Presenters:
Lynn Skubiszewski, LCSW and
Nicole Perry, LCSW
#NASWIL
http://www.youtube.com/watch?v=XSu_sVgGWMk
• Lynn Skubiszewski, LCSW
Palliative Care Social Worker,
JourneyCare
lskubiszewski@journeycare.org
• Nicole Perry, LCSW
Social Worker and Team Manager,
JourneyCare
nperry@journeycare.org
Lynn is a graduate of Aurora University
School of Social Work and has worked in
the academic, geriatric, and healthcare
fields for over 20 years. She has an
interest in coaching the helping
professionals in self care and encouraging
social workers in healthcare settings to
embrace leadership roles in their
multidisciplinary settings.
Nicole has an MSW from the University
of Wisconsin – Madison. She has worked
as a Social Worker since 2006 in the
fields of aging and hospice. Nicole
enjoys leading an interdisciplinary staff
team to provide excellent end of life care
and symptom management to the patients
of JourneyCare.
#NASWIL
• Poor Quality of Life
• Poor self-care = burnout/dissatisfaction = drop out of SW field
• “In light of recent and significant research indicating that social
workers engaged in direct practice are likely to develop symptoms of
secondary traumatic stress, it is imperative that the social work
profession devotes greater attention to and creates greater awareness
of these issues.” (Professional Self-Care and Social Work, policy
statement approved by the NASW Delegate Assembly, 2008)
• Poor self care = reduced ability to be empathic
• Define burnout, compassion fatigue, compassion satisfaction, secondary
trauma, vicarious traumatization/post traumatic stress.
• Research Project
• What is self – care?
• How can you start self care?
• Resilience, Personal Self Care, and Realistic Expectations
• How to Expand Self-Care to the Organization Level
• Summary and Review Resources/Tools
• “A relatively frequent outcome of chronic stress that has received
considerable attention.”
• Refers to the gradual extinguishing of energy of a Social Worker.
• What leads to burnout?
Schaufeli, Leiter, & Maslach, 2009, p 205.
Maslach and Leiter, 2005
Cox and Stiner, 2013
Burnout is the opportunity to rediscover what makes you happy.
10 Phases of Burnout
"Preventing Burnout" by psychologists Herbert Freudenberger and Gail North
: Long-Term Living 59.5 (May 2010): 50-52.
Listen to others who know and care about you
Use assessment tools to help you see the truth
Self awareness – know when you are crossing a line
Is it really the client or is it more than that? Is it your organization? Is it unrealistic productivity expectations?
• TOP 10 SIGNS OF BURNOUT
#10 – Shopping at Kmart feels like you’re taking good care of yourself.
#9 – Patients frequently startle you by waking you up during home
visits.
#8 – Find yourself saying, “You think you’ve got problems, lady?”
#7 – You become aware of a reluctance to go to work and don’t go to
work.
#6 – You accidentally drop your beeper from a high bridge.
• #5 – You jump after the beeper.
• #4 – Giggling during team meetings.
• #3 – Not giggling during team meetings.
• #2 – Eating an entire bag of Dorito chips while making bereavement phone
calls.
• #1 – Who cares about this list anyway?
Larson, National Hospice and Palliative Care Organization
• Similar to PTSD - Easily frustrated, irritable, annoyed
• Symptoms of depression-difficulty maintaining hope
• Feeling over alert, restless
• Feeling ineffective, negative, inadequate
• “CF is the natural, predictable, treatable, and preventable
unwanted consequence of working with suffering people”
(Figley, 2000, p. 124 of Treating Compassion Fatigue)
Compassion Fatigue
•
Compassion Satisfaction
Also called Secondary Traumatic Stress
•
A set of behaviors and emotions that can occur
when the SW is seeking to help a suffering
person.
•
“a feeling of deep sympathy and sorrow for
another who is stricken by misfortune,
accompanied by a strong desire to alleviate the
suffering?
Figley, 1995
Teater, 2012
Larson
•
Defined as the pleasure derived from helping
others.
•
Sounds like:
• I have happy thoughts about those I help
• I like my work
• I enjoy and trust my co-workers
• I am effective
Craig and Sprang, 2010
Although the world is full of suffering, it is full also of the overcoming of it.- Helen Keller
Compassion Fatigue
• Also called Secondary Traumatic
Stress
• A set of behaviors and emotions
that can occur when the SW is
seeking to help a suffering person.
• “a feeling of deep sympathy and
sorrow for another who is stricken
by misfortune, accompanied by a
strong desire to alleviate the
suffering?
Figley, 1995
Teater, 2012
Larson
Compassion Satisfaction
• Defined as the pleasure
derived from helping others.
