Emergency Care & Trauma Symposium 48 th Annual Conference
June 23, 2014
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Debriefing Strategies to Consider When Coping With Acute Stress
Lynnda Zibell Milsap PMH CNS-BC
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Identify acute stress & coping responses Review strategies
to enhance ones coping with acute stress Review triggers,
interventions to prevent compassion fatigue. Objectives
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News headlines on recent cases involving support from EMS
/First Responders; 1.The Multiple Stabbing on East Washington with
deaths 2.Missing Girl, Tortured Boy, Body of Mother Found at
Wisconsin House 3.Foggy pileups kill 2, involve more than 100
vehicles What Do You Read & Hear?
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Fear Grief Sorrow Disbelief Numbness Feeling overwhelmed
Anguish Key First Responder Stress Reponses
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Anger, irritability, sorrow Detachment, guilt ( I should have
done more). Dreams & nightmares Distractibility, flashbacks
Frequent thoughts of what happened Strains in family and work
relationships Normal Stress Reactions After a Response
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Just like it sounds, when you are unable to relieve stresses
that build, they add up & take a toll, which can reach a
critical point. Cumulative Stress
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Affect our physiological responses Overwhelming emotions can
disrupt rational problem-solving Promote adaptive and maladaptive
individual and group behaviors Importance of Psychological
Responses 8
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Potential Stress Responses to a traumatic event Hyper-arousal:
Avoidance: Intrusions: Psychic numbing First Responder & Signs
of Potential Acute Stress Response
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DSM-V, Identifies a traumatic event as one in which we
experience: a threat (actual or perceived) of death or serious
injury to self or others, with a response of intense fear,
helplessness or horror. It is not the event itself, but the meaning
it has for the individual that makes it traumatic. What is a
Traumatic Event?
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Causes a rescuer to experience: Unusually strong emotions that
interferes with the ability to function either during the incident
or after; a highly stressful incident Critical or Traumatic
Situation
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Normal people experience a range of normal reactions,
including: 1.Anxiety, 2.Feeling revved up; 3.Fatigue; irritability;
4.Problems sleeping; 5.Exaggerated startle response, 6.Change in
appetite; 7.Feeling overwhelmed; impatience; 8.Withdrawing from
family and friends. 9.Might just feel fine What Happens After A
Traumatic Event?
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Emotional Condition marked by : Tiredness, feelings of
exhaustion Loss of interest, reduced work effort Frustration that
interferes with job performance. Result from prolonged stress No
joy left in doing your job Apathy Whats the point? attitude Happens
over time Alienation from job activities Burnout
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When a friend is experiencing a trauma in their life that you
have personal experience with, this can trigger past emotions &
feelings Examples; homelessness, physical abuse emotional abuse
Secondary Traumatic Stress
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1.People who come into continued, close contact with trauma
survivors 2.Knowledge about a traumatizing event experienced by a
significant other 3.The stress resulting from helping a traumatized
or suffering person Bride, B. (2007). Prevalence of Secondary
Traumatic Stress Among Social Workers. Social Work: 51(2): 63-70.
Secondary Traumatic Stress
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. Cost of Caring
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A debilitating weariness brought about by repetitive, empathic
response to pain and suffering, `is a result of absorbing &
internalizing the emotions of others & sometimes, coworkers
What is Compassion Fatigue?
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Those who have: Trauma (experience as a witness or as a
patient) Unusual recent stressors-long term or life demands
Excessive empathy (leading to blurred professional boundaries)
Those who are more anxious Poor self care Limited support Daily
barrage of trauma material Abendroth, M. & Flannery, J. (2006).
Thos Who is at Risk for Compassion Fatigue?
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Inability or refusal to control work stressors Lack of
satisfaction for the work Previous unresolved trauma Viewing or
hearing about abuse and trauma on a routine basis Figley, C. R.
