Compassion Fatigue: Are you running on fumes? What is compassion? Feeling deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause * In healthcare Genuine care and concern Identify with the patient Seek to ease their pain *Webster, 1989 1
Why talk about compassion? Compassionate hearts draw us to our fields BUT Constant demand for compassion can drain our professional quality of life (and care for others) Professional Quality of Life The balance between Compassion Satisfaction and Compassion Fatigue The general well-being of a person defined in terms of health and happiness. * Compassion Satisfaction Multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life ** Compassion Fatigue *www.collinsdictionary.com/dictionary/english/quality-of-life **www.cdc.gov/hrqol/concept.htm 2
Professional Quality of Life Professional Quality of Life Compassion Satisfaction Beth Hudnall Stamm, 2009. www.proqol.org What is Compassion Satisfaction? Pleasure you derive from being able to do your work * Fulfillment from work Helping Making a difference Leads to high productivity and morale *Source: http://www.proqol.org/compassion_satisfaction.html 3
What about you? What are some of the most satisfying parts of your job? Professional Quality of Life Professional Quality of Life Compassion Satisfaction Compassion Fatigue Beth Hudnall Stamm, 2009. www.proqol.org 4
Compassion Fatigue is NOT Something you can be immune to Something you have to learn to live with Incurable Compassion Fatigue IS Cost of caring * Emotional indifference Leads to disengagement A process A warning *Figley, 1982 5
Personal testimony Compassion Fatigue by Children s Hospital Colorado Professional Quality of Life Professional Quality of Life Compassion Satisfaction Compassion Fatigue Burnout Beth Hudnall Stamm, 2009. www.proqol.org 6
Burnout Often starts as a high stress level Months of consistent struggle Based in frustration Feel like others take advantage Own needs aren t getting met Am I making a difference? Professional Quality of Life Professional Quality of Life Compassion Satisfaction Compassion Fatigue Burnout Secondary Trauma Beth Hudnall Stamm, 2009. www.proqol.org 7
Secondary Traumatic Stress Personal trauma caused by over-exposure to the traumatic events of others May Cause PTSD symptoms Nightmares Crying spells Avoiding places/situations Insomnia Feelings of guilt Often fear based What percentage of healthcare workers are estimated to suffer from Compassion Fatigue at some point in their career? 1. 10% 2. 20% 3. 50% 4. 80% 8
Who is at risk? Helping professions Personal history of trauma Job is main identity Negative influences Cause Individual Perfectionism Unrealistic expectations Over-extending yourself Perception of co-workers/boss Feeling under-appreciated Poor communication Lack of confidence in ability Believe work does not matter Environmental Lack of support (work & home) Lack of accountability Seeing traumatic events at work Work conflicts with personal beliefs Need more training? Need more challenges? 9
Special considerations Is it personal or is it business? Work Stress Personal Stress Special considerations Where is my focus? The Good The Bad The Ugly 10
Special considerations How much of my day am I exposed to these stressors? and effect Patients Co-workers Friends and Family You! Outlook on life Depression Anxiety Substance use/abuse Physical health Family/social life 11
What about you? Where have you noticed the effects the most? Complex relationships Work Environment Compassion Satisfaction (ProQOL CS) Professional Quality of Life Client Environment Compassion Fatigue Exhaustion Frustration Anger Depressed by Work Environment (ProQOL Burnout) Personal Environment Traumatized by work Secondary Exposure (ProQOL STS) Primary Exposure Beth Hudnall Stamm, 2009. www.proqol.org 12
Early warning signs Physical: Mental: Emotional: Social: headaches cynical depressed miss work trouble sleeping lack motivation anxious over/under eat fatigue apathetic lonely abuse drugs/alcohol high blood pressure indecisive bored isolate low immunities overwhelmed low self-esteem feel responsible for others GI issues poor concentration angry muscle tension Do you have to be at your breaking point to be suffering from Compassion Fatigue? 1. Yes 2. No 13
Stages of Compassion Fatigue Compassion Fatigue is a process It typically follows a pattern Intervention can happen at any stage Case study Nancy became a nurse because she has always enjoyed helping people. She just started a new job, and is so excited to finally be doing what she dreamed about for so long. She spends extra time with each patient just to let them know how much she cares. She s a little overwhelmed by the amount of work to be done, but is glad to put in the extra time and effort to make a difference for her patients and become the world s greatest nurse. 14
Stages of Compassion Fatigue Enthusiastic phase committed, excited, work extra hours Adapted from Jan Spilman 2010 in-service: Caring on empty: creative tools for compassion fatigue transformation and resilience Case study After a few months, Nancy begins to master some of the routine parts of her job and starts to get frustrated that there are so many steps. She notices that many of the other nurses have their own way of getting things done and Nancy starts taking shortcuts as well. Her patients still annoy her some though, and she finds herself spending less time with her patients and more time complaining and gossiping with the other nurses. Sometimes she wonders what it would be like to switch careers. 15
