Compassion Fatigue The Risk of Living Vicariously

Transcription

1 Compassion Fatigue The Risk of Living Vicariously Rita J. DiBiase, ACNP-BC, ACNS-BC, AOCNS, CHPCN(C) Palliative Care Collaborative:8 th Annual Regional Conference Dearborn, MI October 10, 2014

2 Disclosure I have no financial or other conflicts of interest related to this presentation. Any mention of off-label use of drugs will clearly be mentioned as such. 2

3 Objectives Describe the terms Compassion Fatigue, Vicarious Traumatization and Compassion Satisfaction Identify symptoms of Compassion Fatigue and describe assessment instruments Discuss strategies to prevent, transform and treat Compassion Fatigue and describe Compassion Fatigue resiliency 3

4 Compassion Fatigue (CF) Introduced by Dr. Charles Figley A state of tension & 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 event Persistent arousal Profound emotional & physical exhaustion that helping professionals & caregivers can develop over the course of their careers as helpers Disorder that affects those who do their work well Cost of Caring Figley, C., 1995,

5 Compassion Fatigue (Cont d) The helper suffers through their own efforts to empathize & be compassionate Symptoms may be similar to posttraumatic stress disorder (PTSD) Gradual erosion of connection, empathy, hope, compassion Reduced capacity or interest in being empathic or bearing the suffering of clients Often leads to poor self care & extreme self sacrifice in the process of helping Mathieu, F.,

6 Secondary Traumatic Stress (STS) Earlier term Secondary Traumatization is a precursor & subcomponent of CF, along with burnout Result of bearing witness to a traumatic event Can lead to PTSD-like symptoms Work related secondary exposure to extremely or traumatically stressful events Primary exposure if your work puts you directly in the path of danger Secondary exposure exposed to others traumatic events Symptoms rapid in onset & associated with a particular event Figley, 2005; Stamm,

7 Vicarious Traumatization (VT) Profound shift in that workers experience in their world view when they work with clients who have experienced trauma Find it difficult to get rid of the images & experiences they have shared Cumulative process Pearlman & Saakvitne,

8 Burnout Beth Stamm - a leader in field One element of CF Feelings of hopelessness & difficulties dealing with work or doing your job effectively Difficult work environment, poor pay, little control Feelings that your efforts make no difference Associated with high workload or non-supportive environment Stamm, 2005,

9 Burnout (Cont d) Chronicity, acuity & complexity that is perceived to be beyond the capacity of the service provider Many non helping professionals suffer Gradual onset Frustrated & depleted by their work environment, but did not find their world view changed Can make us more vulnerable to CF and VT Resolved if change jobs - not so with CF or VT 9

10 Compassion Satisfaction The pleasure you derive from being able to do your work well A pleasure to help others Positive about your colleagues Ability to contribute to work and society 10

11 What is the Difference Complementary, yet different CF profound emotional & physical erosion that takes place when helpers are unable to refuel and regenerate VT transformation of world view due to cumulative exposure to traumatic images & stories. Intrusive thoughts, imagery & difficulty ridding ourselves of the experiences recounted STS result of bearing witness to traumatic event or series of events, which can lead to PTSD-like symptoms Burnout stress & frustration in workplace, poor pay, unrealistic demands, heavy workload, poor management, inadequate supervision, any occupation Mathieu, F.,

12 A Wife s Story Being Truly Engaged Makes a World of Difference During Time of Need 12

13 Assessment Assessment Instruments Professional Quality Of Life Scale (PROQOL): Compassion Satisfaction and Fatigue (Stamm, 2010) Trauma Recovery Scale (Gentry, 1996) Silencing Response Scale (Baranowsky, 2002) Global Check Sheet (Baranowsky & Gentry, 1998) Index of Clinical Stress (Abel, 1991) 13

14 PROQOL Compassion Satisfaction Burnout Secondary Traumatic Stress 14

15 Symptoms of CF Irritability with co-workers Most dedicated staff (often humourless) Take on extra responsibilities Come to work early, leave late Feeling overwhelmed with workload Have great difficulty setting limits & going home at end of shift Often worry about pateints or clients Sometimes feel guilty going home to better situation Mathieu,

16 Symptoms of CF (Cont d) Avoiding meetings to busy with client work, staff morale can suffer, miss opportunity to debrief Predictability of client issues Avoiding difficult topics with clients Feeling discouraged about lack of resources moral distress Failure to get a life Fatigue and exhaustion Mathieu,

