185CHAPTER 22 Burnout and Resiliency Promoting a Healthy Work Environment The American Association of Critical Care Nurses Healthy Work Environment framework has been adopted to guide ICU practices in[.]
CHAPTER 22 Burnout and Resiliency Promoting a Healthy Work Environment • BOX 22.2 Interventions to Prevent or Mitigate Burnout in ICU Clinicians Organizational Interventions • • • • • • Ensure adequate staffing Implement flexible scheduling or self-scheduling Promote a healthy work environment (see Fig 22.1) Provide communication training Encourage development of support groups Suggest cognitive behavioral therapy Team-Based Interventions • Hold team debriefings after stressful events • Use structured communication tools • Hold team-building and interpersonal skills training Individual-Focused Interventions • Limit number of consecutive days of work • Encourage self-care measures: adequate rest, exercise, healthy eating habits, relaxation techniques, time management, meditation • Hold assertiveness training and stress-reduction training • Encourage work-life balance measures: hobbies, family, and social activities The American Association of Critical-Care Nurses Healthy Work Environment framework has been adopted to guide ICU practices in many critical care settings The framework includes six standards: skilled communication, true collaboration, appropriate staffing, meaningful recognition, effective decisionmaking, and authentic leadership (Fig 22.1).21 Integrating the healthy work environment framework into critical care practice has been identified as a strategy to ensure that the critical care work setting maximizes interprofessional care and teamwork Research using the healthy work environment standards has identified that the Healthy Work Environment components can predict burnout risk and that meaningful recognition and authentic leadership can predict compassion satisfaction.22 Additional commonly recognized principles of a healthy ICU environment include “avoiding or managing conflicts” and “improving end-of-life care.” A healthy work environment may be enhanced by using such strategies as team debriefings, structured communication, and collaborating with team members on critical decisions.14 Several resources are available for promoting a healthy work culture and addressing clinician resiliency in critical care (Box 22.3) Optimal patient outcomes Skilled communication Clinical excellence 185 Authentic leadership Meaningful Healthy recognition work environment True collaboration Effective decision making Appropriate staffing • Fig 22.1 Healthy work environment framework (Modified from American Association of Critical-Care Nurses AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence 2nd ed Aliso Viejo, CA: 2016.) 186 S E C T I O N I I I Pediatric Critical Care: Psychosocial and Societal • BOX 22.3 Resources for Promoting a Healthy Work Culture and Addressing Clinician Resiliency in Critical Care • American Association of Critical-Care Nurses Is your work environment healthy? Aliso Viejo, CA https://www.aacn.org/nursing-excellence/healthywork-environments • Critical Care Societies Collaborative Burnout Summit Session recordings http://ccsconline.org/optimizing-the-workforce/burnout • Podcast American Board of Internal Medicine Burnout and Practicing Today’s Medicine http://blog.abim.org/podcast-burnout-and-practicingtodays-medicine/ • An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Healthcare Professionals A Call for Action https://pdfs semanticscholar.org/f647/8105e21acc3c1616e26b0806f018620c538e.pdf • National Academy of Medicine Communications Toolkit Clinician Well- Being Knowledge Hub Washington, DC: National Academy of Medicine; 2018 https://nam.edu/resource-toolkit-clinician-well-being-knowledgehub/ • American Medical Association Steps Forward Professional Well-Being Physician Burnout: Improve Physician Satisfaction and Patient Outcomes https://edhub.ama-assn.org/steps-forward/module/2702509 • American Nurses Association Healthy Nurse Healthy Nation Grand Challenge Silver Spring, MD: American Nurses Association; 2018 http://www healthynursehealthynation.org/ • Accreditation Council for Graduate Medical Education Improving physician well-being, restoring meaning in medicine Chicago, IL: Accreditation Council for Graduate Medical Education; 2017 http://www.acgme.org/What-WeDo/Initiatives/Physician-Well-Being Summary Pediatric critical care providers are at increased risk of experiencing burnout Raising awareness of the importance of recognizing risk factors and implementing strategies to mitigate burnout in the pediatric ICU remains a priority area of care In acknowledging that burnout can result from administering pediatric critical care and in attempting to build a healthy work environment, pediatric critical care providers can help to promote a better work environment that fosters resiliency In addition to directly benefitting critical care clinicians, addressing burnout and promoting a healthy work environment can positively impact patient- and family-focused care outcomes Key References American Board of Internal Medicine PODCAST: Burnout and Practicing Today’s Medicine 2018 Available at: http://blog.abim.org/ podcast-burnout-and-practicing-todays-medicine/ Critical Care Societies Collaborative website with recordings from national summit on addressing burnout in critical care providers http:// ccsconline.org/optimizing-the-workforce/burnout Critical Care Societies Collaborative National Summit on Prevention and Management of Burnout in the ICU Critical Care Societies Collaborative Available at: http://ccsconline.org/optimizing-the-workforce/burnout Leckie JD I will not cry Ann Am Thorac Soc 2018;7:786 Available at: https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201803159IP#readcube-epdf Linzer M, Guzman-Corrales L, Poplau S Preventing Physician Burnout Chicago, IL: American Medical Association; 2017 Available at: https://www.stepsforward.org/modules/physician-burnout Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN An official Critical Care Societies Collaborative statement: burnout syndrome in critical care health care professionals: a call for action Crit Care Med 2016; 44(7):1414-1421 National Academy of Medicine Resource Toolkit for the Clinician WellBeing Knowledge Hub Washington, DC: National Academy of Medicine; 2018 Available at: https://nam.edu/resource-toolkit-clinician-wellbeing-knowledge-hub/ Nguyen NS, Métraux EL, Morris-Singer AF Combating clinician burnout with community-building NEJM Catalyst catalyst.nejm.org/ doi/full/10.1056/CAT.18.0124/ The full reference list for this chapter is available at ExpertConsult.com e1 References Maslach C, Schaufeli WB, Leiter MP Job burnout Annu Rev Psychol 2001;52:397-422 National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience https://nam.edu/initiatives/clinicianresilience-and-well-being/ Medscape National Physician Burnout, Depression & Suicide Report 2019 https://www.medscape.com/slideshow/2019-lifestyle-burnoutdepression-6011056 Rushton CH, Batcheller J, Schroeder K, Donohue P Burnout and Resilience among nurses practicing in high-intensity settings Am J Crit Care 2015;5:412-420 Bridgeman PJ, Bridgeman MB, Barone J Burnout syndrome among healthcare professionals Am J Health Syst Pharm 2018;75(4): 147-152 Hoff T, Carabetta S, Collinson GE Satisfaction, Burnout, and turnover among nurse practitioners and physician assistants: a review of the empirical literature Med Care Res Rev 2017;76:3-31 Shenoi AN, Kalyanaraman M, Pillai A, et al Burnout and psychological distress among pediatric critical are physicians in the United States Crit Care Med 2018;46:116-122 Maslach C, Jackson SE MBI: Maslach Burnout Inventory; Manual Research Edition Palo Alto, CA: Consulting Psychologists Press; 1986 Meadors P, Lamson A, Swanson M, White, M, Sira N Secondary traumatization in pediatric healthcare providers: compassion fatigue, burnout, and secondary traumatic stress OMEGA (Westport) 2010;60(2): 103-128 10 Gribben JL, Kase SM, Waldman E Weintraub AS A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in pediatric critical care physicians in the united states Pediatr Crit Care Med 2019;20:213-222 11 Crowe S, Sullivant S, Miller-Smith L, et al Grief and burnout in the PICU Pediatrics 