Stages of Compassion Fatigue Enthusiastic phase committed, excited, work extra hours Irritability phase cut corners, avoid patient contact, cynical, daydream Adapted from Jan Spilman 2010 in-service: Caring on empty: creative tools for compassion fatigue transformation and resilience Case study Lately, Nancy has been feeling run down and doesn t have the energy that she used to. The less energy she has, the more her patients annoy her. Although she is kind to her patients, she has a lot she would like to say to them and wishes they would stop needing so much. Sometimes Nancy is so exhausted that she cancels plans so she can go home and sleep or just be by herself. She has started to eat more junk food than she used to and no longer works out. She wishes everyone, including her family, would just give her her space. 16
Stages of Compassion Fatigue Enthusiastic phase committed, excited, work extra hours Irritability phase cut corners, avoid patient contact, cynical, daydream Withdrawal phase exhausted, clients become irritants, neglect family, coworkers, patients and/or ourselves Adapted from Jan Spilman 2010 in-service: Caring on empty: creative tools for compassion fatigue transformation and resilience Case study When Nancy first started working as a nurse she enjoyed hearing her patients stories and bringing them extra things to make them more comfortable. Now she just wishes they would stop being so demanding, and wonders if they are taking advantage of her or making their symptoms seem worse than they are. It doesn t help that her coworkers don t do it right, leaving her with extra work. Sometimes she wonders if her job makes a difference at all; if anyone would notice if she wasn t there. 17
Stages of Compassion Fatigue Enthusiastic phase committed, excited, work extra hours Irritability phase cut corners, avoid patient contact, cynical, daydream Withdrawal phase exhausted, clients become irritants, neglect family, coworkers, clients and/or ourselves Zombie phase autopilot, dislike patients and coworkers, minimal compassion, reduced patience Adapted from Jan Spilman 2010 in-service: Caring on empty: creative tools for compassion fatigue transformation and resilience Case study Nancy has decided that she can t take it anymore and knows she has to make a decision. She has started to have headaches and trouble sleeping, and thinks it is from all of the stress. Part of her just wants to quit trying, maybe even change careers. But, she can t seem to forget about the veteran nurses that seem to still enjoy their jobs. Nancy begins to wonder what the difference is. How can they be happy with so much stress and negativity to deal with? What are they doing differently? 18
Stages of Compassion Fatigue Enthusiastic phase committed, excited, work extra hours Irritability phase cut corners, avoid patient contact, cynical, daydream Withdrawal phase exhausted, clients become irritants, neglect family, coworkers, clients and/or ourselves Zombie phase autopilot, dislike patients and coworkers, minimal compassion, reduced patience Victimization vs. Renewal phase overwhelmed, ill, leaving profession vs. transformation and resilience Adapted from Jan Spilman 2010 in-service: Caring on empty: creative tools for compassion fatigue transformation and resilience Which stage can you relate to the most? 1. Enthusiastic phase 2. Irritability phase 3. Withdrawal phase 4. Zombie phase 5. Victimization phase 6. Renewal phase 17% 17% 17% 17% 17% 17% 1 2 3 4 5 6 19
So, what can I do? At home Leave work responsibility at work Remind yourself why you chose your job field Responsible selfishness : Self-care Create a personal mission statement Be more than your work Remember to laugh/have fun Deal with personal stressors Ask for help So, what can I do at home? Take time for yourself One thing a day One thing a week One thing a month One thing a year 20
So, what can I do at home? Find your passion/outlet Be more than your work Hobbies Volunteer opportunities Keep them different from job duties So, what can I do at home? Post visual reminders 21
So, what can I do at home? Transition from work to home Pick a point in your commute to stop thinking about work Change clothes when you get home Put a time limit on how much you talk about work at home Have a plan in mind to deal with work worries at home So, what can I do? At work Know your job description Say no appropriately/ enforce healthy boundaries Have realistic expectations Organize Prioritize Clarify when uncertain Evaluate long-term impact Reduce multi-tasking Minimize interruptions Choose your battles Look at the big picture not at the moment alone Accept the situation for what it is 22
So, what can I do at work? What can I control? My perception My expectations of others My reaction What can I influence? Co-workers Work environment Family What do I need to let go? So, what can I do at work? Learn to separate from patient pain Your patients suffering is not your fault You are only responsible for providing the best care possible while they are in your care Worrying at home does not heal them faster Unit debriefings after event 23
So, what can I do at work? Follow the 80/20 Principal: 80% of job satisfaction is from 20% of work Don t expect to enjoy all aspects of your job Find ways to do more of what you like So, what can I do at work? What did I learn about myself? Limitations Areas of growth Strengths Warning signs Personal needs 24
So, is it my fault? 1. Yes 2. No So, is it my fault? There s a difference between being your fault and being your problem. 25
Where do I go from here? What are you able to start doing TODAY? How do you rate? Burnout Compassion Fatigue Compassion Satisfaction Professional Quality of Life Scale 5 (ProQOL) www.proqol.org 26
Employee Assistance Program x52600 or EAP@hhsys.org Marie Hodges, Director (x52327 or marie.hodges@hhsys.org) Marisa Kennemer, Counselor (x50600 or marisa.kennemer@hhsys.org) 27