compassion fatigue resiliency - ashnhacertified compassion fatigue specialist training. the...

COMPASSION FATIGUE & RESILIENCY

Renee Rafferty, MS, LPCDirector of Behavioral Health ServicesProvidence 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 ProfessionalVicarious traumatic stress Suffering patientMedia Dying patientsEntertainment Witnessing sufferingStories Witnessing trauma results

Witnessing traumatic narratives

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 powerlessRejection, loss, embarrassments, hearing stories of physical violence,

WHAT IS TRAUMA?

SYMPTOMS

Physical Emotional Thoughts BehaviorHeadaches Dread of working with

certain patients Poor concentration Restlessness

DigestiveProblems

•Reduced ability to feel empathy

Loss of objectivity Frequent use of sick days

Cardiac symptoms

Hopelessness Memory loss Drinking more

Muscle Tension

Anxiety Intrusive thoughts about work

Avoiding interactingwith patients or families

Sleep disturbance

Lack of joyfulness “I can’t do this.” Isolating

Pain Anger “The world is a bad place.” Breaking Professionalboundaries

Loss of energy

Resentment “ It’s someone’s fault” Aggressive language

Lethargy Oversensitivity “This work is too hard.” Isolation

OTHER CAUSES OF COMPASSIONFATIGUE… 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 VIOLENCEIMPACT 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 HAVETO 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 actin 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