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Compassion Fatigue and Self-Care

Medical professionals spend so much time helping others that they often forget to care for themselves. This presentation discusses techniques that promote self-care.

Compassion Fatigue and Self-Care

Estimated watch time: 45 mins

Available credits: none

Presentation Materials:

Welcome to the Community Education Series, hosted by The Recovery Village and Advanced Recovery Systems. 

Hi, everybody. Thank you so much for joining us today; really excited to present. At a later point in the presentation, you will need a pen and paper. If you want to take a minute to grab that while we’re just kind of going through introductory stuff and having people add on, then now would be the perfect opportunity to do that.

As Ashley mentioned, my name is Natasha and there are my credentials. I have a lot of letters behind my name, but Ashley went through and explained what all of that is. So, I am in private practice here in Orlando, currently telehealth because of COVID. Just to give you an idea of the things that we’ll be talking about today, I wanted to do a presentation on compassion fatigue and self-care. I think it’s something that’s really come up in the last few months as we’ve been going through the COVID situation. So, overview of what we’ll be talking about today. First, I want to get a good definition of what compassion fatigue means.

Make sure that you guys have an understanding of what the symptoms are, learn the warning signs that you need to be on the lookout for. This is where your pen and paper is going to come in handy because you’re actually going to do a self-assessment so you can get an idea of what your level of fatigue is. And then, finally, I think the most important part is I want to make sure that you leave today with a self-care plan that is realistic for your life that you can do starting today. 

Let’s hop right into it. First one is, “What is compassion fatigue?” So, this comes from the Compassion Fatigue Awareness Project. If anything that we talk about today seems really interesting to you, highly recommend that as a resource. They tell us that it’s a broadly defined concept, which includes emotional, physical and spiritual distress for those of us that provide care to another. We’re talking about caregiving where people or animals are experiencing significant emotional or physical pain and suffering. As I said in the invite, this is really directed for our health care workers and our first responders, because that’s pretty much what you do on a day-to-day basis. Work with those who are in some kind of distress and, often, you will forget to take care of yourself. 

So, just some vocabulary that we can kind of operate on moving forward, as these things will continue to pop up throughout the presentation. The first one is compassion satisfaction. That’s where we’re talking about the positive aspects of working as a helper. Those that are in the helping field, you went into it for a reason, and there are some really great aspects to your job. Then there’s also compassion fatigue, and those are those negative aspects of working as a helper. We’re also going to talk about burnout. That’s where you feel the inefficacy and that you feel overwhelmed with your job. And then there’s work-related traumatic stress that comes in two different categories. There’s primary traumatic stress, which if you’re in the hospitals, if you’re riding on an ambulance, we’re talking about primary traumatic stress. And then there’s secondary traumatic exposure. That may be if we’re sharing a lot of things with our partners, for example, and they just maybe get overwhelmed with hearing these different stories. So, just some vocabulary so you have a baseline understanding as we go forward. 

 

So, let’s talk a little bit about health care and first responders. What we find is that caregivers really do play host to high levels of compassion fatigue. One of the things that I’ve been surprised by as I started working — even before COVID with clients that are in the health care industry, whether that be physical therapists or physicians assistants, nurses, physicians — I find that there’s not a lot covered in school curriculum about compassion fatigue, which was really surprising to me. That’s another reason I’ve been so passionate about talking out about this subject, because it’s something that we definitely do need to talk about. 

What happens is, day in and day out, you guys struggle sometimes to function in the caregiving environments because it seems like there’s always something heart-wrenching and emotional going on. All of that was true before COVID came along. We already were sometimes in situations where there were not enough nurses for a shift or you just felt exhausted or you felt overwhelmed. And what’s happened now is all of these things have become more acute due to COVID-19, so it’s possible that you’re feeling worse than you already were in your job and you just don’t know what to do. That’s exactly why I wanted to do this presentation today. And my goal, as I stated in the beginning, is to make sure that we are preventing burnout and preventing compassion fatigue by ensuring that you do have a good self-care plan in place, and you know what it is that you’re working with. 

So, most stereotypical therapist’s question there is: How are you feeling? I want you to look at this as a first-degree, second-degree, third-degree burn situation. If you’re at first-degree level, these are some of the things that I would be expecting to hear about. You may have difficulty concentrating. You may be feeling numb, anxious, fearful. You might have noticed a change in your appetite or change in your energy levels. May be really hard for you right now to get out of bed and go to work. You may see that you’re having some difficulty sleeping, or you may be having nightmares. Sometimes, people will have things like headaches, body pains, stomach problems that they may not have had before. You may be noticing that you’re drinking a little bit more, smoking a little bit more or using other drugs. You may have already existing chronic health problems that now seem to be getting worse, and you may be feeling particularly short-tempered. I would not be surprised if any of these things were true for you, considering what’s been happening in the country since about February or so. This is where we’re talking about first-degree situation.

What’s the next level up? So, second-degree burn, and you’ll notice some of these are going to be consistent through the first-, second- and third-degree level. So, easily frustrated: things that maybe normally would not have bothered you now are really bothering you. You may feel that you just are lacking feelings. You’re just feeling indifferent. Maybe you’re blaming other people for things. Maybe you’re feeling particularly irritable. Maybe feeling sad or empathetic. Maybe feeling isolated. For example, you get home, you close yourself in your bedroom, don’t want to talk to anybody, don’t want to look at anybody. You may be feeling tired. You may be feeling exhausted and you may be feeling overwhelmed. 

I’ve noticed in some of my clients, their self-hygiene may start to suffer. You may not have the energy to shower, or you may not be putting on clean clothes as frequently. You may not be washing your hair as often. And then, you’re also struggling with things like feeling like a failure or feeling like nothing that you can do is going to help. Or that you’re not doing your job well, or you may be needing alcohol or other drugs to cope. Not that you’re using more, but it seems like you need that in order to be able to continue doing what you’re doing.

The third-degree is where we get into compassion fatigue. And again, like I said, there’s some similarities with all of these levels. When we’re looking at compassion fatigue, we’re talking about things like excessive blaming — you don’t really want to take accountability for anything. You’re just kind of laying it all on everybody else. You’re bottling up your emotions. A lot of my clients would tell me they don’t have time or they can’t deal with it. They just need to go from one patient to the next. We see again here that isolating from others. You may be voicing excessive complaints about administrative functions.

I know, unfortunately, a lot of times in health care, we spend so much time doing paperwork and documenting everything. At this point, you’re using substance abuse to mask your feelings. You may be coming home and needing to drink a lot of wine, for example, to feel like you’re decompressing from the day. Maybe you’re doing some compulsive behaviors. You’re spending money that you don’t have. You’re overeating, you’re gambling, things that you’ve not done before. The poor self-care comes in again. You know, you’re not attending to your hygiene; maybe you always did your makeup before you went to work, and now you’re not doing that anymore. Again, the apathy: you don’t find things pleasurable anymore. Maybe reading was really a joy for you, and now even the thought of picking up a book just seems like too much. 

You’re mentally and physically tired. You may be in denial about problems. Maybe your loved ones have approached you and said, “Listen, something seems different. Are you okay?” “No, no, I’m fine. I’m fine. There’s nothing wrong.” You may be having difficulty concentrating. For example, when you’re going to put in your notes, you gotta keep rechecking: “Did I put that in?” Making sure that you’re on the right client, making sure, putting in the right medication, those kinds of things. Kind of goes along with being preoccupied, right? You just can’t seem to focus; there’s other stuff on your mind and maybe some legal problems going on as a result of that. We’re talking about recurrence of nightmares and flashbacks to a traumatic event. I know a lot of you are probably dealing with a lot more death than you’re used to. 

