CompassionFatigueStudentNurseJourney：同情疲劳护生的旅程66张课件

1、Compassion Fatigue:Healing the Heart-Renewing the Soul byDonna M. White RN, PhD, CS, CADACFellow-Board Certified Expert in Traumatic StressLemuel Shattuck Hospital, Boston, MAPublic Health Nursing Webinar August 3, 2019 Copyright, D.White 2019第1页，共66页。Copyright, D.White 2019New England Alliance for

2、Public Health Workforce Development Boston University School of Public Health Massachusetts Association of Public Health Nurses (MAPHN)Acknowledgements第2页，共66页。Overview The purpose of this workshop is to present the profile of a Health Care Professional suffering from Compassion Fatigue. The interac

3、tive seminar will identify common stressors that impact performance of professionals working in Health Care. The learner will be given methodologies to identify patterns of Compassion Fatigue and strategies to promote Wellness, Recovery and a renewed sense of identity as a caring professional.Copyri

4、ght, D.White 2019第3页，共66页。Learning ObjectivesUpon completion of this session you will be able to:Identify three symptoms of Secondary Traumatic Stress Disorder (STSD)Describe how Secondary Traumatic Stress Disorder (STSD) and the sequelae Compassion Fatigue, is a risk to Health Care Professionals (H

5、CP)List two Occupational Supports for Health Care Professionals experiencing STSD.Copyright, D.White 2019第4页，共66页。Lemuel Shattuck Hospital Copyright, D.White 2019第5页，共66页。A dedicationSt. Francis of AssisiPatron Saint of Compassion He relinquished a life of wealth & chose a humble life to care for th

6、e sick, the disenfranchised, the poor, prisoners, and believed no one should ever die alone at the end of their earthly life. Copyright, D.White 2019第6页，共66页。Ever wonderWhy you chose your profession?Ever think about the rewards of it?Why you continue even when exhausted?Do you regret anything? Name

7、itHow often do you think about what you do and the impact it has on who you are?How can you learn to “live softly”?Copyright, D.White 2019第7页，共66页。Health Care Professional Prone to Compassion FatigueHeroic treatersIntensely caring and concerned for othersHigh achieversStrong academics - top of their

8、 classDysfunctional home/early lifeHighly competentExcellent employeeDriven to succeedFinds failure difficult Cerney, 2019Copyright, D.White 2019第8页，共66页。Positions availableLong hours with required overtimeMust be available off-shifts,weekends, and holidaysMust be tolerant of aberrant behaviorMust b

9、e willing to handle daily crisesEmotionally draining and physically difficult workSadness and tragedy seen oftenHigh degree of paperwork and responsibilityLow salary that will increase after 20+ yearsCopyright, D.White 2019第9页，共66页。Occupational Signs of StressBiological:Bodily functionsPhysical symp

10、tomsAdverse physiological changesCopyright, D.White 2019第10页，共66页。Occupational Signs of StressPsychological:Decreased tolerance of othersLow frustration abilityLoss of humor and joyCopyright, D.White 2019第11页，共66页。Occupational Signs of StressSocial:WithdrawalIsolation LonelinessUnable to complete ta

11、sksPoor utilization of social networksNegative patterns in supervisionCopyright, D.White 2019第12页，共66页。So what is happening? Copyright, D.White 2019第13页，共66页。Burnouta patient cousin Well intended aspirations evolve into behaviors that can lay the groundwork for burnout and possibly compassion stress

12、 and other negative patterns in the workplaceSuch as Copyright, D.White 2019第14页，共66页。Negative factorsDecreased energy”keeping up the speed”Feelings of inadequacy, possibly failureReduced recognition for good work High propensity towards feelings of guiltFeelings of helplessness/powerlessnessPressur

13、e to succeed-overachieveVulnerability to criticismCopyright, D.White 2019第15页，共66页。Negative factorscontd.Inner-directed rageUnder-assertivenessFeeling victimizedInflexibility*in professions that do not reward flexibilityPersonality influencesperfectionism, rigidity and an enormous capacity for an ex

14、treme workload* Red Cape Syndrome “super-martyr”Copyright, D.White 2019第16页，共66页。Negative factorsA strong work ethic, self-direction and idealism in the workplace can spiral negatively without supervision*Subsurface anger in HCPs equates to a sense of powerlessnessHorizontal violence-misdirected ang

