Compassion Fatigue: It s Not Just for Nurses Anymore 2018 SCEAPA Conference February 12, 2018 Presented by: Troy Schiedehelm, EdD, LPCS & Karla Lever, PhD, LPCS, CEAP Carolinas HealthCare System EAP 720 East Boulevard Charlotte, NC 28203
Disclaimer Drs. Schiedenhelm and Lever work for the Carolinas Healthcare System Employee Assistance Program. The Code Lavender program discussed in this presentation is a program operated within the CHS organization. We receive no royalties or payment from the SC-EAPA for this presentation.
The Problem Stress 40% of workers reported their job was very or extremely stressful; 25% view their jobs as the number one stressor in their lives; Three fourths of employees believe that workers have more on-the-job stress than a generation ago; 26 percent of workers said they were often or very often burned out or stressed by their work ; Job stress is more strongly associated with health complaints than financial or family problems. Retrieved from: http://www.stress.org/workplace-stress/, December 24, 2015
Burnout Definition: A psychological syndrome that develops in response to chronic emotional and interpersonal stress exhibited by emotional exhaustion, depersonalization (as a defense mechanism to gain emotional distance from clients), and feelings of ineffectiveness or lack of personal accomplishment. (Maslach, 2003; Maslach, Schaufeli, & Leiter, 2001)
Burnout vs. Compassion Fatigue Burnout Everyday Stress Relatively Predictable Generally Expected Mitigated by Vacation Gradual onset Compassion Fatigue Counter transference Preoccupation with client s suffering Absorbing client s symptoms May present suddenly
Compassion Fatigue Originally viewed as a response to working with traumatized clients as a type of occupational hazard (Thompson, Amatea, & Thompson, 2014; Devilly, Wright, & Varker, 2009)
Compassion Fatigue The term compassion fatigue was first coined by Carla Joinson to describe nurses worn down by hospital routine. (Joinson, 1992) Compassion fatigue was described by Joinson as a state of exhaustion resulting from prolonged exposure to compassion stress. Avoidance/numbing of compassion for individuals Persistent arousal
Compassion Fatigue Figley (1995) was the first to formulate the construct of compassion fatigue after examining the work conditions and experiences of those working with traumatized clients. However, work-setting factors are determined as insufficient to fully explain the human consequences of working with traumatized clients. (Linley & Joseph, 2007) Compassion fatigue is the negative effect of working with traumatized individuals, which includes symptoms of secondary traumatic stress, such as intrusive thoughts, avoidant behavior, and hypervigilance. (Figley, 2002)
Secondary (vicarious) Traumatic Stress Transformation of a care givers cognitive schemas related to identity, spirituality, and worldview resulting from chronic exposure to traumatic stories or events (Pearlman & Saakvitne, 1995) The components of burnout and compassion fatigue, plus flashbacks, nightmares, and intrusive thoughts (Bride, Radey, & Figley, 2007)
The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. -Rachel Naomi Remen
What Are the Consequences of Compassion Fatigue? *Hopelessness/Despair *Pervasive Negative Attitude *Sleep Disturbance/Nightmares *Difficulty/Inability to Focus *Increased Self-Doubt *Excessive Voicing of Complaints *Ongoing Moral Distress *Decrease of Pleasure *Persistent Stress and Anxiety *Decrease in Productivity *Feelings of Incompetency *Increased Isolation from Others *Appear Sad and Apathetic *Feelings Kept Inside *Less Attention to Physical Care/Self Care/Poor Hygiene *Compulsive Behaviors (overeating, spending, gambling, substance abuse, promiscuity, addictions)
Prevalence (Jacobson, 2012) A 2012 cross-sectional, one-group survey of 325 EAP and other mental health professionals in the USA (55.7% women, 44.0% men), ages 26 to 69 years, assessing risk for compassion fatigue, burnout and compassion satisfaction potential. - 84.5% completed specialized training or formal education to provide individual crisis intervention -83.5% completed specialized training or formal education to provide group crisis intervention no significant different between EAP and MH groups negative coping strategies was a predictor > 12% high risk for compassion fatigue > higher levels of secondary (vicarious) stress
Meta Analysis Cieslak et al., 2014 Based on 41 studies including 8256 workers (including those working as various types of first responders and law enforcement to licensed mental health practitioners and physicians). In general, burnout and STS [secondary traumatic stress] or compassion fatigue are likely to co-occur among professionals exposed indirectly to trauma through their work. In particular, STS and burnout constructs may be empirically indistinguishable if measured within the compassion fatigue framework. (p. 83)
What Does all of This Mean? People who care for other people, will burnout. People who care for other people and don t care for themselves will develop compassion fatigue. Gabriel Rogers, PhD Former CHS-EAP Counselor
Manage and Prevent: Compassion Fatigue, Burnout, and Vicarious Stress
Variables That Buffer Compassion Fatigue According to Research Emotional separation - Boundaries (Badger et al., 2008) Access to supervision (Rich,1997) Training for new and experienced caregivers (Chrestman, 1999) Perceived coping ability (Follette, Polusny, & Millbeck, 1994) Amount of caregiver s experience (Cunningham, 2003) Self-care strategies, and Social support (Chrestman, 1999; Rich, 1997; Schauben & Frazier, 1995)
Boundaries
Access to Supervision and Training Studies have shown that access to supervision and continual training lessen the effects of compassion fatigue. Different types of supervision (clinical, peer, management) yield different levels of effect for the worker. (Tehrani, 2009)
