Good Grief Rounds - CENTILE Conference final good... · Implement Good Grief Rounds in their own...

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Good Grief Rounds Using Storytelling Among Health Care Providers to Increase Community and Meaning in Work

Transcript of Good Grief Rounds - CENTILE Conference final good... · Implement Good Grief Rounds in their own...

Good Grief RoundsUsing Storytelling Among Health Care Providers to Increase Community and Meaning in Work

Learning Objectives

Describe the scope of burnout, secondary trauma, and suicide among care providers.

Summarize the literature supporting the aims of good grief rounds

Discuss the goals, structure, and evaluation data of Good Grief Rounds.

Implement Good Grief Rounds in their own health care setting.

Katherine Morrison, MDAssistant ProfessorUniversity of ColoradoDepartment of [email protected]

Nicole Rondinelli MSN, FNPClinical InstructorUniversity of Colorado

Why Important

Compassion Fatigue

Burnout

Suicide

Patient care

Compassion Fatigue vs. Burnout

Compassion Fatigue

The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events.

Also called “vicarious traumatization” or secondary traumatization (Figley, 1995)

Burnout

Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related

Compassion Fatigue and Burnout Commonalities

Exhaustion (mental, physical and emotional)

Reduced sense of personal accomplishment or meaning

Decreased interactions with others (isolation)

Depersonalization

Burnout Nurses

• Hospital nurses have 40% higher burnout rate than other healthcare workers

• Job dissatisfaction 4x greater than the average for all US workers

• 1 in 5 nurses report they intend to leave their job within a year

Aken, L. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Jama; 10/2002.Vol 288, No. 16.

Burnout Physicians

• Burnout rates range from 30-65% across specialties

• Critical Care 53%

• Emergency Medicine 52%

• Primary Care/ Surgeons 50%

Pcckham, C. Physician Burnout: It just keeps getting worse. Medscape Family Medicine, Jan 26, 15.

Consequences of Burnout for the Individual

Individual

Broken relationships

Problematic alcohol/drug use

Suicidal ideation

Shanafelt, Mayo Clinic Proc, Jan 2017

Consequences of Burnout for Patient Care

Quality of Care

Patient Safety

Patient Satisfaction

Risk of malpractice

Prescribing habits

Patient adherence

Test ordering

Shanafelt, Mayo Clinic Proc, Jan 2017

Suicide Male physicians relative risk is 1.41 x higher than general population

Female physicians 2.3 times higher26% of deaths in physicians aged 25-39 compared to 11% of same age cohort general population

American foundation for suicide prevention 2017

“The fact is that each year we lose over 400 doctors to suicide—that's like an entire medical school gone.”

Wible, Pam. Medscape Family Medicine; Nov 13, 2014

Premise Behind Good Grief Rounds

• Invite residents to share their stories about their work

• Strategy to address emotion and invite connection amidst chaos of a busy day

• Aim• Increase mindfulness• Self-reflection through storytelling• Increase sense of meaning in work• Build community at work

Storytelling”- storytellers all bearing witness to one another’s ordeals, celebrating our common heritage as listeners around the campfire, creating our

identities in the stories we tell”-Rita Charon

Storytelling• Convey information

rapidly

• Release oxytocin

• Create emotional resonance which helps us determine quickly who is

friend or foe

• Leads to empathy which helps form relationships

quickly and widelyZak, Paul. Cerebrum. 2015

Storytelling

Wang, Y. “Integrating Narrative Medicine Storytelling: Increasing Medical Care Students Sense of Meaning in Life.”

