Presentation on theme: "So Your Staff Needs a Self-Care Program?"— Presentation transcript:
1So Your Staff Needs a Self-Care Program? Presenters:Lynn Skubiszewski, LCSW andNicole Perry, LCSW#NASWIL
2Welcome to Our Presentation Ask Audience: How did you feel hearing this, watching this? We would compare this to the effects and the contagion that a self care group could have for your staff and our goal today is to review self care concepts, a research study on a starting a self care group and give you the tools and resources to use this for yourself and your organizations.
3Presenter Biographies Lynn Skubiszewski, LCSW Palliative Care Social Worker,JourneyCareLynn is a graduate of Aurora University School of Social Work and has worked in the academic, geriatric, and healthcare fields for over 20 years. She has an interest in coaching the helping professionals in self care and encouraging social workers in healthcare settings to embrace leadership roles in their multidisciplinary settings.Nicole Perry, LCSWSocial Worker and Team Manager,JourneyCareNicole has an MSW from the University of Wisconsin – Madison. She has worked as a Social Worker since 2006 in the fields of aging and hospice. Nicole enjoys leading an interdisciplinary staff team to provide excellent end of life care and symptom management to the patients of JourneyCare.Who is in the audience today? School SW, private practice, hospice SW? Other disciplines? Why are we the right people to talk about this topic? – SW, nurses are at the front lines – whether it be a community agency, the Red Cross, a staff in the ER, etc. In hospice, SW are the front line when there are intense interpersonal, psychosocial, traumatic issues.
4Why is Self Care Important? Poor Quality of LifePoor self-care = burnout/dissatisfaction = drop out of SW field“In light of recent and significant research indicating that social workers engaged in direct practice are likely to develop symptoms of secondary traumatic stress, it is imperative that the social work profession devotes greater attention to and creates greater awareness of these issues.” (Professional Self-Care and Social Work, policy statement approved by the NASW Delegate Assembly, 2008)Poor self care = reduced ability to be empathic
5“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through the water without getting wet.” ~ RemenHospice examples – Hospice SW example: A hospice SW is called by the RN CM to meet with a new hospice patient. Upon arrival, the SW meets with the patient, an 80 y/o woman with severe dementia. Family talks about their grief at seeing their loved one decline which has happened over the past 10 years. The patient’s eldest daughter discloses that she has been using alcohol and drugs to cope with her feelings of grief. The daughter and her own young adult children are currently living with the patient and when the patient dies, they will have nowhere to go. The family all discloses that in addition to the loss they are experiencing now, they have experienced multiple other losses/deaths in the recent past.Ask audience – who is here? School SW, private practice?
6OutlineDefine burnout, compassion fatigue, compassion satisfaction, secondary trauma, vicarious traumatization/post traumatic stress.Research ProjectWhat is self – care?How can you start self care?Resilience, Personal Self Care, and Realistic ExpectationsHow to Expand Self-Care to the Organization LevelSummary and Review Resources/Tools
7What is Burnout?“A relatively frequent outcome of chronic stress that has received considerable attention.”Refers to the gradual extinguishing of energy of a Social Worker.What leads to burnout?Schaufeli, Leiter, & Maslach, 2009, p 205.Maslach and Leiter, 2005Cox and Stiner, 2013Burnout is caused by lack of fit between a person and their job in these six areas: workload (excessive work with inadequate resources) control (little influence, high accountability with limited power); reward (low pay, recognition or satisfaction), community (social isolation, interpersonal conflict); fairness (inequality, preferential treatment); and values (little sense of purpose or meaning, ethical conflicts)
8Burnout is the opportunity to re-discover what makes you happy. Silver Lining?Burnout is the opportunity to re-discover what makes you happy.
