scale n = ___ 1 2 3 4 5 strongly disagree neutral agree strongly disagree agree 1.you know your...
TRANSCRIPT
SCALE N = ___ 1 2 3 4 5 STRONGLY DISAGREE NEUTRAL AGREE STRONGLY
DISAGREE AGREE
1.You know your strengths, how to use them to help, support colleagues, care for patients.
___ of ___ scored __ or __
2.You know your weaknesses, how to deal with them to protect yourself, family, colleagues, and patients.
___ of ___ scored __ or __
3.You can say “No!” without feeling guilty, making an excuse why not, or becoming defensive.
___ of ___ scored __ or __
2
SCALE N = ___ 1 2 3 4 5 STRONGLY DISAGREE NEUTRAL AGREE STRONGLY
DISAGREE AGREE
4.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.
___ of ___ scored __ 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.
___ of ___ scored __ or __
3
SCALE N = ___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.
__ of ___ checked this box
Irritability or angry outbursts. __ of ___ checked this box
4
UNCERTAINTY
INSECURITY
ANXIETY
DEFENSIVENESS
HOSTILITY
Turned Inward Turned Outward 1. False guilt 1. Anger 2. Depression 2. Jealousy {3. Suicide} 3. Envy {4. Homicide}
Leads to...
SCALE N = ___
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.
Nightmares & trouble falling or staying asleep. __ of ___ checked this box
Emotional numbness, lack of interest in activities & difficulty feeling love & joy.
__ of ___ checked this box
Avoiding thoughts & situations that are reminders of a traumatic event. __ of ___ checked this box
6
SCALE N = ___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:
___ checked ___ of the 5 Common Symptoms of PTSD
___ checked 4 of the 5 Common Symptoms of PTSD
___ checked all 5 Common Symptoms of PTSD
7
“Our Palliative Care Director is leaving the team, the hospital, the state. Even though we are going to have another physician coming, he does not want to do outpatient clinic. Another of our physician {sic} just died tragically last Friday. He is being missed so much. The same Friday one of our chaplain announced her retirement. She will be leaving us at the end of August, and… our APN and executive secretary are actively looking for another job. Our service is going to the pits!
Please we appreciate your prayers for peace, direction and wisdom about what we are going to do in the midst of grief, and people leaving in different ways. Sorry for the bad news. I feel tired and burnout {sic}.”
Part of e-mail from a chaplain colleague and friend…
Compassion fatigue: Development of negative professional attitudes/behaviors resulting from job strain when you experience frustration, powerlessness, and an inability to achieve your work goals.
Burnout: Response to the work environment and not to the
consequences of caring for people who are suffering.
Puchalski & Ferrell, 2010.
Moral distress Compassion fatigue Secondary stress Over-identification Helplessness Hopelessness Boredom Failure
(Wicks, 2006 & Freeman, 2015)
Having a clear realization that stress and pain are a fact of life.
Developing a regimen of work, relaxation, exercise and leisure.
Honing one's communication skills. Establishing strong support systems; family, friends,
worshipping community members, and co‑workers. Enjoying the thrill of discovering new aspects of oneself. Learning to adapt to change and finding challenge in
change. Cultivating flexibility. Accepting crises as important growth opportunities.
From painful past experiences one can discover:• Freedom to share your feelings and emotions with person's
close to yourself.• Freedom to create time for fun and relaxation.• Freedom for special persons in your life.• Freedom to enjoy each day moment by moment.• Freedom to live the sadness and to laugh during the time in
between.• Freedom to pack quality into each day and sharing the
pleasure with others.• Freedom to set aside time for pulling memories into focus.
McIntier, 1996.
Requires a culmination of events.
Often results in the loss of staff• Quit• Transfer• Withdraw• Become cold and
mechanical Quality is compromised.
(Wicks, 2006 & Freeman, 2015)
We must acknowledge the personal responsibility we have to ourselves.
Direct correlation between group morale, absenteeism, and leadership quality.
Communication is just as important between staff and management as between patients and health care providers.
We all need to feel we are being listened to, appreciated, and respected.
Our perceived failures must be addressed. Burnout is the last straw; it must be addressed early
before it grows.(Wicks, 2006 & Freeman, 2015)
Mental fatigue at end of day. Tense feelings, boredom, frustration, and/or
anger toward patients, co-workers. Experiencing physical symptoms. Personal and professional resources perceived as
inadequate. Job requirements perceived as repetitious,
beyond ones ability, and/or physically or emotionally depleting.
(Wicks, 2006)
“The seeds of burnout and the seeds of enthusiasm are in reality the same seeds. Anyone who truly cares can expect to ride the waves of burnout- and occasionally get knocked down by a wave they missed.”
(Wicks, 2006)
Anton Chekov once proclaimed: “Any idiot can face a crisis - it’s the
day-to-day living that wears you out.”
“Health care is one of the few professions where it is socially acceptable to ignore your family, your non-work life, and yourself.”
It is not the demands of our jobs, but rather our compulsive character that is the root of the problem.
