So Your Staff - PowerPoint Presentation

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So Your Staff Needs a Self-Care Program?

Presenters: Lynn Skubiszewski, LCSW andNicole Perry, LCSW

#NASWILSlide2

Welcome to Our Presentation

http://www.youtube.com/watch?v=XSu_sVgGWMkSlide3

Presenter BiographiesLynn Skubiszewski, LCSW

Palliative Care Social Worker, JourneyCare lskubiszewski@journeycare.org

Lynn is a graduate of Aurora University School of Social Work and has worked in the academic, geriatric, and healthcare fields for over 20 years. She has an interest in coaching the helping professionals in self care and encouraging social workers in healthcare settings to embrace leadership roles in their multidisciplinary settings.

Nicole Perry, LCSW Social Worker and Team Manager, JourneyCare nperry@journeycare.org Nicole has an MSW from the University of Wisconsin – Madison. She has worked as a Social Worker since 2006 in the fields of aging and hospice. Nicole enjoys leading an interdisciplinary staff team to provide excellent end of life care and symptom management to the patients of JourneyCare.

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Why is Self Care Important?Poor Quality of LifePoor self-care = burnout/dissatisfaction = drop out of SW field

“In light of recent and significant research indicating that social workers engaged in direct practice are likely to develop symptoms of secondary traumatic stress, it is imperative that the social work profession devotes greater attention to and creates greater awareness of these issues.” (Professional Self-Care and Social Work, policy statement approved by the NASW Delegate Assembly, 2008)Poor self care = reduced ability to be empathicSlide5

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through the water without getting wet.” ~ RemenSlide6

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

Research ProjectWhat is self – care?How can you start self care?Resilience, Personal Self Care, and Realistic Expectations How to Expand Self-Care to the Organization Level

Summary and Review Resources/ToolsSlide7

What is Burnout?“A relatively frequent outcome of chronic stress that has received considerable attention.”Refers to the gradual extinguishing of energy of a Social Worker.

What leads to burnout?Schaufeli, Leiter, & Maslach, 2009, p 205.Maslach and

Leiter, 2005Cox and Stiner, 2013Slide8

Silver Lining?

Burnout is the opportunity to re-discover what makes you happy.Slide9

10 Phases of Burnout"Preventing Burnout" by psychologists Herbert Freudenberger and Gail North

: Long-Term Living 59.5 (May 2010): 50-52.

A compulsion to prove oneself, working harder, neglecting

one's own needs, displacing conflicts by ignoring the root cause of the distress, revision of values in which friends or hobbies are ignored, denial with emergence of cynicism and aggression, withdrawing from social contacts and/or using alcohol or substances to cope, inner emptiness, depression, and actual Burnout Syndrome.Slide10

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

How do you know it is burnout?Listen to others who know and care about youUse assessment tools to help you see the truth Self awareness – know when you are crossing a lineSlide11

Ask yourself these simple questions….1. How often are you tired and lacking energy to go to work in the morning? 2. How often do you feel physically drained, as if your batteries were dead?

3. How often is your thinking process sluggish or your concentration impaired? 4. How often do you struggle to think over complex problems at work? 5. How often do you feel emotionally detached from coworkers or customers, and unable to respond to their needs?Slide12

What Does Burnout Look Like?TOP 10 SIGNS OF BURNOUT#10 – Shopping at Kmart feels like you’re taking good care of yourself.

#9 – Patients frequently startle you by waking you up during home visits.#8 – Find yourself saying, “You think you’ve got problems, lady?”#7 – You become aware of a reluctance to go to work and don’t go to work.#6 – You accidentally drop your beeper from a high bridge.Slide13

What is Burnout, cont’d.#5 – You jump after the beeper.#4 – Giggling during team meetings.

