Posted October 3, 2022
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Professional quality of life greatly affects the overall well-being and work performance of healthcare workers. It is important to address the factors that negatively affect this and form habits through brief interventions.
In this episode, Darcy Copeland, a Professor of Nursing and Nurse Scientist, talks about the study she conducted on brief workplace interventions to address burnout, compassion fatigue, and teamwork in nurses.
Listen and learn in this episode.
KEY TAKEAWAYS FROM THIS EPISODE
Brief Interventions Darcy explored to address burnouts and compassion fatigue:
Each of these were conducted with nurses for only 10 minutes per day over a number of weeks. Nurses were given one activity to do:
-The best thing that happened today.
-What would I have done differently if I could…
-This situation was unexpected and what I did.
-The situation that touched me the most today.
-Would you believe this happened?
-The way I got through this.
Thank and recognize at least three people every day.
Results of the study:
Darcy found in this pilot study encouraging evidence that indeed, only 10 minutes per day of self-care was effective in enhancing nurses’ wellbeing. When nurses were given an opportunity and encouragement to ring-fence 10 mins of shift time for self-care, highly positive feedback was received.
The conclusion – nurse managers out there should look to make this time available and actively encourage staff to choose an activity each day.
Darcy Copeland is a Nursing Professor at The University of Northern Colorado and a Nurse Scientist.
Brief Workplace Interventions Addressing Burnout, Compassion Fatigue, and Teamwork
Find more about Darcy Copeland here:
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Nathan Illman 00:05
Welcome to the Nurse Wellbeing Mission podcast hosted by me Nathan Illman. This is the place where nurse and midwife wellbeing at the top of the agenda. Each episode aims to help nurses and midwives around the world flourish through informative, inspiring and practical content and conversations.
Nathan Illman 00:29
Darcy, so thank you so much for joining me for this conversation. We’re here to talk about one of your recent research articles, if you could just start by introducing yourself telling us a little bit about who you are, where you work and maybe just a little bit of background to the article we’re going to cover today, which is about brief interventions to support nurses well being in the workplace.
Darcy Copeland 00:50
Yeah, sure. So it’s nice to meet you. Thank you for inviting me to do this. My name is Darcy Copeland, I am nurse researcher in the United States, I live in Colorado. My primary job, I kind of have two different roles in my professional life, my primary job is as an Associate Professor of Nursing at the University of Northern Colorado. And then I have a second position as a neuroscientist at a hospital outside of Denver. And as a neuroscientist, there, I kind of have a couple of different roles. But you know, on one hand, I help staff implement best practices into their everyday work. And then I also conduct original research, which is what you discovered was some of the original research that I had done as a part of that position as a neuroscientist. My clinical background is in mental health nursing. So I’ve always been interested in, you know, mental health and well being initially, obviously, of patients. But as my position has morphed and changed over time, like you, I’ve become more and more interested in kind of the mental health of our clinical providers, in my case, particularly nurses, but I’m interested in the mental health of all of our clinicians. And so that’s my research of late has really been focused on issues of kind of moral distress and compassion, fatigue, and burnout and secondary traumatic stress that nurses, particularly nurses experience,
Nathan Illman 02:17
And presumably from your own personal experience, and with the seeing the nurses that you work with, I imagine you’ve you’ve come across some of this stuff, right? Just witnessing colleagues, mental health, suffering, and people struggling with burnout, the stuff that you talk about in your research, you’ve witnessed it firsthand.
Darcy Copeland 02:34
Nathan Illman 02:35
So well, thank you for doing this research is really important, isn’t it? I think there is quite a paucity of research in this area. And it’s great that you’ve decided to focus on on this. So we’re going to talk about this, this paper today. I think just you I suppose you’ve given a little bit of a bit of context, haven’t you, as to why you maybe wanted to do this study. So if we just talk a little bit more about that the context of burnout and compassion, fatigue, and that sort of thing that you write about in the introduction to this study, would you be able to just give us a little bit of a overview of some of those topics that you cover, and also sort of what you decided to measure in this study and the outcomes that you were you were sort of hoping to investigate?
