Living Well While Caring for Others

1. Living Well While Caring for Others Rev. Ann Sidney Charlescraft, DMin, BCC Chaplain for Staff Ministries Department of Chaplaincy & Pastoral Education Division of Faith and Health Ministries Wake Forest Baptist Medical Center Winston-Salem, NC 27106 acharles@wakehealth.edu 336.716.9647

2. Traumatic Stress You can’t describe it unless you’ve seen it. You can’t explain it unless you’ve done it. You can’t imagine it unless you’ve been there Then it never goes away. Beth Stamm, Secondary Traumatic Stress

3. Soul Weariness There is a soul weariness that comes with caring. From daily doing business with the handiwork of fear. Sometimes it lives at the edges of one’s life, brushing against hope and barely making its presence known. At other times, it comes crashing in, overtaking one with its vivid images of another’s terror with its profound demands for attention: nightmares, strange fears, and generalized hopelessness. Stamm, Secondary Traumatic Stress

4. Session I: Compassion Fatigue - What It Is and What It’s Not • Compassion Fatigue . . . is the natural behavior and emotion that arises from knowing about traumatizing events experienced by a significant other and the stress resulting from helping or wanting to help a traumatized person.

5. Compassion Fatigue Symptoms Mental, emotional, spiritual, and physical fatigue Sleep disturbances Anxiety Irritability Anger Depression Reduced or increased appetite High blood pressure Dizziness Guilt Decreased ability to concentrate or attend to tasks

6. Compassion Fatigue Triggers Single exposure to a traumatic event Cumulative work with trauma victims Cumulative deep trauma Cumulative experiences of deep sadness, pain, death and loss Poor boundaries Insufficient resources

7. Compassion Satisfaction The sense of pleasure or satisfaction derived from helping (Figley) Intrinsic “good feeling” of contributing to the positive welfare of another Alleviates some of the fatigue associated with the work of care giving Mitigates some of the effects of compassion fatigue and burnout Enhances sense of well being High potential among health care professionals to exhibit significant compassion satisfaction with chosen profession

8. Compassion Satisfaction Symptoms Joy Happiness Contentment Balance within life Work/life balance Creativity Productivity

9. Compassion Satisfaction Triggers • Situations that call on your best self – and you arrive • Incidences that require your best skills – and they are best for the situation • A good death – chaplain is present, provides listening and loving presence, patient dies without pain and transitions peacefully • Events where you know you made a difference!

10. Burn Out Burnout is a syndrome of emotional exhaustion, depersonalization towards patients, and reduced sense of personal and professional accomplishment. (Maslach) Burnout produces emotional withdrawal and diminished empathy, whereas those with compassion fatigue try to continue to give of themselves and feel as though they have failed at their professions. Betty Stevens-Guille, RN

11. Burnout Symptoms • Emotional exhaustion • Apathy • Emotional withdrawal • Lack of interest – just don’t care • Diminished empathy • Anger • Irritability

12. Burnout Triggers • Insufficient resources (personnel and materials) • Disrespect • Lack of pay • Lack of benefits • Lack of affirmation • Poor boundaries • Lack of growth potential – skill development

13. Compassion Fatigue vs. Burnout • Single exposure Insufficient resources • Cumulative experience Disrespect of deep trauma • Cumulative experience Lack of pay/benefits with death & dying • Poor boundaries Lack of affirmation • Insufficient resources Poor boundaries

14. What We Know • Compassion Fatigue affects a multitude of people – professional care givers such as trauma care nurses, home health care specialists, physicians, intensive care nurses, chaplains, social workers, EMTs, firefighters, and police. • 90% of critical care nurses will experience compassion fatigue as a normal result of their work in an ICU. • family caregivers – spouses, parents, siblings, relatives, friends . . .are affected by compassion fatigue • Caregivers are a susceptible group to emotional blunting, compassion fatigue, depression, and burnout.

15. Caregivers appear to be better at giving care than asking for or receiving care • Self Care (care of the self) is a personal, family, collegial, and organizational responsibility • Diminishment of self occurs when intentional self care is not a practice of the individual and/or encouraged and supported by the institution. • Diminishment of self contributes to compassion fatigue and burnout in strong and dedicated caregivers.

16. Session II:The Danger Zone Professional Quality of Life Inventory 30 item inventory identifying potential for compassion satisfaction (CS) burnout (BO/Compassion Fatigue (CF) subscale) secondary traumatic stress (STS/CF subscale) free inventory not a medical test nor a psychological test can be viewed as a screening tool for stress- related health problems

17. Professional Quality of Life • Compassion Satisfaction – the “good stuff” of caring • Compassion Fatigue – the “bad stuff” of caring • Positive aspects of caring (Compassion Satisfaction) • Altruism • Self confidence, self awareness • Negative aspects of caring (Compassion Fatigue – two aspects)Burnout – hopelessness, simply being worn out Secondary Trauma Stress – exposure to traumatically stressful events resulting in being afraid/fear

18. People Bring Themselves • We have a past & a present • We have beliefs and values • We have varying education, training, and income • We bring our personal situations • We have social support (or maybe not) • We have a history – might include trauma and illness • We have family and close others (or not)

19. Complete the professional quality of life inventory and score using the self-report instrument • In dyads, discuss your surprises and concerns from the ProQoL (take about 5-8 minutes for each person)

20. Session III Self Care . . . is the discipline of attending to one’s own physical, mental, emotional, and spiritual needs through consistent activities and behaviors which enable renewal and growth (Snorton). Self care is a philosophical and theological statement about one’s self and one’s life (Charlescraft).

