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Resiliency and Self-Care for the Healthcare Worker:

Facing the COVID-19 Pandemic

April 17, 2020Presented by

Russell Hilliard PhD, LCSW, LCAT, MT-BC, CHRC, CHC Senior Vice President of Key Initiatives

Seasons Healthcare Management, Inc.


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Resiliency and Self-Care for the Healthcare Worker:

Facing the COVID-19 PandemicApril 17, 2020

Presented by

Russell Hilliard PhD, LCSW, LCAT, MT-BC, CHRC,

CHC Senior Vice President of Key InitiativesSeasons Healthcare Management, Inc.


Hospice & CoronavirusDisclaimer

Please note: Seasons Hospice is dedicated to providing the most up to date

information related to the Coronavirus. With the rapidly changing, daily

evolution of this situation, it is recommended that attendees follow up with

the CDC (Centers for Disease Control) and WHO (World Health

Organization) websites for the most up to date information.


Objectives

1. Identify the unique stressors experienced while providing care in a pandemic.

2. Define balance of authenticity, fear, and resilience.

3. Recognize pathways of coping leading to resilience.

4. State realistic self-care strategies leading to satisfaction throughout the workday.


What the @#$%^??

• Unique stressors during this pandemic include:oLack of preparation

o Shortage of PPE

oBed utilization challenges

oTreatment limitations

o Staffing shortages

oPersonal fears


Video: 'You Can Smell Death': Doctor Describes the COVID-19 Hospital Fight | NBC New York


Balancing Fear, Authenticity, and Resiliency

• During this pandemic, fear is a common and natural response.

• If we are authentic, we are able to recognize our emotions and express them congruently – authenticity implies being true to oneself.

• Resiliency is the set of abilities including problem solving, strength resourcing, practicing acceptance, adaptability, and self-care that afford us that stamina to fulfill our mission, safeguarding against burn out and compassion fatigue.


Our Thoughts & Emotions…

Worries

Fear

AnxietyDepression

Ugh!


Cognitive Patterns

Thoughts Emotions Behaviors


Emotions Need Space and Validation

• All emotions are valid and authentic.oWe tend to judge our emotions as “rational” or “irrational.”

oEmotions need to be recognized and given space to vent, regardless of how we judge them.

o It isn’t always clear how we feel – we use a variety of ways to express our emotions:

▪ Emotions are abstract and finding concrete ways to label them help us to express them – “It’s like a ton of bricks hit me.” or we using physiological descriptions –“It’s like I can’t even breathe.” or “It’s so heavy, I ache all over.”

oExpressing emotions gives a sense of relief – it releases the pressure.

oOn the other side of the emotional expression, we have more space to see clearly.


Cultural Considerations

• Emotional expression is often taught through a socially acceptable lens, defined by the:oFamily of origin

oCulture

oEthnicity

oReligion

• Dis-ease occurs when the societal norms are not meeting the individual’s needs. o Interpreting emotional expression via affect varies among cultures and

regions of the world


Validating Emotions

• Invalidating Responses (not helpful)

o “I know how you feel”o Minimizing – “It’s not that bad”o “At least it’s not…”o “It could be worse…”o “I’m sorry you feel that way”o “You shouldn’t feel that way”o “I can’t even go there…”o “It’s all in _____ hands.”o “It will be what it will be”

• Validating Responses (helpful)

o Mirroring back what they say▪ “You are so overwhelmed right now.”

o Mirroring back the emotion you heard▪ ”I hear the fear in your voice.”

o Verbal nods – “uh huh” “wow”o Mirror affect and body languageo “Tell me more about that…”o “I can’t imagine what you are going

through…”o “You are not alone, I am here with

you.”o Finding comfort in sitting with bearing

witness in silence.