Students randomized into learning narrative medicine storytelling (45) vs control (42)

Narrative medicine group Higher meaning in life awareness Better critical thinking dispositions Greater critical thinking competence

Wang, Y.. J Med Education Vol. 18 No. 3 2014

StorytellingOther models in medical literature that

utilize storytelling include:

• Schwartz Rounds• Doctoring to Heal

• R4R• Balint Groups

• Finding Meaning in Medicine Groups

Ceremony-Leslie Marmon Silko

Meaning in Medicine

556 physicians, 465 (84%) responded

34% met criteria for burnout

Amount of time spent on working on most meaningful activity inversely related to burnout

Shanafelt et al, Career Fit and Burnout Among Academic Faculty

Arch Intern Med. 2009;169(10):990-995

Meaning in Medicine

Krasner and colleagues evaluated the effect of a mindfulness and self-awareness curriculum on primary care physicians looking at burnout, empathy and mood

Large durable improvements Mindfulness Mood Empathy Burnout

Krasner et al, Association of an Educational Program in Mindful Communication with Burnout, Empathy, and Attitudes among Primary Care Physicians. JAMA, September 23/30, 2009—Vol 302, No 12

Meaning in Medicine

Primary Care Group: 32 physicians, 1 NP, 6 sites

Leadership prioritized provider well-being

3 goals were to increase autonomy, efficiency and meaning

Over 4 years emotional work related exhaustion improved significantly as well as measures of organizational health

Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544-1552.

Community and Well-Being

Meta-analysis of 148 studies

308, 849 patients over 7.5 years

Mortality data shows 50% increased survival for those with stronger social relationships

“These findings indicate that the influence of social relationships on the risk of death are comparable with well-established risk factors for mortality such as smoking and alcohol consumption and exceed the influence of other risk factors such as physical inactivity and obesity”

Holt-Lunstad J. 2010. Social Relationships and Mortality Risk, A Meta-analytic Review. PLOS

Gallop Poll

Trusting relationships at work key to retention

Provide emotional compensation in the workplace environment

12 dimensions that describe great work groups My superior or someone at work seems

to care about me I have a best friend at work

One of 9 strategies suggested for organizations: Improve Community at work

Improved physician loungePaid physicians to go out to lunch

Gave one hour of protected time to discuss issuesAll showed improvement in burnout and meaning in work

Shanafelt, Mayo Clinic Proceedings

Format Good Grief Rounds

Theme

Ground Rules

Mindfulness exercise

Reading/Song/Poem

Storyteller

Small Group stories

Large Group Stories/comments on materials

Themes• Importance of collegial relationships• Debriefing• Moral Distress• Making Mistakes• Talking to children about parents

death• When a young person dies• Violence against providers• Burnout and Depression• Loss of Self

Groundrules

Listen generously

If nothing to share be supportive of others

Confidentiality

Manage your technology

Mindfulness

“Mindfulness is awareness of present experience with acceptance, allowing you to see the big picture, recognize patterns, and enhance performance,

creativity, and innovation.”

-- Barbara Fredrickson

MindfulnessDecrease

BurnoutMood Disturbance Stress

Improvements AttentionEmpathy, Self-Compassion, Sleep

HeadspaceInsight Timer

HumanitiesLiteratureScriptures

PoetryMusic

Storyteller • Authentic

• Role Models Vulnerability

• NOT a lecture or didactic session

• Self-Reflection and Meaning key elements

Small Groups

• Size of small groups (2-3)

• Questions for small groups

• Emphasize listening and peer support

• 4-7 min per person person (facilitator keeps time)

Large Group

One learning from each small group

How does it feel to be listened to by a peer?

Questions/comments about extra materials

Data fromEvaluations

• Incorporate feedback

• Information for leadership

• Future Topics

4.44.6 4.54.6

4.84.6

4.4

4.74.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Valued/Useful Relevant Liked Format

Evaluation and Assessment of Good Grief Rounds

Internal Medicine PT/OT/ST combined

Likert Scale 1-5IM evals =189

PT/OT/ST evals=107Total=296

Weighted Averages

Evaluations

Example of Comments “Excellent Conversation” “Always good to talk things out” “It’s good to debrief and talk about our experiences” “Great way to open up to each other” “Format keeps things interesting” “These are always phenomenal. Thank you” “A nice change of pace and good to take time to reflect”

Limitations

Evaluation and Assessment limited

In future link evaluations to learning objectives

Difficult to evaluate as audience constantly changing with IM residents

Good Grief Rounds Practice

Pre-reading: Not moving forward

Theme: Loss of a patient

Ground Rules

Mindfulness exercise

Reading: Airlift by Scott Wilson

Primary Storyteller

Small Group Storytelling

Large Group Learnings

Questions for Small Groups

Do you have a story of a patient who’s death touched you?