21. Self Care Helps to alleviate symptoms of compassion fatigue A daily discipline of attending to one’s physical, mental, emotional, and spiritual needs which enable renewal and growth A personal, family, collegial, and institutional responsibility

22. Components of Good Self Care • Physical – healthy systems, exercise, diet • Mental – cognitive, critical thinking, logic, assessment • Emotional – feelings, expressing hope, joy, sorrow, pain • Spiritual – connections – with self, with others, with someone or something greater than self The integration of physical, mental, emotional, and spiritual well being is greater than the sum of it’s parts. Self care should not be compartmentalized but rather be viewed holistically.

23. What is Well Being? • Elements of well being: • positive self concept • finding meaning and purpose in life • Good physical health • Good emotional adjustment Wellness is a positive state of mind, body, and spirit reflecting a balance of effective adaptation, resilience, and coping mechanisms in personal and professional environments that enhance quality of life (AANA)

24. Physical Well Being • A state of physical well being is not just the absence of disease. It includes lifestyle behavior choices to ensure health, avoid preventable diseases and conditions, and to live in a balanced state of body, mind, and spirit. American Association of Nurse Anesthetists (AANA)

25. Evidence Based Physical Practices • Massage – relieves stress, touch that is healing, lowers blood pressure • Reflexology – head, hands, feet – lowers stress levels, decreased blood pressure, energizes the entire body through pressure point massage • Yoga – physical awareness of the body, can use as a mental, spiritual, and/or physical discipline

26. Evidence Based Physical Practices • Exercise – something you enjoy • Diet – what works best for your body • Aromatherapy - sensory, affects persons physically, mentally, and emotionally – • Scent of cinnamon • Scent of lavender • Scent of pine • Scent of lemon, orange, citrus

27. Mental Well Being • Mental well being or mental health describes how you are feeling and how well you can cope with day to day life. • Mental well being is associated with sense of self, ability to adapt to change, and positive self regard

28. Evidence Based Mental Practices • Cognitive Re-structuring/Reframing – to think differently than your first response to a situation • Reflection – to consider or re-consider a situation in light of values, beliefs, culture, and experience • Journaling- daily practice • Skill Development – conferences, classes, and/or mentoring, learning new skills or refining skills

29. Emotional Well Being • Increased emotional well being is indicated with enhanced coping ability, positive self-esteem, positive self regard, performance and productivity – and possibly longevity (AANA) • Decreased emotional well being is indicated with stress, anxiety, and/or depression

30. Evidence Based Emotional Practices • Crying • Debriefing • Talk therapy • Art therapy • Social connections • Music therapy • Therapeutic music

31. Spiritual Well Being The courage to look within and to trust . . . Deep sense of belonging, of wholeness, of connectedness, and of openness to the infinite; ability to give praise and ask for help. David Benner

32. Evidence Based Spiritual Practices • Breath prayer – breathing alone makes a difference, but breath prayer can encourage mental, emotional, and physical health as well as spiritual health • Meditation – on a word, passage, thought, centering prayer, silence, stillness • Yoga – discipline, centering, focus

33. Well Being Well being isn’t the absence of health problems or brokenness; well being is what you choose, at the center of your life, to do with these frustrating conditions. Howard Clinebell

34. Rest, Renewal, & Reconciliation • Improved spiritual well being has a positive effect on recovery from compassion fatigue • Enhanced skill development positively affects compassion fatigue • Coping improves with rest and renewal, and with greater self understanding and practice of good self care

35. Self Care . . . My Job With a Little Help From My Friends • Self care is a personal, familial, collegial, and institutional responsibility • Self care is a daily discipline • Self care helps to alleviate symptoms of compassion fatigue • Self care is the discipline of attending to one’s own physical, mental, emotional, and spiritual needs through consistent activities and behaviors which enable renewal and growth (Teresa Snorton) • Self care is a philosophical and theological statement about one’s self and one’s life (Charlescraft)

36. SUPPORT: SELF AND OTHERS • Boundary setting – sometimes saying “no” • Receiving peer support • Receiving supervisory support • Receiving organizational support • Knowledge of triggers • Responding to symptoms • Having a plan

37. Stamm’s Challenge Stamm’s challenge to educators, clinicians, and researchers involved in trauma work is to . . . “learn to transform our encounters With these things into opportunities for growth for ourselves and for those whom we seek to heal.”

38. Soulful Fatigue Soulful fatigue will continue on occasion to engulf those who care for others in the intense and broken places of life, but hope resides because of the kind, compassionate, loving care offered by others through God’s good grace. Ann Sidney Charlescraft, 2005