Maybe there’s a particular patient experience that’s just playing on your mind over and over again, and it’s like a movie that you can’t get to stop. Chronic physical things going on, like stomach problems, or maybe there’s like a cold that you can’t seem to shake. This is your mind and your body’s way of letting you know that there’s something going on that you need to get it taken care of. And the reason I use the first-, second- and third-degree analogy is because no matter what level of burn you’re at, there is treatment that is available. That’s what I really want you to remember. Whether you identify with the first-, second- or third-degree level of symptoms, it’s not too late to get help, and that’s exactly why I wanted to do this presentation today. I think that the best way to address that — and this is where you’re going to need your pen and paper — is to get an idea of where you’re at. 

We’re going to do an assessment in real-time. As I explained this, if you have not, grab your pens and paper. Ashley had told me that the PDFs that I wanted for the presentation should have been emailed to you too. If you’ve got those handy, now is the time to grab them. So, what we’re about to complete is called the ProQOL. It stands for the professional quality of life scale. If you do not have access to it, if you do not have it printed out, that’s fine. I have it pulled up on the PDF or on the PowerPoint slide here, and you can just follow along with me. It is a free measure and it goes through 30 different items, and you’re going to be measuring the positive and negative aspects of your job. We’re going to be talking about compassion satisfaction and compassion fatigue, and compassion fatigue has two subscales that we’re going to be measuring. We’re going to be talking about burnout as well as secondary trauma. 

If you write nothing else down today, please write down that website: the ProQOL.org website, another amazing resource in addition to the Compassion Fatigue Project.  They have made everything that I’m about to show you available free of charge. My hope is that if something resonates with you today, you take this back to your colleagues, maybe back to hospital administration, because this is an actual measure where they can see where you’re at, and that’s how we’re able to make changes and put interventions into place. Hopefully, you’ve had enough time to go grab something to write with or print out the measures yourself. 

Here it is. Like I said, if you don’t have it printed out, I have it available for you. What we’re going to do: I’ve got questions one through 13 loaded on here, but it would be helpful if you’ve numbered your paper from one through 30. As I read the questions, what I want you to do is: You’re going to give yourself a grade, and you can see the scale up at the top there. One is for never, two is for rarely, three is for sometimes, four is for often and five is for very often. So, you’re going to honestly reflect on how frequently these things were true for you in the last 30 days. Today’s July 15th. You’re going to be thinking about from the middle of June up until today. You’re doing this at home. Nobody’s looking over your shoulder.

Now’s the time to really do an honest assessment. 
  • So, question number one is: I am happy.
  • Question number two: I am preoccupied with more than one person that I help.
  • Question number three: I get satisfaction from being able to help people.
  • Question number four: I feel connected to others.
  • Question number five: I jump or am startled by unexpected sounds.
  • Question number six: I feel invigorated after working with those I help.
  • Question number seven: I find it difficult to separate my personal life from my life as a helper.
  • Question number eight: I am not as productive at work because I’m losing sleep over traumatic experiences of a person I help.
  • Question number nine: I think that I might have been affected by the traumatic stress of those I help.
  • Question number 10: I feel trapped by my job as a helper.
  • Question number 11: Because of my helping, I have felt on edge about various things.
  • Question number 12: I like my work as a helper.
  • And question number 13: I feel depressed because of the traumatic experiences of the people I help. I’ll leave that up for just another few seconds. And again, the scale’s right at the top there: one being never, five being very often. We’ll head on to the rest of them. Again, the scale’s right there at the top. 
  • Question number 14: I feel as though I am experiencing the trauma of someone I have helped.
  • Question number 15: I have beliefs that sustain me.
  • Number 16: I am pleased with how I am able to keep up with the helping techniques and protocols.
  • Number 17: I’m the person I always wanted to be.
  • Number 18: My work makes me feel satisfied.
  • Number 19: I feel worn out because of my work as a helper.
  • Number 20: I have happy thoughts and feelings about those I help and how I could help them.
  • Number 21: I feel overwhelmed because my case workload seems endless.
  • Number 22: I believe I can make a difference through my work.
  • Number 23: I avoid certain activities or situations because they remind me of frightening experiences of the people I help.
  • Number 24: I am proud of what I can do to help.
  • Number 25: As a result of my helping, I have intrusive frightening thoughts.
  • Number 26: I feel bogged down by the system.
  • Number 27: I have thoughts that I am a success as a helper.
  • Number 28: I can’t recall important parts of my work with trauma victims.
  • Number 29: I am a very caring person.
  • And Number 30: I am happy that I chose to do this work. 

Those are the 30 questions, and I know it’s a lot. I’ll give you another couple of seconds to kind of catch up and get all your answers down. Those of you that were able to print out the worksheets, the other two pages are the scoring of how we’re going to do this. Again, if you don’t have the scoring worksheets, it’s okay. I’ve got it up here on the PowerPoint. Now, if you do have it already printed out, you’ll notice I changed the format a little bit, so just bear right with me. I think it’s easier to explain the way that I broke it down. 

The first thing that we’re going to do is take a look at your compassion satisfaction scale. What you’re going to do is those questions that you see here — numbers three, six, 12, 16, 18, 20, 22, 24, 27 and 30 — you’re going to write in the answers that you got for each of those. Then, find what the total is for those numbers — and those numbers only — for right now. I’ll just explain what we’re doing as you guys go through and kind of do a little bit of math. Compassion satisfaction is about the pleasure that you derive from being able to do your work well. You might feel like it’s enjoyable for you to help others through your work. You may feel good about your colleagues or your ability to contribute to the work setting or even know that you’re helping society as a whole. 

If you notice that you have a higher score in this category, that represents a greater satisfaction related to your ability to be an effective caregiver in your job. If you notice that you’re in the higher range, so 42 or more, you probably derive a good deal of professional satisfaction from your position. If you notice that your scores are below 23, it may be a sign that you are finding problems with your job, or there may be some other reason going on, like maybe you get satisfaction from activities other than your job. What this does is this gives you a baseline of your compassion satisfaction scale. I’ll leave that up for just another minute. I know you guys probably weren’t expecting to do math today. If you need me to come back to anything at the end, I can always come back to it. 

The next thing that we’re going to go through and measure is burnout scale. Let me explain it first — how we do the scoring — ‘cause it’s different than what we just did. This particular section requires you to take an extra step. You’ll notice numbers one, four, 15, 17 and 29 have a star next to them. Take question number one: if I wrote down a five as my answer for number one, I’m going to change that to a one, and that’s what I’m going to be using for my addition. I’m gonna explain that again. For example, you see number four has a star next to it. Let’s say that for number four, I actually wrote down two as my answer. I’m going to change that two to a four, and the four is going to be what I use to get my total. 

The reason that they ask you to reverse the scores is because when they wrote this measure, they found that it works better when the questions are asked in a positive way. But what it does is it gives you more information about the negative form. For example, question one (I am happy) tells them more about the effects of helping when you are not so happy. That’s why they reversed the score. So, most people have probably heard about burnout but have a general idea of what it is. It’s one of the elements of compassion fatigue. That’s where we’re talking about feelings of hopelessness, difficulties in dealing with work or doing your job effectively. Usually, it is a gradual onset until maybe you get to the point where you’re pulling into the parking lot at work and you’re convincing yourself to walk into the building. 