• Sounds like:
• I have happy thoughts about
those I help
• I like my work
• I enjoy and trust my co-workers
#NASWIL
50% of child protection staff suffered from high or very high
levels of compassion fatigue
70% of staff expressed a high or good potential for compassion
satisfaction
Conrad and Kellar-Guenther (2006)
What Creates Compassion
Satisfaction?
• Social workers are affected by exposure to their
clients' traumatic life experiences and behaviors.
Research has demonstrated that secondary traumatic
stress (STS) - also referred to as vicarious trauma,
compassion stress, or compassion fatigue - is
prevalent among mental health professionals who
work with traumatized clients
(Fahy, 2007; Figley, 2002b;Jacobson, 2006;Jenkins & Baird, 2002; McCann &
Pearlman, 1990)
• (VT) common when
population exhibits:
• Suicidal Behavior –
Fatal and Non Fatal • Reported feelings of guilt, failure,
professional self-doubt regarding
their clinical competency, and
anger directed toward the client
(Chemtob et al., 1988, 1989; Ellis &
Dickey, 1998; Grad, Zavasnik, & Groleger,
1997; Kleespies, Penk, & Forsyth, 1993;
Ruskin, Sakinosfsky, Bagby, Dickens, &
Sousa, 2004;Yousaf, Hawthorne, &
Sedgwick, 2002)
#NASWIL
Highest for those who work with:
• Sexual Offenders
• Trauma Victims
• Natural Disaster Victims
• Victims of Terrorist Attacks
• Suicidal Clients
• Refugee Populations
• Violence against Families/Children
… findings suggest that the
experience of compassion
satisfaction and the development of
vicarious resilience counterbalanced the intense difficulty of
bearing witness to clients' traumatic
experiences and the potential for
vicarious traumatization.
• Secondary Traumatic Stress – “the natural and consequent
behaviors and emotions resulting from knowing about a
tramatizing event experienced by a significant other – the stress
resulting from helping or wanting to help a traumatized or
suffering person.”
Figley (1993, 1995)
• Vicarious Traumatization – “the transformation in cognitive
schemas and belief systems as a result of empathic engagement
with survivors of traumatic experiences.” McCann and Pearlman, 1990
Pilot Study at Journey Care
• 5 Advanced Practice Nurses/Nurse Practitioners in Palliative
Program part of Palliative/Hospice Agency
Average Years as APN = 6 ½
• Palliative Care and Hospice Experience = 7 months to 10 years
• Ages: 45 to 60 years of Age
• Question: Do you currently practice Self Care?: 4 out of 5 = Yes
• Question: How long have you engaged in Self Care as a Nursing
Professional? Average 2.5 years
• Coordinator Data
• Palliative Care LCSW with 2 years with
team – 20 years as social worker
experience on
Assess if your
Staff or Team
is in need of
Self Care
• 5 Advanced Practice Nurses
on a Multi-Disciplinary Team
completed 7Assessment
Surveys/Tools
• Use this data to create
meaningful self care
interventions
• Use this data to justify the Self
Care Program
• The participants will learn
valuable info about themselves
#NASWIL
#NASWIL
• The APNs said….
And the
• Self Care is attending to one’s own needs so
that one can bring full energy & attention to
the work tasks at hand during work
appropriate times.
• Unique aspects in “surviving” this work is
that we are building character and strength;
and end of life care brings the reality of life
& God into perspective.
• I maintain compassion by feeling strongly
that no one should die afraid, alone, or in
pain. I know I make a difference to people &
in their lives.
• I nurture myself by getting massages,
exercising, having a Friday night date night
with hubby and staying involved at church.
• What I know for sure about the importance
of Self Care is that you have to be your own
best advocate!
Self Care Assessment
Compassion Fatigue
Assessment
Self Care and Life
Style Balance
Inventory
Burnout
Indicator
Self Care Table
1Risk Factors
Resilience
• Purpose: Help Staff De-Stress,
Palliative
Self Care
Explore Negative Feelings re:
Loss, Expectations, Alleviate
Burnout, Stress Work/Life Balance
• Objective: Create Emotionally
Healthy and Centered Palliative
Staff
• Details: Participate in
Assessments then Meet every 4 to
6 weeks for 30 to 60 minutes
during Work Day
• Varied Interventions Used (based
on what was learned from the assessments)
• Pre-Test/Post-Test
• In order to determine effectiveness of Interventions and Collect
Data to bring to Agency Leadership a simple Pre-Post Test was
administered before the Self Care intervention began and
immediately after. We utilized a 1-10 Scale.
1. Perception of Stress from today’s work day
(1) meaning No Stress (10) Very High Stress
2. Perception of Stress after today’s Self Care Program
3. Would you Practice this Technique again – either on
own or in group setting?