#3 – Not giggling during team meetings.#2 – Eating an entire bag of Dorito chips while making bereavement phone calls.#1 – Who cares about this list anyway?Larson, National Hospice and Palliative Care OrganizationSlide14
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What is Compassion Fatigue?Similar to PTSD - Easily frustrated, irritable, annoyedSymptoms of depression-difficulty maintaining hope

Feeling over alert, restlessFeeling ineffective, negative, inadequate“CF is the natural, predictable, treatable, and preventable unwanted consequence of working with suffering people” (Figley, 2000, p. 124 of Treating Compassion Fatigue) Slide16

Compassion Fatigue and Compassion SatisfactionCompassion Fatigue

Also called Secondary Traumatic StressA set of behaviors and emotions that can occur when the SW is seeking to help a suffering person.“a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering?Figley, 1995

Teater, 2012LarsonCompassion Satisfaction

Defined as the pleasure derived from helping others.Sounds like:I have happy thoughts about those I helpI like my workI enjoy and trust my co-workersI am effectiveCraig and Sprang, 2010Slide17

Compassion Fatigue Scale

Although the world is full of suffering, it is full also of the overcoming of it

.- Helen KellerSlide18

Compassion Fatigue and Compassion SatisfactionCompassion Fatigue

Also called Secondary Traumatic StressA set of behaviors and emotions that can occur when the SW is seeking to help a suffering person.“a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering?Figley, 1995

Teater, 2012Larson

Compassion SatisfactionDefined as the pleasure derived from helping others.Sounds like:I have happy thoughts about those I helpI like my workI enjoy and trust my co-workers#NASWILSlide19

CF and CS Can Co-Occur

50% of child protection staff suffered from high or very high levels of compassion fatigue70% of staff expressed a high or good potential for compassion satisfactionConrad and Kellar-Guenther (2006)Slide20

What Creates Compassion Satisfaction?Slide21

Secondary Trauma and Vicarious Traumatization – Post Traumatic StressSocial

workers are affected by exposure to their clients' traumatic life experiences and behaviors. Research has demonstrated that secondary traumatic stress (STS) - also referred to as vicarious trauma, compassion stress, or compassion fatigue - is prevalent among mental health professionals who work with traumatized clients (Fahy, 2007; Figley, 2002b;Jacobson, 2006;Jenkins & Baird, 2002; McCann & Pearlman,

1990)Slide22

Symptoms of Secondary Traumatic Stress

Increased sensitivity to violence

Not laughing as easily

Trouble sleeping

Difficulty thinking, concentrating or making decisions

Intrusive thoughts and traumatic images

Feeling emotionally numb

Physical complaints

Use of alcohol, drugs

Detachment

Lack of Empathy

Ting, L., Jacobson, J. M., & Sanders, S. (2011). Current levels of perceived stress among mental health social workers who work with suicidal clients. Social Work, 56(4), 327-36.Slide23

(VT) common when population exhibits: Suicidal Behavior – Fatal and Non Fatal - Reported

feelings of guilt, failure, professional self-doubt regarding their clinical competency, and anger directed toward the client (Chemtob et al., 1988, 1989; Ellis & Dickey, 1998; Grad, Zavasnik, & Groleger, 1997; Kleespies, Penk

, & Forsyth, 1993; Ruskin, Sakinosfsky, Bagby, Dickens, & Sousa, 2004;Yousaf, Hawthorne, & Sedgwick, 2002)

Vicarious Traumatization#NASWILSlide24

Secondary Trauma for Social WorkerHighest for those who work with:Sexual Offenders

Trauma VictimsNatural Disaster VictimsVictims of Terrorist AttacksSuicidal ClientsRefugee PopulationsViolence against Families/ChildrenSlide25

Hunter, S. V., P.H.D. (2012).Family Process, 51(2), 179-92.

… findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization.Slide26

Secondary Trauma and Vicarious Traumatization – Post Traumatic StressSecondary Traumatic Stress – “the natural and consequent behaviors and emotions resulting from knowing about a tramatizing

event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person.” Figley (1993, 1995)Vicarious Traumatization – “the transformation in cognitive schemas and belief systems as a result of empathic engagement with survivors of traumatic experiences.” McCann and Pearlman, 1990Slide27

Research StudyPilot Study at Journey CareSlide28

Participant Demographic Data5 Advanced Practice Nurses/Nurse Practitioners in Palliative Program part of Palliative/Hospice Agency

Average Years as APN = 6 ½Palliative Care and Hospice Experience = 7 months to 10 yearsAges: 45 to 60 years of AgeQuestion: Do you currently practice Self Care?: 4 out of 5 = YesQuestion: How long have you engaged in Self Care as a Nursing Professional? Average 2.5 years