You may be feeling like your efforts make no difference. Maybe your workload is too high. Maybe it’s a non-supportive work environment. If you have a higher score on the scale, it means that you are at a higher risk for burnout. That’s where we’re looking at the 42-or-more number. If your score is 23 or below, then we’re looking at a reflection of positive feelings about your ability to be effective in your work. If you’re scoring above a 41, it’s a good idea to think about what’s going on at work that makes you feel like you’re not effective in your position. This may be a reflection of your mood. Maybe you need to take some time off, but what you want to pay attention to is if that high score persists, or if other things are going on, then again, what we’re talking about today is: When do I know if I need help for something? I know that one was just a little bit more confusing, but I promise you the numbers just help to give you an idea of where you’re at. I’ll leave that up for another couple of seconds here.

Last section is the secondary traumatic stress scale. This one works just like how you did in the first section. So, numbers two, five, seven, nine. 11, 13, 14, 23, 25 and 28. You’re going to write your answers just as they were, and then you’re going to give yourself a total. Okay, remember those vocabulary words we covered in the beginning? One of the things that we talked about is secondary traumatic stress, so that’s about your work-related secondary exposure to traumatic stress. It doesn’t happen as often. Usually, if you’re doing things like — if you can see there — if you’re primarily working as a health care worker or ambulance driver, EMS, you’re looking at primary traumatic stress, not necessarily secondary traumatic stress. 

Usually with secondary traumatic stress, those symptoms come on more rapidly, and then those can be associated with a particular event. So again, here, if your score is above 41, it’s a good idea to take some time to think about what’s going on at work that might be frightening to you, or if there’s some other reason that your score is elevated. It doesn’t mean that there’s necessarily a problem, but it’s a good idea that you may want to think about how you’re feeling about your work and your work environment. If your supervisor is supportive, maybe somebody at work that you get along really well with, maybe a therapist. May be a good time to start processing some of that. 

Now that we have an idea of what we’re talking about with our secondary traumatic stress score, our burnout scale score and our compassion satisfaction scale score, you can get an idea of where you are in each of these three different categories. I would encourage you to hold on to the ProQOL measure, or you can access it on that website at any time and measure yourself again in a month on August 15th and see where you’re at then, because this is something that is most helpful if you’re measuring over time. So, we’ve talked a lot about compassion fatigue, what it all means. What are the symptoms? Now, you’ve gotten scores. Now, I feel I definitely want to start focusing on what I think is the most important part: What do we do about it? Where do we go from here? 

I found this quote and I thought it was the most appropriate one for right now: “Taking care of myself doesn’t mean me first. It means me too.” So often, my health care workers put everybody before themselves, and that is not part of what you’re supposed to do for your job. You have to take care of you. What I did was I got some tips from the Compassion Fatigue Project. They talk about things like being kind to yourself, enhancing your awareness with education, accepting where you are on your path at all times. Understanding that the people that are close to you may not be there when you need them the most. Exchange information and feelings with people who can validate you, listen to others who are suffering. There is usually power in numbers. Clarify your personal boundaries. Think about what works for you and what doesn’t. Express your needs verbally, and take positive action to change your environment. The last few slides of the presentation, we’re going to talk very, very specifically about how you do these things. This is more of a broad overview.

They also recommend things like practice health-building activities, make time for things like exercise, massage, yoga. Eat well — we are what we eat. Drink plenty of water daily. Practice the art of self-management — that means using the word “no.” Employ mindful meditation as much as you can. Develop a healthy support system — so, people who contribute to your self-esteem, people who listen well, people who care. Become proactive as opposed to reactive. Reserve your energies for worthy causes — that means take a step back and choose your battles. Live a balanced life. You know, try to sing, dance in silence. Think about those things that bring you happiness, bring you joy. 

The ProQOL measure has a really handy tool, and this is another one of the PDFs that I included as part of the presentation. If it’s not something that you got, again, very easily accessible on the ProQOL website. It’s meant to be a little card that you can print out and maybe hang it up in your workplace. Maybe it’s something that you share with your colleagues. When you’re caring for yourself in the face of difficult work, these are 10 things to do every day. Get enough sleep. Get enough to eat. Vary the work that you do. Some light exercise. Something for fun. Focus on what you did well. Learn from your mistakes. Share a private joke. Pray, meditate, relax. Try to support a colleague. Those are all different things that you can do. 

They also gave some really helpful tips on how you switch between work and off-work, ‘cause this is another one of the things I found with my health care workers. Even when they leave the hospital, it still feels like they’re at work. Make it a conscious process. I mean, sometimes, it may be helpful to say, “Okay, I’m leaving the house. I don’t have to be back for another 48 hours. I’m switching into home mode.” Use images that make you feel safe and protected. Those are going to be your work mode things. You’re connected and cared for. Those are going to be your non-work mode things that’s going to help you switch. Develop rituals that help you switch as you start and stop work — that’s something we’re going to talk about in a little bit here. You can breathe slowly and deeply — that’s something that can calm you when you’re starting a tough job. I wanted to give you a general overview of some coping skills, but I wanted to talk really specifically about what this means for your day-to-day life.

Self-care, self-care and self-care is the answer. The first and most important thing is you have to be kind to yourself. I think, sometimes, my health care workers forget that you guys are human and there’s only so much you can do. I think that when we get into this kind of field, the helping field, of course we want to help everybody. And the truth is that we can’t necessarily save everybody. Think about what your internal narratives sound like. Are you saying things inside your head? Like, “I could have done more. I’m a failure.” If you find yourself using those things, switch it up. Try, instead, something like, I’m doing my best. I’m trying my hardest. I’m giving it my all.” That’s going to be more helpful for you. And if you hear your colleagues saying the same thing, you can also try to just bring a little bit more positivity into that.

Mindfulness: this is a huge one. Be present in your body. I know it can be uncomfortable, but it’s a really important skill to develop. We talked about switching from work mode to home mode. Use that drive home. Use that time to listen to a guided meditation, just breathe, pay attention to your five senses. You can do this even while you’re on shift. Take five, 10 seconds. What are you seeing? Hearing, touching, tasting, smelling? Just run through that really quickly; it’ll help ground you and be present. Right now, as you’re sitting here listening to me, do a body scan. Where are you tense right now? Where are you holding on to that tension in your muscles? Take a deep breath and just relax those muscles as you let out that air.

Think of a place that’s peaceful and relaxing for you, maybe someplace that you went on your last vacation. Is it the beach? Is It a hike that you did in a forest somewhere? Maybe it was a day at the pool with your family. Bring yourself back to that place in your mind’s eye. That’s going to help bring you back to the present moment. Enhance your awareness with education, and congratulations — you get credit for that one. ‘Cause that’s what you’re doing right now because now you’ve learned the signs that you need to look out for, not just in yourself, but in your colleagues as well. If you recognize that they are present, you can do something about it. And that’s always my hope — that you take what you learned from today’s session, and you take it back with you, to your colleagues, to your places of work, so that more people are getting this message. 

Accept there you are on your path at all times. If you notice you are feeling, whether it’s angry, sad, frustrated — I mean, there’s a lot more that I wasn’t able to list here — it’s okay to just sit with that feeling. Oftentimes, we’ll just immediately dismiss how we feel or we think. “Well, this is what I chose to do for a living, so I’m not allowed to be frustrated right now.” That’s just not true. Acknowledge what’s happening. Check in with your body and see what it is that you need. You may need to cry. You may need to walk away from a situation. You may need to talk to somebody about it. That’s okay. What happens is that you keep stuffing down those feelings. Sometimes, we get what I call the volcano effect. You just keep stuffing it down, stuffing it down, and then eventually, you’re going to blow up.

