1. Self Care for Healthcare Professionals Presented by: Jim Messina, Ph.D., CCMHC, NCC Assistant Professor Counseling and Psychology Troy University, Tampa Bay Site Presentation available on www.coping.us

2. Hi There! It seems like yesterday I was talking with your group at Bay Pines on a topic very similar to this topic As Yogi Berra would say: Its like déjà vu all over again

3. "The pessimist complains about the wind; The optimist expects it to change; The realist adjusts the sails." William Arthur Ward

4. Or like Yogi would say: We made too many wrong mistakes

5. Goals for Our Program 1. Identify Compassion Fatigue through Self-Assessment & Remediation Plan for Health care professionals 2. Identify Physical exercises, aerobic & mobility activities that improve self-care for Health care professionals 3. Identify a Nutritional regimen that sustains health, energy & cognitive clarity of health care professionals 4. Identify how competency based continuing education improves the self-care of Health care professionals 5. Identify how to maintain ones sense of humor & emotional balance as a Health care professional 6. Identify what you are willing to commit to which will improve your self-care from this point on

6. Why this Topic now? Yogi would say: If you dont know where youre going, you might end up some place else

7. Who is susceptible to Compassion Fatigue? Healthcare Professionals who are most susceptible to this condition work with people who fit one or more of the following categories: 1. Injured veterans survivors of the Afghanistan & Iraq Wars or other prior wars 2. Veterans suffering from PTSD from being in the Afghanistan & Iraq Wars or other prior wars 3. Patients dealing with life threatening illness like cancer, heart & lung conditions, HIV-AIDS, or other systemic health conditions 4. Hospice eligible individuals facing imminent death due to old age, injury, disease or illnesses 5. Survivors of torture, trauma, or natural or man-made disasters

8. What is Compassion Fatigue? Compassion fatigue is thought to be a combination of secondary traumatization & burnout precipitated by the care delivery that brings health-care professionals into contact with the suffering Szabo, B. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice: 12: 136–142.

9. Difference between Compassion Fatigue & Burnout "Compassion fatigue is when caregivers have such deep empathy they develop symptoms of trauma similar to the patient according to director of the Army Institute of Surgical Research Col Kathryn Gaylord The disorder can also resemble burn out which occurs when emotional exhaustion is experienced due to increased workload & institutional stress & does not involve trauma Compassion fatigue can have detrimental effects on doctor patient relationships since doctors suffering from the disorder often either grow distant from patients or get too close Wilson, E. (2008). New Program Offers Care for Caregivers. Department of Defense Military Health System News, 23 May 2008.

10. Secondary Traumatic Stress People who come into continued, close contact with trauma survivors may also experience emotional disruption, becoming indirect victims of the trauma The natural, consequent behaviors & emotions resulting from knowledge about a traumatizing event experienced by a significant other The stress resulting from helping or wanting to help a traumatized or suffering person Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among Social Workers. Social Work: 51(2): 63-70.

11. Compassion Satisfaction Compassion satisfaction is the ability for clinicians to derive a great sense of meaning & purpose from their work It may aid in alleviating existential terror endemic to the human condition when a society is at war It may be an important buffer in managing & transcending alterations in belief systems & physiological or emotional reactions seen in compassion fatigue Stamm (1999 and 2002) as quoted in: Tyson, J. (2007). Compassion Fatigue in the Treatment of Combat-Related Trauma During Wartime. Clinical Social Work Journal; 35:183–192

12. Major factors contributing to Compassion Fatigue 1. Poor self-care 2. Previous unresolved trauma 3. Inability or refusal to control work stressors 4. Lack of satisfaction for the work Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

13. Predictors of Compassion Fatigue among Hospice Nurses 1. Trauma 2. Anxiety 3. Life demands 4. Excessive empathy (leading to blurred professional boundaries) Abendroth, M. & Flannery, J. (2006). Predicting the Risk of Compassion Fatigue: A Study of Hospice Nurses. Journal of Hospice and Palliative Nursing: 8(6): 346-356.

14. Why Focus on Compassion Fatigue? It is imperative that healthcare professionals take steps to ensure that they are functioning at their best in the therapeutic relationship Facilitating their own personal well–being & avoiding burnout is clearly one way in which this can be achieved Linley, P.A. & Joseph, S. (2007). Therapy work and therapists positive and negative well-being. Journal of Social and Clinical Psychology: 26(3):385–403.

15. Self-Assessment Take the Compassion Self-Assessment Rate each item on a scale from 1 to 10 1 = never experienced 5 = occasionally experienced 10 = frequently experienced

16. What does this Assessment Tell You? If you rated three or more items over 8 or if you rated 5-10 over 5 You are most likely experiencing some level of compassion fatigue already

17. Characteristics of clinicians experiencing compassion fatigue Physically: Chronic sense of exhaustion & fatigue, insomnia, headaches, stomachaches, lack of appetite, physical agitation or retardation, frequent bouts of sickness (e.g., colds, sore throats) Psychologically: often feel irritable, are overwhelmed by the volume & content of their work Relationship with Clients: sense a reduction in their baseline empathy for others, feel numb to patients & families pain, are cynical regarding clients ability to change &/or perceive them as being responsible for many of their problems Organizationally: often report a sense of feeling scattered & unable to meet their professional & personal obligations Mendenhall, T. (2006). Trauma-Response Teams: Inherent Challenges and Practical Strategies in Interdisciplinary Fieldwork. Families Systems, & Health: 24(3):357-362.