(Wicks, 2006)
Ability to empathize is essential • Must see ourselves in our patients• Forces us to confront our vulnerability• Forces us to acknowledge statistical likelihood
Need for Self-awareness• Recognize our vulnerability.• Ability to appreciate the wear and tear of patient
interactions.• Providing patient care is as physically and
emotionally depleting as a disease is to a patient. Need for rest, restoration, and rejuvenation
of body and spirit. (Wicks,
2006)
Results of the emotional pressure from reaching out to others in need: Constant and continuous Reality in medical and nursing professions Need to accept unfortunate outcomes Overwhelmed by frustration Loss of perspective when encountering inevitable failures.
“For every poisoned worker there are a dozen with sub-clinical toxicity.” (Wicks, 2006)
Achieving a positive outcome in the face of adversity:Bending but not breaking.Recovering from a bad experience.Possessing adequate coping mechanisms that function correctly during a time of trauma.Dependent upon foundational capacity of the individual
• Early life experiences• Cognitive flexibility• Effective self-regulation of behavior and physiological
responses(McEwen, Gray, & Nasca, 2014)
Find ways to positively vent and promote communication.
Compliment each other in front of colleagues. Utilize creative problem solving. Verbalize feelings of not being heard or
appreciated. Utilize humor and emphasize the importance of
having joy in your life. Take breaks off the unit/work area. COMMUNICATE (Wicks, 2006)
“ The sharing and gaining of insight into personal frustrations, sadness, and loss can assist the caregiver to find meaning and personal growth from his or her experiences. Often, just the act of converting feelings into words can be healing.” (Freeman,
2015)
Do not believe the pedestal you have been placed upon.
A power greater than you will decide your patient’s fate.
DO NOT EQUATE DEATH WITH FAILURE. Take comfort in knowing you did your very best. Learn to celebrate the journey. Review your day and give yourself quiet time:
• Recognize parallels that lead to over-identification.• Identify unresolved grief.• Challenge yourself to understand why the event/situation
was so upsetting.
Stay in the present. Eat healthy, get your rest, and try to exercise. Find laughter and joy and make it a daily part of
your life. Identify some meaning or growth from the
experience. Learn to “Ride the Dragon”. Do not fear professional grieving, for it is when
the heart is most broken that we are the most open to change and personal growth. (Wicks,
2006 & Freeman, 2015)
“….When all of life – both the perceived good and bad is faced directly with a sense of openness, life’s promises are more fully realized. Moreover, this is not only important for the person experiencing the struggles but also for those they may touch after absorbing the new lessons learned about gratitude, impermanence, the frailty of life, simplicity, meaning-making, and compassion.”
(Wicks, 2006)
“By facing the dragons of reality and truth about our lives, much unforeseen growth, depth, and promise becomes possible. No one wants to experience, and it is not easy to face loss, trauma, serious stress, and loneliness. This is very true. However, if we can learn to ride our dragons rather than run, hide from, or attack them, it can be transforming.” (Wicks, 2006)
Self-care must include mindfulness and self-awareness of the baggage we all carry.
Daily stressors add up like scalding water in a bath and we don’t know when to scream.
Group support (and) staying present… can… assist in maintaining personal resiliency.
We all need to stop running from the emotional pain caring for the dying can cause, and chose to ride the dragon.
(Wicks, 2006)
If we are open to learn from our experiences and embrace the journey we can:• Learn about and embrace our personal strengths.• Understand how helplessness and loss can be faced with
dignity.• Embrace how being vulnerable can open us up to self-
acceptance.• Appreciate how humility can be the very door that leads to
compassion.(Wicks, 2006)
Do not think that love, in order to be genuine, has to be extraordinary. What we need
is to love without getting tired.How does a lamp burn? Through the continuous input of small drops of oil. If the drops of oil run
out, the light of the lamp will cease….-- Mother Teresa
THANK YOUTHANK YOU
Chaplain Terry Irish
626.256.4673 Ext. 85781
Pager 626.423.0023
Cooke, Liz. (2012). “Compassion Fatigue.” PowerPoint presented at City of Hope.
Freeman, B. (2015). Compassionate Person-Centered Care for the Dying: An Evidence-Based Palliative Care Guide for Nurses. New York: Springer Publishing Co.
Puchalski, CM. & Ferrell, B. (2010). Making Health Care Whole. Integrating Spirituality Into Patient Care. © Templeton Press.
McEwen, B.S., Gray, J.D., & Nasca, C. (2014). Recognizing resilience: Learning from the effects of stress on the brain. Neurobiology of Stress, 1(2015), 1-11. An on-line open access article retrieved from: http:// www.journals.Elsevier.com/neurobiologyofstress
McIntier, T. (1996). Preparing Oneself for the Crises of Life .
Nichols, S.W. Mitigating Care Fatigue in Palliative Care Providers: Developing Self-Awareness and Self-Care. Archstone Foundation Grant Teleconference, March 4, 2012.
Wicks, R. (2006). Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to Professional Resilience and Personal Well-Being. New York: Oxford University Press
Wolfelt, A. (2002). Healing A Parent’s Grieving Heart. Fort Collins, CO, Companion Press.
Wolfelt, A. (2003). Understanding Your Grief. Fort Collins, CO, Companion Press.