Compassion Fatigue by liaoqinmei

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									Compassion Fatigue/ Secondary
Traumatic Stress: Caring for the
Caregivers



                           Together We Can
                  April Naturale, MSW, Ph.D.
                                Lafayette, LA
                            October 6, 2010
Goals and Objectives
Goal:
For staff working with abused and traumatized
children to understand and address their risks and
responses to Compassion Fatigue, Secondary
Traumatic Stress and Burnout
Objectives:
• To be able to identify the body and mind’s
  responses to stress
• To learn ways mitigate and address these
   responses by implementing skills and self care
• To monitor changes over time
CONCEPTS OF STRESS VARY

Stress is a cognitive reaction that affects
         humans physiologically



Individuals from different backgrounds,
cultures and geographic areas perceive
            stress differently
    The Physiology of Stress
                  Good Stress
 The good stress allows us to perform at a
  higher level (fight or flight)

   The production of cortisol improves
    memory and enhances immune function

   Spikes in blood pressure flood our
    muscles and brain with oxygen
    The Physiology of Stress
            Bad Stress-Overload

   The allostatic system becomes charged
    too frequently with NO CHANCE TO
    VENT the build up of energy

   Too much cortisol will damage memory,
    hurt or weaken your immune system
    and enlarge your stomach
          Work Stress

Stress measured by increases
in blood pressure is generally
twice as high during the work
day compared to when at home
or time off.
(Pickering, 2005)
     Work Stress

The worst work-related
stress is caused by jobs
where people have little
 control over activities
  and the rate at which
  they have to address
           them
     Environmental Effects
   Responsibility of caring for
    physically and/or emotionally
    abused, neglected children

   Exposure to the fear, grief, pain,
    loss, separation, death of children

   The community/social response
    (or lack of)
          Additional Factors
   Depression-5-10% of the population
    (NIMH, 2005)

   Race-genetics, family illnesses

   Diet –high salt, high fat

   Social Constructs-professional women,
    single parents with children
   The Population of Care
Children react to caregiver’s emotional
              responses

Child care workers put needs of children
           ahead of their own

  Increased responsibility of caring for
 children increases the stress response
Compassion Fatigue



  THE COST OF CARING
Secondary Traumatic Stress


      The experience of
  trauma symptoms in the
   counselors as a result of
        listening to the
  trauma material of clients
               Differentiations
   Not burnout, but can lead there (Figley, 2002)

   Unlike countertransference (Green, 1992)

   Differentiated from vicarious trauma (Pearlman &
    Saakvitne, 1995; Figley, 1999)


   Compassion fatigue and secondary traumatic
    stress are most similar in meaning (Stamm 1999)
    Symptoms (Trauma Specific)
 High adrenaline, physical euphoria,
  numbness-the endorphin effect
  disguises distress
 Coupled with fatigue, cognition can
  change and create an inability to
  recognize poor judgment
 Anger is a common defense
  against recognizing the problem
                       Symptoms
   Posttraumatic stress disorder symptoms;
    Symptoms that parallel those of client
    Monroe, 1999
   Negative cognitive schemas
    Pearlman & Saakvitne, 1995)

 Questioning beliefs; Sense of
  helplessness
 Isolation; Depression; Increased
  substance use; Increased rates of
  physical illness
 Lower staff morale and productivity;
  Higher turnover and errors Stamm, 1997
                                  Disaster Mental Health Management &
                                  Training                              15
   High Risk Symptoms

Medicating or narcotizing
Overeating, excessive drinking
Extramarital affairs
Suicidal gestures
Long Term Exposure Symptoms
Tiredness/weariness yet insomnia

Brooding, wistful, mournful-Depressive

Increasing demoralization

Intellectualizing/Religionizing the work

Grandiosity (I can handle this
  myself/don’t consider asking for help)
              Risk Categories
   Health, mental health, social services
    providers
   Staffs with clients who experience
    profound suffering
   Highly exposed response staffs (media,
    clergy, caregivers)
   Inhibited individuals in these groups
    (more likely to have dissociative
    responses)
Risk Variables
   Lesser educated and lesser
    experienced counselors

