“SO YOU ARE THINKING OF QUITTING?”

(Compassion Fatigue Presentation) (Compassion Fatigue Presentation)

JCMVAMC & Community Service JCMVAMC & Community Service Council Council

Muskogee, OKMuskogee, OK

January 7, 2014January 7, 2014

Jim Lyall, MPA, CIRSJim Lyall, MPA, CIRSLanny Endicott, D.Min., LCSW, LMFTLanny Endicott, D.Min., LCSW, LMFT

Erv Janssen, MDErv Janssen, MD

Objectives for Our Time Together1. Share our growing collaboration: JCMVAMC & CSC2. Discuss dimensions of Compassion Satisfaction – Compassion Fatigue – Burnout3. Explore complexities of Compassion Fatigue

Community Collaboration• The Veterans' Initiative of the CSC

(2009)• The Initiative's relationship with VA

administration & various departments•CSC sponsorship of "Silent Wounds of

War"•Assistance with VA Resource Fair

•Coffee Bunker: veteran drop-in center (Tulsa – 41st & Sheridan)•Wounded Warrior Project• Cognitive Processing Therapy • Training in Military Culture • Question Persuade Refer Suicide

prevention•Moral Injury/Soul Injury Training

Continuing Collaboration•Veteran's Treatment Court•Preventing/Ending Homelessness•Moral/Soul Injury•Annual Veteran's Stand Down

Future Considerations

•Community Based One-Stop-Shop Center•Continuing Communication between VA & Community-based Organizations

Dimensions of Dimensions of “Compassion”“Compassion”

SatisfactionSatisfactionFatigueFatigue

(Secondary Trauma)(Secondary Trauma)

BurnoutBurnout

Compassion SatisfactionCompassion SatisfactionEncouragersEncouragers

Experiences pleasure from helpingExperiences pleasure from helpingPerceives agency as supportivePerceives agency as supportivePersonally enjoys the workPersonally enjoys the workAble to do the workAble to do the workSees work as fulfilling (“work may be Sees work as fulfilling (“work may be viewed as a calling”)viewed as a calling”)

Adapted from Beth Stamm

EncouragersEncouragersExperiences pleasure from helpingExperiences pleasure from helpingPerceives agency as supportivePerceives agency as supportivePersonally enjoys the workPersonally enjoys the workAble to do the workAble to do the workSees work as fulfilling (“work may be Sees work as fulfilling (“work may be viewed as a calling”)viewed as a calling”)

Adapted from Beth Stamm

Compassion FatigueCompassion Fatigue

DiscouragersDiscouragersMissing pleasure from helpingMissing pleasure from helpingAgency not perceived as supportiveAgency not perceived as supportiveDoesn't enjoy the work Doesn't enjoy the work Questions the ability to do the workQuestions the ability to do the workUnfulfilled, disillusioned in the work Unfulfilled, disillusioned in the work

DiscouragersDiscouragersMissing pleasure from helpingMissing pleasure from helpingAgency not perceived as supportiveAgency not perceived as supportiveDoesn't enjoy the work Doesn't enjoy the work Questions the ability to do the workQuestions the ability to do the workUnfulfilled, disillusioned in the work Unfulfilled, disillusioned in the work

• Fatigue• Frequent illness• Sleep problems• Disillusionment with

work• Helplessness• Sense of Hopelessness• Being harsh with other staff• Cynicism

• Powerless to change events• Anger toward the

organization and/or “clientele”• Depression and isolation• Staying away from co-

workers• Reduced commitment to

work• Being absent• Use of Chemicals

For more see: http://www.compassionfatigue.org

BurnoutBurnout

Worn out HelplessExhausted

Loss in Productivity Loss of Self (Soul)

•Takes time to develop•Person is often not aware•Key sign is looking to quit and/or change jobs

Additional Fatigue Additional Fatigue FactorsFactors

Working with the traumatizedWorking with the traumatizedAbsorbing trauma of othersAbsorbing trauma of othersPersonal exposure to traumaPersonal exposure to traumaAccompanying sense of: Accompanying sense of: powerlessness, hopelessness, powerlessness, hopelessness, "wearing out""wearing out"

http://www.proqol.org

Model for BurnoutModel for Burnout

Primary Trauma(s)Primary Trauma(s)

