So Your Staff Needs a Self-Care

Program? Presenters:

Lynn Skubiszewski, LCSW and

Nicole Perry, LCSW

#NASWIL

Welcome to Our Presentation

http://www.youtube.com/watch?v=XSu_sVgGWMk

Presenter Biographies

• Lynn Skubiszewski, LCSWPalliative Care Social Worker,

JourneyCare

Lynn 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, LCSW Social Worker and Team Manager, JourneyCare

Nicole 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.

Why is Self Care Important?• Poor Quality of Life

• Poor 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

“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.” ~ Remen

Outline

• Define burnout, compassion fatigue, compassion satisfaction, secondary trauma, vicarious traumatization/post traumatic stress.

• Research Project

• What is self – care?

• How can you start self care?

• Resilience, Personal Self Care, and Realistic Expectations

• How to Expand Self-Care to the Organization Level

• Summary and Review Resources/Tools

What 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, 2005

Cox and Stiner, 2013

Silver Lining?

Burnout is the opportunity to re-discover what makes you happy.

10 Phases of Burnout"Preventing Burnout" by psychologists Herbert Freudenberger and Gail North : Long-Term Living 59.5 (May 2010): 50-52.

A 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.

Is it really the client or is it more than that? Is it your organization? Is it unrealistic productivity expectations?

How do you know it is burnout?

Listen to others who know and care about you

Use assessment tools to help you see the truth

Self awareness – know when you are crossing a line

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?

What 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.

What 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

What is Compassion Fatigue?

• Similar to PTSD

• Easily frustrated, irritable, annoyed

• Symptoms of depression

• Feeling over alert, restless

• Feeling ineffective, negative, inadequate

• Compassion Fatigue Scale

Compassion Fatigue and Compassion Satisfaction

Compassion Fatigue

• Also called Secondary Traumatic Stress

• A 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, 1995

Teater, 2012

Larson

Compassion Satisfaction

• Defined as the pleasure derived from helping others.

• Sounds like:• I have happy thoughts about those I help• I like my work• I enjoy and trust my co-workers• I am effective

Craig and Sprang, 2010

Compassion Fatigue Scale

Although the world is full of suffering, it is full also of the overcoming of it.- Helen Keller

Compassion Fatigue and Compassion Satisfaction

Compassion Fatigue

• Also called Secondary Traumatic Stress

• A 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, 1995

Teater, 2012

Larson

Compassion Satisfaction

• Defined as the pleasure derived from helping others.

• Sounds like:• I have happy thoughts about

those I help• I like my work• I enjoy and trust my co-workers

CF and CS Can Co-Occur

50% 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 satisfaction

Conrad and Kellar-Guenther (2006)

What Creates Compassion Satisfaction?

Secondary 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)

•

Symptoms 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), 327-36.

• (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

Secondary Trauma for Social Worker

Highest for those who work with:• Sexual Offenders• Trauma Victims• Natural Disaster Victims• Victims of Terrorist Attacks• Suicidal Clients• Refugee Populations• Violence against Families/Children

Hunter, 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.

Secondary 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

Research StudyPilot Study at Journey Care

Participant Demographic Data• 5 Advanced Practice Nurses/Nurse Practitioners in Palliative

Program part of Palliative/Hospice Agency

Average Years as APN = 6 ½• Palliative Care and Hospice Experience = 7 months to 10 years• Ages: 45 to 60 years of Age• Question: Do you currently practice Self Care?: 4 out of 5 = Yes• Question: How long have you engaged in Self Care as a Nursing

Professional? Average 2.5 years

• Coordinator Data• Palliative Care LCSW with 2 years with experience on

team – 20 years as social worker

• 5 Advanced Practice Nurses on a Multi-Disciplinary Team completed Assessment Surveys/Tools

Step One

Assess if your Staff or Team is in need of

Self Care

Burnout Self Test

Resilience Assessment

Self Care and Lifestyle Inventory

Self Care Assessment

Self Care Assessment

• Purpose: Help Staff De-Stress, Explore Negative Feelings re: Loss, Expectations, Alleviate Burnout, Stress Work/Life Balance

• Objective: Create Emotionally Healthy and Centered Palliative Staff

• Details: Meet every 4 to 6 weeks for 30 to 60 minutes during Work Day

• Varied Interventions Used• Pre-Test/Post-Test

Program Description:

Palliative

Self Care

Quantitative Assessment Results – How Did They Score?

• The APNs said….

Qualitative Data…

And the

Research 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 Stress

2. Perception of Stress after today’s Self Care Program

3. Would you Practice this Technique again – either on own or in group setting?

Pre and Post Test Scale

Self Care Interventions Used in Pilot

• Spiritual – 1) Mindfulness Exercise: Leader demonstrated Breathing and Loving Kindness Meditation - Stahl & Goldstein

• Spiritual – 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

Efficacy of Self Care Interventions

Most Effective APN Self Report

• Stretch and Smoothie

• Connect with Nature

• Discuss “The Guilts”

Least Effective APN Self Report

• Meditation: Loving Kindness

• Sharing stories/ideas/frustrations and group Affirmations

Note: Average Stress Level Decreased by at least 2 points on scale for each of the Interventions

Starting Your Own Self-Care ProgramIt’s not that hard…..

What 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 care

• Can 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 do• DOES NOT mean we focus on ourselves and ignore others• NOT about numbing ourselves• DOES NOT indicate narcissism• IS NOT a luxury and does NOT mean we are self-indulgent.

