Objectives. Disclosures. APNA 28th Annual Conference Session 4033: October 25, Wieland, Dawson, Lauerer 1

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1 Self care for Secondary Trauma Experienced by Child and Adolescent Nurses American Psychiatric Nurses Association 28 th Annual Conference, 2014 Indianapolis, Indiana Diane M. Wieland, PhD, MSN, RN, PMHCNS BC, CNE Joy Laurer, DNP, RN, PMHCNS BC Susan Dawson, EdD, RN, PMHCNS, NP BC Objectives To review the literature and research findings on secondary trauma in nurses. To present the results of the Child and Adolescent Council Survey on issues that result in secondary trauma in child and adolescent psychiatric mental health nurses. To discuss self care measures to combat secondary trauma. Disclosures The authors have no conflict of interest to disclose. Wieland, Dawson, Lauerer 1

2 Results of the Child and Adolescent Council Survey Nine (9) work groups were developed based on input from the Child and Adolescent Council Survey. Self care for Nurses :Managing Secondary Trauma was identified as a Work Group. The Inpatient Child and Adolescent Nursing Work Group also identified as a concern, Keeping up Staff Morale Working with Traumatized Youth Bearing the Suffering of Others: The Cost of Caring As nurses we went into our profession to help others. The cost of caring for others is emotional and is called helper stress. The focus is on the nursepatient relationship and development of empathy. There are professional consequence for caring for others especially those who have been traumatized. Empathy Empathy means entering the private perceptual world of the other and becoming thoroughly at home in it. It means temporarily living in the other s life, moving about in it delicately without making judgments. It involves being sensitive, moment by moment, to the changing felt meanings which flow in this other person to the fear or rage or tenderness or confusion or whatever that he or she is experiencing Rogers, C. (1980). Wieland, Dawson, Lauerer 2

EMPATHY Terms Used in the Literature for Helper Stress Empathy Fatigue

Burnout Research Studies on Secondary Traumatic Stress with Nurses in the

, 2004: 20 pediatric nurses working with children with chronic conditions;

and Fatigue Test; 26.4% at high risk; 52.

3 EMPATHY Terms Used in the Literature for Helper Stress Empathy Fatigue Compassion Fatigue Secondary Traumatic Stress Vicarious Traumatization Burnout Research Studies on Secondary Traumatic Stress with Nurses in the USA Maytum, et al., 2004: 20 pediatric nurses working with children with chronic conditions; Interview guide of 11 open questions; Compassion fatigue was a common experience. Abendroth & Flannery, 2006: 218 hospice nurses; Compassion Satisfaction and Fatigue Test; 26.4% at high risk; 52.3% at moderate risk for compassion fatigue Meadors & Lamson, 2008: 185 health care providers in ICUs, 125 nurses; Compassion Fatigue Questionnaire; More personal stress, higher levels of secondary traumatic stress Wieland, Dawson, Lauerer 3

4 Research Studies on Secondary Traumatic Stress with Nurses in the USA Quinal et al., 2009: 42 hospital oncology nurses; Secondary Traumatic Stress Scale; 16 nurses (38%) had moderate secondary secondary stress. Dominquez Gomez & Routledge, 2009: 67 Emergency Department nurses in community hospital; STSS; 33% of nurses met all criteria for PTSD. Townsend & Campbell, 2009: 110 Sexual Assault Nurse Examiners; Compassion Fatigue Test; 25% of nurses experienced traumatic symptoms. Research Studies on Secondary Traumatic Stress with Nurses in the USA Robins, Meltzer & Zelikovsky, 2009: 314 health care professionals at a children s hospital; 136 were nurses; Compassion Satisfaction and Fatigue Test; More years of direct care and greater blurring of caregiver boundaries resulted in higher levels of compassion fatigue. Beck & Gable, (2012). Random sample of 464 Labor and Delivery nurses from AWHONN; quantitative and qualitative; STSS; 35% reported moderate to severe levels of traumatic stress. Some nurses left the bedside for management and teaching jobs. Secondary Traumatic Stress Scale (STSS) 17 items Likert scale, never, rarely, occasionally, often, very often Developed to measure secondary stress symptoms associated with traumatized populations Measures intrusion, avoidance, and arousal; correlates with DSM criteria for PTSD Bride, et al., (2004). (See handout) Wieland, Dawson, Lauerer 4

