Compassion Fatigue: Keeping us Healthy Enough to Care

Transcription

1 Compassion Fatigue: Keeping us Healthy Enough to Care Peter Bjerkerot RN, OCN 1339 Normandy Drive Atlanta, GA WebPage

2 Full Disclosure Statement Celgene Nurse Advisory Boards (Breast, NSCLC, Pancreatic) Nurse Speaker s Bureau Pfizer Oncology Nurse Advisory Boards (Colorectal & Breast) Nurse Speaker s Bureau ProStrakan Speaker s Bureau Novartis Nurse Advisory Board

3 Definitions For This Presentation Compassion--Being open to/moved by suffering of others Empathy-- The ability to experience the experiences of someone else The ability to feel for another person, to imagine ourselves in the same situation, enduring those same experiences and emotions Human beings who spend time with other human beings who are empathetic tend to feel better Empathy begins with the involuntary: a shared emotion- this is hardwired into the brain 2/21/2014

4 Empathic Process Identification - projecting ourselves into the identity of another Incorporation - taking the experience of the other into ourselves Reverberation - feeling the experience through vicarious cognition and somatic experiencing Detachment - withdrawal from the other to gain reason and scrutiny through a more objective perspective Loss of ability to detach may lead to compassion fatigue Reik, Theodore. (1948) Listening with the Third Ear: The inner experience of a psychoanalyst. New York: Grove Press.

5 Role of Mirror Neurons on Empathy Mirror neurons first discovered when studying monkeys Certain regions of the brain were activated when monkeys performed an action and when they observed someone else doing the same action In human brains mirror neurons are involved in learning language, imitating motions and in understanding others intentions and mental states. Mirror neurons in the human brain are indicated in the person s ability to feel empathy Accessed 2/25/2014

6 Empathic Engagement * Input from an event Witnessing an event someone else is experiencing Mirror neurons activated * Actual feelings get formed (fear, * anger, sadness) Intrusive images/painful * emotions occur Unconscious Brain unable to differentiate (yours/theirs) Recollections remain Become internalized Multiplied over and over by exposure to more patient traumas Manifests as symptoms * Compassion Fatigue *

7 Compassion Fatigue (CF) May also be called secondary traumatic stress (STS) A condition characterized by a gradual lessening of compassion over time Common among individuals that work directly with trauma victims such as nurses, psychologists, and first responders.* First diagnosed in nurses in the 1950s. *"Compassion Fatigue - Because You Care". St. Petersburg Bar Association Magazine. Retrieved February 2007.

8 History of Understanding of CF Concept described in 1992* Furthered by research on trauma and negative effects of helping** Biopsychosocialspiritual reactions known for past 150 years Empirical research slow to develop in this area Also known as the cost of caring ** *Joinson, Coping with Compassion Fatigue. Nursing, 22:4, ) **Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel.

9 Who Is At Risk for Compassion Fatigue? Any person delivering health care to patients who have experienced some level of trauma or suffering We as Oncology Nurses are: Highly motivated, high expectations, highly trained and highly skilled Trained in an intensely criticism-laden environment Taught, trained, and rewarded for sacrificing own live for patient needs

10 Who Is At Risk for Compassion Fatigue? Any Professional bearing witness to suffering It s not a question of whether or not caregivers will hurt in the course of treating, but how they will handle it when it happens idealism is part of the nature of medical professionals and caregivers Bloom, SL (2003) Caring for the caregiver: Avoiding and treating vicarious traumatization GW Medical Publishing, (pp )

11 Causes of Compassion Fatigue Bearing witness to suffering Lack of replenishment Unresolved personal trauma Pain in powerless people Loss of patients Witness to death and dying while performing duties - first hand exposure Multiple roles Lack of social support Not appreciating the dangers of empathy Rothschild, B., (2000). The Body Remembers. New York: Norton

12 S&S: Changes in Behavior Impatient Irritable Withdrawn Nightmares Hypervigilance Losing things Appetite changes Regression Increased startle response Moodiness Accident proneness Risk taking Addictive behaviors Lack of self care

13 S&S: Feelings Anxiety Guilt Anger/rage Sadness Fearfulness Shutdown Survival guilt Numbness Depression Emotional roller coaster Overly sensitive Depleted

14 S&S: Workplace Issues Low morale and motivation Errors in judgment Increasing transference/counter issues Poor communication Staff conflicts Apathy Absenteeism Withdrawal Late for work Stigma - Fear of being perceived as weak

