Self Care for Healthcare
Professionals
Presented by:
Jim Messina, Ph.D. , CCMHC, NCC
Assistant Professor
Counseling and Psychology
Troy University, Tampa Bay Site
Presentation available on www.coping.us
Hi There!
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It seems like yesterday I was talking with
your group at Bay Pines on a topic very
similar to this topic
As Yogi Berra would say:
“It’s like déjà vu all over again”
"The pessimist complains about the wind;
The optimist expects it to change;
The realist adjusts the sails."
William Arthur Ward
Or like Yogi would say:
“We made too many wrong mistakes”
Goals for Our Program
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Identify Compassion Fatigue through Self-Assessment &
Remediation Plan for Health care professionals
Identify Physical exercises, aerobic & mobility activities that
improve self-care for Health care professionals
Identify a Nutritional regimen that sustains health, energy &
cognitive clarity of health care professionals
Identify how competency based continuing education improves
the self-care of Health care professionals
Identify how to maintain one’s sense of humor & emotional
balance as a Health care professional
Identify what you are willing to commit to which will improve
your self-care from this point on
Why this Topic now?
Yogi would say:
“If you don’t know where you’re going,
you might end up some place else”
Who is susceptible to
Compassion Fatigue?
Healthcare Professionals who are most susceptible to this condition work
with people who fit one or more of the following categories:
1.
Injured veterans survivors of the Afghanistan & Iraq Wars or other
prior wars
2.
Veterans suffering from PTSD from being in the Afghanistan & Iraq
Wars or other prior wars
3.
Patients dealing with life threatening illness like cancer, heart & lung
conditions, HIV-AIDS, or other systemic health conditions
4.
Hospice eligible individuals facing imminent death due to old age,
injury, disease or illnesses
5.
Survivors of torture, trauma, or natural or man-made disasters
What is
Compassion Fatigue?
Compassion fatigue is thought to be a
combination of secondary traumatization &
burnout precipitated by the care delivery that
brings health-care professionals into contact
with the suffering
Szabo, B. (2006). Compassion fatigue and nursing work: Can we
accurately capture the consequences of caring work? International
Journal of Nursing Practice: 12: 136–142.
Difference between
Compassion Fatigue & Burnout
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"Compassion fatigue is when caregivers have such deep
empathy they develop symptoms of trauma similar to the
patient” according to director of the Army Institute of
Surgical Research Col Kathryn Gaylord
The disorder can also resemble burn out which occurs
when emotional exhaustion is experienced due to
increased workload & institutional stress & does not
involve trauma
Compassion fatigue can have detrimental effects on
doctor patient relationships since doctors suffering from
the disorder often either grow distant from patients or get
too close
Wilson, E. (2008). New Program Offers Care for Caregivers. Department
of Defense Military Health System News, 23 May 2008.
Secondary Traumatic Stress
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People who come into continued, close contact
with trauma survivors may also experience
emotional disruption, becoming indirect victims of
the trauma
The natural, consequent behaviors & emotions
resulting from knowledge about a traumatizing
event experienced by a significant other
The stress resulting from helping or wanting to
help a traumatized or suffering person
Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among Social
Workers. Social Work: 51(2): 63-70.
Compassion Satisfaction
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Compassion satisfaction is the ability for clinicians
to derive a great sense of meaning & purpose from
their work
It may aid in alleviating existential terror endemic
to the human condition when a society is at war
It may be an important buffer in managing &
transcending alterations in belief systems &
physiological or emotional reactions seen in
compassion fatigue
Stamm (1999 and 2002) as quoted in: Tyson, J. (2007). Compassion
Fatigue in the Treatment of Combat-Related Trauma During Wartime.
Clinical Social Work Journal; 35:183–192
Major factors contributing to
Compassion Fatigue
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3.
4.
Poor self-care
Previous unresolved trauma
Inability or refusal to control work stressors
Lack of satisfaction for the work
Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary
traumatic stress disorder in those who treat the traumatized. New York:
Brunner/Mazel.
