Rev. Ann Sidney Charlescraft, DMin, BCCChaplain for Staff Ministries

Department of Chaplaincy & Pastoral EducationDivision of Faith and Health Ministries

Wake Forest Baptist Medical CenterWinston-Salem, NC 27106

acharles@wakehealth.edu 336.716.9647

Traumatic StressYou can’t describe it unless you’ve seen it.

You can’t explain it unless you’ve done it.

You can’t imagine it unless you’ve been there

Then it never goes away.

Beth Stamm, Secondary Traumatic Stress

Soul Weariness

There is a soul weariness that comes with caring. Fromdaily doing business with the handiwork of fear. Sometimes itlives at the edges of one’s life, brushing against hope and barelymaking its presence known. At other times, it comes crashing in,overtaking one with its vivid images of another’s terror with itsprofound demands for attention: nightmares, strange fears, andgeneralized hopelessness.

Stamm, Secondary Traumatic Stress

Session I: Compassion Fatigue - What It Is and What It’s Not

Compassion Fatigue

. . . is the natural behavior and emotion that arises from knowing about traumatizing events experienced by a significant other and the stress resulting from helping or wanting to help a traumatized person.

Compassion Fatigue SymptomsMental, emotional, spiritual, and physical fatigueSleep disturbancesAnxiety IrritabilityAngerDepressionReduced or increased appetiteHigh blood pressureDizzinessGuiltDecreased ability to concentrate or attend to tasks

Compassion Fatigue Triggers

Single exposure to a traumatic eventCumulative work with trauma victimsCumulative deep traumaCumulative experiences of deep sadness, pain,

death and lossPoor boundariesInsufficient resources

Compassion SatisfactionThe sense of pleasure or satisfaction derived from helping

(Figley)

Intrinsic “good feeling” of contributing to the positive welfare of another

Alleviates some of the fatigue associated with the work of care giving

Mitigates some of the effects of compassion fatigue and burnout

Enhances sense of well being

High potential among health care professionals to exhibit significant compassion satisfaction with chosen profession

Compassion Satisfaction SymptomsJoyHappinessContentmentBalance within lifeWork/life balanceCreativityProductivity

Compassion Satisfaction TriggersSituations that call on your best self – and you

arrive

Incidences that require your best skills – and they are best for the situation

A good death – chaplain is present, provides listening and loving presence, patient dies without pain and transitions peacefully

Events where you know you made a difference!

Burn OutBurnout is a syndrome of emotional exhaustion,depersonalization towards patients, and reduced

sense ofpersonal and professional accomplishment. (Maslach)

Burnout produces emotional withdrawal anddiminished empathy, whereas those withcompassion fatigue try to continue to give ofthemselves and feel as though they have failed at their professions. Betty Stevens-

Guille, RN

Burnout SymptomsEmotional exhaustionApathyEmotional withdrawalLack of interest – just don’t careDiminished empathyAngerIrritability

Burnout TriggersInsufficient resources (personnel and

materials)DisrespectLack of payLack of benefitsLack of affirmationPoor boundariesLack of growth potential – skill development

Compassion Fatigue vs. BurnoutSingle exposure Insufficient

resourcesCumulative experience Disrespect

of deep trauma

Cumulative experience Lack of pay/benefitswith death & dying

Poor boundaries Lack of affirmation

Insufficient resources Poor boundaries

What We KnowCompassion Fatigue affects a multitude of people –

professional care givers such as trauma care nurses, home health care specialists, physicians, intensive care nurses, chaplains, social workers, EMTs, firefighters, and police.

90% of critical care nurses will experience compassion fatigue as a normal result of their work in an ICU.

family caregivers – spouses, parents, siblings, relatives, friends . . .are affected by compassion fatigue

Caregivers are a susceptible group to emotional blunting, compassion fatigue, depression, and burnout.

Caregivers appear to be better at giving care than asking for or receiving care

Self Care (care of the self) is a personal, family, collegial, and organizational responsibility

Diminishment of self occurs when intentional self care is not a practice of the individual and/or encouraged and supported by the institution.

Diminishment of self contributes to compassion fatigue and burnout in strong and dedicated caregivers.

Session II:The Danger ZoneProfessional Quality of Life Inventory

30 item inventory identifying potential for compassion satisfaction (CS)burnout (BO/Compassion Fatigue (CF)

subscale)secondary traumatic stress (STS/CF

subscale)free inventory not a medical test nor a psychological testcan be viewed as a screening tool for stress-related health problems

Professional Quality of LifeCompassion Satisfaction – the “good stuff” of

caringCompassion Fatigue – the “bad stuff” of caringPositive aspects of caring (Compassion Satisfaction)

AltruismSelf confidence, self awareness

Negative aspects of caring (Compassion Fatigue – two aspects)

Burnout – hopelessness, simply being worn out

Secondary Trauma Stress – exposure to traumatically stressful events resulting in being afraid/fear

People Bring ThemselvesWe have a past & a present

We have beliefs and values

We have varying education, training, and income

We bring our personal situations

We have social support (or maybe not)

We have a history – might include trauma and illness

We have family and close others (or not)

Complete the professional quality of life inventory and score using the self-report instrument

In dyads, discuss your surprises and concerns from the ProQoL (take about 5-8 minutes for each person)

Session III Self Care

. . . is the discipline of attending to one’s own physical, mental, emotional, and spiritual needs through consistent activities and behaviors which enable renewal and growth (Snorton).