Effects of Supervision (Tehrani, 2010) Professional (Clinical) Supervision & Peer Supervision: Yields a positive effect on 4 positive growth items: -Competence -Career Fulfillment -Increased Learning -Feelings of Doing a Good Job Management Supervision: *limited to career s perceptions of doing a good job, where feelings of not doing a good job and a lack of fulfillment is correlated with anxiety and depression *Most accessed: friends & colleagues (70%) and family (50%), but yields no growth on positive growth items
Personal Factors Your perception creates your reality Leverage your experience and the experience of others to manage compassion fatigue Self-care and social supports (Stamm, 2002) Active problem-focused and emotionfocused coping strategies (Kramen-Kahn & Hansen, 1998; Kraus, 2005; Wallace, Lee, & Lee, 2010)
Successful Self-Management Organization- How well do I prioritize in my life? Coordination- How well do I utilize resources in my life? Activities- How well do I participate in the right behaviors BALANCE? Policies- What values govern my decisions? Objectives- How do I celebrate successes? Self-management strategies as seen in: -Compassionate Mind Training (CMT), (Gilbert, 2009) -Mindfulness-based Stress Reduction (MBSR), -Dialectical Behavior Therapy (DBT), (Christoper & Maris, 2010) (Linehan, 1993; Carmel, Fruzzetti, & Rose, 2014)
Compassion Fatigue among EAP Professionals More than 75% of US employers offer EAP services to their employees (Society for Human Resource Management, 2008) Based on clinician self-report, graduate programs tend not to prepare its students to work with trauma (Munroe, 1999; Salston & Figley, 2003) EAP professionals are at moderate risk for compassion fatigue, low risk for burnout, and have a high potential for compassion satisfaction. However, due to the often reported isolated work environments, self-support may be all that is available. (Jacobson, 2012)
Best Practices How often do you do the following? *Exercise *Maintain Proper Nutrition *Learn to Laugh and Play *Introspection What s going on with me? *Hobbies *Relaxation/Meditation/Deep Breathing/Prayer/Self- Hypnosis
Practical Ways to Recharge Intentional practice of self-compassion/ self-care Take deliberate breaks from work Breath Work/ Breath Prayer Physical exercise Enjoyable recreational activities Establish clear, professional boundaries Accept the truth that successful outcomes are not always achievable (cure) but healing is always possible Create/ maintain social support (people and pets) Spiritual practices (rituals, forgiveness, meditation, etc.)
Get Creative Aromatherapy Guided Imagery Mindfulness Be compassionate with others (in mind and actions) Share compassionate stories (Neuroscience)
Airplane Oxygen Mask Analogy for Self-Care Remember, taking care of yourself is not a luxury. It is an absolute necessity for caregivers. Taken from www.myseniorsite.ca/eldercare-caregiverburn.htm
Code Lavender Integrative Care Rapid Response (ICCR) for emotional and spiritual support Response within 30-minutes Holistic/Integrative Services Team provides spiritual support, mindfulness training, counseling, yoga, etc. ICRR Team comprised of resources on hand such as Chaplain-on-Call, Nursing Supervisor, and EAP Representative Partnership with Administration and Leaders insure integration into culture
Code Lavender Cleveland Clinic averaged 60 Code Lavender calls last year Carolinas Healthcare System received approximately 8 per day, which is almost 3000 for the year Internal research shows improved mood, stress, and hope measures for those involved
Compassion Champion Levels Level 1 Teammate needs a word of encouragement in midst of a rough day. Compassion Champion checks in with the employee Compassion in the moment works wonders Level 2 Teammate is shaken by a professional or personal event and needs more deliberate attention. Triggers the Integrative Rapid Response Team Members of the Team do not work in the same department
Compassion Champion Levels Level 3 Teammate and/or work unit is devastated by a critical incident and needs a formal intervention (e.g., Crisis Incident Response). Partner with resources within the facility Tap into an already created toolbox, such as aromatherapy, positive statements, relaxing music, small snacks
Compassion Champions Recognize that Burnout and Compassion Fatigue are real and start practicing self-care (Level 1). Also watch out for their teammates to see if symptoms of Compassion Fatigue and Burnout are surfacing (Level 2). Actively promote a compassion of culture in the workplace such as Lavender Fridays, Pet Therapy, Chair Massage, Meditation Room, Blessing of Hands, etc. (Level 3). Keep a log of activity at Level 3 for 6 weeks
Toolbox and other Resources *Healing Touch *Reiki *Massage *Health snacks, water, hot tea *Music *Aromatherapy *Guided Imagery *Prayer and/or Meditation (Breath Work)
References Badger, K., Royse, D., & Craig, C. (2008). Hospital social workers and indirect trauma exposure: An explanatory study of contributing factors. Health & Social Work, 33(1), 63-71. Bride, B., Radey, M., & Figley, C.R. (2007). Measuring compassion fatigue. Clinical Social Work Journal, 35, 155-163. Carmel, A., Fruzzetti, A.E., & Rose, M.L. (2014). Dialectical behavior therapy training to reduce clinical burnout in a public behavioral health system. Community Mental Health Journal, 50, 25-30. Chrestman, K.R. (1999). Secondary exposure to trauma and self-reported distress among therapists. Professional Psychology: Research and Practice, 30, 386-393. Christopher, J.C. & Maris, J.A. (2010). Integrating mindfulness as self-care into counselling and psychotherapy training. Counselling and Psychotherapy Research, 10, 114-125.