Compassion Fatigue (ST)Compassion Fatigue (ST)

Stress of LifeStress of Life

BurnoutBurnout

Personal Strategies for Personal Strategies for Prevention RecoveryPrevention Recovery

ExerciseExercise ReadingReading Diet MusicDiet Music

JournalingJournaling “Breathing”“Breathing” Meditation GardeningMeditation GardeningSpiritualSpiritual PhotographyPhotography

SportsSports Sleep SleepFamilyFamily Hobbies Hobbies

Some Strategies Some Strategies at Workat Work

In the Unit, Team, GroupIn the Unit, Team, GroupCreating opportunities to shareCreating opportunities to shareNurturing an encouraging atmosphereNurturing an encouraging atmosphereKeeping information confidentialKeeping information confidentialSpending social time togetherSpending social time togetherMaintaining an atmosphere of safety Maintaining an atmosphere of safety

Self-Care is Self-Care is BalanceBalance

Care for MeCare for Me My My ResponsibilitiesResponsibilities

Professional "Impairment"

Complexities of Compassion Fatigue

Patient/Family

Me/Team Hospital/System

Complexity of Compassion Fatigue (from the perspective of a clinician)

The role of compassion: The VA motto

March 4, 1865: President Abraham Lincoln “To care for him who shall have borne the battle and for his

widow, and his orphan.”

•Thus the framework is set………COMPASSION is foundational for our work in a system with the mission of caring • Compassion engages• The quality of compassion puts us at risk

AND, not only for those who have direct contact with patients, clients or families……but for all who are a part of the VA!!

U. S. Department of Veterans Affairs; Celebrating America’s Freedoms; The Origin of the VA Motto: Lincoln’s Second Inaugural Address

Compassion Fatigue

Related to relationships:• Clinician-patient/clientWithin groups:• In families of those suffering from PTSD: “like a virus, the stress spreads”• In “systems” such as teams, or a hospital

➢ NOT JUST LIMITED TO “CLINICAL STAFF”

Figley, Charles R.: What is Compassion Fatigue-Prevention & Treatment; Gift From Within-PTSD, Resources for Survivors and Caregivers (web page) © Green Cross Foundation

http://www.giftfromwithin.org/html/What-is-Compassion-Fatigue-Dr-Charles-Figley.html

A Concern for the VAIn VA publication: Organizational Health (Vol. 18; Spring 2013)•“Healing the healers”, Linda Belton, p. 4•“Burnout in the VA: How are we doing?”, Katerin Osatuke, p. 5•“All Things Connected….”, Linda Belton, p. 10.

And from a “sister” VA: Puget Sound VA pushing to hire, grow, retain staff: •“Low job satisfaction and morale may be one factor driving turnover”• “Demands of job take a big toll”• “I loved every job I ever had, but I just burned out at the VA” (supervising physician)The Seattle Times, December 20, 2014[http://seattletimes.com/html/localnews/2025279563_vastaffingsxml.html]

PERSONAL REFLECTIONS: TAKING STOCK

1. Introspective (honest, in-depth) effort2. Review with others: ENCOURAGING CONTINUING CONVERSATION

• Family• Friends• Work colleagues• Supervisor?• Professional consultation

3. Structured assessment: PROFESSIONAL QUALITY OF LIFE SCALE

30 question “self test” for self scoringBeth Stamm

What Can Be Done?1. Creative possibilities by continuing the conversation

• Not just complaining• Together generating ideas, exploring possibilities• Minimize “It will never work”

2. The Mayo experience: “Peer Support Trumps Time Off in Preventing MD Burnout”

• 90 minutes every 2nd week (9 month trial period)• 6-8 physicians with trained facilitators/colleagues

vs. unsupervised time off

3. CREW “Being locally creative”!

A randomized controlled trial evaluating the effect of facilitated small group sessions on physician well being and job satisfaction (C. West, L. Dyrbye, J. Sloan, T. Shanafelt); ‐Research Presentation 26 Oct 2012

Peer Support Trumps Time Off in Preventing MD Burnout. Medscape. Nov 06, 2012

COMMENTS

QUESTIONS

"Keeping the conversation going"

Jim Lyall jlyall@csctulsa.org

Lanny Endicott lendicott@oru.edu

Erv Janssen janssenmd@cox.net