Cognitive Distortions

• Dr. Aaron Beck described multiple common cognitive distortions. Those we see most among healthcare professionals include:oFiltering – magnification of negative details while filtering out positives

or vice versa

oPolarized Thinking – “black or white,” all or nothing, either/or, perfection or failure, voids options of gray zone

oOvergeneralization – use of one piece of information to draw dramatic conclusions “We will never have enough PPE!”

oFallacy of Control – external control (everything is happening to me, victim) and internal control (belief that I have more control than I do)

oEmotional Reasoning – I feel it, therefore it must be true.

oHeaven’s Reward Fallacy – self-denial and self-sacrifice will pay off.

oShoulds – “I should…”


Changing Thoughts Change Our Emotions

• Unravel Cognitive Distortions:o Identify faulty thinking

oChallenge faulty thinking

• Cognitive Restructuring:oExplore causes of faulty thinking

oReframing and restructuring them

• Techniqueso Journaling, psychotherapy, talking it out with a trusted person


The Wolf You Feed…

One evening an old Cherokee told his grandson about a battle that goes on inside people.

He said, "My son, the battle is between two ‘wolves’ inside us all.

One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.

The other is good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith."

The grandson thought about it for a minute and then asked his grandfather: "Which wolf wins?"

The old Cherokee simply replied, "The one you feed."


Cognitive Patterns

Thoughts Emotions Behaviors


Healthcare Workers are Human, too!

• “Healthcare workers are professionals and can separate their personal selves from their work.”oThis is a complete myth!

oThis type of thinking is a form of dissociation that can lead to maladaptive coping.

• “Healthcare workers are human and strive to maintain healthy boundaries so their professional and personal selves are balanced.”oThis is a fact!

oMuch easier said than done, but when practiced leads to resiliency and prevents compassion fatigue and burnout.


PTSD and Healthcare Workers

• Healthcare workers experience PTSD as a result of their professional experiences.

• Nearly 400 physicians die by suicide each year – that is equivalent to an entire medical school class.

• Working in this time of a pandemic will leave many of our healthcare workers with PTSD as they serve dying, isolated patients in potentially dangerous work environments.

• How can healthcare workers safeguard against PTSD while working in traumatic situations?


Healthcare Workers At Risk

• Pacing requires we move from one trauma to the next

• Lack time and space to process experiences, explore meaning, or share

• Witnessing patients’ fears and panic

• Seeing patients die alone, hearing loved ones cry for help

• Feelings of helplessness, hopelessness, and overwhelmed

• COVID-19 trauma impacts the worker’s humanity directlyo What if I get the virus?

o What all do we not know about it?

o Will this PPE protect me?

o Will I bring it home to my family?

o My co-worker got sick, am I next?


Trauma Stewardship

"Trauma stewardship refers to the entire conversation about how we come to do this work, how we are impacted by our work, and how we subsequently make sense of and learn from our experiences... By talking about trauma in terms of stewardship, we remember that we are being entrusted with peoples' stories and their very lives.

We understand that this is an incredible honor as well as a tremendous responsibility. We know that as good stewards, we get to create a space for and honor others' hardship and suffering while not assuming their pain as our own. We get to care for them to the best of our ability while not co-opting their paths as our paths.

We are required to develop and maintain a long-term strategy for ourselves such that we can remain whole and helpful to others even amidst their greatest challenges.

To participate in trauma stewardship is to continuously remember the privilege and the sacredness of being called to help another sentient being; it means maintaining our highest ethics, integrity, and responsibility every step of the way."

~Laura van Dernoot Lypsky, Trauma Stewardship


Stewards of Trauma

• Talk about their experiences with people who can hear them.

• Often get through trauma-related work with emotional containers.

• Find ways to express their emotions related to their experiences.

• Moving through the emotions is a skill stewards of trauma hone, rather than avoiding them.

• Practice thought patterns that support realistic balances of the world.

• Find coping – humor, physical release, creative arts, journaling, etc.