Maybe it’s somebody that you didn’t mean to. Exchange information and feelings with people who can validate you, but connections that you have right now with your colleagues that are going through the same thing are so important right now. When you work — I mean, I’m thinking about like emergency rooms or ambulances and, honestly, any of the hospitals right now, any of the COVID units — when you work in those high-stress, fast-paced conditions, you form a bond with each other. I worked on an inpatient unit for a year and a half, and they were my family. Nobody else gets it like the people that you work with. So, think about how you can support each other. Maybe if somebody seems particularly down, you guys can think about, “What did we do yesterday that was just really great? We helped patient X get off of the ventilator,” or, “Patient Y was discharged and they’re going back home.” It’s important that we focus on those kinds of things.

Clarify your personal boundaries. Think about what works for you and what doesn’t. Our loved ones want to support us right now, but they may not know how. We have to tell them; you can’t expect them to be able to read your mind. It’s important, I think, that you think about maybe you need some time to decompress when you come home. It’s okay. If you walk in the door and everybody, you know, you’ve got the dog running up to you and the kids want to know what’s for dinner and you’re just immediately overwhelmed. You may need to just make it clear to your family. “I love you. I’m happy to be home, but I need a little bit of me time before I jump right into helping with homework or making dinner or things like that.”

It’s more effective that you communicate that, rather than assuming that they’re going to know what you need. And it helps our family members when they know what you need for support because it gives them the opportunity to be successful at supporting you. And you’re going to be in a better mood and everybody just wins. We talked about this before: take care of your body. Are you sleeping? Are you eating regularly and nutritiously? Are you showering regularly? Are you hydrating? I have health care workers that’ll go a full 12-hour shift without going to the bathroom. These basic things are more important now than they ever were before. I know it’s easy to let go of them, but you have to focus on these things. I recommend Insight Timer. It’s a free app. It has thousands of free, guided meditations on it. Some of them are specifically built for health care workers. If you’re having a hard time sleeping, maybe try a guided meditation. Try to avoid screen time before you go to bed.

If you’re having a hard time figuring out eating nutritious meals and getting in time to eat nutritious meals, maybe on your day off, or if you have the weekends off, cook in large batches. Stuff that you can store in the freezer or in the fridge. That way, you already have a go-to you don’t need to think about. Maybe you need to set an alarm on your phone every couple of hours, just to remind you to drink water. I have my Tervis tumbler that goes everywhere with me, and I kind of gauge throughout the day. How much have I consumed? Because I want to be making sure that I’m drinking, at a minimum, two of those a day. If your faith or your religion is an important part of your life, maybe you need to be incorporating prayer. Maybe you need to be incorporating time, even if it’s five minutes, with a religious text. That’s the important part about self-care, it doesn’t have to take a huge chunk of your day. Five minutes can make a difference. 

Take breaks. Think about your last shift. When was the last time that you stood outside in the sun during a shift? Even going outside for one minute, just to breathe, just to feel the sun on your skin, it can make a huge difference. Get you a little bit of vitamin D. Maybe leave yourself a note taped to the inside of your car, like a cheerleading message, something like, “I am one person. I’m going to do the best that I can today.” Take a deep breath before you walk in, let your muscles relax and then go into the building. Wear a soothing scent. For some people, that can be lavender. That can just be a little bit of a reminder that it’s okay, you got this. One shift at a time. And then finally, it is okay to ask for help. It is normal to talk to a therapist about what you’re going through and the things that you’re struggling with right now. Working in the health care industry, if somebody had a broken bone, we would expect them to go and get help. Would we not? 

Mental health should be the same way. If you are struggling, if you notice that you’re feeling anxious or depressed, it should be just as normal to go seek help for that kind of thing, as it would be if you have a broken bone. If you’re not sure where to get started, Psychology Today is a great resource. It’s a nationwide database of mental health professionals whose credentials have already been verified. And you can search by ZIP code, you can search by insurance company, all of these different things. That’s a great resource to get started with. Your insurance company, if you have commercial health insurance, they should have some kind of mental health coverage. And if you go on their website or call up the company, they should be able to provide you with a list of participating providers in your ZIP code.

If you work for a large enough company, they may have an EAP that you can have access to. That should immediately get you started with, usually, anywhere between three to six free sessions. If you’re not quite sure where to get started, those are three immediately off the bat that you can start with. The most important thing is that you should feel comfortable talking to that person and you should feel like you can trust them. So often, I have clients come to me who maybe had a therapist — it wasn’t a great experience, and they wait 10 or 15 years before they go see somebody else. Just like how you may have had a less than ideal experience with any kind of business, it’s the fit. And what all of the research tells us is that the most important thing in the therapeutic relationship is that connection that you build with your therapist. So if you go to somebody and it doesn’t quite feel right, it doesn’t mean you failed at it. It doesn’t mean you’re bad at it; it just means that you guys weren’t compatible. It’s okay, and honestly, if that happens, you can feel comfortable to ask that therapist for maybe a referral. 

Encourage your colleagues to seek out help. This is another thing, I want you to bring this message back to your places of work. Let them know that you’re concerned about them, let them know that it’s okay to seek out help. If we don’t have these conversations about how okay it is to go talk to somebody, then we kind of expect each other to continue doing this superhero thing — stuffing our feelings down and ignoring what’s going on. And that’s how we head into the burnout and we head into the compassion fatigue. You’d be surprised if you open up to your colleagues, those that you trust, and say, “You know, I’m kind of struggling right now. I think I’m going to see a therapist. Do you know anybody?” If you open up the conversation, you’d be surprised how many other people have sought out help. But we need to normalize that situation.

What are two things that you did today to take care of you? One of them was you attended today, so you got credit for that. Then, the other thing I want you to think about is what your self-care plan looks like. So, I went over a bunch of things. I want you to make a promise to yourself that you are going to implement one thing, just one thing that we talked about. Whether it’s, “I’m going to start bringing a water bottle to work and make sure that I’m drinking water during my shift,” or, “I’m going to download that Insight Timer app.” Whatever it is, try and implement just one thing for your self-care plan moving forward. It only takes five minutes a day. 

This is one of my favorite quotes, so I wanted to end with it. It’s, “Happiness can be found even in the darkest of times, if one only remembers to turn on the light.” I’m a big Harry Potter fan, and that was Professor Dumbledore. Reach out. We are here to listen. There are plenty of mental health professionals that are here to help. And I know myself, personally, I’ve become more involved with those in the health care industry as we’ve been navigating the COVID crisis. 

Speaking of, my contact information, you’ve got the office phone number there.

You can email me directly at that email address. And then also, if you go to the website, I’m at Lake Nona Behavioral Health Services, and there’s a link to email me at the website as well. 

Thank you guys so much for joining today. Be proud of yourself for taking the time for yourself to develop a plan. To take care of you. That’s the most important thing. You’ve got mental health professionals that are here to help. This is what we do. You don’t have to carry the burden by yourself. We’re here, we care. Alright, thank you so much. 

Thank you for watching this video. We hope you enjoyed the presentation.

Objectives and Summary:

During this webinar, health care workers and first responders are invited to learn about compassion fatigue and how it impacts their work. Attendees will create a self-care plan to help manage work stress.

