COMPASSION FATIGUE & RESILIENCY Renee Rafferty, MS, LPC Director of Behavioral Health Services Providence Health & Services, Alaska
The heart can hold what it loves for a lifetime. -Mark Nepo
WHAT IS COMPASSION FATIGUE? Compassion fatigue has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress (Anewalt, 2009; Figley, 1995). Joinson (1992), a nurse, was the first to describe the concept in her work with emergency room personnel. She identified compassion fatigue as a unique form of burnout that affects individuals in caregiving roles.
WHAT IS COMPASSION FATIGUE? Through our efforts to empathize and show compassion, healthcare workers are impacted by the suffering and trauma the patients experience and the challenges of the work. Unlike Post Traumatic Stress Disorder (PTSD) the caregiver does not physically experience the traumatic event but does experience the event emotionally by caring for the patient (Sabo, 2006).
COMPASSION FATIGUE OR BURNOUT? Compassion Fatigue Burnout Found in occupations dealing directly with trauma victims. Can be found in all sorts of occupations. Occurs from exposure to trauma. Occurs from overworking oneself and occupational stress.
WHAT IS SECONDARY TRAUMATIC STRESS Traumatic learning through witnessing or interacting with trauma survivors. May occur after daily exposure to traumas in conjunction with empathetic response. May occur after one overwhelming stressful event.
SECONDARY TRAUMATIC STRESS Ambient Vicarious traumatic stress Media Entertainment Stories Professional Suffering patient Dying patients Witnessing suffering Witnessing trauma results Witnessing traumatic narratives
WHAT IS TRAUMA? Big T Big events that people recognize as intense and overwhelming. War, Death, Disasters, Abuse, Neglect, Illness, Accidents, physical violence Little t Smaller events that cause people to feel overwhelmed and powerless Rejection, loss, embarrassments, hearing stories of physical violence,
SYMPTOMS Physical Emotional Thoughts Behavior Headaches Dread of working with certain patients Poor concentration Restlessness Digestive Problems Reduced ability to feel empathy Loss of objectivity Frequent use of sick days Cardiac symptoms Hopelessness Memory loss Drinking more Muscle Tension Sleep disturbance Anxiety Intrusive thoughts about work Avoiding interacting with patients or families Lack of joyfulness I can t do this. Isolating Pain Anger The world is a bad place. Breaking Professional boundaries Loss of energy Resentment It s someone s fault Aggressive language Lethargy Oversensitivity This work is too hard. Isolation
OTHER CAUSES OF COMPASSION FATIGUE Increase in acuity of our patients Our system has failed to provide training and treatment for anything other than the presenting medical problems Trauma associated with violence in the workplace
WORKPLACE VIOLENCE An increase in violence is occurring in hospital settings throughout our nation Caregivers are overwhelmed Patient population is more acute Caregivers struggle feeling ineffective Swing between believing they have to put up with violence and wanting protection
HOW DOES THIS INCREASE IN VIOLENCE IMPACT HEALTHCARE PROFESSIONALS? Repeated activation of the threat-response system through painful learning Nervous system becomes chronically dysregulated Become disconnected from work, leadership, and co-workers
THE IMPACT Healthcare professionals are deeply rooted to the their purpose They want to feel like they can help someone get well. They become distressed when they don t have the tools and they cannot see that what they are doing is effective.
INTERVENTIONS ARE MULTI-TIERED Environmental and legal protection Whole person care Clinical pathways Debriefings De-escalation training
DOES EVERYONE IN HEALTHCARE HAVE TO GET COMPASSION FATIGUE No! We can continue to thrive by changing our perceptions and growing our skill sets. We are resilient.
BUILDING BLOCKS OF RESILIENCY Self-regulation Tools Can I get calm? Purpose- Am I connected to the meaning behind my work? Community of health Where? With who? How?
