beyond the response: addressing compassion fatigue and ......beyond the response: addressing...
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Beyond the Response: Addressing Compassion Fatigue and Behavioral Health Needs for Healthcare Providers
Shayne Brannman, MS, ASPR TRACIE Program Director
April Naturale, PhD, ICF Disaster Recovery and Community Resilience Sr. Mgr.
Association of Healthcare Emergency Preparedness Professionals November 5, 2019 Orlando, FL
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Strong Leadership
Cross·Cutting Functions:
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ASPR’s Priorities: Building Readiness for 21st Century Threats
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Why ASPR TRACIE? ASPR TRACIE was developed as a healthcare emergency preparedness information gateway to address the need for: • Enhanced and rapid technical assistance • A comprehensive, one-stop, national knowledge center for healthcare system preparedness
• Multiple ways to efficiently share and receive information between various entities, including peer-to-peer
• A way to leverage and better integrate support (force multiplier) • Helping prepare deployed and field staff via our Technical Resources and Subject Matter Experts
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asprtracie.hhs.gov
1-844-5-TRACIE
ASPR TRACIE: Three Domains
TECHNICAL RESO URCES
• Self-service collection of audience-tailored materials • Subject-specific, SME-reviewed “Topic Collections” • Unpublished and SME peer-reviewed materials highlightingreal-life tools and experiences
• Personalized support and responses to requests forinformation and technical assistance • Accessible by toll-free number (1844-5-TRACIE), email ([email protected]), or web form (ASPRtracie.hhs.gov)
• Area for password-protected discussion among vetted usersin near real-time • Ability to support chats and the peer-to-peer exchange ofuser-developed templates, plans, and other materials
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l h() EXCHANGE ?OH Y'OLUMI: 2 IS'll '
Disaster Behavioral Health: What Do the Feds Do?
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Behavioral Health Resource Examples • Disaster Behavioral Health: Resources at Your
Fingertips • Disaster Behavioral Health Self Care for
Healthcare Workers Modules • Mental/Behavioral Health (non-responders) TC • Opioids: Frequently Asked Questions • The Exchange Issue 4: Disaster Behavioral
Health and Resilience • Tips for Retaining and Caring for Staff after a
Disaster
https://asprtracie.hhs.gov/dbh-resources
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https://asprtracie.hhs.gov/dbh-resources
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Goals Describe how to identify healthcare provider compassion fatigue and secondary traumatic stress
Identify methods for healthcare executives to conduct stress management assessment, implement mitigation efforts, and improve work satisfaction for providers
Describe ways to develop and implement a Cognitive Strengthening Preparedness Program
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CF
• Exhaustion • Overworking • Depression • Helplessness • Obsession with helping
STS
• Symptomsparallelclient’s • Intrusive images • Fear • Avoidance • Helplessness • PTSD
VT
• Negative cognitive schemas • Question beliefs • No sense of safety • Change in world view
Burnout
• Indifference • Frustration with admin, supervisor,peers and policy • Leave profession
Shared Symptoms: Increased substance use/misuse; relationship problems; increased rates of physical illness
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Healthcare Professionals and Exposure to Traumatic Stress
Multiple patients …serious injuries …simultaneous lifesaving efforts …over long periods of time
Unique T raits of Healthcare Workers Highly self reliant Desire to care for others Give vs receive/ need support “Work till it hurts” “Weak” if display emotional distress Skip breaks/meals Staffing patterns require coverage Sacrifice self care for the care of others
Stigma surrounds behavioral health concerns.
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Risk Factors
Professional: Personal: Physical:
See a high number of History of trauma High fat / salt diet trauma cases Isolated/ without Race/genetics
Lack of confidence/ good social support Single professional specific training Lack of good coping caregivers
skills; use of negative coping
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Emotional Personal Workplace
Rapid Heartbeat/ Anxiety Isolation Avo idance Panic Fear Cyn icism Tardiness Headaches Anger Mood Swings Absenteeism GI Distress Sadness/ Confl icts Lack of
Fatigue/ Exhaustion Crying Alcohol and Motivation Sleep Issues Helplessness Substance Misuse Lower Staff Lower Immune Depression Mora le Function Hopelessness
Spiritual Questioning Work/Life, Anger at Higher Power, Hopelessness
Secondary Traumatic Stress Indicators
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The Professional and Interpersonal Effects of STS Professional
Loss of productivity Exhaustion Poor communication Impatience/ increased conflicts among staff Inability to stop working Increased obsession with helping Decreased confidence/ second guessing Detachment/numbing
Interpersonal
Isolation/withdrawal Loneliness Mistrust Anger often directed at loved ones Decreased interest in intimacy/sex Negative impact on parenting
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Common Effects Experienced by Healthcare Providers
• Self medicating • Overeating/drinking • Extramarital affairs • Suicidal gestures
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The Good (Protective) News: Work Satisfaction
Compassionsatisfaction/traumatic growth
Stress management Self confidence/competence Spiritual connection Respect for human openness and resilience
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What Do You Bring from Your Life?