18. So Why Assess for Chronic Fatigue It is expected that most clinicians will at times experience symptoms of compassion fatigue, as these are normal reactions to trauma work However, for some clinicians the experience of compassion fatigue may become so severe as to interfere with their clinical effectiveness & their personal mental health It is for this reason that ongoing monitoring is necessary Bride, B., Radey, M. & Figley, C.R. (2007). Measuring Compassion Fatigue. Clinical Social Work Journal: 35:155-163.

19. Early Assessment Impact Instead of waiting for the clinicians to become symptomatic use inventory tools to look for the presence of challenges to their fundamental assumptions, values & beliefs With early assessment clinicians have the opportunity to transform their discomfort into personal growth & development This should be the aim of a professional supervision & support model to address Compassion Fatigue Tehrani, N. (2007). The cost of caring – the impact of secondary trauma on assumptions, values and beliefs. Counselling Psychology Quarterly: 20(4): 325–339.

20. What You Can Do! Recognize the symptoms of compassion fatigue Learn to ask for help Be aware & accept the limitations of your family, your job & yourself Maintain discipline in daily responsibilities & duties Take time out during the day Take short vacations at least twice a year Try to change little things that gnaw at you & accommodate to those you can't change Organize your time so you can concentrate on vital tasks Admit compassion fatigue is a real problem for you & don't try to cover it up Distinguish between stressful aspects of your job or home life that you can change & those you can't change-change what you can

21. What You can do to ward off Compassion Fatigue 1. Boundary maintenance 2. Self-care 3. Good training 4. Good supervision If given all 4 Healthcare Providers will thrive as compassionate professionals Radey, M. & Figley, C.R. (2007). The Social Psychology of Compassion. Clinical Social Work: 35(1):207–214

22. What can be done on the job! Identify realistic attainable goals for each department & evaluate accordingly Help staff to maintain personal growth both at home & on the job Encourage & support staff to develop an active outside life with a variety of interests Encourage staff to personalize the work environment with meaningful pictures, objects, colors, etc. Encourage staff to be comfortable with themselves by setting limits as to how far to become involved with clients & colleagues Encourage & practice good communication skills on the job Provide for flexible working conditions on the job Encourage trying new ideas outside of the box Sponsor decompression techniques activities such as meditation or exercise that relieve tension & put staff into a more relaxed state Build support systems among staff to discuss problems & help each other look for solutions. Don't just air gripes - look for solutions

23. Implement Stress Reduction & Relaxation Breaks Remember what Yogi said about the game: 90% of the game is half mental So learn to put the mental half aside and relax and let go of the stressors from the work you do on a daily basis

24. OK? Now Lets Talk Sleep! We all know that adults need 8 hours of sound restful sleep every night This is especially true for Healthcare Professionals who work with clients who have loads of stress & trauma in their lives SO what are you going to do about it?

25. So remember you need to have all 8 hours After all Yogi said in this regard: A nickel aint worth a dime anymore So dont kid yourself anything less than 8 hours will not do!!!

26. Training like this helps!!! Sprang et al, found that specialized trauma training did enhance Compassion Satisfaction and reduced levels of Compassion Fatigue and Burnout, suggesting that knowledge & training might provide some protection against the deleterious effects of trauma exposure Sprang, G., Clark, J. & Whitt-Woosley, A. (2007). Compassion Fatigue, Compassion Satisfaction, and Burnout: Factors Impacting A Professionals Quality of Life. Journal of Law and Trauma, 12:259–280.

27. Cause you need to Remember Yogi said: If the world was perfect, it wouldnt be So continue to gain training on Trauma and its impact on clients & helpers so as to learn how to improve the world in which you work

28. So Get More Training on Prevention of Compassion Fatigue It helps to refresh everyones understanding of the impact of the Trauma, which patients & clients have experienced, on the Healthcare Providers who are working with these victims & survivors of trauma

29. How About a Physical Exercise Program? It is important to include an active physical program of exercise to help alleviate the stressors which build up & contribute to Compassion Fatigue

30. Dont PooHoo Physical Exercise Remember what Yogi said about himself applies to Physical Exercise: Half the lies they tell about me arent true.