9A compulsion to prove oneself, working harder, neglecting one's own needs, displacing conflicts by ignoring the root cause of the distress, revision of values in which friends or hobbies are ignored, denial with emergence of cynicism and aggression, withdrawing from social contacts and/or using alcohol or substances to cope, inner emptiness, depression, and actual Burnout Syndrome.10 Phases of Burnout"Preventing Burnout" by psychologists Herbert Freudenberger and Gail North: Long-Term Living 59.5 (May 2010):
10How do you know it is burnout? Listen to others who know and care about youUse assessment tools to help you see the truthSelf awareness – know when you are crossing a lineHow do you know it is burnout?Difference between compassion fatigue and burnout vs. the job.Is it really the client or is it more than that? Is it your organization? Is it unrealistic productivity expectations?
11Ask yourself these simple questions…. 1 Ask yourself these simple questions…. 1. How often are you tired and lacking energy to go to work in the morning? 2. How often do you feel physically drained, as if your batteries were dead? 3. How often is your thinking process sluggish or your concentration impaired? 4. How often do you struggle to think over complex problems at work? 5. How often do you feel emotionally detached from coworkers or customers, and unable to respond to their needs?
12What Does Burnout Look Like? TOP 10 SIGNS OF BURNOUT#10 – Shopping at Kmart feels like you’re taking good care of yourself.#9 – Patients frequently startle you by waking you up during home visits.#8 – Find yourself saying, “You think you’ve got problems, lady?”#7 – You become aware of a reluctance to go to work and don’t go to work.#6 – You accidentally drop your beeper from a high bridge.
13What is Burnout, cont’d. #5 – You jump after the beeper. #4 – Giggling during team meetings.#3 – Not giggling during team meetings.#2 – Eating an entire bag of Dorito chips while making bereavement phone calls.#1 – Who cares about this list anyway?Larson, National Hospice and Palliative Care Organization
15What is Compassion Fatigue? Similar to PTSDEasily frustrated, irritable, annoyedSymptoms of depressionFeeling over alert, restlessFeeling ineffective, negative, inadequateCompassion Fatigue Scale
16Compassion Fatigue and Compassion Satisfaction Also called Secondary Traumatic StressA set of behaviors and emotions that can occur when the SW is seeking to help a suffering person.“a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering?Figley, 1995Teater, 2012LarsonDefined as the pleasure derived from helping others.Sounds like:I have happy thoughts about those I helpI like my workI enjoy and trust my co-workersI am effectiveCraig and Sprang, 2010Compassion fatigue is the trauma you experience as a result of being exposed to someone else’s trauma. The cost of caring, the cost of doing what we love, being traumatized by concern about the suffering of others, profound emotional and physical erosion, indirect trauma
17Compassion Fatigue Scale Although the world is full of suffering, it is full also of the overcoming of it.- Helen Keller
18Compassion Fatigue and Compassion Satisfaction Also called Secondary Traumatic StressA set of behaviors and emotions that can occur when the SW is seeking to help a suffering person.“a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering?Figley, 1995Teater, 2012LarsonDefined as the pleasure derived from helping others.Sounds like:I have happy thoughts about those I helpI like my workI enjoy and trust my co-workersCompassion fatigue is the trauma you experience as a result of being exposed to someone else’s trauma. The cost of caring, the cost of doing what we love, being traumatized by concern about the suffering of others, profound emotional and physical erosion, indirect trauma
1950% of child protection staff suffered from high or very high levels of compassion fatigue 70% of staff expressed a high or good potential for compassion satisfactionConrad and Kellar-Guenther (2006)CF and CS Can Co-Occur
21Secondary Trauma and Vicarious Traumatization – Post Traumatic Stress Social workers are affected by exposure to their clients' traumatic life experiences and behaviors. Research has demonstrated that secondary traumatic stress (STS) - also referred to as vicarious trauma, compassion stress, or compassion fatigue - is prevalent among mental health professionals who work with traumatized clients(Fahy, 2007; Figley, 2002b;Jacobson, 2006;Jenkins & Baird, 2002; McCann & Pearlman, 1990)
