Self Care for Healthcare Professionals

Presented by:Jim Messina, Ph.D. , CCMHC, NCC

Assistant ProfessorCounseling and Psychology

Troy University, Tampa Bay SitePresentation available on www.coping.us

Hi There! It seems like yesterday I was talking

with your group at Bay Pines on a topic very similar to this topic

As Yogi Berra would say:

“It’s like déjà vu all over again”

"The pessimist complains about the wind;

The optimist expects it to change; The realist adjusts the sails."

William Arthur Ward

Or like Yogi would say:

“We made too many wrong mistakes”

Goals for Our Program1. Identify Compassion Fatigue through Self-Assessment &

Remediation Plan for Health care professionals2. Identify Physical exercises, aerobic & mobility activities

that improve self-care for Health care professionals3. Identify a Nutritional regimen that sustains health, energy

& cognitive clarity of health care professionals4. Identify how competency based continuing education

improves the self-care of Health care professionals5. Identify how to maintain one’s sense of humor &

emotional balance as a Health care professional6. Identify what you are willing to commit to which will

improve your self-care from this point on

Why this Topic now?

Yogi would say:

“If you don’t know where you’re going, you might end up some place else”

Who is susceptible to Compassion Fatigue?

Healthcare Professionals who are most susceptible to this condition work with people who fit one or more of the following categories:1.Injured veterans survivors of the Afghanistan & Iraq Wars or other prior wars2.Veterans suffering from PTSD from being in the Afghanistan & Iraq Wars or other prior wars3.Patients dealing with life threatening illness like cancer, heart & lung conditions, HIV-AIDS, or other systemic health conditions4.Hospice eligible individuals facing imminent death due to old age, injury, disease or illnesses5.Survivors of torture, trauma, or natural or man-made disasters

What is Compassion Fatigue?

Compassion fatigue is thought to be a combination of secondary traumatization & burnout precipitated by the care delivery that brings health-care professionals into contact with the suffering

Szabo, B. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice: 12: 136–142.

Difference between Compassion Fatigue & Burnout

"Compassion fatigue is when caregivers have such deep empathy they develop symptoms of trauma similar to the patient” according to director of the Army Institute of Surgical Research Col Kathryn Gaylord

The disorder can also resemble burn out which occurs when emotional exhaustion is experienced due to increased workload & institutional stress & does not involve trauma

Compassion fatigue can have detrimental effects on doctor patient relationships since doctors suffering from the disorder often either grow distant from patients or get too close

Wilson, E. (2008). New Program Offers Care for Caregivers. Department of Defense Military Health System News, 23 May 2008.

Secondary Traumatic Stress

People who come into continued, close contact with trauma survivors may also experience emotional disruption, becoming indirect victims of the trauma

The natural, consequent behaviors & emotions resulting from knowledge about a traumatizing event experienced by a significant other

The stress resulting from helping or wanting to help a traumatized or suffering person

Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among Social Workers. Social Work: 51(2): 63-70.

Compassion Satisfaction Compassion satisfaction is the ability for

clinicians to derive a great sense of meaning & purpose from their work

It may aid in alleviating existential terror endemic to the human condition when a society is at war

It may be an important buffer in managing & transcending alterations in belief systems & physiological or emotional reactions seen in compassion fatigue

Stamm (1999 and 2002) as quoted in: Tyson, J. (2007). Compassion Fatigue in the Treatment of Combat-Related Trauma During Wartime. Clinical Social Work Journal; 35:183–192

Major factors contributing to Compassion Fatigue

1. Poor self-care2. Previous unresolved trauma3. Inability or refusal to control work

stressors4. Lack of satisfaction for the work

Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Predictors of Compassion Fatigue among Hospice Nurses

1. Trauma2. Anxiety3. Life demands4. Excessive empathy (leading to

blurred professional boundaries)

Abendroth, M. & Flannery, J. (2006). Predicting the Risk of Compassion Fatigue: A Study of Hospice Nurses. Journal of Hospice and Palliative Nursing: 8(6): 346-356.

Why Focus on Compassion Fatigue?

It is imperative that healthcare professionals take steps to ensure that they are functioning at their best in the therapeutic relationship

Facilitating their own personal well–being & avoiding burnout is clearly one way in which this can be achieved

Linley, P.A. & Joseph, S. (2007). Therapy work and therapists’ positive and negative well-being. Journal of Social and Clinical Psychology: 26(3):385–403.

Self-Assessment

Take the Compassion Self-Assessment

Rate each item on a scale from 1 to 10 1 = never experienced 5 = occasionally experienced 10 = frequently experienced

What does this Assessment Tell You?