17 Physical Symptoms Physical exhaustion tired vs depleted Insomnia or hypersomnia Headaches & migraines Increased susceptiblity to illness Somatization & hyperchondria 17

18 Behavioral Signs & Symptoms Increased use of alcohol and drugs Other addictions work, shopping, overeating Absenteeism Anger & irritability Exaggerated sense of responsibility Avoidance of clients Indecisiveness doubt clinical skills Forgetfulness Personal relationship stress Attrition Compromised care for clients 18

19 Behavioral - The Silencing Response Unknowingly silence our clients because information is too distressing to bear Inability to attend to stories/experiences redirect to less distressing topic Changing the subject Avoiding topic Providing pat answers Minimizing client distress Boredom Feeling angry Using humour to change or minimize subject Inattention Gentry, E., & Baranowsky, A.,

20 Psychological S&S Emotional exhaustion Distancing Negative self-image Depression Decreased sympathy & empathy Cynicism and embitterment Resentment Dread of working with clients Professional helplessness Diminshed sense of enjoyment/career 20

21 Psychological S&S Depersonalization Disruption of world view/heighted anxiety or irrational fears Increased sense of personal vulnerability Inability to tolerate strong feelings Intimacy issues Hypervigilance Intrusive imagery Hypersensitivity to emotionally charged stimuli Loss of hope Difficulty separating personal & professional life Failure to nurture & develop non-work-related aspects of life 21

22 Strategies Acknowledge CF, protection, likely not preventable Mitigate, transform & treat Green Cross Academy Standards of Self Care Guidelines for Self-Care Four Steps to Wellness Take stock of your stressors Enhance self-care & work/life balance Resiliency skills Commitment to implement changes Compassion Satisfaction Mathieu, F.,

23 Take Stock Deceptively simple Stop racing & take an internal inventory Body scan Tracking and limiting trauma inputs Exercise What s on Your Plate Say No or Yes Reducing stress Access to support How can your family help Mathieu, F.,

24 Work/Life Balance Take charge of your schedule Flexibility Set realistic & achievable goals Assess your environment, relationships, finances, work Body, mind & spirit Scheduled time for yourself exercise, downtime, enjoyable activities Resist filling up free time Mathieu, F.,

25 Self-Care Sleep, rest Nutrition mindful eating Exercise Vacations Rejuvenating activities Manageable work schedule Regular debriefing Mathieu s Must Be Nice warning Time for yourself every day Saying No Self-Care Inventory Mathieu, F.,

26 Self-Care Self-Care Inventory Physical Psychological Emotional Spiritual Workplace Balance Mathieu, F.,

27 Compassion Fatigue Resiliency Improved self-awareness Dealing with stress Mindfulness-based stress reduction Kabat-Zinn Nurses had reduced symptoms of CF, were calmer and more grounded (Cohen-Katz, et al., 2005) Psych grad students decreased stress, negative affect, rumination, anxiety, increase in positive affect and self compassion (Shapiro, Brown & Biegel, 2007) Trauma stewardship - work with distress, remaining grounded in self-awareness (van Dernoot Lipsky, 2009) Somatic empathy & hyperarousal (Rothschild, 2006) 27

28 Compassion Fatigue Resiliency (Cont d) Neurophysiology Somatic empathy Hyperarousal Empathy regulation Autonomic nervous system & arousal regulation Clear thinking Rothschild,

29 Commitment to Change Work with someone who will hold you accountable Short term goals Long term changes Compassion Satisfaction Why did I choose this work? Deeply rewarding explore these rewards Reflective writing 29

30 Principles Two important principles Development & maintenance of intentionality through a non-anxious prescence in both personal and professional spheres Development & maintenance of self-validation, especially self-validated caregiving Gentry, E.,

31 Accelerated Recovery Program Resiliency skills Skills acquisition Self-care Internal conflicts Connection with others Baranowsky & Gentry,

32 ARP Session 1 Assessment Session 2 Time-Line Narrative / Telling the Story Session 3 Desensitization & Reprocessing Session 4 Self-Supervision Session 5 Closure 32

33 Another Wife s Story It Happened Right Before My Eyes 33

34 Thank You! Questions / Comments rdibiase@sympatico.ca 34