After watching this presentation, the viewer will:

  1. Be familiar with the definition of compassion fatigue and why it is prevalent in the health care field.
  2. Identify symptoms of compassion fatigue attendees may be feeling.
  3. Develop a self-care plan that can immediately be implemented.

Presentation Materials:

Welcome to the Community Education Series, hosted by The Recovery Village and Advanced Recovery Systems. 

Hi, everybody. Thank you so much for joining us today; really excited to present. At a later point in the presentation, you will need a pen and paper. If you want to take a minute to grab that while we’re just kind of going through introductory stuff and having people add on, then now would be the perfect opportunity to do that.

As Ashley mentioned, my name is Natasha and there are my credentials. I have a lot of letters behind my name, but Ashley went through and explained what all of that is. So, I am in private practice here in Orlando, currently telehealth because of COVID. Just to give you an idea of the things that we’ll be talking about today, I wanted to do a presentation on compassion fatigue and self-care. I think it’s something that’s really come up in the last few months as we’ve been going through the COVID situation. So, overview of what we’ll be talking about today. First, I want to get a good definition of what compassion fatigue means.

Make sure that you guys have an understanding of what the symptoms are, learn the warning signs that you need to be on the lookout for. This is where your pen and paper is going to come in handy because you’re actually going to do a self-assessment so you can get an idea of what your level of fatigue is. And then, finally, I think the most important part is I want to make sure that you leave today with a self-care plan that is realistic for your life that you can do starting today. 

Let’s hop right into it. First one is, “What is compassion fatigue?” So, this comes from the Compassion Fatigue Awareness Project. If anything that we talk about today seems really interesting to you, highly recommend that as a resource. They tell us that it’s a broadly defined concept, which includes emotional, physical and spiritual distress for those of us that provide care to another. We’re talking about caregiving where people or animals are experiencing significant emotional or physical pain and suffering. As I said in the invite, this is really directed for our health care workers and our first responders, because that’s pretty much what you do on a day-to-day basis. Work with those who are in some kind of distress and, often, you will forget to take care of yourself. 

So, just some vocabulary that we can kind of operate on moving forward, as these things will continue to pop up throughout the presentation. The first one is compassion satisfaction. That’s where we’re talking about the positive aspects of working as a helper. Those that are in the helping field, you went into it for a reason, and there are some really great aspects to your job. Then there’s also compassion fatigue, and those are those negative aspects of working as a helper. We’re also going to talk about burnout. That’s where you feel the inefficacy and that you feel overwhelmed with your job. And then there’s work-related traumatic stress that comes in two different categories. There’s primary traumatic stress, which if you’re in the hospitals, if you’re riding on an ambulance, we’re talking about primary traumatic stress. And then there’s secondary traumatic exposure. That may be if we’re sharing a lot of things with our partners, for example, and they just maybe get overwhelmed with hearing these different stories. So, just some vocabulary so you have a baseline understanding as we go forward. 

 

So, let’s talk a little bit about health care and first responders. What we find is that caregivers really do play host to high levels of compassion fatigue. One of the things that I’ve been surprised by as I started working — even before COVID with clients that are in the health care industry, whether that be physical therapists or physicians assistants, nurses, physicians — I find that there’s not a lot covered in school curriculum about compassion fatigue, which was really surprising to me. That’s another reason I’ve been so passionate about talking out about this subject, because it’s something that we definitely do need to talk about. 

What happens is, day in and day out, you guys struggle sometimes to function in the caregiving environments because it seems like there’s always something heart-wrenching and emotional going on. All of that was true before COVID came along. We already were sometimes in situations where there were not enough nurses for a shift or you just felt exhausted or you felt overwhelmed. And what’s happened now is all of these things have become more acute due to COVID-19, so it’s possible that you’re feeling worse than you already were in your job and you just don’t know what to do. That’s exactly why I wanted to do this presentation today. And my goal, as I stated in the beginning, is to make sure that we are preventing burnout and preventing compassion fatigue by ensuring that you do have a good self-care plan in place, and you know what it is that you’re working with. 

So, most stereotypical therapist’s question there is: How are you feeling? I want you to look at this as a first-degree, second-degree, third-degree burn situation. If you’re at first-degree level, these are some of the things that I would be expecting to hear about. You may have difficulty concentrating. You may be feeling numb, anxious, fearful. You might have noticed a change in your appetite or change in your energy levels. May be really hard for you right now to get out of bed and go to work. You may see that you’re having some difficulty sleeping, or you may be having nightmares. Sometimes, people will have things like headaches, body pains, stomach problems that they may not have had before. You may be noticing that you’re drinking a little bit more, smoking a little bit more or using other drugs. You may have already existing chronic health problems that now seem to be getting worse, and you may be feeling particularly short-tempered. I would not be surprised if any of these things were true for you, considering what’s been happening in the country since about February or so. This is where we’re talking about first-degree situation.

What’s the next level up? So, second-degree burn, and you’ll notice some of these are going to be consistent through the first-, second- and third-degree level. So, easily frustrated: things that maybe normally would not have bothered you now are really bothering you. You may feel that you just are lacking feelings. You’re just feeling indifferent. Maybe you’re blaming other people for things. Maybe you’re feeling particularly irritable. Maybe feeling sad or empathetic. Maybe feeling isolated. For example, you get home, you close yourself in your bedroom, don’t want to talk to anybody, don’t want to look at anybody. You may be feeling tired. You may be feeling exhausted and you may be feeling overwhelmed. 

I’ve noticed in some of my clients, their self-hygiene may start to suffer. You may not have the energy to shower, or you may not be putting on clean clothes as frequently. You may not be washing your hair as often. And then, you’re also struggling with things like feeling like a failure or feeling like nothing that you can do is going to help. Or that you’re not doing your job well, or you may be needing alcohol or other drugs to cope. Not that you’re using more, but it seems like you need that in order to be able to continue doing what you’re doing.

The third-degree is where we get into compassion fatigue. And again, like I said, there’s some similarities with all of these levels. When we’re looking at compassion fatigue, we’re talking about things like excessive blaming — you don’t really want to take accountability for anything. You’re just kind of laying it all on everybody else. You’re bottling up your emotions. A lot of my clients would tell me they don’t have time or they can’t deal with it. They just need to go from one patient to the next. We see again here that isolating from others. You may be voicing excessive complaints about administrative functions.

I know, unfortunately, a lot of times in health care, we spend so much time doing paperwork and documenting everything. At this point, you’re using substance abuse to mask your feelings. You may be coming home and needing to drink a lot of wine, for example, to feel like you’re decompressing from the day. Maybe you’re doing some compulsive behaviors. You’re spending money that you don’t have. You’re overeating, you’re gambling, things that you’ve not done before. The poor self-care comes in again. You know, you’re not attending to your hygiene; maybe you always did your makeup before you went to work, and now you’re not doing that anymore. Again, the apathy: you don’t find things pleasurable anymore. Maybe reading was really a joy for you, and now even the thought of picking up a book just seems like too much. 

You’re mentally and physically tired. You may be in denial about problems. Maybe your loved ones have approached you and said, “Listen, something seems different. Are you okay?” “No, no, I’m fine. I’m fine. There’s nothing wrong.” You may be having difficulty concentrating. For example, when you’re going to put in your notes, you gotta keep rechecking: “Did I put that in?” Making sure that you’re on the right client, making sure, putting in the right medication, those kinds of things. Kind of goes along with being preoccupied, right? You just can’t seem to focus; there’s other stuff on your mind and maybe some legal problems going on as a result of that. We’re talking about recurrence of nightmares and flashbacks to a traumatic event. I know a lot of you are probably dealing with a lot more death than you’re used to. 

