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As Victor Frankl writes, “That which is to give light Must endure burning.”

Coping with Families/Keeping Your Sense of Balance Alex Chamberlain, M.Div., BCC Revised by Kelly Loy, M.Div., BCC St. Luke’s Regional Medical Center. As Victor Frankl writes, “That which is to give light Must endure burning.”. Stress test. Reality is the leading cause

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As Victor Frankl writes, “That which is to give light Must endure burning.”

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  1. Coping with Families/Keeping YourSense of BalanceAlex Chamberlain, M.Div., BCC Revised by Kelly Loy, M.Div., BCCSt. Luke’s Regional Medical Center

  2. As Victor Frankl writes, “That which is to give light Must endure burning.”

  3. Stress test

  4. Reality is the leading cause of stress among those in touch with it. And families can push Our buttons like nothing else!

  5. Families include: • Birth parents • Adoptive parents • Siblings • Stepfamily • Significant Others / Spouses • “Ex” spouse / Family • Cousins, aunts, uncles • Grandparents

  6. Hospitalization often evokes a crisis for family, staff, & MD’s • Ours: clinical situation, staffing issues, time constraints, moral distress, conflicts between disciplines • Theirs: Absence from work, presence of invasive technology, patient’s diagnosis, prognosis, pain, and unresponsiveness • So?? Timing can differ. We respond professionally to the family’s crisis, even if we see it differently or are experiencing our own stress.

  7. Generally, we meet two kinds of families: • Intact Families • Crazy-Making Families

  8. Intact Families… • Normally manage life well. Can handle finances, life transitions, employment, etc. • Hospitalization of a loved one creates stress; usual coping skills are stretched. Life gets out of alignment, where the usual sense of balance is temporarily lost. • Anger, fear, unreasonable expectations (of self, family, patient, modern medicine), tears, withdrawal, and tensions among family members all occur to varying degrees.

  9. Intact Families, Cont. • We can empathize with them, because we are them at times. • They can partner with us to benefit the patient, expressing gratitude appropriately and validating our calling to health care. • The Intact Family enters our world.

  10. Crazy-Making Families • The Crazy-Making family brings us into their world - and we can inadvertently be sucked into their dynamics, dysfunction, and disarray • Crazy-Making families broadly fall into two types: • Chaotic • Controlling

  11. Chaotic Families… • May have less education, finances, family cohesiveness, or communication skills. • Carry problems/dysfunction in ways that run from minor to major, and acute (recent struggles) to chronic (passed down from generation to generation.) • Crisis is normal: may not appear as distressed as the intact family. They are often self-absorbed and ask few questions. • Can lead us to bond with the patient over/against family, as protector.

  12. Controlling Families… • May be professionals in their own field, financially secure, and are used to controlling their own destinies. • Want to call the shots rather than roll with the punches. • Can name a good lawyer, who happens to be a family friend. They not only ask questions, they question the meds, dosages, tests, cleanliness of the room, size of the room, etc.

  13. What doesn’t work: • Reacting rather than responding • Defending yourself, coworkers, St. Luke’s • Yelling, stomping your foot! • Questioning your calling to healthcare • Wishing they would behave differently • Complaining to those who can’t help • Accepting, Accommodating, Avoiding

  14. What works…sometimes: • Assessing: Difficult person or Difficult situation? • Is their behavior today out of character? • Was there a particular incident that triggered their behavior? • Will direct, open conversation help the situation or exacerbate it? • Is there someone in the family who is coping well who can be the point person to whom we relate?

  15. What works…Sometimes, Cont. • Learn to respond rather than react. • Notice: My reaction vs. others • Attempt to reorient everyone’s energy toward what is best for the patient. • Count to ten…literally. Go to a break room and “chill.” Temporarily getting some distance physically for self-care is not the same as avoiding someone or something. • Don’t try to change them: you are not their therapist!

  16. What you might say… • Ask open ended questions using “I” and “We” language. Avoid using “You should…” or “You need to…” • Ask, “I wonder what would help us get a fresh start?” (Even if they list complaints, they are still providing information.) • Say, “Let’s try to narrow it down to one or two key things and work on a solution together.”

  17. What you might say…Cont. • Ask, “I need some help understanding what your greatest concern is today.” • Or, “As family, what do you need?” Remember: Timing is everything! • Ask, “When would be a good time for you so we can review how things are going?”

  18. Enlist help from other disciplines… • Social work • Chaplain • Case Manager • Ethics Committee • Security • Patient Relations

  19. When do you need help? Know Yourself How are you thinking about your professional role? • Meaningful and Rewarding? • Difficult and Painful? Right!

  20. Stress / Compassion Fatigue / Burnout • Stress: “I don’t have the energy to do my job.” • Compassion Fatigue “It hurts too much to do my job.” • Burnout: “I don’t want to do my job.”

  21. Compassion • A feeling of deep sympathy. Com = with Passion = suffer • Often accompanied by a strong desire to alleviate another’s pain or remove its cause

  22. Compassion Vs. Over-Identification “It moved me” “That family touched me” “I took them home with me (inwardly!)” Vs. “That blindsided me” “I felt overwhelmed” “I’ll never be the same”

  23. Compassion Fatigue • State of tension and preoccupation with individual or cumulative trauma of patients/clients. • Re-experiencing traumatic events • Avoidance/numbing of reminders Figley, 1982

  24. Compassion Fatigue Indicators • Insomnia • Dizziness • Aches and Pains • Impaired Immune system • Lowered concentration • Decreased self esteem • Apathy • Anger/Rage • Fear • Sadness

  25. How are you coping? • Chronically using alcohol, drugs, food, or other substances for comfort or avoidance • Blaming, complaining, whining • Looking for a new job, new car, new spouse when your situation is likely to be temporarily overwhelming

  26. Daily Coping Skills: Practice! • Boundaries • Learn how to “waste time” • Learn how to transition between work and home; be intentional • Make Connections: Peers, Family, Friends

  27. Cultivating Resiliency • Make connections • Tolerate change • Face fears • Cognitive flexibility (be willing to reframe) • Be realistic • Accept one’s humanity • The use of humor • Affirmations

  28. Be attentive to yourself: There is a difference between:Prevention (Resilience)andKnowing when to get help after the fact

  29. When to get help • Others can provide reality check • What is your “canary in the coalmine”? • Have you lost the ability to play? • When the symptoms of stress, compassion fatigue, or burnout are unrelenting • When you wonder if you need help

  30. Remember… “To share often and much… to know even one life has breathed easier because you have lived. This is to have succeeded.” - Ralph Waldo Emerson

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