#NASWIL
• Spiritual – 1) Mindfulness Exercise: Leader demonstrated Breathing and Loving
Kindness Meditation - Stahl & Goldstein
• Spiritual – 2) Connect with Nature: Participants walked around a Natural
Setting noting what they could: See, Hear, Smell, Touch, Experience. APN’s
then shared their favorites.
• Relational – The Guilts: Group shared any unresolved guilt, professional
regrets, etc. and placed same on paper to be ritually burned.
• Opportunity to Express Self - To Soothe and Release each APN shared the Ups
and Downs of caring for patients and “doing the job” – then took turns reading
uplifting quotes and affirmations on small pieces of paper in a basket.
• Physical – Group participated in stretching, breathing, listened to leader explain
various health benefits of various ingredients - then participated in making
fruit/greens smoothies – then tasting smoothies.
• Individual vs. Group Activities
Most Effective APN Self Report
Least Effective APN Self Report
• Stretch and Smoothie
• Meditation: Loving
Kindness
• Connect with Nature
• Discuss “The Guilts”
• Sharing
stories/ideas/frustrations and
group Affirmations
Note: Average Stress Level Decreased by at least 2 points
on self report scale for each of the Interventions
It’s not that hard…..
#NASWIL
• Definitions vary (affected by different factors)
• Common theme is that consumers take a more active role in their own
care instead of relying on others to provide care
• Can be easier to say what it is NOT:
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NOT: just for burned out workers, the weak, the maladjusted.
NOT something we don’t have time to do
DOES NOT mean we focus on ourselves and ignore others
NOT about numbing ourselves
DOES NOT indicate narcissism
IS NOT a luxury and does NOT mean we are self-indulgent.
Cox and Steiner, Self-Care in Social Work (2013)
Attendee Examples???
Boundaries
Exhaustion
Calling in sick
Loss of Hope
Depression
Stress Eating
Thoughts of leaving profession
Unprofessional Behavior Sleep Issues
Can’t Separate Work from Home
When you are stressed/burned out you may find
yourself:
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Sharing too much personal data with clients
Sharing information about other staff members
Complaining about your agency or workload
Developing dual relationships
Upstaging their problems/issues with your own
Downplaying other team members or disciplines
Wanting to develop a personal relationship with a
client
• Physical
• Psychological
• Emotional
Basic Framework
• Spiritual
• Professional
• Balance
Self Assessment of Your Self-Care Patterns – PROQOL
Develop Your Own Plan – Research what activities work!
Implement the Plan
Test – Tweak for Effectiveness
• John Kabat-Zinn and Mindfulness
You Tube Video
http://www.youtube.com/watch?v=EU7vKitN4Ro
Can be practiced in 2 ways: Formally and Informally
Formal means taking time each day to intentionally:
Sit
Stand
Lie Down
And Focus on Breath
Bodily Sensations
Sounds
Other senses - thoughts - and emotions
Stahl & Goldstein 2010
Informal Mindfulness is…
Bring mindful awareness to everyday activities such as:
Eating
Exercising
Chores
Work
Relating to Others
Basically any action
• The practice of mindfulness is particularly effective because it
“decouples” the physical sensations of pain from mental and
emotional processes that heighten suffering. Pain comes to be
seen as “just another sensation” and the fear of pain is
significantly reduced. The development of mindfulness, as
Buddhists have known for 2,500 years, brings about mental
and emotional freedom and a decrease in suffering.
• But if we are mindful of the pain – won’t focusing on it
Just increase it?
http://www.wildmind.org/blogs/on-practice/being-mindful-of-pain
• Get comfortable and close your eyes…..
• From Caregiver Stress by Belleruth Naparstek 2008
#NASWIL
Deep Diaphragmic Breathing Techniques will
enable:
Nervous System Balance
Oxygenation
Prevents Muscle Hypertonicity
The Guilts
• Remind yourself that what you do makes a difference.
• Set Realistic goals – “If Only I were….”
• Accept your shortcomings and take action in areas you can improve.
• Do not take yourself so seriously
• Arrange for regular vacation time
• Attend career nurturing events
• Share your thoughts with a trusted friend
• If overwhelmed for long period of time – see a counselor or EAP
Larson, National Hospice and Palliative Care Organization
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Take Stock of Where Things Are – What’s on Your Plate?