What do you remember about the patient?

What did you appreciate about the patient or situation?

What did you learn from the situation about yourself or life?

Thank You

To the IPPC team at Anschutz Medical Center

Dr. Renee Gravios, Dr. Morgan Elmore, Dr. Kate Jennings, Erin Erickson OT, William Jensen MDiv, Erin Nielsen LCSW

Dr. Jennifer Reese and Dr. Marti Shultze for their knowledge, materials and mentorship

To all of you for what you do!!!

References

Zak, Paul. Why Inspiring Stories Make Us React: The Neuroscience of Narrative. Cerebrum. 2015 Jan-Feb; 2015: 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445577/ Published online 2015 Feb 2.

Rabow. MW. Doctoring to HealFostering well-being among physicians through personal reflection. West J Med. 2001 Jan;174(1):66-9.

Kabat-Zinn. Mindfulness in Medicine. JAMA, September 17, 2008—Vol 300, No.11.

Forntey et al. Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study. Ann Fam Med, September/October 2013, Vol 11, No. 5.

Shapiro, S. Effiects of Mindfulness-based stress reduction on medical and premedical students. J. Behav. Med. 1998. Dec: 21(6): 581-99.

Shapiro SL, Astin JA, Bishop SR, et al. Mindfulness-based stress reduction for health care professionals: results from a randomized trial. IntJ Stress Manag. 2005;12(2):164-176

Galantino ML, Baime M, Maguire M, et al. Association of psychological and physiological measures of stress in health-care professionals during an 8-week mindfulness meditation program: mindfulness in practice. Stress Health. 2005;21(4):255-261

References

Kemper, K. Are Mindfulness and Self-Compassion Associated with Sleep and Resilience in Health Professionals?. The Journal of Alternative and Complementary Medicine. August 2015, Vol. 21, No. 8: 496-503

Krasner et al, Association of an Educational Program in Mindful Communication with Burnout, Empathy, and Attitudes among Primary Care Physicians. JAMA, September 23/30, 2009—Vol 302, No 12

Pedersen, R. Empathy development in medical education-a critical review. Med Teach. 2010;32(7):593-600.

Aken, L. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Jama; 10/2002.Vol 288, No. 16.

Peckham, C. Physician Burnout: It just keeps getting worse. Medscape Family Medicine, Jan 26, 15.

American Stress Institute. Compassion Fatigue. https://www.stress.org/military/for-practitionersleaders/compassion-fatigue/

Holt-Lunstad. Social Relationships and Mortality Risk: A Meta-analytic Review. PLOS Medicine. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316 Published: July 27, 2010

American foundation for suicide prevention: https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention

References

Gallup Poll. What makes a great work place? .https://thepeoplegroup.com/wp-content/uploads/2008/04/article-gallup-research-what-makes-a-great-workplace1.pdf

Shanafelt, T. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. n January 2017;92(1):129-146

Schwartz Center: https://www.theschwartzcenter.org/about-us/story-mission/

Remen, R. Finding Meaning in Medicine Groups: http://rishiprograms.org/wp-content/uploads/FindingMeaningMedicine2.pdf

Balint Groups: https://balint.co.uk/about/introduction/

Wang. Y.Integrating Narrative Medicine Storytelling into the Study of the Medical Humanities: Enhancing Medical Care Students' Sense of Meaning in Life and Critical Thinking Capacity. Airiti Magazine. Http://www.airitilibrary.com/Publication/alDetailedMesh?docid=10282424-201506-201506090021-53-64.

Wible, Pam. Physician Suicides 101: Secrets, Lies and Solutions. Medscape Family Medicine; Nov 13, 2014

Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544-1552.

Shanafelt et al, Career Fit and Burnout Among Academic FacultyArch Intern Med. 2009;169(10):990-995