Barnes understanding compassion fatigue phoenix ms
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Understanding Compassion Fatigue The Role of Resiliency and Self-Care in Organizational and Employee Wellness Michael F. Barnes, Ph.D., LPC Clinical Program Manager
Barnes understanding compassion fatigue phoenix ms
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. 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. 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 cant 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. 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. 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 caregivers 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. 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. 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. 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. 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 SUDs than individuals without PTSD have earlier histories
with A & D, more severe use, and poor treatment adherence.
(Khantzian & Albanese, 2008)
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. How Does Someone Become Traumatized? o Direct personal
experience of an event that involves threatened death, actual or
threatened serious injury, or threat to ones 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. 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. 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 ones 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. 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. Symptoms of Compassion Fatigue (From Lombardo & Eyre,
2011: Compassion Fatigue: A Nurses 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. Symptoms of Compassion Fatigue (From Lombardo & Eyre,
2011: Compassion Fatigue: A Nurses 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. Symptoms of Compassion Fatigue at the Organizational Level
Excessive amount of Workers 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. 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. 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. 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. 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
whats important to you. Dont: 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.
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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. 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. 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. 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.