Coordinator DataPalliative Care LCSW with 2 years with experience on team – 20 years as social worker Slide29

5 Advanced Practice Nurses on a Multi-Disciplinary Team completed 7Assessment Surveys/ToolsUse this data to create meaningful self care interventionsUse this data to justify the Self Care ProgramThe participants will learn valuable info about themselves

Step OneAssess if your Staff or Team is in need ofSelf Care

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Burnout Self TestSlide31

Resilience AssessmentSlide32

Self Care and Lifestyle InventorySlide33

Self Care Risk FactorsSlide34

Self Care Assessment

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The APNs said….Self Care is attending to one’s own needs so that one can bring full energy & attention to the work tasks at hand during work appropriate times.Unique aspects in “surviving” this work is that we are building character and strength; and end of life care brings the reality of life & God into perspective.

I maintain compassion by feeling strongly that no one should die afraid, alone, or in pain. I know I make a difference to people & in their lives.I nurture myself by getting massages, exercising, having a Friday night date night with hubby and staying involved at church.What I know for sure about the importance of Self Care is that you have to be your own best advocate!Qualitative Data…

And theSlide40

Quantitative Assessment Results – How Did They Score?Slide41

Quantitative Assessment Results – How Did They Score?Slide42

Purpose: Help Staff De-Stress, Explore Negative Feelings re: Loss, Expectations, Alleviate Burnout, Stress Work/Life BalanceObjective: Create Emotionally Healthy and Centered Palliative StaffDetails

: Participate in Assessments then Meet every 4 to 6 weeks for 30 to 60 minutes during Work DayVaried Interventions Used (based on what was learned from the assessments)Pre-Test/Post-TestProgram Description:

PalliativeSelf CareSlide43

Pre and Post Test ScaleSlide44

Research Project – Palliative Care Staff In order to determine effectiveness of Interventions and Collect Data to bring to Agency Leadership a simple Pre-Post Test was administered before the Self Care intervention began and immediately after. We utilized a 1-10 Scale.

1. Perception of Stress from today’s work day (1) meaning No Stress (10) Very High Stress 2. Perception of Stress after today’s Self Care Program

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

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Self Care Interventions Used in PilotSpiritual – 1) Mindfulness Exercise: Leader demonstrated Breathing and Loving Kindness Meditation - Stahl & Goldstein

Spiritual – 2) Connect with Nature: Participants walked around a Natural Setting noting what they could: See, Hear, Smell, Touch, Experience. APN’s then shared their favorites.Relational – The Guilts: Group shared any unresolved guilt, professional regrets, etc. and placed same on paper to be ritually burned.Opportunity to Express Self - To Soothe and Release each APN shared the Ups and Downs of caring for patients and “doing the job” – then took turns reading uplifting quotes and affirmations on small pieces of paper in a basket.

Physical – Group participated in stretching, breathing, listened to leader explain various health benefits of various ingredients - then participated in making fruit/greens smoothies – then tasting smoothies.Individual vs. Group ActivitiesSlide46

Efficacy of Self Care InterventionsMost Effective APN Self Report

Stretch and SmoothieConnect with NatureDiscuss “The Guilts”

Least Effective APN Self Report

Meditation: Loving KindnessSharing stories/ideas/frustrations and group AffirmationsNote: Average Stress Level Decreased by at least 2 points on self report scale for each of the InterventionsSlide47

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

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What Is Self Care?

Definitions vary (affected by different factors)Common theme is that consumers take a more active role in their own care instead of relying on others to provide careCan be easier to say what it is NOT:

NOT: just for burned out workers, the weak, the maladjusted. NOT something we don’t have time to doDOES NOT mean we focus on ourselves and ignore others

NOT about numbing ourselvesDOES NOT indicate narcissismIS NOT a luxury and does NOT mean we are self-indulgent.Cox and Steiner, Self-Care in Social Work (2013)Slide49

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

Attendee Examples???Boundaries Exhaustion Calling in sick Loss of Hope Depression Stress Eating Thoughts of leaving profession Unprofessional Behavior Sleep Issues Can’t Separate Work from HomeSlide50

