Barnes understanding compassion fatigue phoenix ms


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  • Recently we completed a survey of CeDAR employees, asking them to identify the causes of burnout and secondary trauma that they experience on a daily basis. While different employees identified different specific examples, the items listed on this slide are all categories of problem areas that were identified by our employees. They were also the same issues that were identified in our employee satisfaction surveys.I assume that concerns about communication, change and growth, alterations in policies and procedures, interactions with difficult patients, peer conflict and staffing issues could be a list of possible causes of burnout in any healthcare environment!
  • In the healthcare industry it is important to discuss two specific ways that this trauma transmission can take place.Vicarious Trauma is a term that was identified by McCann and Pearlman in the early 1990’s. Vicarious trauma is a process in which one healthcare worker becomes traumatized from their consistent interactions with one patient or one family, that is especially symptomatic or that has a significantly profound trauma narrative. It is said to be an infectious process where the professional either suddenly or slowly begins to experience similar symptoms as those experienced by the patient. Often the professional is aware of subtle shifts, but struggles to put their finger on what is different. I had this experience several years ago while working with a very violent and paranoid Vietnam Veteran. I found myself experiencing significant intrusive thoughts about his well-being and I was confronted by my wife on new behaviors like locking doors and rechecking the locks consistently throughout the evening. I was not consciously aware of the behavior change or my growing anxiety until I was asked about it. Once identified, I was able to work through it quickly and the symptoms went away.A chiasm is defined as the crossing of two tracks. So Chiasmal Trauma occurs when an entire work group, department, or organization experiences trauma after “crossing paths” with the trauma experience of one particularly difficult patient or family, a co-worker, or beloved leader. The best example of Chiasmal Trauma that I can think of comes from an oncology unit of a hospital where I worked. A woman came into the unit and was visited by her husband and three small girls. The nurses got to know that family. The mother went into remission and left the hospital. A few years later the mother came back in. The family visited and the nurses became reaquanited with the young girls, now a few years older. The mother again went into remission and left the hospital. A few years later the mother returned and passed away. I was called in to debrief the nursing staff and the primary image for most nurses were the children and husband that they had some to know.
  • Now that we have reviewed the common symptoms of compassion fatigue, it is time to look at factors that can assist us in dealing more effectively with work related stress and trauma and that can actually prevent work related compassion fatigue. The first factor is personal resilience. There is a quote from Robert Louis Stevenson’s Mody Dick that I think is a wonderful metaphor to describe individuals who have a high degree of resilience. “Life is not a matter of having good cards, but of playing a poor hand well! More specifically, the American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, and even significant sources of stress. . . “ Resilient individuals overcome adversity by maintaining a connection to supportive people, healthy activities, and to life itself. They also maintain a sense of hope. Across cultures, researchers have found that individuals with the most resilience consistently maintain a solution focus and a belief that focusing on a successful future is more important than focusing on a painful or stressful past. It hasn’t been that long ago that we believed that resilience was something that we were born with. We now know that we are all born with the capacity to develop the traits that are commonly found in resilient individuals.
  • Barnes understanding compassion fatigue phoenix ms

    1. 1. Understanding Compassion Fatigue The Role of Resiliency and Self-Care in Organizational and Employee Wellness Michael F. Barnes, Ph.D., LPC Clinical Program Manager
    2. 2. Objectives We will review each of the six questions below: o What is Compassion Fatigue? o How does one get Compassion Fatigue? • Factors that influence burnout and secondary trauma o What are the symptoms of Compassion Fatigue? o How do you develop a resilient workforce? o What is the influence of self care activities in resilient employees? 2
    3. 3. Reasons to be Aware of Compassion Fatigue According to Carla Joinson (Nursing92), there are four reasons why you need to be aware of compassion fatigue and respond appropriately to it: 1. Compassion Fatigue is emotionally devastating. o May experience great sadness, grief, depression, exhaustion 2. Caregivers’ personalities lead them toward it. o You can’t get compassion fatigue if you are not compassionate, caring, etc. 3. The outside sources that cause it are unavoidable. o Working with death, trauma, grief, anger, conflict have a cost! 4. Compassion Fatigue is almost impossible to recognize without a heightened awareness of it. o Employees must understand what to look for in themselves and their co-workers. o The person with it is usually the last one to know. 3
    4. 4. Continuum of Traumatic Stress Primary Trauma (Primary Trauma Victim) Secondary Trauma (Trauma Experienced by Family Members, Friends, First-Responders, Helping Professionals, etc.) Secondary Trauma Compassion Fatigue (Trauma Experienced by Care-Givers and Helping Professionals) Organizational Trauma Burnout
    5. 5. Burnout • Burnout is a state of physical, emotional, and mental exhaustion. • Generally caused by long-term involvement in emotionally demanding situations. • “Rustout” is a much better term, because it better represents the slow, gradual process that eats away at a caregiver’s spirit (Kottler, 2003). • On a personal level burnout is a leading cause of reduced compassion satisfaction (job satisfaction). • On an organizational level, the more employees experiencing burnout the greater the employee perceptions of a toxic workplace. Mathieu,2012 5
    6. 6. Burnout Maslach (2003), Three dimensions of burnout: • Disillusionment related to a sense of ineffectiveness and lack of accomplishment. The greater the imagined success and power, the greater the potential for disillusionment. • Exhaustion related to great need for services, but limited resources with which to help a client. • Cynicism resulting from unrealistic expectations and a lack of resources. o Care givers and medical professionals must understand their motives for getting into this field and how they influence the three dimensions above! 6
    7. 7. Aspects of work at CeDAR that increases experience of burnout • Poor Communication • To much change • Rules not being well articulated and not followed consistently • Working with Difficult patients • Peer negativity • Staffing Struggles
    8. 8. Incidence of Traumatic Events Worldwide, it is estimated that two-thirds of the population is exposed to a traumatic events that meet the DSM stressor criteria for PTSD. According to the National Center for PTSD: • 61% of men and 51% of women report having experienced at least one traumatic event (lifetime) • 10% of men and 6% of women report having experienced four or more traumatic events (lifetime) • Of these trauma victims, 8% receive diagnosis of PTSD • 1% of American population (New England Journal of Med) • Unresolved trauma symptoms interfere with treatment and can lead to relapse.
