Compassion FatigueMelanie Johnson

Rosario FernandesJune 2011

Relevant quotesFrom physicians

“All 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 Figley“The 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 is- describe an example of compassion fatigue in

the context of their own practice- recognize signs/symptoms of compassion

fatigue- create a compassion fatigue ‘action plan’ to

prevent/manage development of compassion fatigue

What 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’ pain

A ‘cost of caring’ for others in emotional painAlso described as ‘secondary traumatic

stress’

Compassion 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)

Compassion fatigueThe Gentry/Baranowsky (1997) Model of Compassion

Fatigue

PRIMARY TRAUMATIC STRESS+/x (synergistic effect)SECONDARY TRAUMATIC STRESS+/x (synergistic effect)BURNOUT____________________________________= COMPASSION FATIGUE

Compassion satisfaction-Compassion fatigue Model

Professional Quality of Life

Compassion Satisfaction

Compassion Fatigue

Burnout

Secondary

Trauma

From: http://www.proqol.org/Customize_a_Presentation.html

Burnout and Secondary traumatic stress (STS): Co Travelers• Burnout

– Work-related hopelessness and feelings of inefficacy

• Secondary traumatic stress (STS) – Work-related secondary exposure to extremely

or traumatically stressful events• Both share negative affect

– Burnout is about being worn out– STS 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 fatigue

Free tool 30-item self-reportUsed for over 15 yearsAvailable in multiple languages

Available at: http://www.proqol.org/ProQol_Test.html

Pre-inservice assignment: ProQOL scale discussion

What are signs and symptoms of compassion fatigue

Signs and symptoms of compassion fatigue (Gentry 1997)

Intrusive symptoms

Avoidance symptoms

Arousal symptoms

Intrusive symptoms

thoughts/images associated with client’s trauma

obsessive/compulsive desire to help certain clients

inability to let go of work-related mattersthoughts/feelings inadequacy as a caregiver

Avoidance symptoms

loss of enjoyment in activities/cessation of self care activities

loss of hope/sense of dread working with certain clients

loss of sense of competence/potencysecretive self-medication/addiction

Arousal symptoms

increased anxiety, impulsivity/reactivityincreased frustration/angersleep disturbancedifficulty concentrating

Compassion fatigue trajectoryZealot phase

Keen, committed, enthusiastic, extra hoursIrritability phase

Cut corners, avoid pt contact, mocking, daydreamWithdrawal phase

Exhausted, clients become irritants, neglect (family, coworkers, clients, ourselves)

Zombie PhaseAutomatic pilot, distain for clients, no compassion, no

patiencePathology and Victimization vs. Renewal and Maturation

Overwhelmed, ill, leaving profession vs. transformation/resilience

Initially from Jan Spilman 2010 inservice: Caring on empty: creative tools for compassion fatigue transformation and resilience

What 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 style

Enneagram

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?

Self 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 language

Assess and reduced your trauma inputs – use low impact disclosure and teach it to others*

3. 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 ideas

AVOID these strategiesBlame othersIgnore the problemMake big decisionsComplain to coworkersWork harder and longerSelf-medicateNeglect your needs, interests and desiresReduce leisure activitiesUnrealistic expectationsLook for easy answers

Suggestions on ways to use the information from this session…Start 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 out

Periodically complete the ProQOL scale to monitor your compassion satisfaction and fatigueself-care techniques helping?additional support required?

Other ways?