Resilience & Sustainable work practices
Dr Bronwyn Avard
Life is supposed to be fun.
It’s not a job or occupation.
We’re here only once and we
should have a bit of a laugh.
Billy Connolly
• Burn-out & compassion fatigue
• Resilience
• Sustainable work practices
Psychological Distress in Australian Doctors
2013
“Mental health issues are
the single most pervasive
health issue affecting doctors”
Keeping your Grass Greener
Australian Medical Association
But the perceived stigma associated with the issue has limited our progress in addressing these issues
Most suffer in silence
Why are we at such high risk?
• Specific stressors
– Academic & clinical
• Workload
• Team environment with you always as the leader
• High stakes decisions (>108 per day)
• Ethical dilemmas
• Balancing teaching with clinical demands
Why are we at such high risk?
• Specific stressors
– Academic & clinical
– Life
• Personal events – relationship issues
• Time & energy demands – less time for health-promoting activities such as socialisation & exercise
• Lack of time for hobbies
• Sleep deprivation
• Financial
Why are we at such high risk?
• Specific stressors
– Academic & clinical
– Life
– Support & role models
• Competitive professional environment
• Boundaries with work colleagues
• Colleagues/seniors/mentors who are burnt out , stressed or depressed, modelling cynicism & unhealthy behaviours
Why are we at such high risk?
• Specific stressors
– Academic & clinical
– Life
– Support & role models
– Conflict
• ICU is an environment where conflict is not uncommon
• Other staff, colleagues, executives, other teams
Why are we at such high risk?
• Specific stressors
– Academic & clinical
– Life
– Support & role models
– Conflict
– Exposure to death & human suffering
• Lack of opportunities for debriefing
• Needing to “hold it together” and support the rest of the team
Beyond Blue
National Mental Health Survey of Doctors, 2013
“The question that faces the current generation is whether to be part of a constructive change to the future of medicine or
whether to allow history to repeat itself through a culture of denial and self neglect”
Craig Hassad
Preventing compassion fatigue
• Awareness
• Balance
• Connection
Saakvitne & Pearlman
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balant group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balant group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balant group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balant group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balint group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balint group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balint group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balint group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balint group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
Personal
AWARENESS
Self Reflection
BALANCE
Physical, Mental, Emotional
Hobbies, Laughter, Sleep
CONNECTION
Family, Friends
Professional
AWARENESS
Peer group support
e.g. Balint group
BALANCE
Alternating btn tasks & recovery; Time out from
complex work; Boundaries
CONNECTION
Debriefing
Time to “talk shop”
Organisational
AWARENESS
Safe working environment
Audits
BALANCE
Appropriate time for admin tasks & professional
development
CONNECTION
Productive teams
Networking, conferences
• Be mindful of what is causing your stress
– We can get caught up in the work & just 'push on’ rather than trying to reduce our stress & workload
– But stress is just your perception of how much control you have over a situation
– Anxiety & stress come when it seems like you are not in control of everything you think you should be
Resilience
Characteristics of a Resilient Person
• What makes a resilient person?
• Why can one person “bounce back” from adversity when another cannot?
Characteristics of a Resilient
Person
Cognitive strategies and Problem Solving Skills
Social Competence and communication
Autonomy
Sense of Purpose
Protective Factors
• Factors which enhance one’s ability to remain resilient even when experiencing some of the risk factors
Protective Factors
Sense of belonging
Positive environment (feedback and encouragement)
Opportunities for success
Recognition of achievement
CREATING A RESILIENCE MAP
Resilience map
ME
Resilience map
• SELF CARE
ME
Self-care
Relax and sleep
Talk rationally to yourself
Get organized
Exercise
Reduce time urgency
Watch your habits
Talk to friends
Quiet time
Ask for help
Use support groups
Spoil yourself
Focus on the positives
Eat healthily
Resilience map
• WHY?
ME
Resilience map
• VALUES
ME
Resilience map
• BOUNDARIES
ME
Professional boundaries
• Often established by professional societies
• IC-5 : “Guidelines on the Health of Specialists and Trainees”
• IC-6 : “Guidelines for the relationship between fellows, trainees and the healthcare industry”
Personal boundaries
Helpful boundaries
Define what you may and may not do to or for others
Define what you will permit others to do to you or for you
Keeps you from being exploited and feeling resentment and other negative emotions
Protects you from someone else’s negative thinking or behaviour
Less helpful boundaries
Going against values or rights to please others
Allowing others to exploit or abuse you
Exploiting others
What is your role?
What are the implications if boundaries become blurred?
• For you?
• For others in your/ their life?
Resilience map
• SUPPORTS
ME
Involving your support network
Benefits include less load and responsibilities for you
Less emotional stress when you know someone is supporting you
Time for you and your own needs
Increased mental and physical health and wellbeing
IT ‘s GOOD FOR THE MOST IMPORTANT PERSON -
YOU!
AVAILABLE SUPPORTS
What is an Employee Assistance Program?
A benefit which is available to assist employees and their
immediate family members
to resolve personal or work-related difficulties, and to
promote wellbeing through professional counselling.
Key Features
of the EAP
It is a free, voluntaryservice
It is a strictly confidential service which includes:
• No names on reports and invoices
• All PPC Worldwide staff are bound by code of conduct, written consent is required to release information
• The EAP contract stipulates a high level of confidentiality
Short termcounselling/coaching
(face to face, telephone, on-line)
For all employees & your immediate
family
Personal Affirmation
Provides a quick way of re-focusing
Helps you maintain your boundaries
Taps into your personal motivation
Focuses on what you are achieving
Eg. “I am responsible for providing assistance, it is up to the individual what they do with that.”
Resilience exercise
PHYSICAL MENTAL
MOOD SOCIAL
SUSTAINING YOUR CAREER
Individual- Mindfulness - Stress management - Small group discussions
Organisational- Acknowledge prob- Improve efficiency & reduce clerical work - Cultivate sense of community at work - flexibility & work-life balance - align to stated values & mission
• Regular re-prioritisation
– Annual reflection on values, resilience mapping, priorities etc
– Diary management/time management including regular breaks
• E.g. lunch time walks
• Regular long breaks from the workforce
– Many of us are staff specialists and often have the opportunity to do this
– In some Enterprise agreements, there are clauses about purchased leave
?consider negotiating purchasing an extra 4 weeks of leave each year & take 3-6 months off every 4-5 years
• Start the conversation….
– Talk with your seniors
– Talk with your peers
– Talk with your juniors
Lets change this for the future Intensivists!
To my future self….
What to stop?
What to adopt/start?
What to keep doing?
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