    9. 9. PTSD & Substance Abuse Disorders • Prevalence of PTSD and Substance Use Disorders • Among persons who develop PTSD, 52% of men and 28% of women are estimated to develop an alcohol use disorder. • 35% of men and 27% of women develop a drug use disorder. (Najavits, 2007) • The numbers are even higher for veterans, prisoners, victims of domestic violence, first responders, etc. (Najavits, 2004a, 2004b, 2007) • Individuals with PTSD are 3 to 4 times more likely to develop SUD’s than individuals without PTSD have earlier histories with A & D, more severe use, and poor treatment adherence. (Khantzian & Albanese, 2008)
    10. 10. PTSD & Substance Abuse Disorders • Treatment outcomes - PTSD and SUDS • PTSD/SUDS patients are more vulnerable to poorer short- and long-term outcomes. (Ouimette, Moos, & Brown, 2003) • PTSD heightens the likelihood of addiction relapse and the potential for multiple relapses. (Norman, Tate, Anderson, & Brown, 2007) • A trauma history and current trauma symptoms are associated with relapse to alcohol or other substance use in alcohol dependent women. (Heffner, Blom, & Anthenelli, 2011) • PTSD/SUDS has been shown to be associated with poorer treatment outcomes and higher relapse rates. (Sonne, Back, Zuniga, Randall, & Brady, 2003)
    11. 11. How Does Someone Become Traumatized? o Direct personal experience of an event that involves threatened death, actual or threatened serious injury, or threat to one’s physical integrity o Witnessing an event that involves death, injury, or a threat to the physical integrity of another person o Learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associates. o Consider each employee in each of your departments and the multitude of unique ways in which they interact with the clients that you come into contact with! o What is their preparation to deal with these stories on a daily basis? 11
    12. 12. Causes of Secondary Trauma • Vicarious Trauma - (McCann, I.L. & Pearlman, L.A., 1990) Single member of a system is effected due to regular contact with traumatized individual. o Accumulation of memories of clients’ traumatic material that affects and is affected by the therapists perspective of the world. • Chiasmal or Secondary Trauma (Kisher, G. R., 1984) o Chiasm defined as the crossing of two tracks o Entire system crosses tracks with trauma experienced by one system member, on client, beloved leader, etc.
    13. 13. Compassion Fatigue • Burnout + Secondary Trauma = Compassion Fatigue • Freud – trauma occurs when the ego is overwhelmed “as a consequence of an extensive breach being made in the protective shield against stimuli.” (Freud, 1922) o Think in terms of exhaustion of one’s physical and emotional immune systems that fights traumatic infection. 1. The more traumatic the trauma narrative, the greater the likelihood the employee will experience secondary trauma response. 2. The greater the employee stress, burnout or exhaustion, the weaker the psychic immune system and the greater the likelihood that the employee will be impacted by normal daily trauma narratives. 13
    14. 14. Common Symptoms of Compassion Fatigue • Re-experiencing traumatic events o o • Avoidance or numbing of reminders o o o • Recollections of the events, sudden intrusive thoughts Dreams and or nightmares Efforts to avoid thoughts and feelings Diminished interest in activities Detached estrangement from others Persistent arousal o o o Irritability or outbursts of anger Difficulty concentrating Startle response 14
    15. 15. Symptoms of Compassion Fatigue (From Lombardo & Eyre, 2011: Compassion Fatigue: A Nurse’s Primer) • Work-related symptoms o Avoidance or dread of working with certain patients or in certain situations o Reduced ability to feel empathy towards patients or their families o Frequent use of sick days o Lack of joyfulness • Physical symptoms o Headaches o Digestive problems: diarrhea, constipation, upset stomach o Muscle tension o Sleep disturbances: inability to sleep, insomnia, too much sleep o Fatigue o Cardiac symptoms: chest pain/pressure, palpitations, tachycardia 15
    16. 16. Symptoms of Compassion Fatigue (From Lombardo & Eyre, 2011: Compassion Fatigue: A Nurse’s Primer) • Emotional symptoms: o Mood swings o Restlessness o Irritability o Oversensitivity o Anxiety o Excessive use of substances: nicotine, alcohol, illicit drugs o Depression o Anger and Resentment o Loss of Objectivity o Memory issues o Poor concentration, focus, and judgment. 16
    17. 17. Symptoms of Compassion Fatigue at the Organizational Level • • • • • • • • • • • Excessive amount of Worker’s Comp claims High absenteeism Changes in co-workers relationships (conflicts) Inability for teams to work well together Staff challenges organization rules & regulations Aggressive behavior between staff/clients Inability of staff to complete assigned tasks Staff displays lack of flexibility Constant changes in organizational policies Rampant rumors & gossip Unhealthy competition between staff members. Compassion Fatigue Awareness Project, 2008/2009 17
