Compassion FatigueMelanie JohnsonRosario FernandesJune 2011Relevant quotesFrom physiciansAll of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship. (Figley 2002)The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. (Rachel Remem, 1996)Charles FigleyThe very act of being compassionate and empathic extracts a cost under most circumstances. In our effort to view the world from the perspective of the suffering, we suffer.Learning objectivesAfter this inservice, the participants will be able to:describe what compassion fatigue isdescribe an example of compassion fatigue in the context of their own practicerecognize signs/symptoms of compassion fatiguecreate a compassion fatigue action plan to prevent/manage development of compassion fatigueWhat is compassion fatigue?An emotional state with negative psychological and physical consequences that emanate from acute or prolonged caregiving of people stricken by intense trauma, suffering or misfortune (Oncology Nursing Forum. 2009)Results in a loss of capacity for, or interest in, being empathic with others painA cost of caring for others in emotional painAlso described as secondary traumatic stressFrom: Clinical highlights: compassion fatigue. Oncology Nursing Forum. 2009;36(1):28.cost of caring and secondaty traumatic stress (Figley 2002 p2)Rosario can add: Jan Spilman described CF as a serious, but natural consequence of working with people who are suffering or traumatized.4Compassion fatigue (Figley 2002)A state of tension and preoccupation with the individual or cumulative trauma of clients as manifested in one or more ways: re-experiencing the traumatic events, avoidance/numbing of reminders of the traumatic event, persistent arousal combined with the added effects of cumulative stress (burnout)
Figley 2002 p125http://www.psychink.com/inpbcfat.htmAvoidance/numbing - 5Compassion fatigueThe Gentry/Baranowsky (1997) Model of Compassion FatiguePRIMARY TRAUMATIC STRESS+/x (synergistic effect)SECONDARY TRAUMATIC STRESS+/x (synergistic effect)BURNOUT____________________________________= COMPASSION FATIGUEhttp://www.compassionunlimited.com/pdf/CompasionFatigue_ACrucibleofTransformation.pdf6Compassion satisfaction-Compassion fatigue ModelFrom: http://www.proqol.org/Customize_a_Presentation.htmlhttp://www.proqol.org/Customize_a_Presentation.html7Burnout and Secondary traumatic stress (STS): Co TravelersBurnoutWork-related hopelessness and feelings of inefficacySecondary traumatic stress (STS) Work-related secondary exposure to extremely or traumatically stressful eventsBoth share negative affectBurnout is about being worn outSTS is about being afraid Beth Hudnall Stamm, 2009. Professional Quality of Life Scale (ProQOL). www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no changes are made without author authorization, and (c) it is not sold.ProQOL measureMost commonly used measure of negative and positive affects of helping others who experience suffering and traumaMeasure of compassion satisfaction and fatigueFree tool 30-item self-reportUsed for over 15 yearsAvailable in multiple languages
Available at: http://www.proqol.org/ProQol_Test.htmlPre-inservice assignment: ProQOL scale discussion10What are signs and symptoms of compassion fatigueSigns and symptoms of compassion fatigue (Gentry 1997)Intrusive symptoms
Arousal symptomshttp://www.compassionunlimited.com/pdf/CompasionFatigue_ACrucibleofTransformation.pdf12Intrusive symptomsthoughts/images associated with clients traumaobsessive/compulsive desire to help certain clientsinability to let go of work-related mattersthoughts/feelings inadequacy as a caregiverhttp://www.compassionunlimited.com/pdf/CompasionFatigue_ACrucibleofTransformation.pdf
13Avoidance symptomsloss of enjoyment in activities/cessation of self care activitiesloss of hope/sense of dread working with certain clientsloss of sense of competence/potencysecretive self-medication/addictionhttp://www.compassionunlimited.com/pdf/CompasionFatigue_ACrucibleofTransformation.pdf
14Arousal symptomsincreased anxiety, impulsivity/reactivityincreased frustration/angersleep disturbancedifficulty concentrating