References (cont.) Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., & Benight, C.C. (2014). A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma. Psychological Sciences, 11(1), 75-86. Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social work, 48, 451-459. Devilly, G., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary traumatic stress is simply burnout? Effect of trauma therapy on mental health professionals. Australian and New Zealand Journal of Psychiatry, 43, 373-385. Figley, C.R. (1993). Compassion stress: Toward its measurement and management. Family Therapy News, 1, 2. Figley, C.R. (1995). Compassion fatigue: Coping with secondary traumatic stress in those who treat the traumatized. New York: Brunner/Mazel.
References (cont.) Follette, V., Polusny, M., & Millbeck, K. (1994). Mental health and law enforcement professionals: Trauma history, psychological symptoms, and impact of providing services to child sexual abuse survivors. Professional Psychology: Research and Practice, 25, 275-282. Gilbert, P. (2009). The compassionate mind. London: Routledge. Jacobson, J.M. (2012). Risk of compassion fatigue and burnout and potential for compassion satisfaction among employee assistance professionals: Protecting the workforce. Traumatology, 18(3), 64-72. Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22, 116-121.. Kramen-Kahn, B., & Hansen, D. (1998). Rafting the rapids: Occupational hazards, rewards, and coping strategies of psychotherapists. Professional Psychology: Research and Practice, 29, 130-134.
References (cont.) Kraus, V.I. (2005). Relationship between self-care and compassion satisfaction, compassion fatigue and burnout among mental health professionals working with adolescent sex offenders. Counseling and Clinical Psychology Journal, 2, 81-88. Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. Linley, P.A., & Joseph, S. (2007). Therapy work and therapists positive and negative well-being. Journal of Social and Clinical Psychology, 26, 385-403. Masleach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12, 189-192. Maslach, C., Schaufeli, W.B., & Leiter, M.P. (2001). Job burnout. Annual Review of Psychology, 52, 397-422
References (cont.) Miller, C., & Sprang, G. (2017). A components-based practice and supervision model for reducing compassion fatigue by affecting clinician experience. Traumatology, 23(2), 153-164. Munroe, J.F. (1999). Ethical issues associated with secondary trauma in therapists. In B.H. Stamm (Ed.), Secondary traumatic stress: Selfcare issues for clinicians, researchers, and educators (pp. 211-229). Lutherville, MD: Sidran Press. Pearlman, L.A. & Saakvitne, K.W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: Norton. Rich, K.D. (1997). Vicarious traumatization: A preliminary study. In S.B. Edmunds (Ed.), Impact: Working with sexual abusers. Brandon, VT: Safer Society Press. Salston, M.D., & Figley, C.R. (2003). Secondary traumatic stress effects of working with survivors of criminal victimization. Journal of Traumatic Stress, 16, 49-64.
References (cont.) Schauben, L.J., & Frazier, P.A. (1995). The effects on female counselors of working with sexual violence survivors. Psychology of Women Quarterly, 19, 49-64. Society for Human Resources Management. (2008). 2008 Employee benefits: How competitive is your organization. Alexandria, VA: Society for Human Resource Management. Stamm, B.H. (2002). Measuring compassion satisfaction as well as fatigue: Developmental history of the compassion fatigue and satisfaction test. In C.R. Figley (Ed.), Treating compassion fatigue, pp. 107-122. New York: Brunner/Mazel. Tehrani, N. (2010). Compassion fatigue: Experiences in occupational health, human resources, counselling, and police. Occupational Medicine, 60, 133-138. Wallace, S., Lee, J., & Lee, S.M. (2010). Job stress, coping strategies, and burnout among abuse-specific counselors. Journal of Employment Counseling, 47, 111-122.
Carolinas HealthCare System Employee Assistance Program 704-355-5021