Healing the Heart of the Critical Care Nurse:Combating Compassion

FatiguePreventing Burn-out

Michelle A Post, MA, LMFTClinical Aftercare SpecialistOneLegacy, Downtown Los

Angeles mpost@onelegacy.org

213-229-5687

Objectives

1) List 3 warning signs of compassion fatigue

2) Utilize a check-list tool to assess levels of compassion fatigue in self/others

3) Develop self-care plan for daily, weekly, monthly, and yearly renewal that includes self-care techniques

4) LAUGH!

Tell me and I'll forget. Show me and I'll remember.

Involve me and I'll understand.- Confucius

Wise Quote…

Quick Surveys:

• How many of you feel on-the-job stress, or stress in your life as a side effect of your job?

Quick Surveys:

•How many of you deal with chronic pains or illness of some sort?– Headaches– Back or neck pain– Digestive problems (IBS, Diarrhea, Stomach aches,

or Constipation)– High Blood Pressure– Knee pain, arthritis, joint pain– Circulatory or neurological symptoms– Shortness of breath– Or others

Quick Surveys:

•How many of you believe that the mind is connected to the body?

2 examples-Problem focus-Lemon

aka Practitioner Decay?aka Vicarious Trauma?

What is Compassion Fatigue?

Signs and Symptoms

What are the Warning Signs?

aka Vicarious Trauma?aka Practitioner Decay?

What is Compassion Fatigue?

Symptoms?

How Does This Affect Me?

Fatigue

Sadness

Sleep Disturbance

Irrita

bility

Frustration

Weight

Change

Take Are You Burning Out Survey

“You cannot pour from an empty pitcher”

Compassion FatigueTrajectory

Which Phase describes where you are?

a) The Zealot Phaseb) The Irritability Phasec) The Withdrawal Phased) The Zombie Phasee) Pathology vs. Renewal/Maturation

Adapted from Charles R. Figley

*Make a note about which phase describes you as we discuss them. ARS later.

Zealot Phase

•Committed, involved, available•Solving problems/making a

difference•Willingly go the “extra mile”•High enthusiasm•Volunteers without being asked

Adapted from Charles R. Figley

The Irritability Phase

• Begin to cut corners• Begin to avoid clients/patients• Begin to mock co-workers and clients• Begin to denigrate the people we

serve• Use of humor is inappropriate• Oversights, mistakes and lapses of

concentration• Start distancing ourselves from

friends and coworkersAdapted from Charles R. Figley

The Withdrawal Phase• Enthusiasm turns sour• Clients become irritants, instead of

persons• We make complaints about our work

life and our personal life• Tired all the time, don’t want to talk

about what we do.• We start to neglect our family,

clients, coworkers and ourselves• We try to avoid our pain and sadness

Adapted from Charles R. Figley

The Zombie Phase

• Our hopelessness turns to rage• We begin to hate people…any/all people• Others appear incompetent or ignorant

to us• We develop a real distain for our clients• We have…no patience…no sense of

humor…no time for fun

Adapted from Charles R. Figley

Pathology and Victimization vs.Maturation and Renewal

• Overwhelmed and leaving the profession

• Somatic Illness• Perpetuity of Symptoms

orHardinessResiliencyTransformation

Adapted from Charles R. Figley

Compassion FatigueTrajectory

Which Phase describes where you are?

a) The Zealot Phaseb) The Irritability Phasec) The Withdrawal Phased) The Zombie Phasee) Pathology vs. Renewal/Maturation

How Does This Affect Me?

See

Symptoms of Compassion

Fatigue Handout

How Does This Affect Me?

Compare Symptoms of Compassion

Fatigue

With

Normal Grief Handouts

Compassion Fatigue – it exists!

–www.compassionfatigue.org

Tell me and I'll forget. Show me and I'll remember.

Involve me and I'll understand.- Confucius

So, we have it!Now, What Do We DO?