5 Challenge for Child and Adolescent Psychiatric Nurses Complete the STSS yourself Consider that no studies have been completed with psychiatric mental health nurses as subjects/participants. Research needs to be completed. Psychiatric mental health nurses need to provide opportunities for assessment and self care interventions. Secondary Traumatic Stress : What is it? This is relationship centered care. It is the relationship which is the invitation to healing. The nurse will experience feelings around the many stories, feelings and emotions clients express Mirror neurons! We all have our own history, difficulties,pain we can and will be triggered by others stories sometimes we confuse what is us and them Symptoms of Secondary Trauma Stress Feeling hopeless or discouraged about work Depression, anxiety, insomnia Fatigue, physical symptoms, anxiety or depression. Feeling a lack of hope or belief in clients ability to recover or thrive. Questions about job, career, relationship problems. Wieland, Dawson, Lauerer 5

Countertransference /Transference Most of what the nurses experience start as felt reaction then is becomes internalized if not brought to supervision.

Teach strategies for self care that can be used before and after interactions with clients. (must have skills in present!

(Audience participantion) Intensity of the work Children and adolescents may have family of origin issues that are stressful Abandonment, neglect, abuse Lack of

6 Countertransference /Transference Most of what the nurses experience start as felt reaction then is becomes internalized if not brought to supervision. Absorbing the stories. Clinical supervision is essential for nurses who work with trauma. How do we reinforce personal boundaries? Teach strategies for self care that can be used before and after interactions with clients. (must have skills in present!) Why are Child and Adolescent Nurses at Risk For Secondary Traumatic Stress? (Audience participantion) Intensity of the work Children and adolescents may have family of origin issues that are stressful Abandonment, neglect, abuse Lack of support Crises related to diagnoses and hospitalization Stories from the Shelter A case example homelessness, trauma and a nurse s journey. What could have changed the course? What strategies would have been preventative? The work stories from the shelter children and teens experiences with trauma ACE study. Wieland, Dawson, Lauerer 6

Your Stories: Pair Share Audience participation Pair up with the person next to you.

Discuss if your agency or institution has interventions to deal with secondary traumatic stress.

Interventions and Self Care What to do for yourself Strategies to deal with secondary stress: Cognitive behavioral

7 Your Stories: Pair Share Audience participation Pair up with the person next to you. Discuss one story that was traumatizing to you. Identify one issue of care that is traumatizing. Discuss if your agency or institution has interventions to deal with secondary traumatic stress. What services would you like to see? Interventions and Self Care What to do for yourself Strategies to deal with secondary stress: Cognitive behavioral intervention Mindfulness Caseload adjustment Change in job assignment or work group Refer yourself to EAP or another agency Use vacation time How to Cope Today Take one thing at a time Solve little problems Be realistic Adopt a positive attitude Avoid over-scheduling Learn to relax Treat your body well Wieland, Dawson, Lauerer 7

Do for yourself what you do for others Get enough sleep as often

thinking Share your feelings Talk to a doctor, spiritual

your limitations Personalize your work and home environment

Acknowledge one of your Accomplishments Say no to a new

8 Do for yourself what you do for others Get enough sleep as often as you can Take time off when you are sick Watch what you are thinking Share your feelings Talk to a doctor, spiritual advisor, or other professional Learn to ask for help Be aware of your limitations Personalize your work and home environment Teach yourself to Daydream Take your stress temperature Laugh Acknowledge one of your Accomplishments Say no to a new responsibility Complement yourself Be flexible What holds you up? Wieland, Dawson, Lauerer 8

Collaboration to Address Compassion Fatigue in Hospital Staff

Collaboration to Address Compassion Fatigue in Hospital Staff Presenters Sabrina Derrington, MD Jim Manzardo, STB, BCC Kristi Thime, RN, CNML Objectives Understand risk factors for compassion fatigue and