Compassion Fatigue: Caring for Professional Caregivers

Part I: Understanding Compassion Fatigue

The History of Compassion Fatigue Post Traumatic Stress Disorder (PTSD) is first included in the DSM III in 1980 Trauma may be experienced either “directly” or “indirectly” (secondary traumatic stress) An evolution of names for secondary traumatic stress including: Secondary Victimization, Vicarious Trauma, Secondary Trauma, and finally “Compassion Fatigue” which was coined by a nurse, Carla Joinson, in 1992

Compassion Fatigue Is Not the Same As Burn Out Burn out: a state of physical, mental and emotional exhaustion caused by long term involvement in demanding circumstances Burn out is a process, not a condition Origins are usually organizational Symptoms are directly related to the cause

Compassion Fatigue Is Not Counter-transference The process of seeing oneself in the patient Limited to certain relationships Temporary Compassion Fatigue is a cumulative process that is felt beyond any particular relationship

Remembering “Sam”

The professional work centered on the relief of emotional suffering of clients automatically includes absorbing information that is about suffering. Often it includes that suffering as well. - Charles Figley, 1995

Vulnerability for Compassion Fatigue Exposure – daily barrage of traumatic material Empathy – the greater the empathy the more effective the relationship and the greater the risk for Compassion Fatigue Other factors include: emotional state, limited stress management, poor self care, poor support and spirituality

Emotional Indicators Anxiety / increased negative arousal Numbness / flooding Lowered frustration tolerance / irritability Grief symptoms Anger Sadness Depression

Physical Indicators Intrusive thoughts / images Headaches GI symptoms Insomnia / nightmares / sleep disruptions Decreased immune response Lethargy Becoming more accident prone

Personal Indicators Perceptive / assumptive world disturbances Decrease in subjective sense of safety Self isolation Difficulty separating work life from personal life Diminished functioning in non-professional circumstances Increases in in-effective or self destructive self soothing behaviors

Work Indicators Avoidance of certain patients / clients Hyper vigilant response to certain cases Diminished sense of purpose / enjoyment Feelings of therapeutic impotence

Spiritual Indicators Questioning the meaning of life Questioning prior religious beliefs Anger at God Increased skepticism Loss of hope

Managing Compassion Fatigue

Awareness Being attuned to ones needs, limits, emotions and resources Knowing your “renewal zones” Practicing mindfulness Accepting and acknowledging that we are changed by what we do

Balance Maintaining balance among our life activities – work, play, rest Have a personal life! Pursue joyful activities

Connection To oneself To others To the bigger picture Connection increases validation and hope

Jillian’s Coping Strategies Host a pickle eating contest Go to the beach!

Part II: Caring for Professional Caregivers

Why Spiritual Care? Spiritual care of the “meaning maker” Chaplain as professional listener Respected and viewed as agents of hope Access to various disciplines and units within the institution The time to organize and offer staff support

Disciplines to include RN’s Physicians / medical interns & residents Social workers Counselors Rehab therapists CPE students Other chaplains!

Formats for information and support In-service session Orientation sessions: RNs, hospital staff, interns and residents In lieu of / as part of a regularly scheduled staff meeting Lunch / break room Regularly scheduled support groups

Compassion Fatigue In-Service Over view – differentiate from burn out Symptoms of Compassion Fatigue The ABCs of Compassion Fatigue management Give participants time to talk about it! Explain and offer the self Test for Helpers

And let us not grow weary in well doing: for in due season we shall reap, if we faint not. - Galatians 6:9 God bless you!