Predictors of Compassion Fatigue
among Hospice Nurses
1.
2.
3.
4.
Trauma
Anxiety
Life demands
Excessive empathy (leading to blurred
professional boundaries)
Abendroth, M. & Flannery, J. (2006). Predicting the Risk of
Compassion Fatigue: A Study of Hospice Nurses. Journal of Hospice
and Palliative Nursing: 8(6): 346-356.
Why Focus on Compassion
Fatigue?
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It is imperative that healthcare professionals
take steps to ensure that they are
functioning at their best in the therapeutic
relationship
Facilitating their own personal well–being &
avoiding burnout is clearly one way in which
this can be achieved
Linley, P.A. & Joseph, S. (2007). Therapy work and therapists’ positive
and negative well-being. Journal of Social and Clinical Psychology:
26(3):385–403.
Self-Assessment
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Take the Compassion Self-Assessment
Rate each item on a scale from 1 to 10
 1 = never experienced
 5 = occasionally experienced
 10 = frequently experienced
What does this Assessment
Tell You?
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If you rated three or more items over 8
or if you rated 5-10 over 5
You are most likely experiencing some
level of compassion fatigue already
Characteristics of clinicians
experiencing compassion fatigue
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Physically: Chronic sense of exhaustion & fatigue, insomnia,
headaches, stomachaches, lack of appetite, physical agitation or
retardation, frequent bouts of sickness (e.g., colds, sore throats)
Psychologically: often feel irritable, are overwhelmed by the volume
& content of their work
Relationship with Clients: sense a reduction in their baseline
empathy for others, feel numb to patients’ & families’ pain, are cynical
regarding clients’ ability to change &/or perceive them as being
responsible for many of their problems
Organizationally: often report a sense of feeling scattered & unable
to meet their professional & personal obligations
Mendenhall, T. (2006). Trauma-Response Teams: Inherent Challenges and
Practical Strategies in Interdisciplinary Fieldwork. Families Systems, &
Health: 24(3):357-362.
So Why Assess for Chronic
Fatigue
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It is expected that most clinicians will at times
experience symptoms of compassion fatigue, as
these are normal reactions to trauma work
However, for some clinicians the experience of
compassion fatigue may become so severe as to
interfere with their clinical effectiveness & their
personal mental health
It is for this reason that ongoing monitoring is
necessary
Bride, B., Radey, M. & Figley, C.R. (2007). Measuring Compassion
Fatigue. Clinical Social Work Journal: 35:155-163.
Early Assessment Impact
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Instead of waiting for the clinicians to become symptomatic
use inventory tools to look for the presence of challenges
to their fundamental assumptions, values & beliefs
With early assessment clinicians have the opportunity to
transform their discomfort into personal growth &
development
This should be the aim of a professional supervision &
support model to address Compassion Fatigue
Tehrani, N. (2007). The cost of caring – the impact of secondary trauma
on assumptions, values and beliefs. Counselling Psychology Quarterly:
20(4): 325–339.
What You Can Do!
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Recognize the symptoms of compassion fatigue
Learn to ask for help
Be aware & accept the limitations of your family, your job & yourself
Maintain discipline in daily responsibilities & duties
Take “time out” during the day
Take short vacations at least twice a year
Try to change little things that gnaw at you & accommodate to those
you can't change
Organize your time so you can concentrate on vital tasks
Admit compassion fatigue is a real problem for you & don't try to cover
it up
Distinguish between stressful aspects of your job or home life that you
can change & those you can't change-change what you can
What You can do to ward off
Compassion Fatigue
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2.
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4.
Boundary maintenance
Self-care
Good training
Good supervision
If given all 4 Healthcare Providers will thrive as
compassionate professionals
Radey, M. & Figley, C.R. (2007). The Social Psychology of Compassion.
Clinical Social Work: 35(1):207–214
What can be done on the job!