31. Developing a Healthy Exercise Program Identify Benefits Combat Myths about exercising Combat Roadblocks to exercising Identify & overcome: Triggers to avoid, ignore, or stop exercising Look at what is new in exercise offerings

32. Benefits of Healthy Exercise Compensates for fat accumulation by burning calories Provides a "natural high'' by the release of endorphins Strengthens the cardiovascular & respiratory systems if aerobic type exercise sustained for at least fifteen minutes on a regular basis Keeps the muscular system supple Keeps the circulatory system operating at its best Builds bone mass to combat osteoporosis

33. Roadblocks to Exercise Not enough time; my schedule is already so full Implementing a program of exercise takes exceptional effort & planning The health club is too far away. It is not "on my way'' to anywhere An exercise program costs a lot of money. It is unpleasant to get all sweaty when you exercise Exercise can be so boring Exercise makes your body sore

34. Listening to those excuses, makes you sound like a pitcher Remember what Yogi said: All pitchers are liars or crybabies

35. Time for Exercise Make the exercise session a priority of the day Schedule a regular, specific time of day for exercise Choose a convenient time Exercise in the morning before breakfast, in the afternoon before lunch, or in the evening after getting home from work, but before dinner.

36. Place for Exercise Choose an exercise easily performed around the house, e.g., treadmill, stationary cycle, rowing machine, jumping rope, rebound trampoline, jumping jacks, walking, running, biking, swimming Perform exercises that can be done in an air- conditioned environment (stationary cycle, rowing machine, or rebound trampoline). Profuse sweating is not necessary for exercise to be worthwhile

37. Reduce Costs of Exercise Choose an exercise which doesn't involve the purchase of equipment or club memberships, e.g., walking, running, jumping rope, etc.

38. Keep Exercise Interesting Try indoor exercise in front of a TV or while listening to motivational tapes or energizing music Try outdoor exercise in tree-lined or park-like settings with interesting scenery and use a ipad or iphone For either type of exercise, get a partner or group of people to exercise with; make it a social experience that will provide mutual motivation & encouragement

39. Exercise is good for everyone After all Yogi said: I think Little League is wonderful. It keeps the kids out of the house.

40. Start out Slow to Protect Your Body from Being Strained Slowly phase an exercise program in; help your body adjust to the increased activity Use warm-up & cool-down exercises to avoid muscle strain Wear the proper clothing & shoes to avoid body strain or injury

41. If you exercise you will have a new inner depth to rely on Remember what Yogi said: We have deep depth Make it so in your life – now!

42. How about eating a Healthy Diet along with Exercise? Eat a variety of foods to get the nutrients you need & at the same time the right amount of calories to maintain healthy weight. Be sure to eat a balance from these food groups: Vegetables – as much as you want Fruits – 2-3 times a day Whole Grain Foods – at as many meals as possible Plant oils – such as olive, canola, corn, sunflower, peanut & other veg oils Nuts & Beans – 2-3 times a day Fish, Poultry or Eggs – 0-2 times a day You need them for the vitamins, minerals, carbohydrates & protein they provide Pick the lowest fat choices from the food groups Here is a food pyramid from Harvard medical professor Walter Willett, M.D. in his book: Eat, Drink, and be Healthy

44. Another Version of Health Eating To help you get the message how about using the Healthy Eating Plate Version which is the next slide Here your plate consists of: Lots of Vegetables Plenty of Fruits Whole Grains Fish, Poultry, Beans & Nuts A Multivitamin in your daily routine

46. Quick Guide for Healthy Eating! Stay away from: 1. Junk Foods & Sugary Drinks 2. Cold Cuts & Other Processed Meats 3. Bacon & Red Meats Do make sure you 1. Drink lots of sugar free Water, Tea or Coffee 2. Cook with healthy oils

47. So plan your eating habits to support your health Dont Just Talk About It Do Something About It! After all if you dont you might end up like Yogi said: You can observe a lot just by watching. So, get out and do something about it!

48. Maintain a Good Sense of Humor We used Yogi today to get us going in that direction! And I hope he was not right about what was said today when he said: We made too many wrong mistakes

49. So are you going to do something about it? Make a commitment to: 1. Continuously assess your current emotional state 2. Implement a good stress reduction activity for yourself & your co-workers 3. Get 8 hours of sleep a night 4. Have a regular exercise program going for yourself & if possible your co-workers 5. Eat a good balanced diet

50. Because you have to remember Yogi said: It aint over till its over…

51. So there you have it! Dealing with Compassion Fatigue is a TEAM effort which requires administration, co- workers, your families & significant others to understand that it takes a lot of effort to prevent & deal with this insidious & disabling condition! Best of Luck!

52. References Messina, J.J. (2013) Preventing Burnout at: http://coping.us/toolsforpersonalgrowth/preventingburnout.html http://coping.us/toolsforpersonalgrowth/preventingburnout.html Messina, J.J. (2013) Preventing Clinician Compassion Fatigue at: http://coping.us/practicalclinicaltopics/preventcompassionfatigue.html http://coping.us/practicalclinicaltopics/preventcompassionfatigue.html Messina, J.J. (2013) Stress Reduction at: http://coping.us/toolsforpersonalgrowth/stressreduction.html http://coping.us/toolsforpersonalgrowth/stressreduction.html Messina, J.J. (2013)Tools for a Balanced Lifestyle at: http://coping.us/balancedlifestyle.html http://coping.us/balancedlifestyle.html