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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.
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html
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).
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html
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 Professional Vicarious traumatic stress Suffering patient Media Dying patients Entertainment Witnessing suffering Stories 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 powerless Rejection, loss, embarrassments, hearing stories of physical violence,
WHAT IS TRAUMA?
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
Anxiety Intrusive thoughts about work
Avoiding interacting with patients or families
Sleep disturbance
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.
https://www.psychologytoday.com/therapy-types/acceptance-and-commitment-therapy
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
http://themindlab.co.uk/ https://www.psychologytoday.com/blog/pressure-proof/201403/maxed-out-doctors-the-high-cost-burnout-in-medicine
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.
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html
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
https://www.ted.com/playlists/315/talks_to_help_you_manage_stres
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 u
