This program is made possible through a collaborative community-education partnership between The Consortium for Advancements in Health & Human Services, Inc. and Kindred at Home. The primary goal of this effort is to increase public awareness and access to hospice and home health through the provision of community-based education. Contact Hours are awarded to professionals who complete this program by The Consortium for Advancements in Health & Human Services, Inc. ( The Consortium for Advancements in Health and Human Services, Inc. © 2014 Exploring Compassion Fatigue: A Reality for Caregivers Dr. BC Farnahm & Elizabeth Pugh, LBSW, CM

Important Information This education program for healthcare professionals was developed by The Consortium for Advancements in Health and Human Services, Inc. (CAHHS) and is facilitated by Kindred at Home via a community education partnership agreement. CAHHS is a private corporation and is solely responsible for the development, implementation and evaluation of its educational programs. There is no fee associated with receiving contact hours for participating in this program titled, Exploring Compassion Fatigue: A Reality for Caregivers. However, participants wishing to receive contact hours must offer a signature on the sign-in sheet, attend the entire program and complete a program evaluation form. The Consortium for Advancements in Health and Human Services, Inc. is an approved provider of continuing nursing education by the Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. The Consortium for Advancements in Health & Human Services, Inc., is approved as a provider of continuing education in Social Work by the Alabama Board of Social Work Examiners, #0356, Expiration Date: 10/31/2016. This program is Approved by the National Association of Social Workers (Approval # ) for 1- Social Work continuing education contact hour. In most states, boards providing oversight for nursing and social work recognize contact hours awarded by organizations who are approved by another state's board as a provider of continuing education. If you have questions about acceptance of contact hours awarded by our organization, please contact your specific state board to determine its requirements. Provider status will be listed on your certificate. CAHHS does not offer free replacement certificates to participants. In the event that CAHHS elects to provide a replacement certificate, there will be a $20.00 administrative fee charged to the individual who requests it.

Learning Objectives Participants completing this educational program will be able to do the following: Discuss the concept of compassion fatigue. Identify manifestations and/or signs and symptoms of compassion fatigue in the following domains: emotional, behavioral, physical and spiritual. Discuss coping mechanism related to responding to compassion fatigue. Identify formal and informal resources that support self care.

Emotions Are Part of Who We Are… With the materials provided, draw an image that represents the feelings associated with providing services to individuals and families during the end of life. There are no right or wrong images. Be creative…

What is Compassion Fatigue? “A debilitating weariness brought about by repetitive, empathic response to pain and suffering, compassion fatigue is a result of absorbing and internalizing the emotions of clients and, sometimes, coworkers” (LaRowe, 2005) "Compassion fatigue, says LaRowe (2005), is nothing less than secondary traumatic stress, and its effects are much the same as those of posttraumatic stress disorder (PTSD).”

Signs and Symptoms of Compassion Fatigue… The signs and symptoms can be psychological and emotional Often signs and symptoms become behavioral, physical, and spiritual challenges. Common results of compassion fatigue include: distraction, hypersensitivity, overload, and misperception in our communications with self and others. These challenges can lead to costly personal and professional outcomes--- depression and physical illness (LaRowe, 2005).

Emotional/Psychological Apathy Low personal accomplishment Frustration Boredom Anxiety Hopelessness Depression Poor Concentration Irritability Alienation Isolation (LaRowe, 2005)

Behavioral/Professional abuse of chemicals spending less time with patients tardiness and absenteeism making professional errors being critical of others depersonalizing patients being sarcastic and cynical keeping poor records (LaRowe, 2005)

Physical rapid pulse insomnia fatigue reduced resistance to infection weakness and dizziness memory problems weight changes gastrointestinal complaints (LaRowe, 2005)

Spiritual doubt concerning one's values or beliefs feeling angry or bitter toward God withdrawing from fellowship

The Ultimate Costs Associated with Compassion Fatigue… Health Complications “I just don’t feel well, but I can’t really explain what is wrong with me.” Total Burnout “This job isn’t what I thought it would be.” Termination “You are not right for our organization.”

What Professional Caregivers Need to Know… Counter transference is real Coping Skills Self Healing Where to Get Support

Classic Approach to Counter Transference… We review Freud’s work, which states that counter-transference is the result of the unresolved issues of the helper and can negatively impact the helping process as it erodes objectivity (Corey, 1981/2000, p.155). This perspective of counter-transference, coupled with a few cautionary lectures from a professor or two whom we admire, likely contributes to the fear many human service practitioners feel specifically related to emotionally connecting with the people we support and serve.

Understanding Counter Transference… As we mature professionally, many of us realize that our attraction to the helping professions is deeply rooted in our desire and need to connect with others and to realize the power and fragility of our own humanness. Elements of common ground and shared life experiences are a core aspect of connectivity between people. For those of us who make the choice to practice in hospice and/or palliative care settings, the processes of death, dying and bereavement within our own personal lives often become the foundation of our practice.

Reality of Counter Transference… “Working with counter-transference is regarded as a positive and important therapeutic tool, an indispensable instrument in our work. It is the basis of empathy and deeper understanding of both the patient’s and clinician’s own processes” (Katz & Johnson, 2006, p. 4).

Coping Skills Denial, Projection, Rationalization… These are NOT DIRTY words…

Denial… A psychological mechanism through which a person escapes pain associated with reality by unconsciously rejecting that reality (Zastrow, 2007).

Projection… A psychological mechanism through which a person transfers his/her unacceptable ideas to another (Zastrow, 2007).

Rationalization… A person faced with a frustration and/or event, finds justification by masking one’s self and true motivations (Zastrow, 2007).

When do Coping Skills Become Dysfunctional? When we rely on these skills and/or defenses to do “our work” for us and we do not actively engage in the “healing process.” If you do what you have always done, you will get what you’ve always got…

Self Healing… Breaking Habits of Work We ARE Creatures of HABIT… Reshaping Memories and Thought Processes Actively Self Direct the Construction of Memories Reconstruct Language to Reflect Thoughts that Drive HEALTHY Behaviors and Expectations

Where to Get Support… Natural Resources of Support: Family Friends Coworkers Community Groups Church Formal Resources of Support: EAP (Employee Assistance Programs) Mental Health Systems Private Physician Private Counselors/ Therapist

Questions and Comments…

How Can You Help? Make a referral Request a speaker for your next community organization event or church function Help us recruit volunteers Tell others what you have heard about today (hospice and our organization)

References Corey, G. (2000). Theory & practice of group counseling (5th ed.). Belmont: Brook/Cole. (Original work published 1981). Katz, R. S., & Johnson, T. A. (Eds.). (2006). When professionals weep: Emotional and countertransference responses in end-of- life care. New York: Routledge Taylor & Francis Group. (Price, Unknown). LaRowe, K. (2006). Compassion Fatigue. Retrieved February 6, 2007, from fatigue.com

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