Hardwiring Advance Care Planning in BMT: More Than Just the Paper

Abstract

s / Biol Blood Marrow Transplant 21 (2015) S114eS126 S124 Sarah Thirlwell , Kim Amtmann-Buettner . 1 BMT, Moffitt Cancer Center, Tampa, FL; 2 Professional Nursing Development, Moffitt Cancer Center, Tampa, FL; 3 Inpatient BMT, Moffitt Cancer Center, Tampa, FL; 4 Supportive Care Medicine, Moffitt Cancer Center, Tampa, FL; 5 Patient and Family Services, Moffitt Cancer Center, Tampa, FL Topic Significance & Study Purpose/Background/Rationale: BMT nurses deliver the treatments that can lead to patient and family acute and chronic suffering, and sometimes death, for the hope of cure and control of disease. In 2010, staff of our BMT Unit began demonstrating severe compassion fatigue (CF) with an increase in moral distress, nurse turnover rate, medical leave usage, conflict among staff, patients and families, and increased requests to Psychosocial Care for debriefing. Nursing Leadership, in partnership with other disciplines, recognized the need to address CF and create a plan to alleviate burnout and to increase nurses’ resiliency. Methods, Intervention, & Analysis: In 2011, the ProQOL5 survey, a valid CF assessment tool, was distributed to inpatient BMT nurses. The nurse manager then partnered with staff, Organizational Development, Social Work, Chaplaincy and Supportive Care Medicine to identify strategies to decrease CF among inpatient BMT nurses. A strategic plan was implemented to provide education about CF, to offer debriefing support, to hold skill-building sessions for resiliency and stress reduction techniques, to promote quality end-of-life care, and to improve workflow to promote selfcare. After implementation of the interventions, the ProQOL5 survey was repeated in 2013. Findings & Interpretation: Comparison of the results of the ProQOL5 surveys from 2011 to 2013 revealed improvement in the survey sub-domains of Compassion Satisfaction, Burnout, and Secondary Trauma. The result suggests that, when compared to standard compassion fatigue scores, BMT inpatient nurses experience slightly above average compassion satisfaction, low burnout as opposed to average burnout, and a low level of secondary trauma. Discussion & Implications: BMT nurses can experience severe compassion fatigue as a result of the care they deliver on a daily basis. A strategic and multimodal approach to alleviate CF can have a positive impact. Although the survey results did show improvement from 2011 to 2013, compassion fatigue is an ongoing concern for BMT nurses. Next steps include creation of a staff respite room on the BMT unit and the formation of a Code Lavender Team.