1. Healing the Heart of the Critical Care Nurse: Combating Compassion Fatigue Preventing Burn-out Michelle A Post, MA, LMFT Clinical Aftercare Specialist OneLegacy, Downtown Los Angeles mpost@onelegacy.org 213-229-5687 mpost@onelegacy.org

2. Objectives 1)List 3 warning signs of compassion fatigue 2)Utilize a check-list tool to assess levels of compassion fatigue in self/others 3)Develop self-care plan for daily, weekly, monthly, and yearly renewal that includes self- care techniques 4)LAUGH!

3. Tell me and I'll forget. Show me and I'll remember. Involve me and I'll understand. - Confucius Wise Quote…

4. Quick Surveys: How many of you feel on-the-job stress, or stress in your life as a side effect of your job?

5. Quick Surveys: How many of you deal with chronic pains or illness of some sort? –Headaches –Back or neck pain –Digestive problems (IBS, Diarrhea, Stomach aches, or Constipation) –High Blood Pressure –Knee pain, arthritis, joint pain –Circulatory or neurological symptoms –Shortness of breath –Or others

6. Quick Surveys: How many of you believe that the mind is connected to the body? 2 examples -Problem focus -Lemon

7. aka Practitioner Decay? aka Vicarious Trauma? What is Compassion Fatigue?

8. Signs and Symptoms What are the Warning Signs?

9. aka Vicarious Trauma? aka Practitioner Decay? What is Compassion Fatigue?

10. Symptoms? How Does This Affect Me? Fatigue Sadness Sleep Disturbance Irritability Frustration Weight Change Take Are You Burning Out Survey

11. “You cannot pour from an empty pitcher”

12. Compassion Fatigue Trajectory Which Phase describes where you are? a) The Zealot Phase b) The Irritability Phase c) The Withdrawal Phase d) The Zombie Phase e) Pathology vs. Renewal/Maturation Adapted from Charles R. Figley *Make a note about which phase describes you as we discuss them. ARS later.

13. Zealot Phase Committed, involved, available Solving problems/making a difference Willingly go the “extra mile” High enthusiasm Volunteers without being asked Adapted from Charles R. Figley

14. The Irritability Phase Begin to cut corners Begin to avoid clients/patients Begin to mock co-workers and clients Begin to denigrate the people we serve Use of humor is inappropriate Oversights, mistakes and lapses of concentration Start distancing ourselves from friends and coworkers Adapted from Charles R. Figley

15. The Withdrawal Phase Enthusiasm turns sour Clients become irritants, instead of persons We make complaints about our work life and our personal life Tired all the time, don’t want to talk about what we do. We start to neglect our family, clients, coworkers and ourselves We try to avoid our pain and sadness Adapted from Charles R. Figley

16. The Zombie Phase Our hopelessness turns to rage We begin to hate people…any/all people Others appear incompetent or ignorant to us We develop a real distain for our clients We have…no patience…no sense of humor…no time for fun Adapted from Charles R. Figley

17. Pathology and Victimization vs. Maturation and Renewal Overwhelmed and leaving the profession Somatic Illness Perpetuity of Symptoms or Hardiness Resiliency Transformation Adapted from Charles R. Figley

18. Compassion Fatigue Trajectory Which Phase describes where you are? a) The Zealot Phase b) The Irritability Phase c) The Withdrawal Phase d) The Zombie Phase e) Pathology vs. Renewal/Maturation

19. How Does This Affect Me? See Symptoms of Compassion Fatigue Handout

20. How Does This Affect Me? Compare Symptoms of Compassion Fatigue With Normal Grief Handouts

21. Compassion Fatigue – it exists! –www.compassionfatigue.orgwww.compassionfatigue.org

22. Tell me and I'll forget. Show me and I'll remember. Involve me and I'll understand. - Confucius So, we have it! Now, What Do We DO?

23. Be gentle with yourself. You are a helper, not a magician. You cannot change anyone else; you can only change how you relate to them. Give support, encouragement and praise to your peers and supervisors. Learn to accept praise in return. Remember: Feeling helpless at times is normal. Admit it without shame. Caring and being there are often more important than DOING. How can you care for yourself?

24. Change your routine often and your tasks when you can. Recognize the difference between complaining that RELIEVES and complaining that reinforces negative stress. Before going to bed at night, focus on a good thing that occurred during the day. How can you care for yourself?

25. Be CREATIVE! Seek affirmation and re-direction from your peers and supervisors. Avoid “shop talk” when socializing with peers. Schedule “withdraw” periods during the week, and strictly limit interruptions to this time away from your usual tasks. How can you care for yourself?

26. Change your vocabulary: –Say “I CHOOSE” instead of “I should, I ought to or I have to.” –Say “I won't” rather than “I can't.” If you never say “NO”, what is your “YES” worth? Frustration and irritability are far more harmful than admitting you’re unable to do something. PUT A LOT OF LAUGHTER AND JOY IN THE FABRIC OF YOUR LIFE. How can you care for yourself?

27. Research & Studies that support journaling as a way of improving health - James Pennebaker - Stephen J. Lepore - Annette Stanton, Ph D - Ariel Gore (Body & Soul, March 2010) some scientific research shows that brief, intense bursts of emotional release writing – 15-20 min/day for 4 consecutive days – is directly related to increased immune system functioning which can last for several weeks.

28. Again…. Explore Your Own Grief Take sometime to self-reflect. Adapted from J. William Worden, Ph.D.: Personal Death Awareness Where to Start?

29. Exploring Your Own Grief 1) How do you know when you are coping well? How do you know when you are not coping well? Two we are going to discuss:

30. Exploring Your Own Grief 2) How has your work affected your views about grief and loss? Two we are going to discuss:

31. Write down what you do to take care of yourself over the last year: Daily? Weekly? Monthly? Yearly? What do you do to care for yourself?

32. Do these address your needs on various levels of self care? PHYSICAL NUTRITIONAL SPIRITUAL SOCIAL EMOTIONAL What do you do to care for yourself?

33. Ideas to BEEF IT UP!!!! What do you do to care for yourself?

34. Easy ideas for daily/weekly: -Take a break from watching news -Biofeedback w Meditation -Laughing Yoga (Experiential) What do you do to care for yourself?

35. Easy ideas for daily/weekly: Cotton Ball with Nice Smell -take one home What do you do to care for yourself?

36. Research about Pet Scans, Healing, and Creativity

37. Easy ideas for weekly/monthly: Free Flow Writing/Poetry w timer What do you do to care for yourself?

38. Rituals to say good bye in crisis work or grief work: How do you say goodbye to clients who die? How do you say good bye to your work day?

39. Mementos - Crafts -My Worry Doll -Grover -– Funny Pens -Space on your desk

40. ME>>>> DODGERS!!! Weekly/Monthly?

41. Easy ideas for weekly/monthly: Art work Bubbles*** (release your stress and pop the bubbles) Play – Parachute Swing on the swings at a park, walk in mud What do you do to care for yourself?

42. Office Olympics or Pageant of the Masters

43. Music / Dance - Bird

44. Yearly Self Care Ideas? - Vacation on a Va-Cobligation

45. Yearly Self Care Ideas? - Vacation on a Vacobligation

46. Yearly Self Care Ideas? -Scrapbook – particularly changes or losses in life

47. Your Other Ideas? Now, add one item to your: Daily Weekly Monthly Yearly

48. Your Other Ideas? Do these address your needs on various levels of self care? PHYSICAL NUTRITIONAL SPIRITUAL SOCIAL EMOTIONAL

49. Closing ~Fingerprints