(Ed.) (1995). Compassion fatigue: Coping with secondary traumatic
stress disorder in those who treat the traumatized. New York:
Brunner/Mazel. Additional Factors that Make One Vulnerable to
CF
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Affects many dimensions of your well- being Nervous system
arousal (Sleep disturbance) Emotional intensity increases Cognitive
ability decreases Behavior and judgment impaired Isolation and loss
of morale Compassion Fatigue Symptoms
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Depression and PTSD (potentiate) Loss of self-worth and
emotional modulation Identity, worldview, & spirituality
impacted Beliefs and psychological needs-safety, trust, esteem,
intimacy, and control Loss of hope and meaning=existential despair
Anger toward perpetrators or causal events Symptoms, continued
Decrease in sense of safety ( 911) Self isolation Difficulty
separating work life from personal life Diminished functioning in
non-professional circumstances Increases in ineffective or self
destructive self soothing behaviors Personal/Work Indicators
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Discuss a case that caused you to take it home with you- or
caused some symptoms of compassion fatigue Identify what factors
caused you to identify with the person/victim/family/event Note
commonalities and choose a person to share these findings with the
larger group Panos, A Small Group Exercise #1
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Substance abuse Sleep disturbances Blaming Low self-esteem
Frequent headaches Increased irritability Less ability to feel joy
Although symptoms vary, these may indicate that you or coworkers
have compassion fatigue Depression Anger Chronic lateness
Hypertension Extra work Exhaustion (physical or emotional)
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Overwhelmed by unfinished personal business Stress affects you
deeply Personal concerns often intrude on work Feeling vulnerable
all the time Association with trauma affects you deeply Small
changes are enormously draining How Do You Feel?
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A daily act of self-centering can bring you back to awareness
of the goodness of the world. Set an alarm for the same time each
day and take four deep breaths Create another act where you can
sink into the experience, feel the sensations, and note, I am
worthy of my own time. Daily self-centering
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Mindfulness meditation Reconnect with others Boundary
maintenance Up to date education Routine Supervision Time to Keep
Healthy
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Spend time daily on an activity you find meaningful that is not
related to work. Examples include; reading, writing, walking,
listening to music, building, playing - whatever re-energizes you.
Your Self Care Plan
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A= Awareness Issues and Contributing Factors What types of
cases contribute to your stress level increasing your vulnerability
to compassion fatigue?
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Being attuned to ones needs, limits, emotions and resources
Knowing your renewal zones Accepting and acknowledging that we are
changed by what we do Awareness
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Self Care Find someone to talk to Understand that the pain is
normal Start exercising and eating properly Get enough sleep Take
some time off Develop interest outside of work Identify whats
important
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Suggestions of What Not To Do Blame others Fall into the habit
of complaining Hire a lawyer Work harder and longer Self medicate
Neglect personal needs and interests
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Even Mother Teresa Understood Compassion Fatigue Effects Wrote
in her plan to her superiors that it was MANDATORY for her nuns to
take an entire year off from their duties every 4-5 years to allow
them to heal from the effects of their care- giving work.
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1.Have quiet alone time in a calm place- a safe retreat where
you feel safe & renewed 2.Have an awareness of what restores
and replenishes you. 3.Find ways to acknowledge loss and grief
4.Stay clear with commitment to career goals or your personal
mission 5.Learn to focus on what you can control 6.Look at
situations as entertaining challenges and opportunities, not
problems or stresses Balancing Yourself
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Long-term sleep disturbances Feelings of isolation or
depression Rage Sudden change in life attitude Sudden catastrophic
decision-making ( quit job, divorce) Potential Serious Signs of
Distress After An Event
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Be as non judgmental & accepting of yourself as you would
in dealing with those your treat who have undergone a traumatic
event Remember that the symptoms you are experiencing as a result
of the traumas are related to the experience itself not that you
are a weak person The need to support you is ongoing Hey You Are A
Strong Person!
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When should I seek outside support for dealing with a tough
case? Approximately 2-3 months
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Who is responsible for your self-care? What are barriers listed
in priority that keep you from self-care activities? What is your
current level of energy? How does your team care for each other
with challenging patient care issues? Draw a circlerepresent 24
hours a day. Your Self-Care Plan
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Local; Red Cross, Chaplains, Social Workers, Area Hospitals,
professional counselors, Your team National; 1. International
Critical Incident Stress Foundation 2. SAMHSA ( Substance Abuse
& Mental Health Services Administration)-free handout for
coping for your team Resources
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Mental health screening & triage Crisis intervention
Emotional care and support Problem solving & referrals Advocacy
& education Red Cross Resources for You & Your Team
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Compassion Fatigue Awareness Project www.compassionfatigue.org
www.compassionfatigue.org Compassion Fatigue
http://www.breathofrelief.com http://www.breathofrelief.com Google
compassion fatigue and you will find many other helpful resources
SAMHSA ICISMF Red Cross On-line resources
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Thanks For All You Do.
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Thank You For Allowing Me to Participate in Your Conference
[email protected]