Boundaries and ProfessionalismWhen you are stressed/burned out you may find yourself:

Sharing too much personal data with clientsSharing information about other staff membersComplaining about your agency or workloadDeveloping dual relationshipsUpstaging their problems/issues with your ownDownplaying other team members or disciplinesWanting to develop a personal relationship with a clientSlide51

PhysicalPsychologicalEmotionalSpiritualProfessional

BalanceWhat is good self care?Basic FrameworkSlide52

Wellness WheelSlide53

In Balance Wellness WheelSlide54

Start with You

Self Assessment of Your Self-Care Patterns – PROQOLDevelop Your Own Plan – Research what activities work!Implement the PlanTest – Tweak for EffectivenessSlide55

Self Care ToolsSlide56

Resources/Tools for Self-CareJohn Kabat-Zinn and Mindfulness

You Tube Video http://www.youtube.com/watch?v=EU7vKitN4RoSlide57

Can be practiced in 2 ways: Formally and InformallyFormal

means taking time each day to intentionally:SitStandLie DownAnd Focus on BreathBodily Sensations

SoundsOther senses - thoughts - and emotions Stahl & Goldstein 2010

What is Mindfulness Meditation?Slide58

Informal Mindfulness is…

Bring mindful awareness to everyday activities such as:EatingExercisingChoresWorkRelating to OthersBasically any action

Mindfulness Meditation cont’dSlide59

Mindfulness and Physical PainThe practice of mindfulness is particularly effective because it “decouples” the physical sensations of pain from mental and emotional processes that heighten suffering. Pain comes to be seen as “just another sensation” and the fear of pain is significantly reduced. The development of mindfulness, as Buddhists have known for 2,500 years, brings about mental

and emotional freedom and a decrease in suffering.But if we are mindful of the pain – won’t focusing on it Just increase it?http://www.wildmind.org/blogs/on-practice/being-mindful-of-painSlide60

Meditation with MusicGet comfortable and close your eyes…..

From Caregiver Stress by Belleruth Naparstek 2008

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And we have to mention…The Breath

Deep

Diaphragmic

Breathing Techniques will enable:Nervous System BalanceOxygenationPrevents Muscle HypertonicitySlide62

Setting Realistic ExpectationsThe Guilts

Remind yourself that what you do makes a difference.Set Realistic goals – “If Only I were….”Accept your shortcomings and take action in areas you can improve.

Do not take yourself so seriouslyArrange for regular vacation time

Attend career nurturing eventsShare your thoughts with a trusted friendIf overwhelmed for long period of time – see a counselor or EAPLarson, National Hospice and Palliative Care OrganizationSlide63

Top Self-Care Tips for HelpersTake Stock of Where Things Are – What’s on Your Plate?

Start a Self Care Idea CollectionFind Time for Yourself Every DayDelegate and Learn to Ask for HelpHave a Transition from Work to HomeLearn to Say Yes or No More OftenAssess Your Trauma Inputs – Work/Non-work RelatedLearn more about Compassion Fatigue and TraumaSupervision/Peer SupportWorkshops and TrainingConsider Working Part Time

ExerciseMathieu, F. (2007) www.compassionfatigue.orgSlide64

What Else Can You Use?Physical Self Care – eat well, exercise, get enough sleep, get medical care

Psychological Self Care – reflect, journal, engage in leisure activities, let others help youEmotional Self Care – have pleasant thoughts about your self, engage in laughter/play, express emotions in appropriate channelsSpiritual Self Care – pray, meditateCreate team rituals – Healing Circles, Drumming, Light a Candle, Burn RegretsProfessional Self Care – take a break, take a vacation, balance case load

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

Cox and Steiner, 2013Slide65

Takin’ it to the streets

Self Care on Agency Level#NASWILSlide66

Expand Self Care Beyond You

Explain why it is important to organizations:Poor quality of life, burnout/dropoutMore satisfied employees have lower absenteeism rates, high productivity and better service to clients.Research shows enormous costs (financial and human being costs) with unhealthy organizations.The Corporate Executive Board places the cost of employee turnover as high as “200 times annual salary for certain positions.” But even if your lowest-level workers cost just $4,000 to replace and absorb their lost productivity, aggregating this cost for a full year likely produces a total cost number in the hundreds of thousands or millions, a number that would stagger most executives

. www.retentioninstitute.com

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Facts your agency’s leadership need to know….. How does burnout affect your heath?“most

disenchanted employees developed heart problems at a 79% higher rate than their less-stressed peers.”Earlier research had shown that job burnout can lead to a range of health problems, including obesity, insomnia, and anxiety.Colleague and supervisor support contributed significantly to explaining the variance in burnout intensity.