22Symptoms of Secondary Traumatic Stress Increased sensitivity to violence Not laughing as easily Trouble sleeping Difficulty thinking, concentrating or making decisions Intrusive thoughts and traumatic images Feeling emotionally numb Physical complaints Use of alcohol, drugs Detachment Lack of Empathy Ting, L., Jacobson, J. M., & Sanders, S. (2011). Current levels of perceived stress among mental health social workers who work with suicidal clients. Social Work, 56(4),
23Vicarious Traumatization (VT) common when population exhibits:Suicidal Behavior –Fatal and Non Fatal -Reported feelings of guilt, failure, professional self-doubt regarding their clinical competency, and anger directed toward the client(Chemtob et al., 1988, 1989; Ellis & Dickey, 1998; Grad, Zavasnik, & Groleger, 1997; Kleespies, Penk, & Forsyth, 1993; Ruskin, Sakinosfsky, Bagby, Dickens, & Sousa, 2004;Yousaf, Hawthorne, & Sedgwick, 2002)Vicarious Traumatization
24Secondary Trauma for Social Worker Highest for those who work with:Sexual OffendersTrauma VictimsNatural Disaster VictimsVictims of Terrorist AttacksSuicidal ClientsRefugee PopulationsViolence against Families/Children
25Hunter, S. V., P.H.D. (2012). Family Process, 51(2), 179-92. … findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization.Hunter, S. V., P.H.D. (2012). Family Process, 51(2),
26Secondary Trauma and Vicarious Traumatization – Post Traumatic Stress Secondary Traumatic Stress – “the natural and consequent behaviors and emotions resulting from knowing about a tramatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person.” Figley (1993, 1995)Vicarious Traumatization – “the transformation in cognitive schemas and belief systems as a result of empathic engagement with survivors of traumatic experiences.” McCann and Pearlman, 1990
27Pilot Study at Journey Care Research StudyPilot Study at Journey Care
28Participant Demographic Data 5 Advanced Practice Nurses/Nurse Practitioners in Palliative Program part of Palliative/Hospice AgencyAverage Years as APN = 6 ½Palliative Care and Hospice Experience = 7 months to 10 yearsAges: 45 to 60 years of AgeQuestion: Do you currently practice Self Care?: 4 out of 5 = YesQuestion: How long have you engaged in Self Care as a Nursing Professional? Average 2.5 yearsCoordinator DataPalliative Care LCSW with 2 years with experience on team – 20 years as social worker
295 Advanced Practice Nurses on a Multi-Disciplinary Team completed Assessment Surveys/Tools Step OneAssess if your Staff or Team is in need ofSelf Care
39Objective: Create Emotionally Healthy and Centered Palliative Staff Purpose: Help Staff De-Stress, Explore Negative Feelings re: Loss, Expectations, Alleviate Burnout, Stress Work/Life BalanceObjective: Create Emotionally Healthy and Centered Palliative StaffDetails: Meet every 4 to 6 weeks for 30 to 60 minutes during Work DayVaried Interventions UsedPre-Test/Post-TestProgram Description:PalliativeSelf Care
40Quantitative Assessment Results – How Did They Score?
42Research Project – Palliative Care Staff In order to determine effectiveness of Interventions and Collect Data to bring to Agency Leadership a simple Pre-Post Test was administered before the Self Care intervention began and immediately after. We utilized a 1-10 Scale.1. Perception of Stress from today’s work day(1) meaning No Stress (10) Very High Stress2. Perception of Stress after today’s Self Care Program3. Would you Practice this Technique again – either on own or in group setting?
44Self Care Interventions Used in Pilot Spiritual – 1) Mindfulness Exercise: Leader demonstrated Breathing and Loving Kindness Meditation Stahl & GoldsteinSpiritual – 2) Connect with Nature: Participants walked around a Natural Setting noting what they could: See, Hear, Smell, Touch, Experience. APN’s then shared their favorites.Relational – The Guilts: Group shared any unresolved guilt, professional regrets, etc. and placed same on paper to be ritually burned.Opportunity to Express Self - To Soothe and Release each APN shared the Ups and Downs of caring for patients and “doing the job” – then took turns reading uplifting quotes and affirmations on small pieces of paper in a basket.Physical – Group participated in stretching, breathing, listened to leader explain various health benefits of various ingredients - then participated in making fruit/greens smoothies – then tasting smoothies.Individual vs. Group Activities
45Efficacy of Self Care Interventions Most Effective APN Self ReportLeast Effective APN Self ReportMeditation: Loving KindnessSharing stories/ideas/frustrations and group AffirmationsStretch and SmoothieConnect with NatureDiscuss “The Guilts”Note: Average Stress Level Decreased by at least 2 points on scale for each of the Interventions
46Starting Your Own Self-Care Program It’s not that hard…..