•Be gentle with yourself.

• You are a helper, not a magician. You cannot change anyone else; you can only change how you relate to them.

• Give support, encouragement and praise to your peers and supervisors. Learn to accept praise in return.

• Remember: Feeling helpless at times is normal. Admit it without shame. Caring and being there are often more important than DOING.

How can you care for yourself?

• Change your routine often and your tasks when you can.

• Recognize the difference between complaining that RELIEVES and complaining that reinforces negative stress.

• Before going to bed at night, focus on a good thing that occurred during the day.

How can you care for yourself?

•Be CREATIVE!•Seek affirmation and re-

direction from your peers and supervisors.

•Avoid “shop talk” when socializing with peers.

•Schedule “withdraw” periods during the week, and strictly limit interruptions to this time away from your usual tasks.

How can you care for yourself?

• Change your vocabulary: – Say “I CHOOSE” instead of “I should,

I ought to or I have to.” – Say “I won't” rather than “I can't.”

• If you never say “NO”, what is your “YES” worth?

• Frustration and irritability are far more harmful than admitting you’re unable to do something.

• PUT A LOT OF LAUGHTER AND JOY IN THE FABRIC OF YOUR LIFE.

How can you care for yourself?

Research & Studies that support journaling as a way of improving health

- James Pennebaker - Stephen J. Lepore - Annette Stanton, Ph D - Ariel Gore (Body & Soul, March 2010)

some scientific research shows that brief, intense bursts of emotional release writing – 15-20 min/day for 4 consecutive days – is

directly related to increased immune system functioning which can last for several weeks.

Again….Explore Your Own

GriefTake sometime to self-reflect.

Adapted from J. William Worden, Ph.D.: Personal Death Awareness

Where to Start?

Exploring Your Own Grief

1) How do you know when you are coping well? How do you know when you are not coping well?

Two we are going to discuss:

Exploring Your Own Grief

2) How has your work affected your views about grief and loss?

Two we are going to discuss:

Write down what you do to take care of yourself over

the last year:Daily?

Weekly?Monthly?Yearly?

What do you do to care for yourself?

Do these address your needs on various levels of self care?

PHYSICALNUTRITIONAL

SPIRITUALSOCIAL

EMOTIONAL

What do you do to care for yourself?

Ideas to BEEF IT UP!!!!

What do you do to care for yourself?

Easy ideas for daily/weekly:

-Take a break from watching news

-Biofeedback w Meditation

-Laughing Yoga(Experiential)

What do you do to care for yourself?

Easy ideas for daily/weekly:

Cotton Ball with Nice Smell

-take one home

What do you do to care for yourself?

Research about Pet Scans, Healing, and Creativity

Easy ideas for weekly/monthly:

Free Flow Writing/Poetry w

timer

What do you do to care for yourself?

Rituals to say good bye in crisis work or grief work:

How do you say goodbye to clients who die?

How do you say good bye to your work day?

Mementos - Crafts -My Worry Doll

-Grover -– Funny Pens-Space on your

desk

ME>>>> DODGERS!!!

Weekly/Monthly?

Easy ideas for weekly/monthly:

• Art work • Bubbles*** (release your

stress and pop the bubbles)

• Play – Parachute • Swing on the swings

at a park, walk in mud

What do you do to care for yourself?

Office Olympics

orPageant of the

Masters

Music / Dance - Bird

Yearly Self Care Ideas?

- Vacation on a Va-Cobligation

Yearly Self Care Ideas?

- Vacation on a Vacobligation

Yearly Self Care Ideas?

-Scrapbook – particularly changes or

losses in life

Your Other Ideas?

Now, add one item to your:Daily

WeeklyMonthlyYearly

Your Other Ideas?

Do these address your needs on various levels

of self care?PHYSICAL

NUTRITIONALSPIRITUAL

SOCIALEMOTIONAL

Closing~Fingerprints