2017;139:e20164041 12 Pastores SM, Kvetan V, Coopersmith CM, et al for the Academic Leaders in Critical Care Medicine (ALCCM) Task Force of the Society of the Critical Care Medicine Workforce, workload, and burnout among intensivists and advanced practice providers: a narrative review Crit Care Med 2019;47:550-557 13 Rehder KJ, Cheifetz IM, Markovitz BP, Turner DA; Pediatric Acute Lung Injury and Sepsis Investigators Network Survey of in-house coverage by pediatric intensivists: characterization of 24/7 in-hospital pediatric critical care faculty coverage Pediatr Crit Care Med 2014;15:97-104 14 Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN An official Critical Care Societies Collaborative statement: burnout syndrome in critical care health care professionals: a call for action Crit Care Med 2016;44(7):1414-1421 15 Kleinpell R, Moss M, Good V, Gozel D, Sessler C The critical nature of addressing burnout prevention: results from the critical care societies collaborative’s national summit and survey on prevention and management of burnout in the ICU Crit Care Med 2019; 47(12):1692-1698 16 Shanafelt TD, Noseworthy JH Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout Mayo Clin Proc 2017;92(1):129-146 17 Nguyen NS, Metraux MA, Morris-Singer AF Combating clinician burnout with community-building NEJM Catal 2018 https:// catalyst.nejm.org/doi/abs/10.1056/CAT.18.0124 18 Connor KM Assessment of resilience in the aftermath of trauma J Clin Psychiatry 2006;67(suppl 2):46-49 19 Mallak LA Measuring resilience in health care provider organizations Health Manpow Manage 1998;24(4-5):148-152 20 Gillespie BM, Chaboyer W, Wallis M Development of a theoretically derived model of resilience through concept analysis Contemp Nurse 2007;25(1-2):124-135 21 American Association of Critical Care Nurses Healthy Work Environments Standards https://www.aacn.org/nursing-excellence/healthy-workenvironments?tab5Patient%20Care 22 Kelly L, Todd M Compassion fatigue and the healthy work environment AACN Adv Crit Care 2017;28:351-358 e2 Abstract: It is acknowledged that critical care providers, including those working in pediatric critical care, are at risk for burnout As burnout often results in high staff turnover, workplace dissatisfaction, and clinician distress, implementing proactive measures to promote healthy work environments, build individual resilience, and mitigate clinician burnout has become a priority in critical care This chapter presents an overview of strategies to identify and prevent burnout in pediatric critical care providers and to promote clinician resilience Tactics to advance and integrate individual and organizational measures to build clinician resiliency and promote a healthy work environment are highlighted Key Words: burnout, compassion fatigue, resilience, pediatric critical care, healthy work environment, intensive care unit SECTION IV Pediatric Critical Care: Cardiovascular 23. Structure and Function of the Heart, 188 24. Regional Peripheral Circulation, 203 25. Endothelium and Endotheliopathy, 218 26. Principles of Invasive Cardiovascular Monitoring, 227 27. Assessment of Cardiovascular Function, 239 28. Cardiac Failure and Ventricular Assist Devices, 248 29. Echocardiographic Imaging, 270 30. Diagnostic and Therapeutic Cardiac Catheterization, 289 31. Pharmacology of the Cardiovascular System, 300 32. Cardiopulmonary Interactions, 320 33. Disorders of Cardiac Rhythm, 329 34. Shock States, 352 35. Pediatric Cardiopulmonary Bypass, 363 36. Critical Care After Surgery for Congenital Cardiac Disease, 380 37. Cardiac Transplantation, 411 38. Physiologic Foundations of Cardiopulmonary Resuscitation, 420 39. Performance of Cardiopulmonary Resuscitation in Infants and Children, 444 187 ... community-building NEJM Catalyst catalyst.nejm.org/ doi/full/10.1056/CAT.18.0124/ The full reference list for this chapter is available at ExpertConsult.com e1 References Maslach C, Schaufeli WB, Leiter MP... build individual resilience, and mitigate clinician burnout has become a priority in critical care This chapter presents an overview of strategies to identify and prevent burnout in pediatric critical