Darcy Copeland 03:16
Yeah, so in this particular study, I was looking at the effects of brief. So number one, brief interventions that were done, while nurses were at work, the effects of those interventions on their burnout, secondary traumatic stress, compassion, satisfaction, I can mention those a little more in just a second. And there’s a lot of research indicating that the phenomenon of teamwork in health care among healthcare providers and burnout are inversely related to the more burnout providers have, the worse their teamwork is, the better their teamwork is the less burnout they have. So I also looked at teamwork in the context of the study. So the instrument I use to measure burnout is sort of sits under this kind of larger framework of what is referred to as professional quality of life. So that particular model of professional quality of life kind of differentiates professional quality of life as two things on one side is compassion, satisfaction, which is all of the like, warm, fuzzy goodness we get when we help other people, you know, we want more and more and more of that. And then the flip side of that is compassion fatigue. And this particular model breaks compassion fatigue into two components, one being secondary traumatic stress, which is kind of the emotional burden of, you know, repeatedly being in contact with humans who are suffering. And then the other side of that is burnout and burnout in this particular model refers more to kind of workplace situational things like short staffing and lack of resources and just the amount of work and the time you have to do the work, it’s more that kind of operational stuff. So it takes burnout as secondary traumatic stress and collapses that into compassion fatigue. So if we’re so I measured professional quality of life using this instrument and an instrument that one of our federal agencies has to measure health care, teamwork.
Nathan Illman 05:23
Okay. And so I guess, so for nurses listening to this, who sort of don’t have any kind of technical or scientific background or familiar with these terms and things to compassion, fatigue is sort of like it’s the negative effects of some aspects of nursing work, right. It’s that he said, there’s the occupational factors, the stresses of the job, and the sort of emotional aspect of potentially traumatic things that they’re witnessing or hearing about whatever as part of that role.
Darcy Copeland 05:51
Exactly. One thing I do like about this particular model of professional quality of life, is that it doesn’t only focus on the idea of compassion, fatigue, I mean compassion fatigue is definitely something we want to decrease among healthcare providers. But it also recognizes that there’s this other part of our work that is referred to as compassion satisfaction, that we can do things to potentially bolster that. So it’s not necessarily just about reducing compassion fatigue, we can also do things to increase our compassion satisfaction.
Nathan Illman 06:25
Right. And I suppose, yeah, the issue is compassion fatigue, right is obviously not coming from a nursing background. But as a psychologist, you know, this is something I’ve sort of seen witnessed myself and other colleagues, it’s where you kind of you almost feel like you’re almost your attitude towards the work and towards your clients or your patients might change when you’re feeling that, right. It’s the sort of perhaps not paying as much attention and or failed a feeling of not wanting to go into work sometimes. And it’s quite serious effects kind of on the quality of the work, and obviously, presumably, teamwork, which is why you’re measuring that.
Darcy Copeland 07:00
Nathan Illman 07:01
Okay. So I suppose, do you want to talk us through the methodology that you use, you mentioned is specifically looking at brief interventions, maybe actually talk a little bit about why you chose brief interventions? We were talking about that before we started recording where we sort of the context of that, why is that important to look at brief interventions, and then tell us about the ones that you chose, and maybe why you chose those ones, that kind of thing?
Darcy Copeland 07:25
Sure. So I also have a lot of interest in have do work in issues of kind of ethics and moral distress. And so I kind of approached this with the idea that all of these things, burnout, compassion fatigue, secondary traumatic stress, are work-related injuries, and if we sort of think about them as work related, then it sort of changes, kind of who has the onus to maybe prevent them. So rather than kind of telling nurses, you know, you need to take care of yourselves, you need to protect yourselves, you know, in your off time, you should, you know, eat well, and sleep well, and exercise and spend time with family and do all those things to take care of yourselves when you’re not at work. So I wanted to kind of reframe that. And again, framing it as a work-related injury, that we need to do something about it while you’re here at work, like it is our workplaces responsibility to help mitigate some of this stuff. So knowing that I wanted to find things that nurses could do, realistically do while they were at work being paid, necessitated that they’d be brief little nuggets of things, that wouldn’t be, you know, overburdened some in the course of their work, but also could be justified paid time. So that was the rationale for the brief part of it. So I think you asked about the methodology. Sorry, the methodology was really a pilot study, I wanted to see kind of primarily, would it work? If I asked nurses to take five minutes out of their workday to do these things? Would they do it? So that’s kind of the acceptability piece? And could they do it? Like, would they find a way to fit it into their schedules in a way that works? So acceptability and feasibility, were really the two primary things I was looking at with the intention of figuring out if it was acceptable to people and if they were able to do it, you know, maybe launching it on a on a larger scale. So the secondary piece of it was really to look at outcomes. And because it was a small pilot study, drawing statistical conclusions is a little dicey, nevertheless, did see good outcomes, which is always good. So the brief interventions that I chose to implement were all out there in the literature. This is all evidence-based stuff. So the interventions I chose were journaling. And I asked participating nurses to do one of these activities, whatever, I randomized them into one of these groups and just ask them to do whatever activity they were assigned to, for five minutes. During every shift, they worked for six weeks. So one group was asked, I provided them with a journal with some prompts, because not everybody knows how to journal. So it had some prompts in it. So one group was asked to journal for five minutes while they were at work, one group was asked to meditate for five minutes while they were at work. And I just show them how to access there are several apps out there. But ones that could that had five minute meditations. So they were asked to meditate for five minutes, one group was asked to spend five minutes outdoors, we have the luxury at our hospital to have kind of a, we call it a healing garden. So it’s just, you know, a nice space that we can, it’s quiet for patients, and there’s, you know, grass and flowers and fountains. And so I asked a group to spend five minutes out there with no cell phones and no pagers, just to literally, you know, observe nature for five minutes. And then the last group, I asked them to practice gratitude. So a little different than the other five minute intervention. So they were asked to do two things they were asked to thank three people every day, and just recognize, it could be a patient, it could be a staff member, it could be a family member, but just to thank and recognize at least three people a day. So those are the interventions.