Cox and Steiner, Self-Care in Social Work (2013)

Click icon to add picture

You Know You Don’t Have Good Self Care When…

Attendee Examples???

Boundaries Exhaustion Calling in sick Loss of HopeDepression Stress Eating Thoughts of leaving profession

Unprofessional Behavior Sleep Issues Can’t Separate Work from Home

Boundaries and Professionalism

When you are stressed/burned out you may find yourself:• Sharing too much personal data with clients• Sharing information about other staff members• Complaining about your agency or workload• Developing dual relationships• Upstaging their problems/issues with your own• Downplaying other team members or disciplines

• Physical

• Psychological

• Emotional

• Spiritual

• Professional

• Balance

What is good self care?

Basic Framework

Wellness Wheel

In Balance Wellness Wheel

Start with You

Self Assessment of Your Self-Care Patterns – PROQOL

Develop Your Own Plan – Research what activities work!

Implement the Plan

Test – Tweak for Effectiveness

Self Care Tools

Resources/Tools for Self-Care

• John Kabat-Zinn and Mindfulness

You Tube Video http://www.youtube.com/watch?v=EU7vKitN4Ro

Can be practiced in 2 ways: Formally and Informally

Formal means taking time each day to intentionally:

Sit

Stand

Lie Down

And Focus on Breath

Bodily Sensations

Sounds

Other senses - thoughts - and emotionsStahl & Goldstein 2010

What is Mindfulness Meditation?

Informal Mindfulness is…

Bring mindful awareness to everyday activities such as:

Eating

Exercising

Chores

Work

Relating to Others

Basically any action

Mindfulness Meditation cont’d

Mindfulness 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 it

Just increase it?

http://www.wildmind.org/blogs/on-practice/being-mindful-of-pain

Meditation with Music

• Get comfortable and close your eyes…..

• From Caregiver Stress by Belleruth Naparstek 2008

Setting Realistic ExpectationsThe Guilts• Remind 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 seriously

• Arrange for regular vacation time

• Attend career nurturing events

• Share your thoughts with a trusted friend

• If overwhelmed for long period of time – see a counselor or EAP

Larson, National Hospice and Palliative Care Organization

Top Self-Care Tips for Helpers

• Take Stock of Where Things Are – What’s on Your Plate?• Start a Self Care Idea Collection• Find Time for Yourself Every Day• Delegate and Learn to Ask for Help• Have a Transition from Work to Home• Learn to Say Yes or No More Often• Assess Your Trauma Inputs – Work/Non-work Related• Learn more about Compassion Fatigue and Trauma• Supervision/Peer Support• Workshops and Training• Consider Working Part Time• Exercise

Mathieu, F. (2007) www.compassionfatigue.org

What Else Can You Use?

• Physical Self Care – eat well, exercise, get enough sleep, get medical care

• Psychological Self Care – reflect, journal, engage in leisure activities, let others help you

• Emotional Self Care – have pleasant thoughts about your self, engage in laughter/play, express emotions in appropriate channels

• Spiritual Self Care – pray, meditate

• Create team rituals – Healing Circles, Drumming, Light a Candle, Burn Regrets

• Professional Self Care – take a break, take a vacation, balance case load

• Balance Plan – among work, family, relationships, play, rest

• Supervision

Cox and Steiner, 2013

Takin’ it to the streets

Self Care on Agency Level

Expand Self Care Beyond You

• Explain why it is important to organizations:• Poor quality of life, burnout/dropout• More 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.www.retentioninstitute.com

•  

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), 163-171. Anne Fisher, contributor April 2, 2013 Fortune 500 Magazine

So why are we so stressed?

1. United States of America – 13 days 2. Belgium – 20 days 3. Japan – 25 days 4. Korea – 25 days 5. Canada – 26 days 6. United Kingdom – 28 days 7. Australia – 28 days 8. Brazil – 34 days 9. Austria – 35 days (42 for elderly) 10. Germany – 35 days 11. France – 37 days 12. Italy – 42 days

Within a Larger Organization

• Create a Proposal• Use Facts from this Presentation• Do a Needs Assessment• Collaborate with others who are like-minded• Get a decision-maker/leader to buy in• Do a small sample/test project• Can 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)

What Can Organizations/Employers Do?

• Encourage/pay for Supervision• Create Task Force to Develop Self Care Program• Encourage – allow time for staff to meet with Mentors• Create Wellness Programs• Create a climate where sharing frustrations is “Normal” and

help staff develop ways to Let the Frustrations Go!• Offer skill building opportunities• Employee Recognition Programs• Flex Time – Generous Vacations – Realistic Productivity

Expectations• Improve Orientation and Performance Reviews• Schwartz Rounds

Schwartz 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.org

• Schwartzcenter.org

Research your partners in community

Forge relationship and create small SELF CARE consortium

Share resources across agencies

Join professional associations

Social Work Supports in Social Media such as Linked In

NASW

If you are a small group or private practice?

How to be more resilientTake 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 full

I’m giving

All my love and joy in living

Then near empty,

Tired of living,

And I’m the

One who needs the giving.

This cup, this cup,

This cup of life,

It’s always overflowing;

We give and get

And get and give,

Life’s balance

Keeps on going.

Take this cup,

I’ve filled it up,

With love and joy and laughter.

Now it’s empty,

Fill it up.

Repeat, By: Laura Byrnes

Forever, after.

• Thank You for Attending• Questions

May I be filled with loving kindness

May I be well

May I be Peaceful and at ease

May I be happy

Stahl and Goldstein, 2010

Closing