Identify realistic attainable goals for each department & evaluate accordingly
Help staff to maintain personal growth both at home & on the job
Encourage & support staff to develop an active outside life with a variety of
interests
Encourage staff to personalize the work environment with meaningful pictures,
objects, colors, etc.
Encourage staff to be comfortable with themselves by setting limits as to how far
to become involved with clients & colleagues
Encourage & practice good communication skills on the job
Provide for flexible working conditions on the job
Encourage trying new ideas “outside of the box”
Sponsor “decompression techniques” activities such as meditation or exercise that
relieve tension & put staff into a more relaxed state
Build support systems among staff to discuss problems & help each other look for
solutions. Don't just air gripes - look for solutions
Implement Stress Reduction &
Relaxation Breaks
Remember what Yogi said about the game:
“90% of the game is half mental”
So learn to put the mental half aside and
relax and let go of the stressors from the
work you do on a daily basis
OK? Now Let’s Talk Sleep!
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We all know that adults need 8 hours of
sound restful sleep every night
This is especially true for Healthcare
Professionals who work with clients who
have loads of stress & trauma in their lives
SO what are you going to do about it?
So remember you need to
have all 8 hours
After all Yogi said in this regard:
“A nickel ain’t worth a dime anymore”
So don’t kid yourself anything less than 8
hours will not do!!!
Training like this helps!!!
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Sprang et al, found that specialized trauma training
did enhance Compassion Satisfaction and reduced
levels of Compassion Fatigue and Burnout,
suggesting that knowledge & training might provide
some protection against the deleterious effects of
trauma exposure
Sprang, G., Clark, J. & Whitt-Woosley, A. (2007). Compassion Fatigue,
Compassion Satisfaction, and Burnout: Factors Impacting A Professional’s
Quality of Life. Journal of Law and Trauma, 12:259–280.
Cause you need to Remember
Yogi said:
“If the world was perfect, it wouldn’t be”
So continue to gain training on Trauma and its
impact on clients & helpers so as to learn how
to improve the world in which you work
So Get More Training on Prevention
of Compassion Fatigue
It helps to refresh everyone’s understanding
of the impact of the Trauma, which patients
& clients have experienced, on the
Healthcare Providers who are working with
these victims & survivors of trauma
How About a Physical Exercise
Program?
It is important to include an active physical
program of exercise to help alleviate the
stressors which build up & contribute to
Compassion Fatigue
Don’t PooHoo Physical
Exercise
Remember what Yogi said about himself
applies to Physical Exercise:
“Half the lies they tell about me
aren’t true.”
Developing a Healthy Exercise
Program
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Identify Benefits
Combat Myths about exercising
Combat Roadblocks to exercising
Identify & overcome: Triggers to avoid,
ignore, or stop exercising
Look at what is new in exercise
offerings
Benefits of Healthy Exercise
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Compensates for fat accumulation by burning calories
Provides a "natural high'' by the release of
endorphins
Strengthens the cardiovascular & respiratory systems
if aerobic type exercise sustained for at least fifteen
minutes on a regular basis
Keeps the muscular system supple
Keeps the circulatory system operating at its best
Builds bone mass to combat osteoporosis
Roadblocks to Exercise
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Not enough time; my schedule is already so full
Implementing a program of exercise takes
exceptional effort & planning
The health club is too far away. It is not "on my way''
to anywhere
An exercise program costs a lot of money.
It is unpleasant to get all sweaty when you exercise
Exercise can be so boring
Exercise makes your body sore
Listening to those excuses,
makes you sound like a pitcher
Remember what Yogi said:
“All pitchers are liars or crybabies”
Time for Exercise
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Make the exercise session a priority of the day
Schedule a regular, specific time of day for
exercise
Choose a convenient time
Exercise in the morning before breakfast, in the
afternoon before lunch, or in the evening after
getting home from work, but before dinner.
