1. Exploring Compassion Fatigue: A Reality for Caregivers
Dr. BC Farnahm & Elizabeth Pugh, LBSW, CM
This program is made possible through a collaborative community-education partnership between The Consortium for Advancements in Health & Human Services, Inc. and Affinity Hospice. 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. (

2. 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 Affinity Hospice 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: 10/31/2018.
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.

3. 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.

4. 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…

5. 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).”
Clarity Information:
“Compassion Fatigue: This term has replaced the more familiar term "burn-out." It refers to a physical, emotional and spiritual fatigue or exhaustion that takes over a person and causes a decline in his or her ability to experience joy or to feel and care for others. Compassion fatigue is a one-way street, in which individuals are giving out a great deal of energy and compassion to others over a period of time, yet aren’t able to get enough back to reassure themselves that the world is a hopeful place. It’s this constant outputting of compassion and caring over time that can lead to these feelings.”
Source:

6. 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).
Clarity Information:
“Compassion fatigue comes from a variety of sources. Although it often affects those working in care-giving professions - nurses, physicians, mental health workers and clergymen - it can affect people in any kind of situation or setting where they’re doing a great deal of caregiving and expending emotional and physical energy day in and day out.”
“Although those in the health care and mental health professions are most at risk of developing these feelings, it is not limited to these arenas. It affects those who don’t work outside the home as severely as those who do. Take someone who is actively engaged in taking care of a family member, especially during a crisis period when there is a higher need to give out feelings of compassion and sensitivity. If the crisis doesn’t pass quickly and the individual continues functioning at this level, he is just as susceptible to compassion fatigue over time as those in high-risk professions.”
Source:

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

8. 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)

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

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

11. 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.”

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

13. 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.

14. 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. 

15. 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).

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

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

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

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

20. 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…

21. 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

22. 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

23. Questions and Comments…

24. 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)

25. Tip to Support End of Life Conversations
Points For Health Care Providers to Consider-
1. Don't assume patients and families don't want to talk about death and terminal nature of their illness. Many times they do.
2. Be sensitive to their sensitivities.
3. Be honest, always.
4. Encourage patients and their family members to tell you what they're afraid of, even if it's hard to talk about.
5. Don't dismiss your own fears and/or feelings. They matter, too.
6. We are available to meet with the health care community to discuss hospice care with patients and families.
Nathan Hurst, Seattle Times staff reporter

26. Basic Hospice Criteria
Patients are eligible to receive Medicare hospice benefits when they meet all of the following conditions:
Patient is eligible for Medicare Part A (Hospital Insurance).
Patient’s doctor and the hospice medical director certify the terminal illness and patient’s have 6 months or less to live if the illness runs its normal course.
Patient/Caregiver sign a statement choosing hospice care instead of other Medicare-covered benefits to treat the terminal illness.*
Patient receives care from a Medicare-approved hospice program.
* Medicare will still pay for covered benefits for any health problems that aren’t related to the terminal illness.

27. Hospice Care Benefits to Remember
Reduced phone calls from patients/ families. 
Decrease anxiety especially with out of town families.
Better compliance with medication regime and appointments.
Our staff has a presence in the home providing a better understanding of family dynamics and can help coordinate care.
We can coordinate nursing home admission with physician if patient is unable to be cared for at home.
Reduced hospitalizations.
More satisfied patients.

28. 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  

29. Questions & Answers:

30. Complete Program Evaluations & Award Certificates