So Your Staff Needs a Self-Care Program?

1. So Your Staff Needs a Self-Care Program? Presenters: Lynn Skubiszewski, LCSW and Nicole Perry, LCSW #NASWIL

2. Welcome to Our Presentation http://www.youtube.com/watch?v=XSu_sVgGWMk

3. Presenter Biographies • Lynn Skubiszewski, LCSWPalliative 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. #NASWIL

4. Why is Self Care Important? • Poor Quality of Life • Poor 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 empathic

5. “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.” ~ Remen

6. Outline • Define burnout, compassion fatigue, compassion satisfaction, secondary trauma, vicarious traumatization/post traumatic stress. • Research Project • What 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/Tools

7. 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, 2005 Cox and Stiner, 2013

8. Silver Lining? Burnout is the opportunity to re-discover what makes you happy.

9. 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. 10 Phases of Burnout "Preventing Burnout" by psychologists Herbert Freudenberger and Gail North : Long-Term Living 59.5 (May 2010): 50-52.

10. Listen to others who know and care about you Use assessment tools to help you see the truth Self awareness – know when you are crossing a line How do you know it is burnout? Is it really the client or is it more than that? Is it your organization? Is it unrealistic productivity expectations?

11. 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?

12. 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.

13. 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 Organization

15. What is Compassion Fatigue? • Similar to PTSD - Easily frustrated, irritable, annoyed • Symptoms of depression-difficulty maintaining hope • Feeling over alert, restless • Feeling 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)

16. Compassion Fatigue and Compassion Satisfaction Compassion Fatigue Compassion Satisfaction Defined as the pleasure derived from helping others. Sounds like: I have happy thoughts about those I help I like my work I enjoy and trust my co-workers I am effective Craig and Sprang, 2010 • Also called Secondary Traumatic Stress • A 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, 2012 Larson

17. Compassion Fatigue Scale Although the world is full of suffering, it is full also of the overcoming of it.- Helen Keller

18. Compassion Fatigue and Compassion Satisfaction Compassion Fatigue Compassion Satisfaction Defined as the pleasure derived from helping others. Sounds like: I have happy thoughts about those I help I like my work I enjoy and trust my co-workers • Also called Secondary Traumatic Stress • A 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, 2012 Larson #NASWIL

19. 50% of child protection staff suffered from high or very high levels of compassion fatigue 70% of staff expressed a high or good potential for compassion satisfaction Conrad and Kellar-Guenther (2006) CF and CS Can Co-Occur

20. What Creates Compassion Satisfaction?

21. Secondary Trauma and Vicarious Traumatization – Post Traumatic Stress • Social 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)

22. Symptoms of Secondary Traumatic StressIncreased sensitivity to violenceNot laughing as easilyTrouble sleepingDifficulty thinking, concentrating or making decisionsIntrusive thoughts and traumatic imagesFeeling emotionally numbPhysical complaintsUse of alcohol, drugsDetachmentLack of EmpathyTing, 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.

23. (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 #NASWIL

24. Secondary Trauma for Social Worker Highest for those who work with: • Sexual Offenders • Trauma Victims • Natural Disaster Victims • Victims of Terrorist Attacks • Suicidal Clients • Refugee Populations • Violence against Families/Children

25. 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.

26. Secondary Trauma and Vicarious Traumatization – Post Traumatic Stress • Secondary 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, 1990

27. Research Study Pilot Study at Journey Care

28. Participant Demographic Data • 5 Advanced Practice Nurses/Nurse Practitioners in Palliative Program part of Palliative/Hospice Agency Average Years as APN = 6 ½ • Palliative Care and Hospice Experience = 7 months to 10 years • Ages: 45 to 60 years of Age • Question: Do you currently practice Self Care?: 4 out of 5 = Yes • Question: How long have you engaged in Self Care as a Nursing Professional? Average 2.5 years • CoordinatorData • Palliative Care LCSW with 2 years with experience on team – 20 years as social worker

29. 5 Advanced Practice Nurses on a Multi-Disciplinary Team completed 7Assessment Surveys/Tools • Use this data to create meaningful self care interventions • Use this data to justify the Self Care Program • The participants will learn valuable info about themselves Step One Assess if your Staff or Team is in need of Self Care #NASWIL

30. Burnout Self Test

31. Resilience Assessment

32. Self Care and Lifestyle Inventory

33. Self Care Risk Factors

34. Self Care Assessment #NASWIL

39. 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 the

40. Quantitative Assessment Results – How Did They Score?

41. Quantitative Assessment Results – How Did They Score?

42. Purpose: Help Staff De-Stress, Explore Negative Feelings re: Loss, Expectations, Alleviate Burnout, Stress Work/Life Balance • Objective: Create Emotionally Healthy and Centered Palliative Staff • Details: Participate in Assessments then Meet every 4 to 6 weeks for 30 to 60 minutes during Work Day • Varied Interventions Used (based on what was learned from the assessments) • Pre-Test/Post-Test Program Description: Palliative Self Care

43. Pre and Post Test Scale

44. 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? #NASWIL

45. Self Care Interventions Used in Pilot • Spiritual – 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 Activities

46. Efficacy of Self Care Interventions Most Effective APN Self Report Least Effective APN Self Report Meditation: Loving Kindness Sharing stories/ideas/frustrations and group Affirmations • Stretch and Smoothie • Connect with Nature • Discuss “The Guilts” Note: Average Stress Level Decreased by at least 2 points on self report scale for each of the Interventions

47. Starting Your Own Self-Care Program It’s not that hard….. #NASWIL

48. 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 care • Can 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 do • DOES NOT mean we focus on ourselves and ignore others • NOT about numbing ourselves • DOES NOT indicate narcissism • IS NOT a luxury and does NOT mean we are self-indulgent. Cox and Steiner, Self-Care in Social Work (2013)

49. 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 Home

50. Boundaries and Professionalism When you are stressed/burned out you may find yourself: • Sharing too much personal data with clients • Sharing information about other staff members • Complaining about your agency or workload • Developing dual relationships • Upstaging their problems/issues with your own • Downplaying other team members or disciplines • Wanting to develop a personal relationship with a client