CAN YOU HAVE TOO MUCH COMPASSION? Feeling deeply allows us to connect with the patient Creating Armor can hurt us too Awareness of the impact of the trauma can help us to navigate the complexity and keep our bodies healing Boundaries protect us
SELF-REGULATION Behaviorally: Self-regulation is the ability to act in your long-term best interest, consistent with your deepest values. Emotionally: Self-regulation is the ability to calm yourself down when you're upset and comfort yourself up when you're experiencing a big emotion.
SELF-REGULATION Keeping your body calm Managing your thoughts Managing your feelings Mindful Pleasure Minimize distractions
WHY DO WE NEED SELF-REGULATION?
DIAPHRAGMATIC BREATHING One hand on abdomen, one on chest. Inhale to count of 7, Focus on moving abdomen forward and not moving chest. Exhale to same count. Once comfortable, you won t need hand placement.
In my experience, healthily vulnerable people use every occasion to expand, change, and grow. -Fr. Richard Rohr
REDUCING OUR OVERALL ANXIETY According to Dr. David Lewis-Hodgson of Mindlab International, which conducted the research, the top song produced a greater state of relaxation than any other music tested to date. In fact, listening to that one song -- "Weightless" - - resulted in a striking 65 percent reduction in participants' overall anxiety, and a 35 percent reduction in their usual physiological resting rates. Weightless
ARE YOU DOING YOUR OWN HEALING? We d like to believe that there are two kinds of people in the world those who need help and those who offer help. The truth is that we are both. We need to give and we need to need. -The Compassion Collective
RELATIONSHIP THEORY Koloroutis (2007) identified three core relationships for transforming practice using RBN (The nurse s relationship with patients and families, the nurse s relationship with self, and the nurse s relationship with colleagues. The nurse s relationship with self is a core concept in managing compassion fatigue. Nurses need to be assertive, to express personal needs and values, and to view work-life balance as an achievable outcome. This relationship with self is essential for optimizing one s health, for being empathic with others, and for being a productive member of a work group within a healthcare facility.
EMPOWERING OUR THOUGHTS Our thoughts create our reality and impact our health. What we believe about our environment becomes the reality. Do we process or vent? What beliefs do we hold that keep stress stuck?
Kelly McGonigal Ted Talk
RESOURCES The Greater Good Science Center- -University of California Berkeley
BUILDING A COMMUNITY OF HEALTH Build relationships that are open and require vulnerability Practice having the real conversation Focus on strengths
HEALTHY COMMUNITY The people around us can show us what we value Our community can push us to grow or keep us trapped We are highly influenced by the people we bring into our life
CONNECT TO YOUR PURPOSE EVERYDAY o What is your morning ritual? o What do you do during the day to see purpose? o What questions are you asking yourself? o How are you asking others about their purpose?
FIND INSPIRATION IN OUR STORIES Stories captivate the brain and produce oxytocin, a substance shown to increase generosity, compassion, trustworthiness, and sensitivity to social cues Stories define our purpose and communicate our personal mission.
REFERENCES Anewalt, P. (2009). Fired up or burned out? Understanding the importance of professional boundaries in home health care hospice. Home Healthcare Nurse, 27(10), 591-597 Gentry, J.E., Baggerly, J., & Baranowsky, A. (2004). Training as treatment: Effectiveness of the certified compassion fatigue specialist training. The International Journal of Emergency Mental Health, 6(3), 147-155 Joinson, C. (1992). Coping with compassion fatigue. Nursing 22(4), 116, 118-119, 120.
REFERENCES Koloroutis, M. (2007). Relationship-based care: A model for transforming practice. Minneapolis, MN: Creative Health Care Management, Inc Lombardo, B., Eyre, C., (Jan 31, 2011) "Compassion Fatigue: A Nurse s Primer" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 3 Sabo, B.M. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice, 12, 136-142.
LINKS https://www.ted.com/playlists/315/talks_to_help_ you_manage_stres https://www.youtube.com/watch?v=ufcavejslru