Nathan Illman 11:37
Fantastic. And with the journaling. Do you mind just explaining a little because I know you had some prompts, didn’t you? So because a lot of people when they say when you say journaling, they say, Well, what am I journaling on?
Darcy Copeland 11:49
Right? Yeah, and let me, Okay, so I can tell you the prompts. So yeah, it gave everybody a journal. And on the kind of inside cover of the journal, I just taped these prompts, so I can read to you what they were, if they chose to use them if they didn’t, that was fine. So one was, How would a patient visitor or colleague observer describe a particular situation that you encountered at one prompt, the best thing that happened today was, what I would have done differently if I could, this was unexpected, and here’s what I did. The situation that touched me the most today was, would you believe this happened? The way I got through this was, so those were the prompts that I put in there.
Nathan Illman 12:34
I suppose it’s like getting people to think about training perspective and sort of building their self-efficacy thinking about how did I do this? What strength, you know, getting people to think about their strengths and stuff, isn’t it as well? Okay, nice. And so you mentioned, I suppose, before we go on to the results of what you found, it’d be good to just cover a little bit more about you to pick these five minute interventions. These are all from, like you said, they’re evidence based, I’m actually really curious to know, because you sort of review in your introduction about existing research, there’s looked at some of these other programs and things that have been beneficial. And the conclusions are largely that stress management and mindfulness-based interventions, these sorts of things are beneficial for burnout, at least in the short term. But some of them, like take a long time to implement, don’t they? So I’m curious to know, from your sort of personal and professional perspective on where you sit with these, how you feel about those sorts of things? I mean, obviously, you’ve you chose to research the brief ones. But yeah, what’s your take on the longer kind of more intensive interventions?
Darcy Copeland 13:38
Well, there’s plenty of evidence out there that these things in long stints work things like you mentioned, like mindfulness, we know mindfulness has a positive effect on our mental well, being that we’ve had, we’ve got decades of research that tells us that I think we don’t know as much, you know, actually, now that you mentioned this, I think an area of kind of research opportunity is to look at sort of dose response, you know, this particular study I did seems to indicate that, you know, an hour of meditation is great, and we know it will improve mental health and well being well, will maybe five minutes meditation will also have an effect on people’s mental health and wellbeing. So if you want to do 60 minutes then and are able, then that’s great. But if you can only do five minutes, then do it. Don’t feel like you have to commit to a long prolonged kind of intervention.
Nathan Illman 14:35
I guess it comes back to the same old thing is just there’s such individual differences with people as well. I’ll learn a new. I know you mentioned it, I think in your discussion, which we’ll come to but I think you said about, you know, we actually, you know, moving forward, you maybe need to look at people’s prior experience with certain intervention. Some people might be more versed in gratitude practice or whatever. So the effect they get from it might be more or less than someone else. And so it’s just I suppose it just ties the complexity of psychological interventions, doesn’t it? And there’s there’s plenty of scope for, for examining this stuff in finer grained detail. It’s quite hard, isn’t it? To sort of control all these things.
Darcy Copeland 15:12
To that point. I mean, I purposefully randomized people into what group they were in.
Nathan Illman 15:18
Darcy Copeland 15:18
Just to sort of dampen the possibility that people would gravitate to something that they were already knew and were comfortable doing. I didn’t want that to necessarily, you know, I don’t know for sure that it would have impacted the outcome. But I wanted to eliminate the possibility.
Nathan Illman 15:36
Yeah, yeah. It’s a nice, nice move to try and reduce the impact of that. Okay, so you’ve got a group of nurses, they’ve been randomized to one of four groups. So you’ve got journaling, gratitude, meditation and outside time. So tell us about what you found the results, you don’t have to tell us this, you know, this specific data, I’m not going to be unkind to you. Just you can just summarize what you found.