    18. 18. Resilience Life is not a matter of having good cards, but of playing a poor hand well. Robert Louis Stevenson (1907) • Resilience . . . Is the ability to spring back from and successfully adapt to adversity. • Those who have overcome adversity tell us loud and clear that ultimately resilience is a process of connectedness, of linking to people, to interests, and ultimately to life itself. • Researchers have found that across all cultures, hope and a belief that a successful future matters more than a stressful past, is at the heart of resilient individuals. • We are all born with the capacity to develop the traits commonly found in resilient survivors. •
    19. 19. Common traits of Resiliency • Self Awareness o Fearlessly look within and face the truth regarding distress • Internal Locus of Control o Freedom to make decisions based on their own beliefs o Functionally dependent • Engaged in Social Activities o Social support o Friends outside of work • Self-Care – Work/Life Balance o Able to maintain outside interests o Exercise programs • Flexibility/Solution Orientation o Expressive individuals who can think “outside the box” • Humor o Maintain light-hearted perspective with the ability to laugh at oneself. • Clear Sense of Personal Ethic Related to Fairness, Compassion, etc. o Other aware (issues, problems, etc. impacting those around them. o Give support to others. 19
    20. 20. Resilience (A Working Model) Charney, ISTSS Keynote Presentation, 2013 Social Support Moral Compass Role Model Cognitive Appraisal Spirituality / Religion Optimism Facing Fears Exercise Active Coping Resilience
    21. 21. Recommendations for Family Physicians who experience Compassion Fatigue American Academy of Family Physicians (Family Practice Management , April, 2000) Do: • Find someone to talk to. • Understand that the pain you feel is normal. • Get enough sleep. • Take some time off. • Develop interests outside of medicine. • Identify what’s important to you. Don’t: • Blame others. • Look for a new job, buy a new car, get a divorce, or have an affair. • Fall into the habit of complaining with your colleagues. • Hire a lawyer. • Work harder and longer. • Self medicate. • Neglect your own needs and interests. 21
    22. 22. Examples of Healthy Self-Care Activities From Saakvitne and Pealrman (1996) Transforming the Pain: A workbook on Vicarious Traumatization Physical Self-Care: • • • • • • • Eat Healthily Exercise Get a massage Get medical care when sick Take time to be sexual Get enough sleep Take a vacation Psychological Self-Care: • • • • • • Take time to reflect Write in a journal Get personal therapy Decrease life stress Be curious Try in things Spiritual Self-Care: • Find a spiritual connection or community • Be open to inspiration • Be open to not knowing • Meditate • Pray Relationship Care: • Stay in contact with important people in your life. • Seek out comforting activities with the important people in your life • Allow the important people in your life to really get to know you. 22
    23. 23. Preventing Burnout and Compassion Fatigue in the Workplace 1. Identify the challenges that you face in your day-to-day work environment. These challenges can be associated with your actual work responsibilities, relationships with co-workers and others, management or organizational issues, etc. 2. Identify the resources that are available in your work environment that may be able to assist you in dealing more effectively with the challenges listed above. 3. Identify five things that you will do differently in your work life to overcome challenges and prevent Burnout/CF. These may be unique ideas or utilization of resources. 1. 2. 3. 4. 5. 4. Discuss your findings/insights with someone around you.
    24. 24. Self-Care Assessment (Part 1) 1. Physical Self-Care o What do you already do to take care of yourself physically? o What do you wish you did more of to take care of yourself physically? 2. Emotional Self-Care o What do you already do to take care of yourself emotionally? o What do you wish you did more often to take care of yourself emotionally? 3. Spiritual Self-Care o What do you already do to take care of yourself spiritually? o What do you wish you did more often to take care of yourself spiritually? 4. Relationship Care o What do you already do to insure the health of your important relationships? o What do you which you did more often to take care of your important relationships?
    25. 25. Self-Care Assessment (Part II) • Given your answers to the questions above, start to develop a personal self-care plan. (Compassion Fatigue Awareness Project, 2009/2009) • List 5 things that you MUST do on any given day to insure appropriate self-care. 1. 2. 3. 4. 5. • List 5 things that would energize you and that you would like to fit into every day. 1. 2. 3. 4. 5.