Download of ___ checked this box

1
STRONGLY
DISAGREE
2
DISAGREE
SCALE
N = ___
3
4
NEUTRAL
AGREE
5
STRONGLY
AGREE
1.
You know your strengths, how to use them to help, support
colleagues, care for patients.
___ of ___ scored __ or __
2.
You know your weaknesses, how to deal with them to protect yourself,
family, colleagues, and patients.
___ of ___ scored __ or __
3.
You can say “No!” without feeling guilty, making an excuse why not, or
becoming defensive.
___ of ___ scored __ or __
2
SCALE
1
STRONGLY
DISAGREE
2
DISAGREE
3
NEUTRAL
N = ___
4
AGREE
5
STRONGLY
AGREE
4.
You know how to do good “self-care” , take care of family, be effective
co-worker/colleague, perform job at highest level, and be contributing
citizen in world.
___ of ___ scored __ or __
5.
If you experience stressful/disturbing incident at work, you know how to
“Self-Debrief” to process event, learn and grow, so you will not
experience long-term personal/professional harm.
___ of ___ scored __ or __
3
SCALE
N = ___
In the list below, please check box of any statement that describes how you
have felt in the past several months, since the beginning of 2015.
Hypervigilance & exaggerated startle response – being on guard &
jumpy.
__ of ___ checked this box
Irritability or angry outbursts.
__ of ___ checked this box
4
UNCERTAINTY
Leads
to...
INSECURITY
ANXIETY
DEFENSIVENESS
HOSTILITY
Turned Inward
1. False guilt
2. Depression
{3. Suicide}
Turned Outward
1. Anger
2. Jealousy
3. Envy
{4. Homicide}
SCALE
N = ___
In the list below, please check box of any statement that describes how
you have felt in the past several months, since the beginning of 2015.
Nightmares & trouble falling or staying asleep.
__ of ___ checked this box
Emotional numbness, lack of interest in activities & difficulty feeling
love & joy.
__ of ___ checked this box
Avoiding thoughts & situations that are reminders of a traumatic event.
__ of ___ checked this box
6
SCALE
N = ___
In the list below, please check box of any statement that describes how you
have felt in the past several months, since the beginning of 2015.
5 Common Symptoms of Post-Traumatic Stress Disorder (PTSD)
Important notes: Of the 27 Pre-Evaluations completed May 14th:
___ checked ___ of the 5 Common Symptoms of PTSD
___ checked 4 of the 5 Common Symptoms of PTSD
___ checked all 5 Common Symptoms of PTSD
7
“Our Palliative Care Director is leaving the team, the hospital, the state.
Even though we are going to have another physician coming, he does
not want to do outpatient clinic. Another of our physician {sic} just died
tragically last Friday. He is being missed so much. The same Friday one
of our chaplain announced her retirement. She will be leaving us at the
end of August, and… our APN and executive secretary are actively
looking for another job. Our service is going to the pits!
Please we appreciate your prayers for peace, direction and wisdom
about what we are going to do in the midst of grief, and people leaving
in different ways. Sorry for the bad news. I feel tired and burnout {sic}.”
Part of e-mail from a chaplain colleague and friend…

Compassion fatigue: Development of negative professional
attitudes/behaviors resulting from job strain when you
experience frustration, powerlessness, and an inability to
achieve your work goals.

Burnout: Response to the work environment and not to the
consequences of caring for people who are suffering.
Puchalski & Ferrell, 2010.








Moral distress
Compassion fatigue
Secondary stress
Over-identification
Helplessness
Hopelessness
Boredom
Failure
(Wicks, 2006 & Freeman, 2015)








Having a clear realization that stress and pain are a fact of
life.
Developing a regimen of work, relaxation, exercise and
leisure.
Honing one's communication skills.
Establishing strong support systems; family, friends,
worshipping community members, and co-workers.
Enjoying the thrill of discovering new aspects of oneself.
Learning to adapt to change and finding challenge in
change.
Cultivating flexibility.
Accepting crises as important growth opportunities.

From painful past experiences one can discover:
• Freedom to share your feelings and emotions with person's
•
•
•
•
•
•
close to yourself.
Freedom to create time for fun and relaxation.
Freedom for special persons in your life.
Freedom to enjoy each day moment by moment.
Freedom to live the sadness and to laugh during the time in
between.
Freedom to pack quality into each day and sharing the pleasure
with others.
Freedom to set aside time for pulling memories into focus.
McIntier, 1996.



Requires a culmination
of events.
Often results in the loss
of staff
• Quit
• Transfer
• Withdraw
• Become cold and
mechanical
Quality is compromised.
(Wicks, 2006 & Freeman, 2015)






We must acknowledge the personal responsibility we
have to ourselves.
Direct correlation between group morale,
absenteeism, and leadership quality.
Communication is just as important between staff
and management as between patients and health care
providers.
We all need to feel we are being listened to,
appreciated, and respected.
Our perceived failures must be addressed.
Burnout is the last straw; it must be addressed early
before it grows.
(Wicks, 2006 & Freeman, 2015)





Mental fatigue at end of day.
Tense feelings, boredom, frustration, and/or anger
toward patients, co-workers.
Experiencing physical symptoms.
Personal and professional resources perceived as
inadequate.
Job requirements perceived as repetitious, beyond
ones ability, and/or physically or emotionally
depleting.
(Wicks, 2006)
“The seeds of burnout and the seeds of
enthusiasm are in reality the same seeds. Anyone
who truly cares can expect to ride the waves of
burnout- and occasionally get knocked down by a
wave they missed.”
(Wicks, 2006)
Anton Chekov once proclaimed:
“Any idiot can face a crisis - it’s the
day-to-day living that wears you out.”


