participants in this study were able to show compassion. • Talk to a co-worker for support. In most cases, the participants chose to talk to a co-worker who worked as a LTC nursing staff member because they could relate to their situation and feelings more intensely.

  27. Recommendations (For future studies) It is recommended mentorship-training programs be implemented nationwide. It is recommended policies be implemented that require LTC management intervention. It is recommended LTC nursing workers receive dementia caregiver training. It is recommended future research include interviewing LTC nursing worker’s family, friends and co-workers. It is recommended future research include adding quantitative data.

  28. Thank You For Your Attention

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  42. Discussion and Questions

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