Maybe there’s a particular patient experience that’s just playing on your mind over and over again, and it’s like a movie that you can’t get to stop. Chronic physical things going on, like stomach problems, or maybe there’s like a cold that you can’t seem to shake. This is your mind and your body’s way of letting you know that there’s something going on that you need to get it taken care of. And the reason I use the first-, second- and third-degree analogy is because no matter what level of burn you’re at, there is treatment that is available. That’s what I really want you to remember. Whether you identify with the first-, second- or third-degree level of symptoms, it’s not too late to get help, and that’s exactly why I wanted to do this presentation today. I think that the best way to address that — and this is where you’re going to need your pen and paper — is to get an idea of where you’re at. 

We’re going to do an assessment in real-time. As I explained this, if you have not, grab your pens and paper. Ashley had told me that the PDFs that I wanted for the presentation should have been emailed to you too. If you’ve got those handy, now is the time to grab them. So, what we’re about to complete is called the ProQOL. It stands for the professional quality of life scale. If you do not have access to it, if you do not have it printed out, that’s fine. I have it pulled up on the PDF or on the PowerPoint slide here, and you can just follow along with me. It is a free measure and it goes through 30 different items, and you’re going to be measuring the positive and negative aspects of your job. We’re going to be talking about compassion satisfaction and compassion fatigue, and compassion fatigue has two subscales that we’re going to be measuring. We’re going to be talking about burnout as well as secondary trauma. 

If you write nothing else down today, please write down that website: the ProQOL.org website, another amazing resource in addition to the Compassion Fatigue Project.  They have made everything that I’m about to show you available free of charge. My hope is that if something resonates with you today, you take this back to your colleagues, maybe back to hospital administration, because this is an actual measure where they can see where you’re at, and that’s how we’re able to make changes and put interventions into place. Hopefully, you’ve had enough time to go grab something to write with or print out the measures yourself. 

Here it is. Like I said, if you don’t have it printed out, I have it available for you. What we’re going to do: I’ve got questions one through 13 loaded on here, but it would be helpful if you’ve numbered your paper from one through 30. As I read the questions, what I want you to do is: You’re going to give yourself a grade, and you can see the scale up at the top there. One is for never, two is for rarely, three is for sometimes, four is for often and five is for very often. So, you’re going to honestly reflect on how frequently these things were true for you in the last 30 days. Today’s July 15th. You’re going to be thinking about from the middle of June up until today. You’re doing this at home. Nobody’s looking over your shoulder.

Now’s the time to really do an honest assessment. 
  • So, question number one is: I am happy.
  • Question number two: I am preoccupied with more than one person that I help.
  • Question number three: I get satisfaction from being able to help people.
  • Question number four: I feel connected to others.
  • Question number five: I jump or am startled by unexpected sounds.
  • Question number six: I feel invigorated after working with those I help.
  • Question number seven: I find it difficult to separate my personal life from my life as a helper.
  • Question number eight: I am not as productive at work because I’m losing sleep over traumatic experiences of a person I help.
  • Question number nine: I think that I might have been affected by the traumatic stress of those I help.
  • Question number 10: I feel trapped by my job as a helper.
  • Question number 11: Because of my helping, I have felt on edge about various things.
  • Question number 12: I like my work as a helper.
  • And question number 13: I feel depressed because of the traumatic experiences of the people I help. I’ll leave that up for just another few seconds. And again, the scale’s right at the top there: one being never, five being very often. We’ll head on to the rest of them. Again, the scale’s right there at the top. 
  • Question number 14: I feel as though I am experiencing the trauma of someone I have helped.
  • Question number 15: I have beliefs that sustain me.
  • Number 16: I am pleased with how I am able to keep up with the helping techniques and protocols.
  • Number 17: I’m the person I always wanted to be.
  • Number 18: My work makes me feel satisfied.
  • Number 19: I feel worn out because of my work as a helper.
  • Number 20: I have happy thoughts and feelings about those I help and how I could help them.
  • Number 21: I feel overwhelmed because my case workload seems endless.
  • Number 22: I believe I can make a difference through my work.
  • Number 23: I avoid certain activities or situations because they remind me of frightening experiences of the people I help.
  • Number 24: I am proud of what I can do to help.
  • Number 25: As a result of my helping, I have intrusive frightening thoughts.
  • Number 26: I feel bogged down by the system.
  • Number 27: I have thoughts that I am a success as a helper.
  • Number 28: I can’t recall important parts of my work with trauma victims.
  • Number 29: I am a very caring person.
  • And Number 30: I am happy that I chose to do this work. 

Those are the 30 questions, and I know it’s a lot. I’ll give you another couple of seconds to kind of catch up and get all your answers down. Those of you that were able to print out the worksheets, the other two pages are the scoring of how we’re going to do this. Again, if you don’t have the scoring worksheets, it’s okay. I’ve got it up here on the PowerPoint. Now, if you do have it already printed out, you’ll notice I changed the format a little bit, so just bear right with me. I think it’s easier to explain the way that I broke it down. 

The first thing that we’re going to do is take a look at your compassion satisfaction scale. What you’re going to do is those questions that you see here — numbers three, six, 12, 16, 18, 20, 22, 24, 27 and 30 — you’re going to write in the answers that you got for each of those. Then, find what the total is for those numbers — and those numbers only — for right now. I’ll just explain what we’re doing as you guys go through and kind of do a little bit of math. Compassion satisfaction is about the pleasure that you derive from being able to do your work well. You might feel like it’s enjoyable for you to help others through your work. You may feel good about your colleagues or your ability to contribute to the work setting or even know that you’re helping society as a whole. 

If you notice that you have a higher score in this category, that represents a greater satisfaction related to your ability to be an effective caregiver in your job. If you notice that you’re in the higher range, so 42 or more, you probably derive a good deal of professional satisfaction from your position. If you notice that your scores are below 23, it may be a sign that you are finding problems with your job, or there may be some other reason going on, like maybe you get satisfaction from activities other than your job. What this does is this gives you a baseline of your compassion satisfaction scale. I’ll leave that up for just another minute. I know you guys probably weren’t expecting to do math today. If you need me to come back to anything at the end, I can always come back to it. 

The next thing that we’re going to go through and measure is burnout scale. Let me explain it first — how we do the scoring — ‘cause it’s different than what we just did. This particular section requires you to take an extra step. You’ll notice numbers one, four, 15, 17 and 29 have a star next to them. Take question number one: if I wrote down a five as my answer for number one, I’m going to change that to a one, and that’s what I’m going to be using for my addition. I’m gonna explain that again. For example, you see number four has a star next to it. Let’s say that for number four, I actually wrote down two as my answer. I’m going to change that two to a four, and the four is going to be what I use to get my total. 

The reason that they ask you to reverse the scores is because when they wrote this measure, they found that it works better when the questions are asked in a positive way. But what it does is it gives you more information about the negative form. For example, question one (I am happy) tells them more about the effects of helping when you are not so happy. That’s why they reversed the score. So, most people have probably heard about burnout but have a general idea of what it is. It’s one of the elements of compassion fatigue. That’s where we’re talking about feelings of hopelessness, difficulties in dealing with work or doing your job effectively. Usually, it is a gradual onset until maybe you get to the point where you’re pulling into the parking lot at work and you’re convincing yourself to walk into the building. 