If you rated three or more items over 8 or if you rated 5-10 over 5

You are most likely experiencing some level of compassion fatigue already

Characteristics of clinicians experiencing compassion fatigue

Physically: Chronic sense of exhaustion & fatigue, insomnia, headaches, stomachaches, lack of appetite, physical agitation or retardation, frequent bouts of sickness (e.g., colds, sore throats)

Psychologically: often feel irritable, are overwhelmed by the volume & content of their work

Relationship with Clients: sense a reduction in their baseline empathy for others, feel numb to patients’ & families’ pain, are cynical regarding clients’ ability to change &/or perceive them as being responsible for many of their problems

Organizationally: often report a sense of feeling scattered & unable to meet their professional & personal obligations

Mendenhall, T. (2006). Trauma-Response Teams: Inherent Challenges and Practical Strategies in Interdisciplinary Fieldwork. Families Systems, & Health: 24(3):357-362.

So Why Assess for Chronic Fatigue

It is expected that most clinicians will at times experience symptoms of compassion fatigue, as these are normal reactions to trauma work

However, for some clinicians the experience of compassion fatigue may become so severe as to interfere with their clinical effectiveness & their personal mental health

It is for this reason that ongoing monitoring is necessary

Bride, B., Radey, M. & Figley, C.R. (2007). Measuring Compassion Fatigue. Clinical Social Work Journal: 35:155-163.

Early Assessment Impact Instead of waiting for the clinicians to become

symptomatic use inventory tools to look for the presence of challenges to their fundamental assumptions, values & beliefs

With early assessment clinicians have the opportunity to transform their discomfort into personal growth & development

This should be the aim of a professional supervision & support model to address Compassion Fatigue

Tehrani, N. (2007). The cost of caring – the impact of secondary trauma on assumptions, values and beliefs. Counselling Psychology Quarterly: 20(4): 325–339.

What You Can Do! Recognize the symptoms of compassion fatigue Learn to ask for help Be aware & accept the limitations of your family, your job &

yourself Maintain discipline in daily responsibilities & duties Take “time out” during the day Take short vacations at least twice a year Try to change little things that gnaw at you & accommodate to

those you can't change Organize your time so you can concentrate on vital tasks Admit compassion fatigue is a real problem for you & don't try to

cover it up Distinguish between stressful aspects of your job or home life that

you can change & those you can't change-change what you can

What You can do to ward off Compassion Fatigue

1. Boundary maintenance2. Self-care3. Good training4. Good supervision

If given all 4 Healthcare Providers will thrive as compassionate professionals

Radey, M. & Figley, C.R. (2007). The Social Psychology of Compassion. Clinical Social Work: 35(1):207–214

What can be done on the job!

Identify realistic attainable goals for each department & evaluate accordinglyHelp staff to maintain personal growth both at home & on the jobEncourage & support staff to develop an active outside life with a variety of interestsEncourage staff to personalize the work environment with meaningful pictures, objects, colors, etc.Encourage staff to be comfortable with themselves by setting limits as to how far to become involved with clients & colleaguesEncourage & practice good communication skills on the jobProvide for flexible working conditions on the jobEncourage trying new ideas “outside of the box”Sponsor “decompression techniques” activities such as meditation or exercise that relieve tension & put staff into a more relaxed stateBuild support systems among staff to discuss problems & help each other look for solutions. Don't just air gripes - look for solutions

Implement Stress Reduction & Relaxation Breaks

Remember what Yogi said about the game:

“90% of the game is half mental”

So learn to put the mental half aside and relax and let go of the stressors from the work you do on a daily basis

OK? Now Let’s Talk Sleep!

We all know that adults need 8 hours of sound restful sleep every night

This is especially true for Healthcare Professionals who work with clients who have loads of stress & trauma in their lives

SO what are you going to do about it?

So remember you need to have all 8 hours

After all Yogi said in this regard:

“A nickel ain’t worth a dime anymore”

So don’t kid yourself anything less than 8 hours will not do!!!

Training like this helps!!! Sprang et al, found that specialized trauma

training did enhance Compassion Satisfaction and reduced levels of Compassion Fatigue and Burnout, suggesting that knowledge & training might provide some protection against the deleterious effects of trauma exposure

Sprang, G., Clark, J. & Whitt-Woosley, A. (2007). Compassion Fatigue, Compassion Satisfaction, and Burnout: Factors Impacting A Professional’s Quality of Life. Journal of Law and Trauma, 12:259–280.

Cause you need to Remember

Yogi said:

“If the world was perfect, it wouldn’t be”

So continue to gain training on Trauma and its impact on clients & helpers so as to learn how to improve the world in which you work

So Get More Training on Prevention of Compassion Fatigue

It helps to refresh everyone’s understanding of the impact of the Trauma, which patients & clients have experienced, on the Healthcare Providers who are working with these victims & survivors of trauma

How About a Physical Exercise Program?

It is important to include an active physical program of exercise to help alleviate the stressors which build up & contribute to Compassion Fatigue

Don’t PooHoo Physical Exercise

Remember what Yogi said about himself applies to Physical Exercise:

“Half the lies they tell about me aren’t true.”