47What Is Self Care? Definitions vary (affected by different factors) Common theme is that consumers take a more active role in their own care instead of relying on others to provide careCan be easier to say what it is NOT:NOT: just for burned out workers, the weak, the maladjusted.NOT something we don’t have time to doDOES NOT mean we focus on ourselves and ignore othersNOT about numbing ourselvesDOES NOT indicate narcissismIS NOT a luxury and does NOT mean we are self-indulgent.Cox and Steiner, Self-Care in Social Work (2013)
48You Know You Don’t Have Good Self Care When… Page 34 of book – struggles with self-careFunny example – medical experimentationAudience examplesAttendee Examples???Boundaries Exhaustion Calling in sick Loss of Hope Depression Stress Eating Thoughts of leaving profession Unprofessional Behavior Sleep Issues Can’t Separate Work from Home
49Boundaries and Professionalism When you are stressed/burned out you may find yourself:Sharing too much personal data with clientsSharing information about other staff membersComplaining about your agency or workloadDeveloping dual relationshipsUpstaging their problems/issues with your ownDownplaying other team members or disciplines
50Physical Psychological Emotional Spiritual Professional Balance What is good self care?Basic FrameworkPage 32 in Cox book
55Resources/Tools for Self-Care John Kabat-Zinn and MindfulnessYou Tube Video
56What is Mindfulness Meditation? Can be practiced in 2 ways: Formally and InformallyFormal means taking time each day to intentionally:SitStandLie DownAnd Focus on BreathBodily SensationsSoundsOther senses - thoughts - and emotionsStahl & Goldstein 2010What is Mindfulness Meditation?
57Mindfulness Meditation cont’d Informal Mindfulness is…Bring mindful awareness to everyday activities such as:EatingExercisingChoresWorkRelating to OthersBasically any actionMindfulness Meditation cont’d
58Mindfulness and Physical Pain The practice of mindfulness is particularly effective because it “decouples” the physical sensations of pain from mental and emotional processes that heighten suffering. Pain comes to be seen as “just another sensation” and the fear of pain is significantly reduced. The development of mindfulness, as Buddhists have known for 2,500 years, brings about mental and emotional freedom and a decrease in suffering.But if we are mindful of the pain – won’t focusing on itJust increase it?
59Meditation with Music Get comfortable and close your eyes….. From Caregiver Stress by Belleruth Naparstek 2008
60Setting Realistic Expectations The GuiltsRemind yourself that what you do makes a difference.Set Realistic goals – “If Only I were….”Accept your shortcomings and take action in areas you can improve.Do not take yourself so seriouslyArrange for regular vacation timeAttend career nurturing eventsShare your thoughts with a trusted friendIf overwhelmed for long period of time – see a counselor or EAPLarson, National Hospice and Palliative Care Organization
61Top Self-Care Tips for Helpers Take Stock of Where Things Are – What’s on Your Plate?Start a Self Care Idea CollectionFind Time for Yourself Every DayDelegate and Learn to Ask for HelpHave a Transition from Work to HomeLearn to Say Yes or No More OftenAssess Your Trauma Inputs – Work/Non-work RelatedLearn more about Compassion Fatigue and TraumaSupervision/Peer SupportWorkshops and TrainingConsider Working Part TimeExerciseMathieu, F. (2007)
62What Else Can You Use?Physical Self Care – eat well, exercise, get enough sleep, get medical carePsychological Self Care – reflect, journal, engage in leisure activities, let others help youEmotional Self Care – have pleasant thoughts about your self, engage in laughter/play, express emotions in appropriate channelsSpiritual Self Care – pray, meditateCreate team rituals – Healing Circles, Drumming, Light a Candle, Burn RegretsProfessional Self Care – take a break, take a vacation, balance case loadBalance Plan – among work, family, relationships, play, restSupervisionCox and Steiner, 2013
63Takin’ it to the streets Self Care on Agency Level
64Expand Self Care Beyond You Explain why it is important to organizations:Poor quality of life, burnout/dropoutMore satisfied employees have lower absenteeism rates, high productivity and better service to clients.Research shows enormous costs (financial and human being costs) with unhealthy organizations.The Corporate Executive Board places the cost of employee turnover as high as “200 times annual salary for certain positions.” But even if your lowest-level workers cost just $4,000 to replace and absorb their lost productivity, aggregating this cost for a full year likely produces a total cost number in the hundreds of thousands or millions, a number that would stagger most executives.
