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UNITED STATES DEPARTMENT OF LABOR

Reducing compassion fatigue in inpatient pediatric oncology nurses (Sullivan et al., 2019)

Review Guidelines

Causal Evidence Guidelines

Absence of conflict of interest. 

Citation

Sullivan, C. E., King, A., Holdiness, J., Durrell, J., Roberts, K. K., Spencer, C., Roberts, J., Ogg, S. W., Moreland, M. W., Browne, E. K., Cartwright, C., Crabtree, V. M., Baker, J. N., Brown, M., Sykes, A., & Mandrell, B. N. (2019). Reducing compassion fatigue in inpatient pediatric oncology nurses. Oncology Nursing Forum, 46(3), 338-347.

Highlights

  • The study's objective was to examine the impact of a self-care program for pediatric oncology nurses on burnout, secondary traumatic stress, and compassion satisfaction. 

  • The study used an interrupted time series design to compare outcomes before and after nurses participated in the self-care program using the Professional Quality of Life Scale V. 

  • The study suggested there was no relationship between the self-care program and nursing burnout, secondary traumatic stress, or compassion satisfaction. 

  • The quality of causal evidence presented in this report is low because the authors did not observe outcomes for multiple periods before and after the intervention. This means we are not confident that the estimated effects are attributable to the self-care program; other factors are likely to have contributed. 

Intervention Examined

Self-care Program for Pediatric Oncology Nurses

Features of the Intervention

Compassion fatigue and burnout can lead to more use of sick days and high employee turnover. Due to the nature of their work, pediatric oncology nurses are at an increased risk for experiencing compassion fatigue. No standardized interventions exist that address compassion fatigue and burnout for pediatric oncology nurses. For this study, a pilot compassion fatigue intervention was developed and evaluated. 

The self-care program was grounded in the Neuman Systems Model that emphasizes resilience and protective stressors as a whole system approach to reducing compassion fatigue and increasing overall health and energy. The program was developed for pediatric oncology nurses and consisted of four main components (education, health and wellness, grief and bereavement, and respite room) designed to promote a healthy lifestyle and better self-care practices. Nurses were provided with an educational binder that contained materials on compassion fatigue, compassion satisfaction, and self-care practice. Nutrition and physical activity supports were provided through individual consultations with a clinical registered dietitian, a monthly newsletter with healthy recipes and resources for exercise, an activity tracker (Fitbit), and sleep hygiene resources. To offer a supportive emotional environment, monthly group remembrance services and debriefs were held to honor patients who had died, and supportive services focused on individual quality of life, spiritual, and counseling were available. Lastly, a respite room furnished with self-care activities and resources, music, healthy snacks, and furniture for relaxation was created on the inpatient unit. 

Features of the Study

The authors compared the outcomes of participants before and after they participated in the self-care program. The study sample consisted of 59 pediatric oncology nurses employed at St. Jude Children's Research Hospital in Memphis, Tennessee, in an inpatient unit specializing in the complex care of children with solid and central nervous system tumors. Participants were primarily women (92 percent), ages 20-29 (61 percent), and had been RNs for fewer than five years (58 percent). 

The Professional Quality of Life Scale V (ProQOLV) was used to assess self-reported burnout, secondary traumatic stress, and satisfaction with one's ability to provide compassionate care (compassion satisfaction). 

Findings

Health and Safety

  • The study suggested there may have been a relationship between participation in the self-care program and reduced secondary traumatic stress after 4 months, however these effects were not found at the 2-month nor 6-month mark. Additionally, the study suggested there was no relationship between the self-care program and nursing burnout or compassion satisfaction at 2, 4, or 6 months. 

Considerations for Interpreting the Findings

The authors compared the outcomes of participants measured before and after they participated in the self-care program (at 2, 4, and 6 months of participation). CLEAR’s guidelines require that the authors must observe outcomes for multiple periods before the intervention to rule out the possibility that participants had increasing or decreasing trends in the outcomes examined before enrollment in the program. That is, if nurses who had increasing burnout tended to participate in the program, we might anticipate further increases over time, even if they did not participate in the program. Without knowing the trends before program enrollment, we cannot rule this out. Therefore, the study is not eligible for a moderate causal evidence rating, the highest rating available for nonexperimental designs. 

Furthermore, this program was conducted in only one inpatient pediatric oncology unit and may not be generalizable to other settings.

Causal Evidence Rating

The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to the self-care program; other factors are likely to have contributed. 

Reviewed by CLEAR

September 2022