You may be feeling like your efforts make no difference. Maybe your workload is too high. Maybe it’s a non-supportive work environment. If you have a higher score on the scale, it means that you are at a higher risk for burnout. That’s where we’re looking at the 42-or-more number. If your score is 23 or below, then we’re looking at a reflection of positive feelings about your ability to be effective in your work. If you’re scoring above a 41, it’s a good idea to think about what’s going on at work that makes you feel like you’re not effective in your position. This may be a reflection of your mood. Maybe you need to take some time off, but what you want to pay attention to is if that high score persists, or if other things are going on, then again, what we’re talking about today is: When do I know if I need help for something? I know that one was just a little bit more confusing, but I promise you the numbers just help to give you an idea of where you’re at. I’ll leave that up for another couple of seconds here.

Last section is the secondary traumatic stress scale. This one works just like how you did in the first section. So, numbers two, five, seven, nine. 11, 13, 14, 23, 25 and 28. You’re going to write your answers just as they were, and then you’re going to give yourself a total. Okay, remember those vocabulary words we covered in the beginning? One of the things that we talked about is secondary traumatic stress, so that’s about your work-related secondary exposure to traumatic stress. It doesn’t happen as often. Usually, if you’re doing things like — if you can see there — if you’re primarily working as a health care worker or ambulance driver, EMS, you’re looking at primary traumatic stress, not necessarily secondary traumatic stress. 

Usually with secondary traumatic stress, those symptoms come on more rapidly, and then those can be associated with a particular event. So again, here, if your score is above 41, it’s a good idea to take some time to think about what’s going on at work that might be frightening to you, or if there’s some other reason that your score is elevated. It doesn’t mean that there’s necessarily a problem, but it’s a good idea that you may want to think about how you’re feeling about your work and your work environment. If your supervisor is supportive, maybe somebody at work that you get along really well with, maybe a therapist. May be a good time to start processing some of that. 

Now that we have an idea of what we’re talking about with our secondary traumatic stress score, our burnout scale score and our compassion satisfaction scale score, you can get an idea of where you are in each of these three different categories. I would encourage you to hold on to the ProQOL measure, or you can access it on that website at any time and measure yourself again in a month on August 15th and see where you’re at then, because this is something that is most helpful if you’re measuring over time. So, we’ve talked a lot about compassion fatigue, what it all means. What are the symptoms? Now, you’ve gotten scores. Now, I feel I definitely want to start focusing on what I think is the most important part: What do we do about it? Where do we go from here? 

I found this quote and I thought it was the most appropriate one for right now: “Taking care of myself doesn’t mean me first. It means me too.” So often, my health care workers put everybody before themselves, and that is not part of what you’re supposed to do for your job. You have to take care of you. What I did was I got some tips from the Compassion Fatigue Project. They talk about things like being kind to yourself, enhancing your awareness with education, accepting where you are on your path at all times. Understanding that the people that are close to you may not be there when you need them the most. Exchange information and feelings with people who can validate you, listen to others who are suffering. There is usually power in numbers. Clarify your personal boundaries. Think about what works for you and what doesn’t. Express your needs verbally, and take positive action to change your environment. The last few slides of the presentation, we’re going to talk very, very specifically about how you do these things. This is more of a broad overview.

They also recommend things like practice health-building activities, make time for things like exercise, massage, yoga. Eat well — we are what we eat. Drink plenty of water daily. Practice the art of self-management — that means using the word “no.” Employ mindful meditation as much as you can. Develop a healthy support system — so, people who contribute to your self-esteem, people who listen well, people who care. Become proactive as opposed to reactive. Reserve your energies for worthy causes — that means take a step back and choose your battles. Live a balanced life. You know, try to sing, dance in silence. Think about those things that bring you happiness, bring you joy. 

The ProQOL measure has a really handy tool, and this is another one of the PDFs that I included as part of the presentation. If it’s not something that you got, again, very easily accessible on the ProQOL website. It’s meant to be a little card that you can print out and maybe hang it up in your workplace. Maybe it’s something that you share with your colleagues. When you’re caring for yourself in the face of difficult work, these are 10 things to do every day. Get enough sleep. Get enough to eat. Vary the work that you do. Some light exercise. Something for fun. Focus on what you did well. Learn from your mistakes. Share a private joke. Pray, meditate, relax. Try to support a colleague. Those are all different things that you can do. 

They also gave some really helpful tips on how you switch between work and off-work, ‘cause this is another one of the things I found with my health care workers. Even when they leave the hospital, it still feels like they’re at work. Make it a conscious process. I mean, sometimes, it may be helpful to say, “Okay, I’m leaving the house. I don’t have to be back for another 48 hours. I’m switching into home mode.” Use images that make you feel safe and protected. Those are going to be your work mode things. You’re connected and cared for. Those are going to be your non-work mode things that’s going to help you switch. Develop rituals that help you switch as you start and stop work — that’s something we’re going to talk about in a little bit here. You can breathe slowly and deeply — that’s something that can calm you when you’re starting a tough job. I wanted to give you a general overview of some coping skills, but I wanted to talk really specifically about what this means for your day-to-day life.

Self-care, self-care and self-care is the answer. The first and most important thing is you have to be kind to yourself. I think, sometimes, my health care workers forget that you guys are human and there’s only so much you can do. I think that when we get into this kind of field, the helping field, of course we want to help everybody. And the truth is that we can’t necessarily save everybody. Think about what your internal narratives sound like. Are you saying things inside your head? Like, “I could have done more. I’m a failure.” If you find yourself using those things, switch it up. Try, instead, something like, I’m doing my best. I’m trying my hardest. I’m giving it my all.” That’s going to be more helpful for you. And if you hear your colleagues saying the same thing, you can also try to just bring a little bit more positivity into that.

Mindfulness: this is a huge one. Be present in your body. I know it can be uncomfortable, but it’s a really important skill to develop. We talked about switching from work mode to home mode. Use that drive home. Use that time to listen to a guided meditation, just breathe, pay attention to your five senses. You can do this even while you’re on shift. Take five, 10 seconds. What are you seeing? Hearing, touching, tasting, smelling? Just run through that really quickly; it’ll help ground you and be present. Right now, as you’re sitting here listening to me, do a body scan. Where are you tense right now? Where are you holding on to that tension in your muscles? Take a deep breath and just relax those muscles as you let out that air.

Think of a place that’s peaceful and relaxing for you, maybe someplace that you went on your last vacation. Is it the beach? Is It a hike that you did in a forest somewhere? Maybe it was a day at the pool with your family. Bring yourself back to that place in your mind’s eye. That’s going to help bring you back to the present moment. Enhance your awareness with education, and congratulations — you get credit for that one. ‘Cause that’s what you’re doing right now because now you’ve learned the signs that you need to look out for, not just in yourself, but in your colleagues as well. If you recognize that they are present, you can do something about it. And that’s always my hope — that you take what you learned from today’s session, and you take it back with you, to your colleagues, to your places of work, so that more people are getting this message. 