65Facts your agency’s leadership need to know… Facts your agency’s leadership need to know….. How does burnout affect your heath? “most disenchanted employees developed heart problems at a 79% higher rate than their less- stressed peers.” Earlier research had shown that job burnout can lead to a range of health problems, including obesity, insomnia, and anxiety. Colleague and supervisor support contributed significantly to explaining the variance in burnout intensity. Hamama, L. (2012) Journal of Counseling and Development : JCD, 89(2), Anne Fisher, contributor April 2, 2013 Fortune 500 Magazine
66So why are we so stressed? 1. United States of America – 13 days2. Belgium – 20 days3. Japan – 25 days4. Korea – 25 days5. Canada – 26 days6. United Kingdom – 28 days7. Australia – 28 days8. Brazil – 34 days9. Austria – 35 days (42 for elderly)10. Germany – 35 days11. France – 37 days12. Italy – 42 daysSo why do Americans have work stress?We retire at an older age than other countriesWe work more jobIdentity tied to job/careerWe work longer hoursWe have less vacation daysWe have less national holidaysSo why are we so stressed?
67Within a Larger Organization Create a ProposalUse Facts from this PresentationDo a Needs AssessmentCollaborate with others who are like-mindedGet a decision-maker/leader to buy inDo a small sample/test projectCan do quantitative analysis to show effects of self-care program participation (ex: monitor employee sick days in relation to number of self-care programs attended)
68What Can Organizations/Employers Do? Encourage/pay for SupervisionCreate Task Force to Develop Self Care ProgramEncourage – allow time for staff to meet with MentorsCreate Wellness ProgramsCreate a climate where sharing frustrations is “Normal” and help staff develop ways to Let the Frustrations Go!Offer skill building opportunitiesEmployee Recognition ProgramsFlex Time – Generous Vacations – Realistic Productivity ExpectationsImprove Orientation and Performance ReviewsSchwartz Rounds
69Schwartz Rounds…offers healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss social and emotional issues that arise in caring for patients. In contrast to traditional medical rounds, the focus is on the human dimension of medicine.Caregivers have an opportunity to share their experiences, thoughts and feelings on thought-provoking topics drawn from actual patient cases. The premise is that caregivers are better able to make personal connections with patients and colleagues when they have greater insight into their own responses and feelings.Schwartzcenter.orgIn healthcare settings -
70If you are a small group or private practice? Research your partners in communityForge relationship and create small SELF CARE consortiumShare resources across agenciesJoin professional associationsSocial Work Supports in Social Media such as Linked InNASWIf you are a small group or private practice?
71How to be more resilient Take this cup,I’ve filled it up,With love and joy and laughter.Now it’s empty,Fill it up.Repeat,Forever after.First, so fullI’m givingAll my love and joy in livingThen near empty,Tired of living,And I’m theOne who needs the giving.This cup, this cup,This cup of life,It’s always overflowing;We give and getAnd get and give,Life’s balanceKeeps on going.Repeat, By: Laura ByrnesForever, after.
72Thank You for Attending Questions May I be filled with loving kindness May I be wellMay I be Peaceful and at easeMay I be happyStahl and Goldstein, 2010Closing