Your 5/14/15 Pre-Evaluation Results

1. NURSING’S OTHER CALLING -Caring For Your OWN HEART (Part 2)Thursday, October 16, 2015South Carolina Society of ChaplainsSession #2Speaker: Rev. Dr. Terry Irish, D. Min., BCCCity of Hope National Medical CenterDuarte, California

2. Your 5/14/15 Pre-Evaluation Results SCALE N = 27 1 2 3 4 5 STRONGLY DISAGREE NEUTRAL AGREESTRONGLY DISAGREEAGREE • You know your strengths, how to use them to help, support colleagues, care for patients. 26 of 27 scored 4 or 5 • You know your weaknesses, how to deal with them to protect yourself, family, colleagues, and patients. 23 of 27 scored 4 or 5 • You can say “No!” without feeling guilty, making an excuse why not, or becoming defensive. 15 of 27 scored 4 or 5

3. Your 5/14/15 Pre-Evaluation Results SCALE N = 27 1 2 3 4 5 STRONGLY DISAGREE NEUTRAL AGREESTRONGLY DISAGREEAGREE • You know how to do good “self-care” , take care of family, be effective co-worker/colleague, perform job at highest level, and be contributing citizen in world. 21 of 27 scored 4 or 5 • If you experience stressful/disturbing incident at work, you know how to “Self-Debrief” to process event, learn and grow, so you will not experience long-term personal/professional harm. 15 of 27 scored 4 or 5

4. Your 5/14/15 Pre-Evaluation Results SCALE N = 27 In the list below, please check box of any statement that describes how you have felt in the past several months, since the beginning of 2015. Hypervigilance & exaggerated startle response – being on guard & jumpy. 4 of 27 checked this box Irritability or angry outbursts. 15 of 27 checked this box Nightmares & trouble falling or staying asleep. 9 of 27 checked this box

5. Your 5/14/15 Pre-Evaluation Results SCALE N = 27 In the list below, please check box of any statement that describes how you have felt in the past several months, since the beginning of 2015. Emotional numbness, lack of interest in activities & difficulty feeling love & joy. 9 of 27 checked this box Avoiding thoughts & situations that are reminders of a traumatic event. 9 of 27 checked this box

6. Your 5/14/15 Pre-Evaluation Results SCALE N = 27 In the list below, please check box of any statement that describes how you have felt in the past several months, since the beginning of 2015. 5 Common Symptoms of Post-Traumatic Stress Disorder (PTSD) Important notes: Of the 27 Pre-Evaluations completed May 14th: 6 checked 3 of the 5 Common Symptoms of PTSD 2 checked 4 of the 5 Common Symptoms of PTSD 1 checked all 5 Common Symptoms of PTSD

7. Your 7/9/15 Post-Evaluation Started today’s Session with same Evaluation questions as 5/14. DNE and I wanted to see how much progress you each feel you have made in past 8 weeks. Question (honest answer, please): How many of you have used ANY of the handouts you received on May 14th to help you address some issues that are most pressing/distressing right now. If so, which handouts did you find most helpful?

8. Realities of Care Fatigue • Chronic bereavement Multiple losses, anticipatory, unresolved grief • Compassion fatigue “The development of negative professional attitudes and behaviors as a result of job strain. Work Environments can cause job strain when the worker experiences frustration, powerlessness, and an inability to achieve work goals.” (Puchalski & Ferrell, 2010) • Burnout “… is a response to the work environment and not to the consequences of caring for people who are suffering.” (Puchalski & Ferrell, 2010) • Particular stressor Feeling inadequate due to inability to alleviate others’ suffering (Bright, 1996; Hooyman & Kramer, 2006; Vachon, 2000.)

9. Realities of Care Fatigue • Stress, cumulative loss, and emotional labor can negatively impact those who care for the chronically ill and dying and can diminish their ability to provide effective care; • Therefore, it is imperative to provide staff with self-care education and opportunities to reflect and process grief to ensure their well-being. (Nevidjon, 2004; Vachon, 2010; Ferrell & Coyle, 2010)

10. Self-Care at Work • Recognize stress as an occupational hazard of trauma work • Accept your reactions as normal responses to specialized work • Limit exposure to trauma material • Books-conferences-discussions-movies (Pizanti, 2006)

11. Self-Care at Work • Develop supportive environment for discussing own reactions to work • Build a network of professional connections • Consider personal counseling to work through issues • Make use of the COH EAP – Employee Assistance Program (Pizanti, 2006)

12. Self-Care at Work • Develop supportive environment for discussing own reactions to loss • Work within supportive organization • Set and maintain clear boundaries on therapeutic relationships

13. Self-Care Resources Processing a Death ~ Sample Priming Questions • How did you find out the person died? Were you there or did someone call you? • If you were present, when he or she died, what was that experience like? • Can you identify ways in which this death brought up some experiences of loss from your past? • How has dealing with losses in the past prepared you to deal with the losses you face now? In what ways do you feel ill-prepared? • What good memories do you have of the person who died? Think or write a bit about one of those good memories. (Nichols, 2012)

14. Self-Care at Work Spiritual care of Nurses • Identify self-violence, suffering or injury • Empower nurses to care for themselves & others • Promote spiritual, psychological and physical abundance - not scarcity (Pizanti, 2006)