   Greater length of assignment results
    in higher STS risk

   Gender and ethnicity have been found
    to affect STS (women and minority
    status)
          Child Care Workers
   Are generally self sacrificing
     -many place themselves in danger
     -many will work ‘till it hurts
     -many will skip breaks
     -many will ignore/fight direction to
      rotate assignments, go off duty or
      take benefit time even when
      encouraged
         Automatic Responses
 Caregivers react to stressful situations by
  training- without the benefit of thought-they go
  right to caring for others
 Concerns for family don’t disappear-We put our
  own emotions on hold
 Cognitive reactions reinforce physical reactions
  (our thinking controls our actions)


                              Disaster Mental Health Management &
                              Training                              21
     What Can You Do?
Learn
Be Aware
Monitor
Think
Practice
Change
Manage
          Prevention: Structural
   Vary caseload of trauma and non
    trauma cases

   Utilize buddy system

   Access supervision routinely
    (Dugall, Herberman, Delahanty, Inslicht & Baum, 2000).


   Supervisors-mandate case rotation
    and use of benefit time (Monroe, 1999)
Prevention: Professional Perspective
•   Expect, seek & accept peer
    support

• Master controlled, limited
  empathy
• Define structure and boundaries

•   Monitor overidentification

•   Self assess-PRO QUAL-IV

•   Commit to implementing self-care
     Prevention: Personal
Recognize when you are:
          Hungry Angry Lonely Tired

Maintain support systems

Schedule personal time, engage in
pleasurable activities

Maintain a balance

Practice Self Care
Prevention: Professional Perspective
  Be realistic

  Commit to implementing self-care

  Recognize that the world won’t fall
    apart without you

  LET GO
              As a Unit
•   Give yourselves permission to celebrate
    even in the midst enormous stress-
    play, laugh, experience joy

•   Be together-don’t isolate

•   Communicate, communicate,
    communicate (e.g. I need you to
    understand, we will get through this
    together, let’s stay connected)

•   Plan for every day
                                              27
  Simple Stress Management
Managers, Professionals and Front Line
staff can mitigate compassion fatigue and
burnout by using stress management
techniques.
Learn those personally effective ways of
using relaxation:
   - focused breathing;
   - distraction;
   - seek support, comfort from loved ones
   - use positive self talk
        Physical Tools
Breathing, Stretching, Walking

Healthy Diet-Avoid excesses

Body Work Body Work Body Work
(Exercise,Yoga, Meditation, Guided Imagery, Self
Hypnosis)

Meditation

Music
Start with the 333 STOP Method

      STOP Where You Are
           3 Minutes
           3 Breaths
         3 Times a day

Graduate to the Relaxation Response
                       Disaster Mental Health Management &
                       Training                              30
          Cognitive Tools
•   Interrupt the Automatic Response/Reduce
    the Reaction
•   CBT (Messaging; Thought
    Stopping/Insertion)
•   Emotion Regulation (Turn Down the
    Vibration)
•   Reintroduce Routing-Return to Normal
    Activity

                         Disaster Mental Health Management &
                         Training                              31
                Affirmations
   Familiarize yourself with the action of
    affirmations both auditory and visual

   Sample different expert’s work-choose
    voices and images that are pleasant to
    your eyes/ears

   Schedule the use of these tools to obtain
    maximum benefit
                                                32
               Leisure Tools
Try Acupuncture, Art, Awareness, Create, Cook,
Dance, Dream, Draw, Exercise, Enjoy, Explore,
Go Home, Kick-Box, Laugh, Limit work, Loosen
up, Listen to music, Massage, Meditate, Practice
Yoga, Paint, Pet the Pet, Sing, Sit Quietly, Sleep,
Start a Book, Stretch, Talk to Yourself, Family and
Friends, Wade, Walk, Watch a bug, or a movie or
the sunset, Whistle, Wish
         Do Something other than WORK
 Stay focused on answering the question that is being asked.
 Read the introductory words and think for a moment how you
    will respond to the questions by starting with the
    introductory words.

1. What problem(s) do this work bring to your life? Begin your
   response:
 “Being a child care worker brings ________________to my
   life….” (e.g.: excessive worry )

2. How has this problem affected your family life or other
   relationships? Begin your response:

“This problem, _________________, has affected my life by…”

3. What have you done to cope with or address this problem?
   Begin your response:

“To cope with this problem, I have….”
        Publications Website
National Mental Health Information Ctr
www.mentalhealth.samhsa.gov/cmhs/katrina/p
 ub_respond.asp
National Center for Posttraumatic Stress
 Disorder www.ncptsd.org
Compassion Satisfaction & Fatigue Test
 www.isu.edu/~bhstamm/tests/satfat.htm

								
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