Place for Exercise
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Choose an exercise easily performed around the house,
e.g., treadmill, stationary cycle, rowing machine,
jumping rope, rebound trampoline, jumping jacks,
walking, running, biking, swimming
Perform exercises that can be done in an airconditioned environment (stationary cycle, rowing
machine, or rebound trampoline). Profuse sweating is
not necessary for exercise to be worthwhile
Reduce Costs of Exercise
Choose an exercise which doesn't involve
the purchase of equipment or club
memberships, e.g., walking, running,
jumping rope, etc.
Keep Exercise Interesting
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Try indoor exercise in front of a TV or while listening to
motivational tapes or energizing music
Try outdoor exercise in tree-lined or park-like settings
with interesting scenery and use a ipad or iphone
For either type of exercise, get a partner or group of
people to exercise with; make it a social experience that
will provide mutual motivation & encouragement
Exercise is good for everyone
After all Yogi said:
“I think Little League is wonderful.
It keeps the kids out of the house.”
Start out Slow to Protect Your
Body from Being Strained
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Slowly phase an exercise program in;
help your body adjust to the increased
activity
Use warm-up & cool-down exercises to
avoid muscle strain
Wear the proper clothing & shoes to
avoid body strain or injury
If you exercise you will have a
new inner depth to rely on
Remember what Yogi said:
“We have deep depth”
Make it so in your life – now!
How about eating a Healthy
Diet along with Exercise?
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Eat a variety of foods to get the nutrients you need & at the
same time the right amount of calories to maintain healthy
weight.
Be sure to eat a balance from these food groups:
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Vegetables – as much as you want
Fruits – 2-3 times a day
Whole Grain Foods – at as many meals as possible
Plant oils – such as olive, canola, corn, sunflower, peanut & other veg oils
Nuts & Beans – 2-3 times a day
Fish, Poultry or Eggs – 0-2 times a day
You need them for the vitamins, minerals, carbohydrates &
protein they provide
Pick the lowest fat choices from the food groups
Here is a food pyramid from Harvard medical professor Walter
Willett, M.D. in his book: “Eat, Drink, and be Healthy”
Another Version of Health
Eating
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To help you get the message how about
using the Healthy Eating Plate Version
which is the next slide
Here your plate consists of:
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Lots of Vegetables
Plenty of Fruits
Whole Grains
Fish, Poultry, Beans & Nuts
A Multivitamin in your daily routine
Quick Guide for Healthy
Eating!
Stay away from:
1. Junk Foods & Sugary Drinks
2. Cold Cuts & Other Processed Meats
3. Bacon & Red Meats
Do make sure you
1. Drink lots of sugar free Water, Tea or
Coffee
2. Cook with healthy oils
So plan your eating habits to
support your health
Don’t Just Talk About It Do Something About
It!
After all if you don’t you might end up like
Yogi said:
“You can observe a lot just by watching.”
So, get out and do something about it!
Maintain a Good Sense of
Humor
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We used Yogi today to get us going in
that direction! And I hope he was not
right about what was said today when he
said:
“We made too many wrong mistakes”
So are you going to do
something about it?
Make a commitment to:
1.
Continuously assess your current emotional state
2.
Implement a good stress reduction activity for
yourself & your co-workers
3.
Get 8 hours of sleep a night
4.
Have a regular exercise program going for
yourself & if possible your co-workers
5.
Eat a good balanced diet
Because you have to
remember
Yogi said:
“It ain’t over till it’s over…”
So there you have it!
Dealing with Compassion Fatigue is a TEAM
effort which requires administration, coworkers, your families & significant others to
understand that it takes a lot of effort to
prevent & deal with this insidious & disabling
condition!
Best of Luck!
References
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Messina, J.J. (2013) Preventing Burnout at:
http://coping.us/toolsforpersonalgrowth/preventingburnout.html
Messina, J.J. (2013) Preventing Clinician Compassion Fatigue at:
http://coping.us/practicalclinicaltopics/preventcompassionfatigue.html
Messina, J.J. (2013) Stress Reduction at:
http://coping.us/toolsforpersonalgrowth/stressreduction.html
Messina, J.J. (2013)Tools for a Balanced Lifestyle at:
http://coping.us/balancedlifestyle.html