Darcy Copeland 15:59
So going back to those initial two kind of questions about feasibility and acceptability, overwhelmingly, yes, it was feasible, they nurses were able to do this. And in terms of acceptability, nurses did it. I had them keep track of how often they did it. And more than 80% of the shifts that they worked, they actually committed to doing these things. So in terms of feasibility and acceptability, hands down, these things can and will be done. If people want to do them, and or have the opportunity to do them. Probably the more interesting thing that you’re kind of getting at with these are the effects that preliminary effects, again, is small sample size, but nevertheless did see positive effects in burnout, particularly burnout and secondary traumatic stress and certain elements of teamwork. I have to look at the specific statistics here, but I want to say it was the journaling group, I believe, kind of came out on top, their scores tended to change the most all of the scores changed, no matter what group a person was in, their, you know, their scores tended in the right direction, teamwork, increased burnout, secondary traumatic stress decreased. But I believe it was the journaling group that kind of had the best kind of effects with I think the gratitude group kind of coming in close behind.
Nathan Illman 17:28
And you actually ran the study, didn’t you? So you’re on the ground with these nurses and delivering this, you know, the the study protocol and stuff. So I mean, what’s and you, you mentioned you providing the paper, there’s some examples of sort of qualitative feedback, isn’t there from these nurses, their experience of it? So just talk a little bit about that, you know, what they said in terms of its acceptability, but also in terms of maybe some of the feedback they gave you about the specific interventions?
Darcy Copeland 17:56
Yeah, sure. I’ll read a couple of the comments. So somebody from the gratitude group said that I do believe it made a difference with every person, it definitely promotes positivity. Somebody from the journaling group said, journaling really helps me and I will continue, nurses need to use every strategy possible. It helps me wind down after my shift and reflect on my personal accomplishments for the day. Somebody from the meditation group said on days that I was really fatigued, it helped me feel a bit refreshed, I found the practice itself very relaxing and comfortable, I think I’ll continue to practice it. Somebody from the outside group said, I came back feeling like some heaviness or negative energy was released from the back of my head, and I felt lighter, it did make a difference, I was able to relax and unwind before coming back to the floor, I didn’t realize how much stress builds up in such a small amount of time. So yeah, I mean, to your point like this, this sort of qualitative narrative does really kind of speak volumes. Yeah.
Nathan Illman 18:56
it was really nice to see that you put that in as well, because I think it you know, when we’re looking at just quantitative data, so to non-researchers, that means basically, just numbers and statistics, it kind of strips away the human element sometimes, doesn’t it? I think it’s nice that you sort of, it’s bringing back to the front, and it’s like actual human beings that you’ve done this research with, and this is how their experience of it.
Darcy Copeland 19:18
And how grateful I am to hear people say, first of all, that it worked. And oh, I think I’ll continue doing it. I mean, that’s just happy news for a researcher.
Nathan Illman 19:30
Yeah. And I think, you know, you know, just, I was excited about your results. And I’m aware, it’s a pilot study, and it’s a small sample. And, of course, you know, as a sort of researcher myself, like I understand some of those limitations, I think, but I am also, I think it’s great that you looked at that adherence and feasibility side of things because from my perspective, I’m interested in organizational interventions, and I feel the same way you do about that moral responsibility as a workplace based injury organization turns in well, here the health system is largely funded by the government. So it feels like a government like a societal responsibility, but needs things that are going to be workable, don’t we, for nurses, because it’s you know, the research is really clear about there being when nurses it’s very time poor on the job. And there’s so many demands actually doing the 12-hour meditation course is just not going to happen for most nurses. And what we need is scalable interventions, don’t we? So I think actually the adherence and feasibility but is as important as the whether it’s good works, because you need or you need to establish that something is possible for everyday nurses, don’t you?
Darcy Copeland 20:40
Right, exactly. It’s the exact same sentiments. Yeah,
Nathan Illman 20:44
Yeah. So I suppose taking this forward, then you do this as a pilot study? Have you? Do you have any intention? Or are you in the process of expanding upon it? Or what are your sort of like next steps with it.
Darcy Copeland 20:56
So the hospital I work at is part of a larger system, I’ve got kind of side rails on a couple other projects that I’ve been working on. But now hope to come back to this and do exactly what you’re saying, kind of implement this on on a bit of a larger scale, and at multiple trying to do it at multiple locations now, so collaborating with neuroscientists at these other facilities would be my next step.