Start a Self Care Idea Collection
Find Time for Yourself Every Day
Delegate and Learn to Ask for Help
Have a Transition from Work to Home
Learn to Say Yes or No More Often
Assess Your Trauma Inputs – Work/Non-work Related
Learn more about Compassion Fatigue and Trauma
Supervision/Peer Support
Workshops and Training
Consider Working Part Time
Exercise
Mathieu, F. (2007) www.compassionfatigue.org
• Physical Self Care – eat well, exercise, get enough sleep, get medical care
• Psychological Self Care – reflect, journal, engage in leisure activities, let others help
you
• Emotional Self Care – have pleasant thoughts about your self, engage in
laughter/play, express emotions in appropriate channels
• Spiritual Self Care – pray, meditate
• Create team rituals – Healing Circles, Drumming, Light a Candle, Burn Regrets
• Professional Self Care – take a break, take a vacation, balance case load
• Balance Plan – among work, family, relationships, play, rest
Cox and Steiner, 2013
Takin’ it to the streets
Self Care on Agency
Level
#NASWIL
• Explain why it is important to organizations:
• Poor quality of life, burnout/dropout
• More satisfied employees have lower absenteeism rates, high
productivity and better service to clients.
• Research shows enormous costs (financial and human being
costs) with unhealthy organizations.
• The Corporate Executive Board places the cost of employee
turnover as high as “200 times annual salary for certain
positions.” But even if your lowest-level workers cost just
$4,000 to replace and absorb their lost productivity,
aggregating this cost for a full year likely produces a total
cost number in the hundreds of thousands or millions, a
number that would stagger most executives.
www.retentioninstitute.com
1. United States of America – 13 days
2. Belgium – 20 days
3. Japan – 25 days
4. Korea – 25 days
5. Canada – 26 days
6. United Kingdom – 28 days
7. Australia – 28 days
8. Brazil – 34 days
9. Austria – 35 days (42 for elderly)
10. Germany – 35 days
11. France – 37 days
12. Italy – 42 days
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Create a Proposal
Use Facts from this Presentation
Do a Needs Assessment
Collaborate with others who are like-minded
Get a decision-maker/leader to buy in
Do a small sample/test project
Can do quantitative analysis to show effects of self-care
program participation (ex: monitor employee sick days in
relation to number of self-care programs attended)
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Encourage/pay for Supervision
Create Task Force to Develop Self Care Program
Encourage – allow time for staff to meet with Mentors
Create Wellness Programs – Including EAP
Create a climate where sharing frustrations is “Normal” and
help staff develop ways to Let the Frustrations Go!
Offer skill building opportunities
Employee Recognition Programs
Flex Time – Generous Vacations – Realistic Productivity
Expectations
Improve Orientation and Performance Reviews
Schwartz Rounds
• …offers healthcare providers a regularly scheduled
time during their fast-paced work lives to openly and
honestly discuss social and emotional issues that arise
in caring for patients. In contrast to traditional medical
rounds, the focus is on the human dimension of
medicine.
• Professional caregivers have an opportunity to share
their experiences, thoughts and feelings on thoughtprovoking topics drawn from actual patient cases. The
premise is that care providers are better able to make
personal connections with patients and colleagues
when they have greater insight into their own
responses and feelings.
Schwartzcenter.org
Research your partners in community
Forge relationship and create small SELF CARE
consortium
Share resources across agencies
Join professional associations
Social Work Supports in Social Media such as
Linked In, Facebook , NASW
Form Healing Circles
Therapists working with traumatized clients described inspiration
and strength they drew from working with clients whom they
sometimes described as ‘‘heroes.’’
Quotes from therapists working with victims of violence:
I learned about how human beings have so many resources to
face tragedy, the importance of spirituality, tolerance and the
ability to survive.
This work generates a positive change as you generally may
become more resourceful, less fearful, more dynamic, more
resolute, more active and eager to question yourself permanently.
Vicarious Resilience: A New Concept in Work With Those Who Survive Trauma
PILARHERNAŁ NDEZ,PH.D., DAVIDGANGSEI, PH.D. & DAVID ENGSTROM, PH.D. Family
Process, Vol. 46 June 2007, pages: 229-241
#NASWIL
Take this cup,
I’ve filled it up,
With love and joy and laughter.
Now it’s empty,
Fill it up.
Repeat,
Forever after.
First, so full
I’m giving
All my love and joy in living
Then near empty,
Tired of living,
And I’m the
One who needs the giving.
This cup, this cup,
This cup of life,
It’s always overflowing;
We give and get
And get and give,
Life’s balance
Keeps on going.
Take this cup,
I’ve filled it up,
With love and joy and laughter.
Now it’s empty,
Fill it up.
Repeat,
By: Laura Byrnes
Forever, after.
• Thank You for Attending
• Questions
May I be filled with loving
kindness
May I be well
May I be Peaceful and at ease
May I be happy
Stahl and Goldstein, 2010