15Compassion fatigue trajectoryZealot phaseKeen, committed, enthusiastic, extra hoursIrritability phaseCut corners, avoid pt contact, mocking, daydreamWithdrawal phaseExhausted, clients become irritants, neglect (family, coworkers, clients, ourselves)Zombie PhaseAutomatic pilot, distain for clients, no compassion, no patiencePathology and Victimization vs. Renewal and MaturationOverwhelmed, ill, leaving profession vs. transformation/resilienceInitially from Jan Spilman 2010 inservice: Caring on empty: creative tools for compassion fatigue transformation and resiliencehttp://www.compassionunlimited.com/pdf/PowerPointPresentation.pdf (Gentry)16What characteristics do you think would put a person at risk?Personal risk factorsUnresolved personal trauma and lossCurrent life stressorsLow levels of social supportLow sense of control over lifeLack of meaningful personal relationshipsPersonality-based coping styleEnneagram
Work-related risk factorsEmpathyInsufficient training of experienceHigh frequency of exposure to traumatic materialCaring for the most vulnerable in societyInsufficient recovery timePoor or no supervisionIsolation and systemic fragmentationLack of systemic resources
What are tools you use to handle stress in yourlife?READ: What are some strategies you might use to battle Compassion Fatigue in your life?Rosario loves this saying by Dr Eric Gentry, PhD: The truth is, that for all the pain, these symptoms are a blessing. They point out to caregivers that their lives are out of balance and needing intervention.Suggestion: Before you flip slides, lets ask participants for as many ideas they can come up with for each category20Self Care Strategies1. Physical
a. Care for your body sufficient rest and respite, nutritious food, 30 minutes aerobic exercise 3 times per week. Regular medical, dental, and psychological check ups.Recharge/renew daily: exercise, prayer, meditation, mindfulness, good nutrition
2. Psychological and/or Emotional
Engage in personal therapy to resolve traumatic stress, past and present***Be aware of YOUR compassion fatigue early warning signs and have a detailed response plan at hand.Use the Enneagram or other personality system to identify and develop your personality-based coping style**As Spillman says, Exercise your humour muscle! Laugh out loud!Try to soften critical self talk; replace with self-affirming languageAssess and reduced your trauma inputs use low impact disclosure and teach it to others*
*** Jan Spillman suggested finding a therapist you like who works with BOTH what is in your mind and what is in your BODY.** How do participants feel personality styles make one vulnerable to CF? brainstorm thoughts?* Ask Participants what they understand by this. Jan suggested avoiding TV, esp certain TV shows, even the News!223. Spiritual
JournalingCare for your spirit develop and nurture a supportive spiritual life. Creating a daily mindfulness practice (meditation, awareness pauses, haiku) can be particularly helpful
4. Professional and/or Workplace
Maintain personal/professional life balanceDelegate -- learn to say no; learn to ask for help at home and at workHave a transition ritual between work and homeGet good, regular supervision or consultationWork at the level of your competence; attend workshops and professional training regularlyConsider working partime! What is your ideal schedule?
Action plan: MY self-care ideasShowalter S. American Journal of Hospice and Palliative Medicine. 2010;27(4):239-42.
25AVOID these strategiesBlame othersIgnore the problemMake big decisionsComplain to coworkersWork harder and longerSelf-medicateNeglect your needs, interests and desiresReduce leisure activitiesUnrealistic expectationsLook for easy answersShowalter S. American Journal of Hospice and Palliative Medicine. 2010;27(4):239-42.26Suggestions on ways to use the information from this sessionStart a self care idea collection, including activities for stress relief, stress reduction and stress resilience.START NOW: Pick 1 self-care technique that is new to you and try it outPeriodically complete the ProQOL scale to monitor your compassion satisfaction and fatigueself-care techniques helping?additional support required?Other ways?