Independent Schools of New Zealand Senior Leaders Forum Auckland 2013 CARING FOR THE CARERS: Organisational Responsibilities Peter Huggard University of Auckland

You cant wipe the tears from someone’s face without getting your hands wet

As you do so, you may recall some of your own experiences that have relevance to you – think about why these memories have re-surfaced, and the significance of them for you. Later, as we discuss support, think of how you access your own support systems Invitation to engage in the process as the discussion develops

This presentation: an invitation to explore the nature and management of compassion fatigue and vicarious traumatisation, and to consider organisational responsibilities Describe the constructs of compassion fatigue, burnout, and compassion satisfaction Experiences from working in health care Approaches to managing these experiences Prevention and support strategies, including organisational responsibilities, and combining these understandings to look at both individual and organisational resilience Invite you to consider connections between ‘health’ and ‘education’

Compassion Fatigue Self-Test . . . the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced by a significant other . . (Figley, 1995) Charles Figley Compassion Fatigue Self-Test for Psychotherapists

Compassion Fatigue is composed of two parts: Burnout, being worn down and overwhelmed by work Secondary Traumatic Stress – experiencing work-related fear from traumatic stress exposure

PTSD intrusion avoidance hypervigilance CONSTANT STATE OF ALERTNESS The person has been exposed to a traumatic event in which both of the following were present:  (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror DSM IV-TR (2000) PTSD intrusion avoidance hypervigilance CONSTANT STATE OF ALERTNESS

“We view vicarious traumatization as an occupational hazard, an inescapable effect of trauma work. It is not something that clients do to us; it is a human consequence of knowing, caring, and facing the reality of trauma” (p.25) Laurie Anne Pearlman Karen Saakvitne

Burnout The term burnout first used to describe the emotional and physical exhaustion displayed by some human service workers in health care agencies. Herbert Freudenberger (1975) Multiple dimensional view (Maslach Burnout Inventory) Emotional exhaustion Depersonalisation Reduced personal accomplishment Christina Maslach (1981) Burnout can lead to a deterioration in the quality of services provided by the helping professional. Ayala Pines (1981)

Burnout The term burnout first used to describe the emotional and physical exhaustion displayed by some human service workers in health care agencies. Herbert Freudenberger (1975) Multiple dimensional view (Maslach Burnout Inventory) Emotional exhaustion Depersonalisation Reduced personal accomplishment Christina Maslach (1981) Burnout can lead to a deterioration in the quality of services provided by the helping professional. Ayala Pines (1981)

Burning brightly . . Burning dimly . . . Burning out . . . . Frank Lamendola (1996)

Compassion Satisfaction . . . an expression of the positive aspects of care-giving (Stamm, 2002, Treating Compassion Fatigue) Beth Stamm

Compassion Fatigue (STS) Satisfaction Burnout + sig. Resilience Compassion Fatigue (STS) Satisfaction Burnout Empathy Spirituality Emotionality ProQOL

Compassion Fatigue (STS) Satisfaction Burnout + sig. Resilience Compassion Fatigue (STS) Satisfaction Burnout - sig. Empathy Spirituality Emotionality ProQOL

Compassion Fatigue Satisfaction Burnout + sig. Resilience Compassion Fatigue Satisfaction Burnout Spiritual Beliefs Relationship with a Higher Power + sig. Empathy - sig. Spirituality Emotionality ProQOL

Strongest association with compassion fatigue Personal Strengths Emotional Competence These two subscales were the most strongly, and negatively, associated with CF

Personal Strengths I can deal with whatever comes up I believe that past success gives confidence for new challenge I see the humour side of things I believe that coping with stress strengthens I tend to bounce back after illness or hardship I believe I give my best effort no matter what I believe I should act on a hunch

Emotional Competence I feel confident in my ability to care for patients exhibiting strong emotional distress I am aware of my emotions as I experience them I feel confident in my ability to understand my own emotional responses to my patients’ distress I feel competent in my ability to understand the reasons for my patient’s strong emotional distress I feel confident in my ability to care for the emotional as well as the physical needs of my patients I feel able to initiate access to additional support, if required, to help me to understand and manage my emotions in relation to my patients

Emotional Competence I feel confident in my ability to care for patients exhibiting strong emotional distress I am aware of my emotions as I experience them I feel confident in my ability to understand my own emotional responses to my patients’ distress I feel competent in my ability to understand the reasons for my patient’s strong emotional distress I feel confident in my ability to care for the emotional as well as the physical needs of my patients I feel able to initiate access to additional support, if required, to help me to understand and manage my emotions in relation to my patients

Emotional Competence I feel confident in my ability to care for patients exhibiting strong emotional distress I am aware of my emotions as I experience them I feel confident in my ability to understand my own emotional responses to my patients’ distress I feel competent in my ability to understand the reasons for my patient’s strong emotional distress I feel confident in my ability to care for the emotional as well as the physical needs of my patients I feel able to initiate access to additional support, if required, to help me to understand and manage my emotions in relation to my patients QUESTION: Does my organisation make it easy for staff to put their hand up and ask for help?