Self care is a philosophical and theological statement about one’s self and one’s life (Charlescraft).

Self CareHelps to alleviate symptoms of compassion

fatigue

A daily discipline of attending to one’s physical, mental, emotional, and spiritual needs which enable renewal and growth

A personal, family, collegial, and institutional responsibility

Components of Good Self CarePhysical – healthy systems, exercise, diet

Mental – cognitive, critical thinking, logic, assessment

Emotional – feelings, expressing hope, joy, sorrow, pain

Spiritual – connections – with self, with others, with someone or something greater than self

The integration of physical, mental, emotional, and spiritual well being is greater than the sum of it’s parts. Self care

should notbe compartmentalized but rather be viewed holistically.

What is Well Being?Elements of well being:

positive self concept finding meaning and purpose in lifeGood physical healthGood emotional adjustment

Wellness is a positive state of mind, body, and spiritreflecting a balance of effective adaptation,

resilience, and coping mechanisms in personal and professionalenvironments that enhance quality of life (AANA)

Physical Well Being

A state of physical well being is not just the absence of disease. It includes lifestyle behavior choices to ensure health, avoid preventable diseases and conditions, and to live in a balanced state of body, mind, and spirit.

American Association of Nurse Anesthetists (AANA)

Evidence Based Physical PracticesMassage – relieves stress, touch that is healing,

lowers blood pressure

Reflexology – head, hands, feet – lowers stress levels, decreased blood pressure, energizes the entire body through pressure point massage

Yoga – physical awareness of the body, can use as a mental, spiritual, and/or physical discipline

Evidence Based Physical PracticesExercise – something you enjoy

Diet – what works best for your body

Aromatherapy - sensory, affects persons physically, mentally, and emotionally – Scent of cinnamonScent of lavender Scent of pineScent of lemon, orange, citrus

Mental Well BeingMental well being or mental health describes

how you are feeling and how well you can cope with day to day life.

Mental well being is associated with sense of self, ability to adapt to change, and positive self regard

Evidence Based Mental PracticesCognitive Re-structuring/Reframing – to think

differently than your first response to a situation

Reflection – to consider or re-consider a situation in light of values, beliefs, culture, and experience

Journaling- daily practice

Skill Development – conferences, classes, and/or mentoring, learning new skills or refining skills

Emotional Well Being

Increased emotional well being is indicated with enhanced coping ability, positive self-esteem, positive self regard, performance and productivity – and possibly longevity (AANA)

Decreased emotional well being is indicated with stress, anxiety, and/or depression

Evidence Based Emotional PracticesCryingDebriefingTalk therapyArt therapySocial connectionsMusic therapyTherapeutic music

Spiritual Well BeingThe courage to look within and to trust . . .

Deep sense of belonging, of wholeness, of

connectedness, and of openness to the infinite;

ability to give praise and ask for help.

David Benner

Evidence Based Spiritual PracticesBreath prayer – breathing alone makes a

difference, but breath prayer can encourage mental, emotional, and physical health as well as spiritual health

Meditation – on a word, passage, thought, centering prayer, silence, stillness

Yoga – discipline, centering, focus

Well BeingWell being isn’t the absence of health

problems

or brokenness; well being is what you choose,

at the center of your life,

to do with these frustrating conditions.

Howard Clinebell

Rest, Renewal, & ReconciliationImproved spiritual well being has a positive

effect on recovery from compassion fatigue

Enhanced skill development positively affects compassion fatigue

Coping improves with rest and renewal, and with greater self understanding and practice of good self care

Self Care . . . My Job With a Little Help From My FriendsSelf care is a personal, familial, collegial, and

institutional responsibility

Self care is a daily discipline

Self care helps to alleviate symptoms of compassion fatigue

Self care is the discipline of attending to one’s own physical, mental, emotional, and spiritual needs through consistent activities and behaviors which enable renewal and growth (Teresa Snorton)

Self care is a philosophical and theological statement about one’s self and one’s life (Charlescraft)

SUPPORT: SELF AND OTHERSBoundary setting – sometimes saying “no”Receiving peer supportReceiving supervisory supportReceiving organizational supportKnowledge of triggersResponding to symptomsHaving a plan

Stamm’s ChallengeStamm’s challenge to educators, clinicians, andresearchers involved in trauma work is to . . .

“learn to transform our encounters

With these things into opportunities for growth for

ourselves and for those whom we seek to heal.”

Soulful Fatigue

Soulful fatigue will continue on occasion to engulf those who care for others in theintense and broken places of life, but hoperesides because of the kind, compassionate,loving care offered by others through God’sgood grace.

Ann Sidney Charlescraft, 2005