Nathan Illman 21:23
And I’m interested to know what your, so I mean, I suppose like journaling came out as taught, but it’s something you probably want to investigate a bit more with a larger sample. Do you have any advice for nurses in general who might be watching this? I mean, based on the conclusions you found, and maybe just your personal experience of using some of these interventions, what would your advice be for the you know, the average nurse if you like, who’s who’s watching or listening to this conversation?
Darcy Copeland 21:49
That’s a really good question. And kind of to add to what I just mentioned about how have I sort of continued this work a major way I’ve continued this work is on a weekly basis, I encounter someone or a group or in a meeting some pushback about the idea that the these types of things are easy to implement, and can be done. So I’ve definitely gotten resistance that I’m constantly sort of pushing back against, I hear a lot we talked before we started recording, I hear a lot of providers say I just don’t have time, you know, I don’t have time to do that. I don’t have time to take care of myself. And I like I said, I pushed back on at least a weekly basis to really have people kind of reflect on that. Like, really, you do have time. Everybody has five minutes. Everybody has five minutes. Yeah, they just don’t kind of, I don’t know, realize they have five minutes. So people I think get sort of caught in this rut of thinking that like you were saying, like to take care of myself, I need to devote buckets of time and energy, when that’s really not the case, taking care of ourselves can be really small snippets of things, it can be purposefully thanking people in my workplace purposefully finding something to recognize in another person, purposefully spending time outside, listening to birds, watching the wind, you know, blow the grass. Yeah, so really, just really trying to instill in people that taking care of yourself does not have to be like we were saying, or it doesn’t have to be an hour at the gym. It doesn’t have to be an hour long yoga class of meditation, it can be these, you can take care of yourselves and much, much smaller ways that every single solitary person has the time to do I don’t care how busy you are.
Nathan Illman 23:45
It’s very fascinating. I guess we’re supposed to sort of hang what you just said onto a bit of a sort of psychological like concept is you’re talking about mindset really around self care, aren’t you? It’s a mindset is like our beliefs and attitudes and expectations about a particular thing. So it’s, there’s this misconception or misguided mindset about what self-care is and how one achieves self-care or Yeah, sort of well, being that many people, I think, nurses, but I think many, many people in general think that it needs to be the day long yoga or meditation retreat or, or going to the gym five times a week or whatever. But actually, what you’re saying and you’re sort of encouraging advising here is that it’s small things it’s several minutes. And that’s something we know from the research literature about habits you know, it’s it’s actually small actions we take each day that then become a habit that then lead to this kind of like virtuous cycle basically of taking better care of ourselves. So I’m really pleased that you found some preliminary evidence to support this and I think it’s, it’s really powerful, isn’t it when because at the end of the day, you’ve got to change people’s minds about this, how many like you’re saying you’re on a weekly basis, you’re coming up against this mindset and actually where when someone like you does research, you can say, well, we found this. And this is a piece of evidence to to kind of…
Darcy Copeland 25:06
People have a great capacity to brush it off. Yeah, something else we were talking about before you started recording some other work I’ve done, you know, after it was specifically code events and getting teams together to talk about the experience. And you know, in that common comment was, we don’t have time after a code event in an emergency department, we don’t have time to get together to debrief it and talk about how things went and how we’re doing. Again, that was another study that we really should have proved that, you know, even in a busy emergency department, a busy Trauma Center, the staff found time to do it and found it effective. And to sort of counter this narrative that providers have that I don’t have time to do it, I have to get back out to work, kind of flipping that back on people and asking them, okay, if you’re let’s pretend and pretend you’re my colleague, if you came to me and said, Darcy, I need to take five minutes to step outside. I would nine times out of 10 probably be like, Absolutely, Nathan, you know, go take your five minutes, I could totally cover for you. Not a problem. But we have this, like you’re saying this mindset that we have to get back out there when I don’t know we don’t extend the same compassion, I guess to ourselves that we know we would our colleagues, if our colleagues came to us and said, Hey, here’s what I needed. Yeah, we were doing.
Nathan Illman 26:25
Yeah, it’s a really interesting shift, I think, isn’t it that that we need to support people to make both at an individual level but then with organizations and it all becomes about the culture within the organization? Doesn’t it have? Yeah, which as you know, is hard to change. Okay, Darcy? Well, thank you so much for talking about that paper with me today. As I said, I’d love to talk to you more about some of your other research and other time. If people would like to find you and look at your other research, where’s the best place for them to go?
Darcy Copeland 26:54
So again, I my primary worksite is at the University of Northern Colorado, in the School of Nursing. So you can you know, find your faculty profiles through there would probably be the easiest place.
Nathan Illman 27:06
Okay, that’s it. Thank you very much.
Darcy Copeland 27:08