15、er and subtle sabotage towards others in their livesHighly critical and fault finding Dropplemann & Thomas, 2019 Copyright, D.White 2019第17页，共66页。Burnout“A state of physical, emotional and mental exhaustion caused by long-term involvement in emotionally demanding situations”. -Pines & Arnson, 1988Co

16、pyright, D.White 2019第18页，共66页。Stages of BurnoutThe Honeymoon - Thank you so much! The Awakening - expectations are differentThe Brownout - self-confidence wanesFull Scale Burnout - open criticismThe Phoenix Phenomena - you can get well Maslach, 1985, et alCopyright, D.White 2019第19页，共66页。Burnout Th

17、e essence of the problem is not the recognition of the feelings. It is the clash between expectations and reality.Can emerge graduallyCopyright, D.White 2019第20页，共66页。A Conspiracy of SilenceThe work of Healthcare in this century is physically exhausting and emotionally dauntingcaring for the serious

18、ly ill, the dying, the wounded and the diseased.Effects on the provider are myriadViewed as “just doing my job”Professional disciplines minimize their contribution Finke, 2019Copyright, D.White 2019第21页，共66页。Figleys Model of Compassion Stress and FatigueEmotionalContagionEmpathicAbilityEmpathicConce

19、rnEmpathicResponseDisengagementSense of AchievementCompassionStressCopyright, D.White 2019第22页，共66页。Blurring of rolesCompassion stress has its roots in burnout.A sense of achievement can be known as a “helpers high”. The reward of the task completion is greater for the professional than the fulfillm

20、ent of the need in the person being cared for.Empathic responses can fuel continued spiraling to fulfill the needs of others leading to exhaustion. Copyright, D.White 2019第23页，共66页。Cognitive Impact ofSecondary Traumatic StressDiminished concentrationConfusionSpacinessLoss of meaningDecreased self-es

21、teemPreoccupation with traumaTrauma imageryApathyRigidityDisorientationWhirling thoughtsThoughts of self-harm or harm towards othersSelf-doubtPerfectionismMinimizationCopyright, D.White 2019第24页，共66页。Emotional Impact ofSecondary Traumatic StressPowerlessnessAnxietyGuiltAnger-rageSurvivor guiltShutdo

22、wnNumbnessFearHelplessnessSadnessDepressionHypersensitivityEmotional roller coasterOverwhelmedDepletedCopyright, D.White 2019第25页，共66页。Spiritual Impact ofSecondary Traumatic StressQuestioning the meaning of lifeLack of self-satisfactionPervasive hopelessnessLoss of purposeEnnuiAnger at GodQuestionin

23、g of prior religious beliefsCopyright, D.White 2019第26页，共66页。Interpersonal Impact ofSecondary Traumatic StressWithdrawnDecreased interest in intimacy or sexMistrustImpact on parenting (protectiveness, concern about aggression)Projection of anger or blameIntoleranceLonelinessIsolation from friendsCop

24、yright, D.White 2019第27页，共66页。Physical Impact ofSecondary Traumatic StressShockSweatingRapid heartbeatBreathing difficultiesAches and painsDizzinessImpaired immune system Somatic reactions Copyright, D.White 2019第28页，共66页。Behavioral Impact ofSecondary Traumatic StressClingyImpatientIrritableWithdraw

25、nMoodyRegressionSleep disturbancesAppetite changesNightmaresHypervigilanceElevated startle responseUse of negative coping (smoking, alcohol or other substance misuse)Accident pronenessLosing thingsSelf-harm behaviorsCopyright, D.White 2019第29页，共66页。Crimean War“Their moans would pierce the heart” -Ir

26、ish Nurse 1864Copyright, D.White 2019第30页，共66页。PTSD ExperiencesWhat Constitutes a Sufficiently Traumatic Experience: The person has experiences an event outside the range of usual human experience that would be markedly distressing to almost anyone: a serious threat to his or her life or physical in

27、tegrity; serious threat or harm to their children, spouse or other close relatives, or friends; sudden destruction of his home or community: or seeing another person seriously injured or killed in an accident or by physical violence. (APA, 1994)Copyright, D.White 2019第31页，共66页。Secondary Traumatic St

