Evidence-Based Review and Discussion Points

Abstract

Critical care nurses are often exposed to psychologically taxing conditions while delivering life-sustaining care to critically ill patients and their families. Compassion fatigue, a consequence of repetitive exposures to psychologically taxing clinical conditions, has significant detrimental effects on critical care nurses, health care organizations, and the quality of care received by critically ill patients. Characterized as a psychological and physiological response to repetitive and chronic intrapersonal and secondary traumatic stressors, compassion fatigue is suspected to be counterbalanced through recognition of positive aspects of the delivery of nursing care and through organizational characteristics such as the implementation of a meaningful recognition program. Meaningful recognition programs may serve as an organizational strategy that attenuates compassion fatigue and improves compassion satisfaction, changes that are likely to enhance nurse retention and the delivery of high-quality nursing care.The authors of this EBR conducted a descriptive study to assess the impact of a meaningful recognition program among adult critical care nurses across several health care organizations. In this study, the authors recruited hospitals with adult intensive care units that had implemented The Diseases Attacking the Immune System (DAISY) Award program for more than 18 months, awarded at least 4 awards per year, and recognized nurses who were nominated as well as nurses who received the awards. Fourteen of the hospitals included in this study had an existing program for meaningful recognition. In contrast, 10 hospitals included in the study had yet to implement The DAISY Award program and thus were classified as hospitals without a meaningful recognition program. In total, 24 hospitals participated in this descriptive study and 1136 adult critical care nurses completed online surveys on compassion fatigue and a series of single-item measures to capture job-related satisfaction, enjoyment, stress, and burnout, as well as their intentions to leave their current position and the profession. The Professional Quality of Life instrument, a 30-item self-report measure, was administered to capture 2 aspects of compassion fatigue: burnout and secondary trauma.The findings of the study provide evidence of the effects of meaningful recognition programs on compassion satisfaction and burnout among adult critical care nurses. The authors report that individuals who receive meaningful recognition are significantly more likely to have lower levels of burnout and higher levels of compassion satisfaction. However, no significant differences were found in the levels of burnout, secondary traumatic stress, and compassion satisfaction or in the intention to leave between adult critical care nurses employed at hospitals with versus without a meaningful recognition program. Thus, the authors conclude that “acknowledging and valuing nurses’ contributions to care is a powerful tool of meaningful recognition programs that reduces burnout and boosts compassion satisfaction.”Lesly Kelly, rn, phd, lead author of the EBR article, offers additional information about the study. She comments that “the study stemmed from a desire to further examine the relationship between meaningful recognition and burnout” among critical care nurses. She adds, “The initial study exploring burnout across intensive care units within 1 academic medical center revealed that millennial critical care nurses experienced higher burnout and that meaningful recognition was associated with lower burnout and heightened compassion satisfaction.” After that initial study, Kelly wanted to know more about the relationships among burnout, compassion satisfaction, and meaningful recognition programs.According to Kelly, compassion fatigue and burnout are a very real concern for critical care nurses. She also notes that burnout and compassion fatigue have a significant impact on patient care. “Our study identified that the meaningful recognition of critical care nurses, a known component of a healthy work environment, is a tangible and promising strategy for preventing burnout and compassion fatigue,” Kelly remarks.Kelly encourages readers of the American Journal of Critical Care to consider implementation of a meaningful recognition program. “Now that we have established relationships among burnout, compassion fatigue, and meaningful recognition, nurse leaders have a tool to potentially reduce burnout, compassion fatigue, and turnover among adult critical care nurses,” she states.Kelly and her coauthors are now interested in exploring the relationships among components of the American Association of Critical-Care Nurses’ healthy work environment model and burnout. Kelly and team have begun a multisite study to begin to understand how characteristics of a healthy work environment affect burnout.This feature briefly describes the personal journey and background story of the EBR article’s investigators, discussing the circumstances that led them to undertake the line of inquiry represented in the research article featured in this issue.Lesly A. Kelly, rn, phd, is an assistant professor at Arizona State University, College of Nursing and Health Innovation, Tempe, Arizona, and director of the RN clinical research program at Banner University Medical Center Phoenix. She has been a registered nurse for 12 years and completed her PhD in 2009.As a clinician and scientist, Kelly states that her goal is to research issues significant to the nursing profession and relevant to patient care. “I believe that research should not end with publication, and with a joint appointment, I am able to build relationships and implement evidence-based changes based on our study findings,” she comments.Kelly comments that a key to success of the study was having an established relationship with The DAISY Foundation. She adds, “Staff of The DAISY Foundation were a resource in helping to identify hospitals with ongoing, robust DAISY Award programs and those hospitals that had not yet initiated a meaningful recognition program. As a result, we had a strong research design and great success with recruitment of hospitals.”