15 The Three Truths Truth #1: No one is immune to the effects of secondary traumatic stress - Choose fast or slow burn Truth #2: The more dependent on work for worth and adequacy = less resiliency Truth #3: For all the pain, the symptoms are an alert to take action Damasio, A., (1999). The Feeling of What Happens. New York: Harcourt Brace

16 SHARED EXPERIENCE COMPASSION SATISFACTION AND COMPASSION FATIGUE (PROQOL) VERSION 5 (2009) For today s exercise: Change the word [help] to care for Change the word [helper] to nurse Accessed 2/25/2014

17 Compassion Satisfaction Compassion satisfaction is about the pleasure you derive from being able to do your work well Higher scores on this scale represent a greater satisfaction related to your ability to be an effective caregiver in your job. Accessed 2/25/2014

18 Compassion Satisfaction Scale

19 Compassion Satisfaction Average score is 50 About 25% of people score higher than 57 and about 25% of people score below 43. If you are in the higher range, you probably derive a good deal of professional satisfaction from your position. If your scores are below 40, you may either find problems with your job OR you might derive your satisfaction from activities other than your job There may be other reasons as well Accessed 2/25/2014

20 Burnout Most people have an intuitive idea of what burnout is From the research perspective, burnout is one of the elements of Compassion Fatigue (CF) It is associated with feelings of hopelessness and difficulties in dealing with work or in doing your job effectively They can reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or a non-supportive work environment Higher scores on this scale mean that you are at higher risk for burnout. Accessed 2/25/2014

21 Burnout Score

22 Burnout The average score on the burnout scale is 50 About 25% of people score above 57 and about 25% of people score below 43. If your score is below 43, this probably reflects positive feelings about your ability to be effective in your work. If you score above 57 you may wish to think about what at work makes you feel like you are not effective in your position. Your score may reflect your mood today Perhaps you were having a bad day or are in need of some time off. If the high score persists or if it is reflective of other worries, it may be a cause for concern. Accessed 2/25/2014

23 Secondary Traumatic Stress The second component of Compassion Fatigue (CF) is secondary traumatic stress (STS). It is about your work related, secondary exposure to extremely or traumatically stressful events. Developing problems due to exposure to other s trauma is somewhat rare but does happen to many people who care for those who have experienced extremely or traumatically stressful events Accessed 2/25/2014

24 Secondary Traumatic Stress Score

25 Secondary Traumatic Stress The average score on this scale is 50 About 25% of people score below 43 and about 25% of people score above 57. If your score is above 57, you may want to take some time to think about what at work may be frightening to you or if there is some other reason for the elevated score. While higher scores do not mean that you do have a problem, they are an indication that you may want to examine how you feel about your work and your work environment. You may wish to discuss this with your supervisor, a colleague, or a health care professional. Accessed 2/25/2014

26 Biology and Happiness Our brains are not trying to make us happy They are trying to regulate us to help us survive. Biologically we are driven to survive, not to become happy. Once we feel safe in terms of survival, issues like desires, pleasures and happiness, become more prominent A. H. Maslow (1943) A Theory of Human Motivation Originally Published in Psychological Review, 50,

27 Research-based suggestions for Improving mood, Increasing life satisfaction and Mitigating Compassion Fatigue Recognize the risks for your self Find a way to debrief distressing material Work on self awareness every day Take an inventory of how balanced your life is-be intentional about balancing it out Evaluate your tension reducing behaviors Be intentional about protecting yourself

28 Becoming Happier Don t deny negative emotions [fear, sadness, anxiety] move toward them and accept them. Intersect pleasure and meaning central. It is not state of status or bank account mind is what matters most. Spin fewer plates: Do the obvious: Express Gratitude Squeeze in less. Sleep, Exercise, Eat interests are state of In yourself and in others

29 Take Care of Your Self Physical Self Care Psychological Self Care Emotional Self Care Spiritual Self Care Workplace Self Care Strive for balance with your work life and work day Strive for balance among work, family, relationships, play and rest

30 Knowing others is intelligence; knowing yourself is true wisdom. Mastering others is strength; mastering yourself is true power. Tao Te Ching Tao Te Ching by Lao-tzu. (J. Legge, Translator)(Sacred Books of the East, Vol 39) [1891]

31 Peter Bjerkerot RN, OCN 1339 Normandy Drive Atlanta, GA WebPage Thank you Any Questions???