Developing a Healthy Exercise Program

Identify Benefits Combat Myths about exercising Combat Roadblocks to exercising Identify & overcome: Triggers to

avoid, ignore, or stop exercising Look at what is new in exercise

offerings

Benefits of Healthy Exercise Compensates for fat accumulation by burning

calories Provides a "natural high'' by the release of

endorphins Strengthens the cardiovascular & respiratory

systems if aerobic type exercise sustained for at least fifteen minutes on a regular basis

Keeps the muscular system supple Keeps the circulatory system operating at its

best Builds bone mass to combat osteoporosis

Roadblocks to Exercise Not enough time; my schedule is already so

full Implementing a program of exercise takes

exceptional effort & planning The health club is too far away. It is not "on

my way'' to anywhere An exercise program costs a lot of money. It is unpleasant to get all sweaty when you

exercise Exercise can be so boring Exercise makes your body sore

Listening to those excuses, makes you sound like a pitcher

Remember what Yogi said:

“All pitchers are liars or crybabies”

Time for Exercise Make the exercise session a priority of the

day Schedule a regular, specific time of day for

exercise Choose a convenient time Exercise in the morning before breakfast,

in the afternoon before lunch, or in the evening after getting home from work, but before dinner.

Place for Exercise Choose an exercise easily performed around the

house, e.g., treadmill, stationary cycle, rowing machine, jumping rope, rebound trampoline, jumping jacks, walking, running, biking, swimming

Perform exercises that can be done in an air-conditioned environment (stationary cycle, rowing machine, or rebound trampoline). Profuse sweating is not necessary for exercise to be worthwhile

Reduce Costs of Exercise

Choose an exercise which doesn't involve the purchase of equipment or club memberships, e.g., walking, running, jumping rope, etc.

Keep Exercise Interesting Try indoor exercise in front of a TV or while

listening to motivational tapes or energizing music

Try outdoor exercise in tree-lined or park-like settings with interesting scenery and use a ipad or iphone

For either type of exercise, get a partner or group of people to exercise with; make it a social experience that will provide mutual motivation & encouragement

Exercise is good for everyone

After all Yogi said:

“I think Little League is wonderful. It keeps the kids out of the house.”

Start out Slow to Protect Your Body from Being Strained

Slowly phase an exercise program in; help your body adjust to the increased activity

Use warm-up & cool-down exercises to avoid muscle strain

Wear the proper clothing & shoes to avoid body strain or injury

If you exercise you will have a new inner depth to rely on

Remember what Yogi said:

“We have deep depth”

Make it so in your life – now!

How about eating a Healthy Diet along with Exercise? Eat a variety of foods to get the nutrients you need & at the

same time the right amount of calories to maintain healthy weight.

Be sure to eat a balance from these food groups: Vegetables – as much as you want Fruits – 2-3 times a day Whole Grain Foods – at as many meals as possible Plant oils – such as olive, canola, corn, sunflower, peanut & other veg oils Nuts & Beans – 2-3 times a day Fish, Poultry or Eggs – 0-2 times a day

You need them for the vitamins, minerals, carbohydrates & protein they provide

Pick the lowest fat choices from the food groups Here is a food pyramid from Harvard medical professor

Walter Willett, M.D. in his book: “Eat, Drink, and be Healthy”

Another Version of Health Eating

To help you get the message how about using the Healthy Eating Plate Version which is the next slide

Here your plate consists of: Lots of Vegetables Plenty of Fruits Whole Grains Fish, Poultry, Beans & Nuts A Multivitamin in your daily routine

Quick Guide for Healthy Eating!

Stay away from:1.Junk Foods & Sugary Drinks2.Cold Cuts & Other Processed Meats3.Bacon & Red MeatsDo make sure you1.Drink lots of sugar free Water, Tea or Coffee2.Cook with healthy oils

So plan your eating habits to support your health

Don’t Just Talk About It Do Something About It!After all if you don’t you might end up like Yogi said:

“You can observe a lot just by watching.”So, get out and do something about it!

Maintain a Good Sense of Humor

We used Yogi today to get us going in that direction! And I hope he was not right about what was said today when he said:

“We made too many wrong mistakes”

So are you going to do something about it?

Make a commitment to:1.Continuously assess your current emotional state2.Implement a good stress reduction activity for yourself & your co-workers3.Get 8 hours of sleep a night4.Have a regular exercise program going for yourself & if possible your co-workers5.Eat a good balanced diet

Because you have to remember

Yogi said:

“It ain’t over till it’s over…”

So there you have it!

Dealing with Compassion Fatigue is a TEAM effort which requires administration, co-workers, your families & significant others to understand that it takes a lot of effort to prevent & deal with this insidious & disabling condition!

Best of Luck!

References Messina, J.J. (2013) Preventing Burnout at:

http://coping.us/toolsforpersonalgrowth/preventingburnout.html

Messina, J.J. (2013) Preventing Clinician Compassion Fatigue at: http://coping.us/practicalclinicaltopics/preventcompassionfatigue.html

Messina, J.J. (2013) Stress Reduction at: http://coping.us/toolsforpersonalgrowth/stressreduction.html

Messina, J.J. (2013)Tools for a Balanced Lifestyle at: http://coping.us/balancedlifestyle.html