Pathways of Coping Leading to Resilience

• When in crisis mode:oDo the very next thing.

oRemind yourself to focus on the now. Stay in the present.

oBreathe – there are many breathing techniques that are highly impactful while also being short and easy.

oDon’t go it alone, if at all possible.

oMind your basic needs – eat, sleep, go to the bathroom.

• If you are not in crisis mode:oDo all of the above!

oMind your thoughts – beware of cognitive distortions.

oPractice integrative self care strategies.


Look for the Good

Video: Front line nurses in COVID-19 pandemic find solace in ‘Hope Huddles’


Integrative Self-Care Strategies• What do we mean by ”integrative?”

o Refers to making them a part of your daily life – self-care is best when it is integrated with your work, family, and play experiences.

• Mr. Rogers reminds us to “look for the helpers.”

• Yogis teach us how to breathe, have moving meditation, and fall asleep (yoga nidra).

• Meditation has significant research supporting its effects on reducing stress and anxiety and improving sleep.

• Music therapists teach us how music can release emotion, provide validation, and soothe our anxieties.

• Massage therapists help us identify how our “tissues hold our issues” and how to release them.

• Spiritual leaders remind us we are never alone, the universe is vast, and purpose is always unfolding.

• The Big Book of AA reminds us to practice living in acceptance.

• Mental health professionals help us see that self-care is essential, never selfish.


Team Strategies

• My cup may be bone dry, but your cup is overflowing today – let’s work together to make it happen.

• Creative team strategies to consider:oGive time and space, albeit brief, for honoring the pains

oOffer validation for pains shared

oCreate space for hope to be enlightened

▪ Short readings

▪ Meditation

▪ breathing exercises

▪ Music

▪ Can we invite humor?


Where would we be without you?

• During the beginning of the AIDS epidemic, we didn’t know what was causing so much illness and healthcare workers suited up, showed up, and served.

• When no one else showed up, healthcare workers did.

• When young men died alone without family at their side, healthcare workers were there to escort them on their journey.

• We need you now more than ever. Your resilience and self-care is essential. Taking moments for yourself is essential…


Tribute to Healthcare Workers

• Video: "Truly Brave" (SFGMC Virtual Chorus)


Questions & Answers


Resiliency and Self-Care for the Healthcare Worker:Facing the COVID-19 Pandemic

Post Activity-Survey and References

When the webinar ends, you will automatically be redirected to the post-activity survey. You must fill this survey out to receive your NCPD/CE certificate.


ReferencesAckerman, C. (2020). 25 CBT Techniques and Worksheets for Cognitive Behavioral Therapy. Retrieved 4/17/20 from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/

Grohol, J. (2020). 15 Common Cognitive Distortions. Retrieved 4/10/20 from https://psychcentral.com/lib/15-common-cognitive-distortions/ .

Lim, N. (2016). Cultural differences in emotion: differences in emotional arousal between the East and the West. Integrative Medicine Research, 5(2), 105-09.

Lipsky, L.V.D. & Burk, C. (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Vberret-Koehler Publishers: San Francisco.

Muluneh, A. (2020). The Wolf You Feed. Retrieved 4/10/20 from https://www.aidamuluneh.com/the-wolf-you-feed-1

Pogosyan, M. (2016). Emotion perception across cultures. Psychology Today, October 9, 2016.

Robertson, H., et al. (2016). Resiliency of primary healthcare professionals: A systemic review. British Journal of General Practice, 66(647).

Sanchez, M, Simon, A., Ford., D. (2019). PTSD in Tx ICU Nurses. Journal of Heart and Lung Transplantation, 38(4), S93-S94.

Sawicki, S. (2019). Mental Health Workers Vicarious Trauma, Secondary Traumatic Stress, and Self-Care. DBC Publishing.

Lipsky, L.V.D. & Burk, C. (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Vberret-Koehler Publishers: San Francisco.

https://www.aidamuluneh.com/the-wolf-you-feed-1


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for reference - seasons hospice & palliative care · 17.04.2020 · for reference only not for...

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