Signs & Symptoms of Compassion Fatigue Physical Exhaustion Insomnia Headaches Increased susceptibility to illness Somatization Hypochondria

Signs & Symptoms of Compassion Fatigue Behavioural Increased in alcohol use (and other drugs) Absenteeism Anger and irritability Avoidance of clients Impaired ability to make decisions Problems in personal relationships Attrition Compromised care for clients The Silencing Response

Signs & Symptoms of Compassion Fatigue Psychological Emotional exhaustion Distancing Negative self image Depression Reduced ability to feel sympathy and empathy Cynicism Resentment Dread of working with certain clients Feeling professional helplessness Diminished sense of enjoyment/career Depersonalisation Fear

Signs & Symptoms of Compassion Fatigue Psychological Disruption of world view/ Heightened anxiety or irrational fears Increased sense of personal vulnerability Inability to tolerate strong feelings Problems with intimacy Intrusive imagery Hypersensitivity to emotionally charged stimuli Insensitivity to emotional material Loss of hope Difficulty separating personal and professional lives Failure to nurture and develop non-work related aspects of life

The Silencing Response “Silencing” patients as a coping mechanism – particularly with people experiencing compassion fatigue Can be through words or actions Developed the “Silencing Response Scale” Dr Anna Baranowsky Toronto

1 signifies rarely/never and 10 means very often/always SILENCING RESPONSE SCALE Chose the number that best reflects you experience (over the last 2 weeks) 1 signifies rarely/never and 10 means very often/always Question No.   Response 1 Are there times when you believe your client(s) is/are repeating emotional issues you feel were already covered? 2 Do you get angry with your clients? 3 Are there times when you react with sarcasm towards your clients? 4 Are there times when you fake interest? 5 Do you feel that listening to certain experiences of your client(s) will not help? 6 Do you feel that letting your clients talk about their trauma will hurt them? 7 Do you feel that listening to your clients’ talk about their experiences will hurt you? 8 Are there times that you blame your clients for the bad things that have happened to them?

9 Are there times when you are unable to believe what your clients are telling you because what they are describing seems overly traumatic? 10 Are there times when you feel numb, avoidant or apathetic before meeting with certain clients? 11 Do you consistently support certain clients in avoiding important therapeutic material when time is not a constraint? 12 Are there times when sessions do not seem to be going well or the client’s treatment progress appears to be blocked? 13 Do you become anxiously aroused when a client is angry with you? 14 Are there times when you cannot remember what a client has just said? 15 Are there times when you cannot focus on what a client is saying? Total Score

SUPPORT & SELF CARE STRATEGIES

A B C Awareness: of our needs limits of our physical and emotional resources A B C Balance: between activities, work, play, and rest Connection: to oneself, others, and something larger Saakvitne & Pearlman (1996)

Resilience building strategies Building positive nurturing professional relationships and networks Maintaining positivity Developing emotional insight Achieving life balance and spirituality Becoming more reflective Jackson, D., Firtko, A. & Edenborough, M. (2007). Personal resilience as a strategy for surviving in the face of workplace adversity: a literature review. Journal of Advanced Nursing, 60(1), 1-9.

But these are general approaches towards having a safe workplace, and are both individual and organisational obligations – what about legislation that provides for this?

Health and Safety in Employment Amendment Act 2002 7 New section 5 substituted The principal Act is amended by repealing section 5, and substituting the following section: “5 Object of Act The object of this Act is to promote the prevention of harm to all persons at work and other persons in, or in the vicinity of, a place of work by— “(a) promoting excellence in health and safety management, in particular through promoting the systematic management of health and safety; and “(b) defining hazards and harm in a comprehensive way so that all hazards and harm are covered, including harm caused by work-related stress and hazardous behaviour caused by certain temporary conditions;

Organizational Processes Top-down acknowledgement of the ‘additional’ consequences of being in a ‘carer’ role Commitment to providing processes that assist staff to manage these consequences Monitoring of staff workload and assignments EMOTIONAL SAFETY POLICY CRUISIE JOBS

Jayne Huggard & Jan Nichols (2011) Jayne Huggard & Jan Nichols (2011). Emotional Safety in the Workplace: one Hospice’s response for effective support. International Journal of Palliative Nursing, 17(12), 611-617.

Peer Group Processes The Guardian Angel “Peer monitoring” “Belonging” processes – collegiality, decreased sense of isolation Organizational culture of fun Appropriate work load balance The Guardian Angel Group Support Delilah Smith

The Separation of Sky and Water Individual Processes Strategies for disengagement: Effective professional supervision Defusing/debriefing Boundary setting Healthy work-life-home balance The Separation of Sky and Water Michelangelo

Achievement – Mark Huddleston Individual Processes Strategies for gaining a sense of achievement: Setting achievable goals Being open to feedback Focus on successes Develop a tolerance for setbacks Positive self-statements Use of rituals Achievement – Mark Huddleston

Link to resilience, both individual and organisational – a guideline Amy Stephenson, John Vargo, Erica Seville (2010). Measuring and Comparing Organisational Resilience in Auckland. The Australian Journal of Emergency Management, Volume 25(2)27 – 32 Resilient Organisations Research Group – Universities of Canterbury and Auckland Developed a measure of organisational resilience Sampled 1009 Auckland organisations and established the validity of the instrument http://www.resorgs.org.nz

A new model of Organisational Resilience Planning Dimension Adaptive Capacity Dimension Planning Strategies Leadership Participation in Exercises Staff Involvement External Resources Situation Monitoring and Recovery Priorities Reporting Proactive Posture Minimisation of Silos Internal Resources Decision Making Innovation and Creativity Information and Knowledge

What is Organisational Resilience? Resilient Organisations: University of Canterbury and University of Auckland • Leadership • Staff Engagement • Situation Awareness • Decision Making • Innovation and Creativity • Effective Partnerships • Leveraging Knowledge. • Breaking Silos • Internal Resources • Unity of Purpose • Proactive Posture • Planning Strategies • Stress Testing Plans

So, in conclusion; Thank you for your Attention p.huggard@auckland.ac.nz