Should all PICU staff receive mandatory counselling? ppt colville 2018.pdf · Should all PICU staff...

Should all PICU staff receive mandatory counselling?

Gillian Colville

Consultant Clinical Psychologist

St George’s Hospital, London

Outline

• Question

• Evidence

• Context: New sources of strain

• Types of distress

• Levels of intervention : individual, unit, organisation

• Individual strategies

• Conclusions

Question

Should all PICU staff receivemandatory counselling?

More questions

• How serious is the problem?

• How can we measure it?

• What is the nature of their distress?

• What are the root causes of this distress?

• Is it getting worse?

• What can we do about it?

More questions

• How serious is the problem?

• How can we measure it?

• What is the nature of their distress?

• What are the root causes of this distress?

• Is it getting worse?

• What can we do about it?

Evidence of distress

• Burnout rising faster in doctors relative to general general population between 2011 and 2014 (Shanafelt et al 2015)

Shanafelt et al. Mayo Clin Proc 2015;90(12):1600-1613

Evidence of distress

• Burnout rising faster in doctors relative to general general population between 2011 and 2014 (Shanafelt et al 2015)

• Critical Care specialty reports most burnout (Medscape annual survey 2018)

Burnout Report 2018 n>15,000 Physicians

Evidence of distress

• Burnout rising faster in doctors relative to general general population between 2011 and 2014 (Shanafelt et al 2015)

• Critical Care specialty reports most burnout (Medscape annual survey 2018)

• ICU staff report more PTSD symptoms (Mealer et al )

• Moral distress higher in intensive care staff (Whitehead et al)

• ? Moral distress higher in PICU (Larson et al 2017)

Context: new sources of strain

• Increased levels in survival with significant morbidity

• Increased expectations of public and organisations

• Downsides of Family Centred Care

• Terrorism

• Criticism/vilification in media and social media

• Admin burden

“Our data compared with the historical data

suggests that pediatric critical care may have

exchanged mortality for morbidity over the

last several decades.”

Pollack et al 2014

Context: new sources of strain

• Increased levels in survival with significant morbidity

• Increased expectations of public and organisations

• Downsides of Family Centred Care

• Terrorism

• Criticism/vilification in media and social media

• Admin burden

Outstanding care

Context: new sources of strain

• Increased levels in survival with significant morbidity

• Increased expectations of public and organisations

• Downsides of Family Centred Care

• Terrorism

• Criticism/vilification in media and social media

• Admin burden

Coats H et al. Am J Crit Care 2018;27(1): 52-8

Context: new sources of strain

• Increased levels in survival with significant morbidity

• Increased expectations of public and organisations

• Downsides of Family Centred Care

• Terrorism

• Criticism/vilification in media and social media

• Admin burden

2017….

Importance of social betrayal in the development of traumatic stress

Low social betrayal *High social betrayal*

Low life threat Child sexual abuse

*High life threat* Accident, serious illness Murder, terrorism

Context: new sources of strain

• Increased levels in survival with significant morbidity

• Increased expectations of public and organisations

• Downsides of Family Centred Care

• Terrorism

• Criticism/vilification in media and social media

• Admin burden

Context: new sources of strain

• Increased levels in survival with significant morbidity

• Increased expectations of public and organisations

• Downsides of Family Centred Care

• Terrorism

• Criticism/vilification in media and social media

• Admin burden

Evidence for interventionsWest et al 2016; Pangioti et al 2016

• Inconsistent definitions of burnout across studies

• Limited follow up data

• Some evidence of added benefit of combined/organisational approach over individual only

• Also, resilience training, mindfulness, reflective practice, moral distress consultation services, trauma-informed service educational packages, evidence base for individual trauma focussed CBT and EMDR (NICE 2005)