28、ressSTS is the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by another human being. It is the stress resulting from helping or wanting to help a traumatized or suffering person. (Figley, 1993a)Copyright, D.White 2019第32页，共66页。Vicarious Traum

29、atizationVicarious traumatization refers to a transformation in the persons inner experience resulting from empathic engagement with trauma material. Graphic accounts of abuse & pain Effects are cumulative & permanent McCann & Pearlman, 2019 Copyright, D.White 2019第33页，共66页。Vicarious TraumatizationE

30、ffects may be intrusive and painfulEmotional residue may remain after direct exposureContamination of personal lifeDisruption of schema or beliefs about the self and the world.Also called Transformational World ViewCopyright, D.White 2019第34页，共66页。Posttraumatic Embitterment DisorderA distinct state

31、of moodDiffers from depression, hopelessness, and anger but can share common emotional features or exist in parallel with themIn contrast to angerhas additional quality of self-blame and a feeling of injusticeA feeling of being let down and is nagging and self-increasingPerson may feel vengeful but

32、helpless. Linden, Rotter, et al (2019) Copyright, D.White 2019第35页，共66页。I am not what happened to me. I am what I choose to become. Carl JungCopyright, D.White 2019第36页，共66页。Figleys Model of Compassion Stress and FatigueProlonged ExposureSecondary Traumatic StressTraumatic RecollectionsCompassion Fa

33、tigueDegree of Life DisruptionCopyright, D.White 2019第37页，共66页。Emotional and Spiritual EffectsThrough exposure to graphic accounts of abuse experiences, and the realities of peoples intentional cruelty to one another, a caring person is vulnerable to the emotional and spiritual effects of vicarious

34、traumatization. Copyright, D.White 2019第38页，共66页。PTSD and STSDPTSDStressorOutside of usual human experiences Serious threat to self Sudden destruction of ones environmentRe-experience of Trauma eventAvoidance/numbing of remindersPersistent arousal Copyright, D.White 2019第39页，共66页。PTSD and STSDSTSDSt

35、ressorOutside of usual human experiences Serious threat to Traumatized Person Sudden destruction of TPs environmentRe-experiencing Trauma Event of TPAvoidance/numbing of remindersPersistent arousal Copyright, D.White 2019第40页，共66页。Compassion Fatigue DefinedIdentical to Secondary Traumatic Stress Dis

36、order (STSD)Is the equivalent of PTSDPotential for chemical use Figley, 2019 Copyright, D.White 2019第41页，共66页。Clinical Practice IssuesLoss of therapeutic realismNegative or non-existent supervisionPersonal health changesSelf-neglectTransference/CountertransferenceCompassion Stress and Compassion Fat

37、igueCopyright, D.White 2019第42页，共66页。Clinical Practice Issues, continuedDiminished interaction with colleagues and team disciplineBlack/White-all or nothing thinkingEmotionalismJudgmental behaviorUse of chemicals for stress reduction (use, abuse, dependence)Impaired PracticeCopyright, D.White 2019第4

38、3页，共66页。Culture of the WorkplaceKey marker for identifying issues for employee performanceand health maintenanceProfessional: established roles, clear policies and protocols, supervision sessions, reasonable expectations Negative and Punitive. “the bureaucratic response”Harried and rushed.“a ticking

39、 clock”Fragmented and productivity driven “just get it done”Team oriented vs. discipline specific“thats not my job”Poor reflection of specific culturesChronic role strainCopyright, D.White 2019第44页，共66页。“You have brains in your headYou have feet in your shoes. You can steer yourself in any direction

40、 you choose!” -Dr. SeussCopyright, D.White 2019第45页，共66页。Key points for clinical practiceSupervision*Boundary adherenceSelf-awarenessProcessing of events and emotionsHorizontal violenceDe-obligate yourselfCopyright, D.White 2019第46页，共66页。More stuff to knowThe way you feel or behave is never caused b

41、y others or the way they treat you.The way you behave is influenced by how you feel.The way you feel is created and controlled and maintained by interpretations in your mind.Anything that was learned can be unlearned.*You can change the way you think!Getting reasonably upset instead of overly upset