Accept there you are on your path at all times. If you notice you are feeling, whether it’s angry, sad, frustrated — I mean, there’s a lot more that I wasn’t able to list here — it’s okay to just sit with that feeling. Oftentimes, we’ll just immediately dismiss how we feel or we think. “Well, this is what I chose to do for a living, so I’m not allowed to be frustrated right now.” That’s just not true. Acknowledge what’s happening. Check in with your body and see what it is that you need. You may need to cry. You may need to walk away from a situation. You may need to talk to somebody about it. That’s okay. What happens is that you keep stuffing down those feelings. Sometimes, we get what I call the volcano effect. You just keep stuffing it down, stuffing it down, and then eventually, you’re going to blow up.

Maybe it’s somebody that you didn’t mean to. Exchange information and feelings with people who can validate you, but connections that you have right now with your colleagues that are going through the same thing are so important right now. When you work — I mean, I’m thinking about like emergency rooms or ambulances and, honestly, any of the hospitals right now, any of the COVID units — when you work in those high-stress, fast-paced conditions, you form a bond with each other. I worked on an inpatient unit for a year and a half, and they were my family. Nobody else gets it like the people that you work with. So, think about how you can support each other. Maybe if somebody seems particularly down, you guys can think about, “What did we do yesterday that was just really great? We helped patient X get off of the ventilator,” or, “Patient Y was discharged and they’re going back home.” It’s important that we focus on those kinds of things.

Clarify your personal boundaries. Think about what works for you and what doesn’t. Our loved ones want to support us right now, but they may not know how. We have to tell them; you can’t expect them to be able to read your mind. It’s important, I think, that you think about maybe you need some time to decompress when you come home. It’s okay. If you walk in the door and everybody, you know, you’ve got the dog running up to you and the kids want to know what’s for dinner and you’re just immediately overwhelmed. You may need to just make it clear to your family. “I love you. I’m happy to be home, but I need a little bit of me time before I jump right into helping with homework or making dinner or things like that.”

It’s more effective that you communicate that, rather than assuming that they’re going to know what you need. And it helps our family members when they know what you need for support because it gives them the opportunity to be successful at supporting you. And you’re going to be in a better mood and everybody just wins. We talked about this before: take care of your body. Are you sleeping? Are you eating regularly and nutritiously? Are you showering regularly? Are you hydrating? I have health care workers that’ll go a full 12-hour shift without going to the bathroom. These basic things are more important now than they ever were before. I know it’s easy to let go of them, but you have to focus on these things. I recommend Insight Timer. It’s a free app. It has thousands of free, guided meditations on it. Some of them are specifically built for health care workers. If you’re having a hard time sleeping, maybe try a guided meditation. Try to avoid screen time before you go to bed.

If you’re having a hard time figuring out eating nutritious meals and getting in time to eat nutritious meals, maybe on your day off, or if you have the weekends off, cook in large batches. Stuff that you can store in the freezer or in the fridge. That way, you already have a go-to you don’t need to think about. Maybe you need to set an alarm on your phone every couple of hours, just to remind you to drink water. I have my Tervis tumbler that goes everywhere with me, and I kind of gauge throughout the day. How much have I consumed? Because I want to be making sure that I’m drinking, at a minimum, two of those a day. If your faith or your religion is an important part of your life, maybe you need to be incorporating prayer. Maybe you need to be incorporating time, even if it’s five minutes, with a religious text. That’s the important part about self-care, it doesn’t have to take a huge chunk of your day. Five minutes can make a difference. 

Take breaks. Think about your last shift. When was the last time that you stood outside in the sun during a shift? Even going outside for one minute, just to breathe, just to feel the sun on your skin, it can make a huge difference. Get you a little bit of vitamin D. Maybe leave yourself a note taped to the inside of your car, like a cheerleading message, something like, “I am one person. I’m going to do the best that I can today.” Take a deep breath before you walk in, let your muscles relax and then go into the building. Wear a soothing scent. For some people, that can be lavender. That can just be a little bit of a reminder that it’s okay, you got this. One shift at a time. And then finally, it is okay to ask for help. It is normal to talk to a therapist about what you’re going through and the things that you’re struggling with right now. Working in the health care industry, if somebody had a broken bone, we would expect them to go and get help. Would we not? 

Mental health should be the same way. If you are struggling, if you notice that you’re feeling anxious or depressed, it should be just as normal to go seek help for that kind of thing, as it would be if you have a broken bone. If you’re not sure where to get started, Psychology Today is a great resource. It’s a nationwide database of mental health professionals whose credentials have already been verified. And you can search by ZIP code, you can search by insurance company, all of these different things. That’s a great resource to get started with. Your insurance company, if you have commercial health insurance, they should have some kind of mental health coverage. And if you go on their website or call up the company, they should be able to provide you with a list of participating providers in your ZIP code.

If you work for a large enough company, they may have an EAP that you can have access to. That should immediately get you started with, usually, anywhere between three to six free sessions. If you’re not quite sure where to get started, those are three immediately off the bat that you can start with. The most important thing is that you should feel comfortable talking to that person and you should feel like you can trust them. So often, I have clients come to me who maybe had a therapist — it wasn’t a great experience, and they wait 10 or 15 years before they go see somebody else. Just like how you may have had a less than ideal experience with any kind of business, it’s the fit. And what all of the research tells us is that the most important thing in the therapeutic relationship is that connection that you build with your therapist. So if you go to somebody and it doesn’t quite feel right, it doesn’t mean you failed at it. It doesn’t mean you’re bad at it; it just means that you guys weren’t compatible. It’s okay, and honestly, if that happens, you can feel comfortable to ask that therapist for maybe a referral. 

Encourage your colleagues to seek out help. This is another thing, I want you to bring this message back to your places of work. Let them know that you’re concerned about them, let them know that it’s okay to seek out help. If we don’t have these conversations about how okay it is to go talk to somebody, then we kind of expect each other to continue doing this superhero thing — stuffing our feelings down and ignoring what’s going on. And that’s how we head into the burnout and we head into the compassion fatigue. You’d be surprised if you open up to your colleagues, those that you trust, and say, “You know, I’m kind of struggling right now. I think I’m going to see a therapist. Do you know anybody?” If you open up the conversation, you’d be surprised how many other people have sought out help. But we need to normalize that situation.

What are two things that you did today to take care of you? One of them was you attended today, so you got credit for that. Then, the other thing I want you to think about is what your self-care plan looks like. So, I went over a bunch of things. I want you to make a promise to yourself that you are going to implement one thing, just one thing that we talked about. Whether it’s, “I’m going to start bringing a water bottle to work and make sure that I’m drinking water during my shift,” or, “I’m going to download that Insight Timer app.” Whatever it is, try and implement just one thing for your self-care plan moving forward. It only takes five minutes a day. 

This is one of my favorite quotes, so I wanted to end with it. It’s, “Happiness can be found even in the darkest of times, if one only remembers to turn on the light.” I’m a big Harry Potter fan, and that was Professor Dumbledore. Reach out. We are here to listen. There are plenty of mental health professionals that are here to help. And I know myself, personally, I’ve become more involved with those in the health care industry as we’ve been navigating the COVID crisis. 

Speaking of, my contact information, you’ve got the office phone number there.

You can email me directly at that email address. And then also, if you go to the website, I’m at Lake Nona Behavioral Health Services, and there’s a link to email me at the website as well. 

Thank you guys so much for joining today. Be proud of yourself for taking the time for yourself to develop a plan. To take care of you. That’s the most important thing. You’ve got mental health professionals that are here to help. This is what we do. You don’t have to carry the burden by yourself. We’re here, we care. Alright, thank you so much. 

Thank you for watching this video. We hope you enjoyed the presentation.

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