Initiatives

• US Critical Care Collaboration Call for Action 2016

• US NEJM Catalyst Project

• Canadian programme re Moral Distress University of Alberta

• First Chief Wellness Officer at Stanford – Tait Shanafelt

Initiatives

• US Critical Care Collaboration Call for Action 2016

• US NEJM Catalyst Project

• Canadian programme re Moral Distress University of Alberta

• First Chief Wellness Officer at Stanford – Tait Shanafelt

Initiatives

• US Critical Care Collaboration Call for Action 2016

• US NEJM Catalyst Project

• Canadian programme re Moral Distress University of Alberta

• First Chief Wellness Officer at Stanford – Tait Shanafelt

Initiatives• US Critical Care Collaboration Call for Action 2016

• US NEJM Catalyst Project

• Canadian programme re Moral Distress University of Alberta

• First Chief Wellness Officer at Stanford – Tait Shanafelt

• UK ‘Thriving at work’ report by Stevenson and Farmer 2017

• UK PICS survey 2018

• UK Collaboration ICS/BACCN/FICM

‘Thriving at Work’ 2017

Initiatives• US Critical Care Collaboration Call for Action 2016

• US NEJM Catalyst Project

• Canadian programme re Moral Distress University of Alberta

• First Chief Wellness Officer at Stanford – Tait Shanafelt

• UK ‘Thriving at work’ report by Stevenson and Farmer 2017

• UK PICS survey 2018

• UK Collaboration ICS/BACCN/FICM

Initiatives• US Critical Care Collaboration Call for Action 2016

• US NEJM Catalyst Project

• Canadian programme re Moral Distress University of Alberta

• First Chief Wellness Officer at Stanford – Tait Shanafelt

• UK ‘Thriving at work’ report by Stevenson and Farmer 2017

• UK PICS survey 2018

• UK Collaboration ICS/BACCN/FICM

What should we measure ?

•Burnout

•Moral distress

•Post-traumatic stress

Burnout

•Maslach Burnout Inventory (22 items on emotional exhaustion, depersonalisation, low personal accomplishment)

•aMBI (9-item version)

•ProQOL (burnout, compassion fatique, job satisfaction

Intensive Care Medicine 2018;44: 681-689

Burnout- Individual level- Team level- Organisation level

Burnout- Individual level- Team level- Organisation level

“When we work on resilience, we’re just trying to create a ‘super canary’… But it’s the toxic gas that’s killing the canaries that we really have to be focused on.”

De Chant NEJM Catalyst 2018

Burnout- Individual level- Team level- Organisation level

Burnout- Individual level- Team level- Organisation level

HALT Campaign

49

Moral distress

•Moral Distress Scale - R (Hamric et al 2012)

•Measure of Moral Distress - HP (Hamric et al 2018)

Moral Distress- Team level

Post-Traumatic Stress Disorder

•Trauma Screening Questionnaire (Brewin et al 2002)

PTSD- Individual level

PTSD- Individual level

Moral Distress- Team level

Burnout- Individual level- Team level- Organisational level

Individual strategies

RECOVER

RECHARGE

Pleasant Event Scheduling

“Life is like riding a bicycle. To keep your balance, you must keep moving.” – Albert Einstein

JOB CRAFTING

MONITORING WELLBEING

60

MONITORING WELLBEING

• Renew-O-Meter• Compassion Fatigue

stresschecker icu

MONITORING WELLBEING

PROCESSING/REFLECTINGSplurge writing• 5 minutes• Pen and paper (or phone if easier)• Just write whatever comes into your head• Use this as technique especially when you

are feeling overwhelmed or mixed up or your mood changes to a more negative state

FINDING MEANING

Existential perspective – helped by mentoring

Kompanje EO. Intensive Care Medicine 2018;44(5):690-1

Disch J. Crit Care Medicine 2018;44(5):690-1

Should all PICU staff receivemandatory counselling?

Answer to the original question:

Answer to the original question: No

Answer to the original question: No but

Answer to the original question: No but• they should have access to it when they need it;

• they should be helped to understand and monitor the emotional impact of their work;

• they should have good supervision/mentoring available to them;

• their units should address the need for time for reflection and

• address staff wellbeing in protocols for traumatic incidents;

• their organisations should support work life balance;

• their professional bodies should lobby on issues related to their wellbeing;

• society should acknowledge the nature of the strain they are under and their requirements re staffing and resources

THANK YOU

“Don’t be afraid to care; revel in your humanity.

You are amazing in what you do –

you just don’t get told enough.”

Handy J. A life less ordinary. JICS 2018;19(2):21