Personal commitments Professional commitments Physical and mental condition Vulnerabilities Self-awareness
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Sometimes hiding
from the wor1d
is good self-care.
What Is Self Care?
The ability to maintain physical, emotional, relational, and spiritual health in times of stress
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http:rylrichardson.com
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Exercise: Path to Self Care
Work Stress Warning Signs
NegativeStrategies
Positive Strategies
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The Core Four
Regulated Sleep Physical Movement Active Mental Relaxation Social Support and Close Relationships
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Ask Yourself…
One thing to reduce stress and burnout? Do I need help to carry it out? Do I need reminders? When in my day can I do this? What resources do I need? How can I use my self care plan to remain resilient during disaster work?
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Leisure Activities Action Plan
• • •
•
Paper and pen/electronic device Three leisure activities Date and time you can perform each Add to your calendar once a week for a month
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Skills: Building Resilience
Attitude Self-Awareness Internal Control
Optimism Social Support Humor
Exercise Spirituality Perseverance/Patience
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Skills: Professional/Peer Support Provide emotional/practical help Speak as equals, reciprocity Maintain contact after each shift or difficult patient encounters
Strategize, share concerns Vary caseload Practice self care Practice within scope of abilities
Work within the rules Identify CF and STS symptoms Seek support Practice controlled empathy Set helpful boundaries
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Wellness
What is Organizational Wellness?
• A culture of care • Established by executive management
• Strengthened by guidance/ policy
Supports employee work satisfaction,stress mitigation, and management,starting with the workplace environment.
Source: http://www.globalwomenconnected.com/2017/11/seven-dimensions-wellness/
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http://www.globalwomenconnected.com/2017/11/seven-dimensions-wellness/
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Organizational Response to Traumatic Stress Events
• • • • •
• • •
PFA Drills Referrals Team training Information / psychoeducation meetings Groups for highly exposed Individual crisis intervention Focus on resilience and coping
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Experience and Training
• • Professional skills development Sense of confidence and competence
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Stop • Look -. Reframe
Cognitive Strengthening Program
• • • • •
Cognitive restructuring / reframing Attention diversion Mindfulness training Adaptive engaging Adaptive affective expression
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Attention Diversion
• Purposeful emotion regulation • Decreases intense feelings • Temporary
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About Mindfulness • Cognitive strengthener • Any level is positive • Focus on present moment • Acknowledge things as they are
Mindfulness Exercise
• Sit in quiet place • Feet on ground • Hands on lap • Close your eyes • Focus on breathing • Thoughts come and go • Inhale positivity • Exhale stress
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Adaptive Engaging • •
• • •
With others who understand and accept you In helpful activities o o Increase coping skills Build resilience
Maintain integrity, dignity, and civility Avoid toxicity Avoid negative coping behaviors
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Adaptive Affective Expression
Identify distressing emotions Express emotions in healthy ways Identify your prodromal activities Identify and plan for triggers
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Additional Resources
• ASPR TRACIE: www.asprtracie.hhs.gov • Division for At-Risk Individuals, Behavioral Health & Community Resilience (ABC):www.phe.gov/Preparedness/planning/abc
• SAMHSA Disaster Technical Assistance Center (SAMHSADTAC): www.samhsa.gov/dtac
• National Center for Posttraumatic Stress Disorder: www.ptsd.va.gov
• Professional Quality of Life (PROQOL): http://www.proqol.org
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http://www.asprtracie.hhs.gov/http://www.phe.gov/Preparedness/planning/abchttp://www.samhsa.gov/dtachttp://www.ptsd.va.gov/http://www.proqol.org/
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Audience Discussion and Q&A
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Contact Us
asprtracie.hhs.gov 1-844-5-TRACIE [email protected]
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mailto:[email protected]:asprtracie.hhs.gov
Beyond the Response: Addressing Compassion Fatigue and Behavioral Health Needs for Healthcare ProvidersASPR’s Priorities: Building Readiness for 21st Century ThreatsWhy ASPR TRACIE?ASPR TRACIE: Three DomainsBehavioral Health Resource ExamplesGoals Signs of Various DisordersHealthcare Professionals and Exposure to Traumatic Stress Risk Factors Secondary Traumatic Stress IndicatorsThe Professional and Interpersonal Effects of STSCommon Effects Experienced by Healthcare ProvidersThe Good (Protective) News: Work SatisfactionWhat Do You Bring from Your Life?What Is Self Care?Exercise: Path to Self CareThe Core FourAsk Yourself…Leisure Activities Action PlanSkills: Building ResilienceSkills: Professional/Peer SupportWhat is Organizational Wellness?Organizational Response to �Traumatic Stress EventsOrganizational Readiness ToolsExperience and Training�Cognitive Strengthening ProgramAttention DiversionAbout MindfulnessAdaptive EngagingAdaptive Affective Expression Additional ResourcesAudience Discussion and Q&AContact Us