42、can give you choice and control. Managing Emotions Under Pressure, 2019Copyright, D.White 2019第47页，共66页。Methodologies for Biopsychosocial Role StrainPersonal PhilosophySupport GroupsWorkplace Support (lunch time meetings, gyms, spiritual areas, supervision luncheons, away days)Exercise programsEduca

43、tional pursuitsRTW (Return-to-Work) Contracts (when applicable, established boundaries and parameters) Copyright, D.White 2019第48页，共66页。Healthy Strategies for Survival Assertiveness Training - Learning how to present personal views without aggression Health Promotion - Learning & self - health care

44、Adaptation - Goal surrender Learning to “Roll with the Punches” Cooperation - Affiliation “Social Glue” bonding Develop emotional resilienceCopyright, D.White 2019第49页，共66页。Healthy Strategies for Survival, continued Recognition of competingoriginates in primal drivesfood, power, sex Supervision - Ne

45、w techniques/new perspective Continuous critical thinking Methodologies for role strainCopyright, D.White 2019第50页，共66页。More Healthy StrategiesTherapyindividual or groupEmployee Assistance Program (EAP) consultationQuiet/sacred areas “Take 5 Room”Study groupsYoga/exercise/good nutrition*Stress e-mai

46、l forumsStress reduction programsCompassionate writing Copyright, D.White 2019第51页，共66页。Healthy StrategiesMental diversionssongs, movies, storiesSchedule vacations routinelyAlternative TherapiesDiningnot gulping food*Pursue and interesthobbiesEncourage recreationPrivate time on a daily basisContact

47、with family & friendsCopyright, D.White 2019第52页，共66页。Ten Worry Stopping TechniquesSet aside a special time for worrying. Concentrate only on worrying during selected times.Ask yourself: “What is the absolute worst thing that may happen?”Ask yourself: “Will that absolute worst thing really happen?”

48、How many times?Use “self-talk” and thought-stopping to short circuit “worries.” STOP!Learn and use Scientific Conflict Resolution Techniques for family and personal decisions. Resolve internal conflict; reduce worrying.Copyright, D.White 2019第53页，共66页。Ten Worry Stopping Techniques, continuedInstead

49、of imagining and re-imagining the negative, picture what you ideally want to have happen. Imagine it and then develop an action plan to begin to move toward that ideal.Learn to disagree agreeably. To protect use I- messages and active listening techniques, “I believe.discussion”Take a risk & ask que

50、stionsyou cant know everything!Read. Books and articles are available to teach yourself.Talk to those you trust for their guidance Accept realityknow the limits of your control The crisis will passwith or without you being stressedCopyright, D.White 2019第54页，共66页。Stress Hardiness The concept of “str

51、ess hardiness” or resistance to stress was developed by Dr. Suzanne Kobasa at City University in New York. Dr. Kobasa has studied many groups of people who have very stressful occupations. Those who seem to cope with their job stress, having a hardiness to it, have three specific characteristics. Ho

52、w do these apply to you?Copyright, D.White 2019第55页，共66页。3 Characteristics of Stress HardinessCommitmentControlChallenge Kobasa, 1979, 1985Copyright, D.White 2019第56页，共66页。Fourth “C”The fourth “C” stands for “closeness.”Everyone who wants to be stress hardy must have someone (one person or one hundr

53、ed) with whom to share the stress, a confidante who is willing to “be there” when times are tough. -Betty Morgan RN, PhD, CSCopyright, D.White 2019第57页，共66页。Positive Effects?“a heightened sensitivity & enhanced empathy for the suffering of victims, resulting in a deeper sense of connection with othe

54、rsa deep sense of hopefulness about the capacity of human beings to endure, overcome and even transform their traumatic experience: and a more realistic view of the world, through the integration of the dark sides of humanity with healing images”. McCann & Pearlman, 1990 Copyright, D.White 2019第58页，

55、共66页。Small StuffChoose your attitude every dayListen with your earsand eyesStrive for integritynot fameListen to your own adviceThink of the “Plane analogy”Cherish tranquilityRest without guiltLearn to relax when you are “too busy” Copyright, D.White 2019第59页，共66页。and finally.“I want to know what sustains you from the inside when all else falls away. I want to know if you can be alone with yourself.and if you like the company you