“Health care is one of the few professions where it
is socially acceptable to ignore your family, your
non-work life, and yourself.”
It is not the demands of our jobs, but rather our
compulsive character that is the root of the
problem.
(Wicks, 2006)

Ability to empathize is essential
• Must see ourselves in our patients
• Forces us to confront our vulnerability
• Forces us to acknowledge statistical likelihood

Need for Self-awareness
• Recognize our vulnerability.
• Ability to appreciate the wear and tear of patient
interactions.
• Providing patient care is as physically and
emotionally depleting as a disease is to a patient.

Need for rest, restoration, and rejuvenation
of body and spirit.
(Wicks, 2006)
Results of the emotional pressure from reaching out
to others in need:





Constant and continuous
Reality in medical and nursing professions
Need to accept unfortunate outcomes
Overwhelmed by frustration
Loss of perspective when encountering inevitable failures.
“For every poisoned worker there are a dozen with
sub-clinical toxicity.”
(Wicks, 2006)
Achieving a positive outcome in the face of adversity:




Bending but not breaking.
Recovering from a bad experience.
Possessing adequate coping mechanisms that function
correctly during a time of trauma.
Dependent upon foundational capacity of the individual
•
•
•
Early life experiences
Cognitive flexibility
Effective self-regulation of behavior and physiological
responses
(McEwen, Gray, & Nasca, 2014)
Find ways to positively vent and promote
communication.
 Compliment each other in front of colleagues.
 Utilize creative problem solving.
 Verbalize feelings of not being heard or appreciated.
 Utilize humor and emphasize the importance of
having joy in your life.
 Take breaks off the unit/work area.
 COMMUNICATE
(Wicks, 2006)

“ The sharing and gaining of insight into
personal frustrations, sadness, and loss can
assist the caregiver to find meaning and
personal growth from his or her
experiences. Often, just the act of
converting feelings into words can be
healing.”
(Freeman, 2015)






Do not believe the pedestal you have been placed
upon.
A power greater than you will decide your patient’s
fate.
DO NOT EQUATE DEATH WITH FAILURE.
Take comfort in knowing you did your very best.
Learn to celebrate the journey.
Review your day and give yourself quiet time:
•
•
•
Recognize parallels that lead to over-identification.
Identify unresolved grief.
Challenge yourself to understand why the event/situation
was so upsetting.






Stay in the present.
Eat healthy, get your rest, and try to exercise.
Find laughter and joy and make it a daily part of
your life.
Identify some meaning or growth from the
experience.
Learn to “Ride the Dragon”.
Do not fear professional grieving, for it is when the
heart is most broken that we are the most open to
change and personal growth.
(Wicks, 2006 & Freeman, 2015)
“….When all of life – both the perceived good and bad is
faced directly with a sense of openness, life’s promises
are more fully realized. Moreover, this is not only
important for the person experiencing the struggles but
also for those they may touch after absorbing the new
lessons learned about gratitude, impermanence, the frailty
of life, simplicity, meaning-making, and compassion.”
(Wicks, 2006)
“By facing the dragons of reality and truth about our lives,
much unforeseen growth, depth, and promise becomes
possible. No one wants to experience, and it is not easy to
face loss, trauma, serious stress, and loneliness. This is
very true. However, if we can learn to ride our dragons
rather than run, hide from, or attack them, it can be
transforming.”
(Wicks, 2006)

Self-care must include mindfulness and self-awareness
of the baggage we all carry.

Daily stressors add up like scalding water in a bath and
we don’t know when to scream.

Group support (and) staying present… can… assist in
maintaining personal resiliency.

We all need to stop running from the emotional pain
caring for the dying can cause, and chose to ride the
dragon.
(Wicks, 2006)

If we are open to learn from our experiences and
embrace the journey we can:
•
•
•
•
Learn about and embrace our personal strengths.
Understand how helplessness and loss can be faced with dignity.
Embrace how being vulnerable can open us up to selfacceptance.
Appreciate how humility can be the very door that leads to
compassion.
(Wicks, 2006)
Do not think that love, in order to be genuine,
has to be extraordinary. What we need
is to love without getting tired.
How does a lamp burn? Through the continuous input
of small drops of oil. If the drops of oil run out,
the light of the lamp will cease….
-- Mother Teresa
THANK YOU
Chaplain Terry Irish
[email protected]
626.256.4673 Ext. 85781
Pager 626.423.0023
Cooke, Liz. (2012). “Compassion Fatigue.” PowerPoint presented at City of Hope.
Freeman, B. (2015). Compassionate Person-Centered Care for the Dying: An Evidence-Based
Palliative Care Guide for Nurses. New York: Springer Publishing Co.
Puchalski, CM. & Ferrell, B. (2010). Making Health Care Whole. Integrating Spirituality Into Patient
Care. © Templeton Press.
McEwen, B.S., Gray, J.D., & Nasca, C. (2014). Recognizing resilience: Learning from the effects of
stress on the brain. Neurobiology of Stress, 1(2015), 1-11. An on-line open access article
retrieved from: http:// www.journals.Elsevier.com/neurobiologyofstress
McIntier, T. (1996). Preparing Oneself for the Crises of Life .
Nichols, S.W. Mitigating Care Fatigue in Palliative Care Providers: Developing Self-Awareness and
Self-Care. Archstone Foundation Grant Teleconference, March 4, 2012.
Wicks, R. (2006). Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to
Professional Resilience and Personal Well-Being. New York: Oxford University Press
Wolfelt, A. (2002). Healing A Parent’s Grieving Heart. Fort Collins, CO, Companion Press.
Wolfelt, A. (2003). Understanding Your Grief. Fort Collins, CO, Companion Press.