15. Self-Care Resources Explore your own beliefs and values * Think of a time when you faced a major life transition, change or loss. How did it affect you spiritually? How did your spirituality affect the experience? Did you discover spiritual strength during that time? How did you want to be supported spiritually? *From “Offering Spiritual Support For Family or Friends” http://www.caringinfo.org/UserFiles/File/faith_brochure.pdf

16. Self-Care at Home • Take time to laugh, have fun, socialize with co-workers • But not about work • Seek spiritual renewal in your life • Worship – prayer – Scripture + + + (Sacred text) • Emphasize self-care and self-nurturing activities (Pizanti, 2006)

17. Self-Care at Home • Take sabbaticals from trauma work – if possible • Take mental health breaks purposefully

18. Self-Care at Home • Develop hobbies, sports and creative interests • Develop restful, meditative activities • Yoga, music, reading, gardening… • Nurture supportive relationships and roles for yourself outside work

19. Self-Care at Home • Use nature as a healing force in life • Guard against addictive behaviors • Be rested, fit and eat well • Set clear boundaries between home and work • Use clothing/rituals to mark change from work to leisure

20. Self-Care at Home • Nurture a sense of joy, grace, beauty, love and connection in life • Seek out experiences which instill comfort and hope • Connect with community and friends +++

21. Your compassionate presence makes a difference Your presence and compassionate, listening ear are the two most important tools you bring to any intervention. (Stanley, 2002) Compassionate Presence = A Way of Being (Nichols, 2012)

22. Intervention — Health care Professionals Patient Communication • Compassionate presence and follow-up • Reflective listening/query about important life events—spirituality as connection • Support patient sources of spiritual strength and note in chart • Connect patient to community resources • Referral to chaplain or other spiritual care professional (Puchalski, 2014)

23. HANNAH - 2010

29. “My Best Day Ever!”

30. HANNAH - 2014

32. Your Destiny “I don’t know what your destiny will be, but one thing I know. The ones among you who will be really happy are those who have sought and found how to serve.” -- Albert Schweitzer

33. Finding Yourself "The best way to find yourself is to lose yourself in the service of others." -- Mahatma Gandhi

34. QUESTIONS?

35. THANK YOU Chaplain Terry Irish tirish@coh.org 626.256.4673 Ext. 85781 Pager 626.423.0023

36. BIBLIOGRAPHY Anandarajah, Gowri and Hight, Ellen. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. Am Fam Phy 63(1):81-88, 2001. Bright, R. (1996) Grief and Powerlessness: Helping People Regain Control of Their Lives, (165-167). London: Kingsley. Ferrell, B. R., & Coyle, N. (Eds.). (2010). Textbook of palliative nursing (3rd ed.). New York, NY: Oxford University Press. Fitchett, G., & Canada, A. L. (2010). The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention. In J. C. Holland (Ed.). Psycho-oncology, 2nd Edition. New York: Oxford University Press. Hooyman, N. R., & Kramer, B. J. (2006). Living Through Loss: Interventions Across the Life Span, (347-360). New York: Columbia University Press. Nevidjon, M. (2006). Managing from the middle: Integrating midlife challenges of children, elder parents, and career. Clinical Journal of Oncology Nursing, 8(1), 72-75. Nichols, S.W. Mitigating Care Fatigue in Palliative Care Providers: Developing Self-Awareness and Self-Care. Archstone Foundation Grant Teleconference, March 4, 2012. Osterman, Paulette, and Schwartz-Barcott, Donna. Presence: Four Ways of Being There. Nurs For31(2):23-30, April-June, 1996. Peery, B. (2009. What’s in a Name? PlainViews, 6(2). Perez, Jacqueline C. Healing Presence. Care Manage J 5(1):41-46, Spring, 2004.

37. BIBLIOGRAPHY Puchalski, C., & Romer A.L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3 (1), 129-137.  Puchalski, CM, Ferrell, B, Virani, R, Otis-Green, S, Baird, P, Bull, J, Chochinov, H, Handzo, G, Nelson-Becker, H, Prince-Paul, M, Pugliese, K, Salmasy, D. Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference. J Palliat Med 2009; 12:885-904. Puchalski, CM, Ferrell, B. (2010). Making Healthcare Whole – Integrating Spirituality into Health Care. West Conshohocken, PA: Templeton Press. Puchalski, CM, Handzo, G, Prince-Paul, M, Otis-Green, S. Improving the Spiritual Domain of Palliative Care. American Academy of Hospice and Palliative Medicine, Preconference workshop, San Diego, March, 2014. Spiritual Care of the Nurse, CH (MAJ) Robin W. Pizanti, RN. Stanley, Karen J. (2002). The Healing Power of Presence: Respite From the Fear of Abandonment. Onc Nurs For 29(6):935-940 . Vachon, M. (2010). The experience of the nurse in end-of-life care in the 21st century. In B. R. Ferrell, & N. Coyle (Eds.), Textbook of palliative nursing (3rd ed., pp. 1011-1029). New York: Oxford University Press. Vachon, M.L.S. (2000) Burnout and Symptoms of Stress in Staff Working in Palliative Care. In H.M. Chochinov & W. Breitbart (Eds.), Handbook of Psychiatry in Palliative Medicine, (303-319). New York: Oxford University Press. Wolfelt, AD. (2002). Healing A Parent’s Grieving Heart. Fort Collins, CO, Companion Press.