1. Sandi Hebley, RN, CHPN, LMSW Faith Presbyterian Hospice

2.  whatsyourgrief.com (blog)  Cumulative grief aka grief overload aka “holy crap I can’t handle all this loss!”

3.  1. Describe the effects of daily exposure to death and other losses  Distinguish between Burnout and Cumulative Grief/Chronic Sorrow/ Compassion Fatigue  List and explain at least three strategies for self care as a path to avoiding and healing Chronic Sorrow (Grief)

4.  “What too often is lacking in professional training programs is how to deal with one’s own grief response when clients die, what can be referred to as ‘professional grief.’… Professional grief usually takes the form of hidden grief – grief that is internalized and not openly expressed. There is no natural outlet for it, and the demands of work overshadow it. This lack of expression may result in cumulative grief, or what sometimes is referred to as bereavement overload. This can further lead to a legacy of vulnerability, burnout, or post- traumatic stress reaction.” -NASW

5.  Grief precipitated by the occurrence of multiple losses with little time allowed for separate grieving.  General expectation is that professionals who work in high loss settings get used to dying and death.  In fact, familiarity with death does not make it easier to accept loss or to manage professional grief more effectively.

6.  “We’re good people who are staunchly committed to helping others.”  Close relationships are formed as we care for these patients and their families over time, and emotional challenges arise: deaths, ethical dilemmas, chaotic family situations.  These situations can result in more emotional giving that ultimately results in an inability to attain a health balance of empathy and objectivity. nursing.onclive.com www.friedsocialworker.com

7.  “We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.” Figley, 1995

8.  Trauma may be experienced directly or indirectly.  “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.” Figley, 1995  The greater the empathy the more effective the relationship and the greater the risk for Compassion Fatigue. National Association of Catholic Chaplains

9.  Chronic exposure to human suffering turns optimism into despair, kindness into resignation.  We suffer the cumulative negative effect of experiencing many scenes of trauma, many deaths with no time to grieve. Intrusive images interfere with our clarity of mind…  We suffer the cumulative emotional residue of continuously working with suffering. Instead of withdrawing, we keep trying harder to give ourselves fully.J.C. Bays

10.  Physical symptoms  Headaches  Insomnia  Decreased immune response  Lethargy  Emotional symptoms  Anxiety  Numbness  Irritability/anger  Loss of hope

11.  Feeling of losing sense of self to the client  Neglecting self-care  Heightened sense of personal vulnerability  Avoiding emotionally charged situations  Self-medicating

12.  Burnout  Diminished caring  Less capacity for compassion  Urge to withdraw  Circumstantial  Grief overload/Compassion Fatigue  Exhaustion but continued efforts to generate empathy  Self-criticism, lack of joy in life  Relational

13.  Portnoy, Dennis. 1996. from Overextended and Undernourished: A Self-Care Guide for People in Helping Roles.

14.  If we chose to work with human pain, trauma, suffering and grief, we must accept responsibility for educating ourselves about the hazards associated with this work, monitor our exposure and symptoms, and use appropriate tools to keep ourselves healthy. J.C. Bays

15.  Balance  Between engagement and detachment  Interacting and alone time  Professional demands and personal needs  Set boundaries  Make time  Find support  Professional organizations  Counselor  Friends

16.  Connect/re-connect to spiritual meaning/support  Faith community  Readings  Prayer/meditation  Recharge your personal “batteries”  Physical exercise  Make time to eat quietly  Play with your pet or children  Find relaxation

17.  Exercise in relaxation.

18.  NASW (2006). Understanding Professional Grief. www.helpstartshere.orgwww.helpstartshere.org  Hospice of the Western Reserve. 2013. Grief in the Workplace. www.hospicewr.orgwww.hospicewr.org  Lawson, S. K. 2013. Hospice Social Workers: The Incidence of Compassion Fatigue. (Dissertation) udini.proquest.com  Panos, A. 2007. Understanding and Preventing Compassion Fatigue- A Handout for Professionals. National Center for Crisis Management. www.nc-cm.orgwww.nc-cm.org

19.  Figley, CR. 1995. Compassion /Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. An overview. 1-20. New York: Brunner/Mazel.  Bays, JC. 2013. Staying Healthy in the Midst of Suffering and Disease. www.balancedweightmanagement.com www.balancedweightmanagement.com  Spilman, J. 2010. Cumulative Grief in Healthcare Professionals… caregiverwellness.blogspot.com

20.  National Association of Catholic Chaplains. 2008. Compassion Fatigue: Caring for Professional Caregivers. Conference Presentation.