Hamama, L. (2012) Journal of Counseling and Development : JCD, 89(2), 163-171. Anne Fisher,

contributor April 2, 2013 Fortune 500 MagazineSlide68

So why are we so stressed?

1. United States of America – 13 days 2. Belgium – 20 days 3. Japan – 25 days 4. Korea – 25 days 5. Canada – 26 days 6. United Kingdom – 28 days 7. Australia – 28 days

8. Brazil – 34 days 9. Austria – 35 days (42 for elderly) 10. Germany – 35 days 11. France – 37 days 12. Italy – 42 days Slide69

Within a Larger OrganizationCreate a ProposalUse Facts from this PresentationDo a Needs AssessmentCollaborate with others who are like-minded

Get a decision-maker/leader to buy inDo a small sample/test projectCan do quantitative analysis to show effects of self-care program participation (ex: monitor employee sick days in relation to number of self-care programs attended)Slide70

What Can Organizations/Employers Do?Encourage/pay for SupervisionCreate Task Force to Develop Self Care Program

Encourage – allow time for staff to meet with MentorsCreate Wellness Programs – Including EAPCreate a climate where sharing frustrations is “Normal” and help staff develop ways to Let the Frustrations Go!Offer skill building opportunitiesEmployee Recognition ProgramsFlex Time – Generous Vacations – Realistic Productivity ExpectationsImprove Orientation and Performance ReviewsSchwartz RoundsSlide71

Schwartz Rounds…offers

healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss social and emotional issues that arise in caring for patients. In contrast to traditional medical rounds, the focus is on the human dimension of medicine. Professional caregivers have an opportunity to share their experiences, thoughts and feelings on thought-provoking topics drawn from actual patient cases. The premise is that care providers are better able to make personal connections with patients and colleagues when they have greater insight into their own responses and feelings.

Schwartzcenter.org

Schwartzcenter.orgSlide72

Research your partners in communityForge relationship and create small SELF CARE consortium

Share resources across agenciesJoin professional associationsSocial Work Supports in Social Media such as Linked In, Facebook , NASWForm Healing Circles

If you are a small group or private practice?Slide73

Develop Vicarious ResilienceTherapists working with traumatized clients described inspiration and strength they drew from working with clients whom they sometimes described as ‘‘heroes.’’

Quotes from therapists working with victims of violence:I learned about how human beings have so many resources to face tragedy, the importance of spirituality, tolerance and the ability to survive.This work generates a positive change as you generally may become more resourceful, less fearful, more dynamic, more resolute, more active and eager to question yourself permanently.

Vicarious Resilience: A New Concept in Work With Those Who Survive TraumaPILARHERNAŁ NDEZ,PH.D., DAVIDGANGSEI, PH.D. & DAVID

ENGSTROM, PH.D. Family Process, Vol. 46 June 2007, pages: 229-241#NASWILSlide74

How to be more resilientTake this cup,

I’ve filled it up,With love and joy and laughter.Now it’s empty,Fill it up. Repeat,Forever after.First, so fullI’m givingAll my love and joy in living

Then near empty,Tired of living,And I’m theOne who needs the giving.This cup, this cup,

This cup of life,It’s always overflowing;We give and getAnd get and give,Life’s balanceKeeps on going.Take this cup,I’ve filled it up,With love and joy and laughter.Now it’s empty,Fill it up.Repeat, By: Laura ByrnesForever, after. Slide75

Thank You for AttendingQuestionsMay I be filled with loving kindnessMay I be wellMay I be Peaceful and at ease

May I be happyStahl and Goldstein, 2010Closing