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RESILIENCY FOR THE
CAREGIVER -RECOGNITION OF BURN OUT AND KEYS TO
SUSTAINING THE WORK
Lacey Sheppard, LCSW
Objectives 1. Brief review on statistics for general caregiving roles.
2. Discuss in detail the pitfalls that caregivers face and go over the set up for burn out.
3. Define burn out, compassion fatigue, secondary traumatic stress, vicarious trauma and parallel process.
4. Describe caregiver protective factors and how this fosters resilience.
5. Review best practices from a macro population health perspective clear into individual practices, with an emphasis on the specifics of a tailored self care plan.
ABOUT MEMy preferred name is Lacey. I identify as a female with preferred pronouns she, her, and hers.
I was raised in Washington State. I love being outside. I have many hobbies. I am a partner and a mother. I am spiritual.
I have an ACE score. I have personally experienced burn out and vicarious trauma as a professional caregiver. I have done some healing work.
I am a Licensed Clinical Social Worker. I have training and a very special interest in Trauma-Informed Care Practices within HealthCare. I am a leader in the field. I am supervisor and supervisee.
I have worked in several different healthcare organizations. I currently work as a Behavioral Health Provider at Summit Medical Group - Bend Memorial Clinic.
COMMON LANGUAGE
Caregiver – a person who provides direct care.
HealthCare – All organizations, individuals, and practitioners that are providing a health service.
Patient – an individual receiving a health service (also referred to as a client).
Trauma – “is a wound. Typically trauma refers to either a physical injury, such as a broken bone, or an emotional state of profound and prolonged distress in response to an overwhelmingly terrifying or unstable experience” (TIO, 2019).
THE SET UP
A recent survey in February 2019, indicated that 44% of physicians' self reported burn out, with one of the leading causes answered, “too many bureaucratic causes” (Berg, 2019).
The major set up for professional caregiver
burn out is organizational
unrealistic demands.
At an institutional level, burnout results in greater job turnover and increased thoughts of quitting among physicians and nurses. (Reith, 2018) .
In health care, EMR documentation expectations far exceed the time given in a full patient day. Many providers often find that the charting demands take over time at home, and it is common to hear of providers charting at home in the evening, after working a 10 hour day.
Disconnection from organizational leaders with the caregivers providing services on the ground.
The Set Up
There is importance of acknowledging the personal caregiver’s
needs as equally important as the
individual they are caring for.
Many family caregivers often put loved one’s needs first and above their own. Over time this can lead to resentment, fatigue, and caregiver stress. Untended to, this can lead to burn out and compassion fatigue.
“In a 2015 report by the National Alliance for Caregiving and AARP found that 43.5 million Americans were providing unpaid care for an adult or child” (Psychology Today, 2015). This sometimes creates financial stress and hardship.
Cultural beliefs for caregiving vary across nations, with some common values of honoring certain age groups of older adults and children. Personal caregivers in some cultures take on caring for many family members in need, at the same time. This can create stress with caring for multiple people.
BURN OUT “A gradual wearing down over time” (TIO, 2019).
This can happen to anyone. Burn out often happens to caregivers in the helping field more so than other professional roles. This is due to the nature of the helping.
This can be experienced as poor job satisfaction, feeling powerless and easily overwhelmed by the work.
The social psychologist, Maslach, developed a model of burnout consisting of three dimensions: emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment (Reith, 2018).
Burn OutRisk Factors for Caregiver Burn Out (TIO, 2019):
• Personal Trauma History • The type of content the caregiver is exposed to while helping• New caregivers to the work, without being prepared for the type of
content when working with individuals going through trauma, or previous trauma experience.
• Empathy over extension• Isolation
At an institutional level, burnout results in greater job turnover and increased thoughts of quitting among physicians and nurses (Reith, 2018).
“Caregivers are at even higher risk if they have a history of trauma in their own backgrounds” -
- Sandra Bloom, 03.
COMPASSION STRESSPreviously referred to as Compassion Fatigue, this is referring to the felt stress with caring and helping those that are experiencing trauma or have experienced trauma.
TIO describes this as “ a natural outcome of knowing about trauma experienced by a client, friend, or family member…”.
It can be a felt experience of profound physical and emotional exhaustion. Often easily overwhelmed, disconnected, and lost sight of values or meaning in the work. At times one can feel hopeless and question their role.
Vicarious Trauma and Secondary Traumatic Stress
Vicarious Traumatization is the transformative effect on the caregiver serving survivors of trauma and this can directly cause maladaptive thinking, disengagement, and change with felt empathy and worldview (Bloom, 2003; TIO,2019).
Secondary Traumatic Stress (STS) is a concept that was developed by trauma specialists in the 90s as service providers seemed to be exhibiting symptoms similar to Post Traumatic Stress Disorder without having necessarily been exposed to direct trauma themselves. Clinically significant symptoms may result and become imperative.
Burn Out Measure Screens
If you want to take a further step to see if you are burned out with a formal screen, here are some recommendations:
1. Professional Quality of Life Scale (ProQOL)
2. Secondary Traumatic Stress Scale
Copyrighting is something to look into.
PARALLEL PROCESS Parallel process is the way in which the caregiver, the organization in which they work/live, and the recipient of the care, mirror behaviors. There is a direct correlation and impact on one another noted in the cognition and behavior. The very behaviors the caregiver may be trying to help of the patient, is being exhibited by the caregiver and within the organization (Bloom, 2010).
With burn out, from an organizational level, this can be felt throughout leadership and executives as they start to resemble the overwhelm, disconnection, and resentment alongside the providers and patients.
Bloom, 2010
PROTECTIVE FACTORS & RESILIENCY“Sometimes, all a caregiver can do for a patient is his or her best. Accept that reality. Just provide kindness and smile. Feeling of love.“
-Daila Lama. Trauma Informed Oregon Defines PF:1. Team Spirit2. Seeing change as a result of
your work3. Training4. Supervision5. Balanced caseload6. Stress Reduction Training
Like-Minded Values of Resilient Caregivers: 1. Empathy 2. Compassion 3. Love4. Respect5. Dignity 6. Connectedness to value and meaning
in the work
BEST PRACTICES TO SUSTAIN CAREGIVING “Deeply resilient people let themselves be transformed by their experiences.”
- Al Siebert, PhD. Mayo Clinic Burn Out Prevention Recs:1. Involve Leadership2. Choose Incentives Wisely3. Encourage a Work-Life Balance4. Encourage Peer Support5. Furnish Resources for Self-care and Mental Health6. Target Burnout from Day One of Medical School(Reith, 2018 adapted from Mayo Clinic)
BEST PRACTICES TO SUSTAIN CAREGIVING
Individual Practices:
1. Developing and implementing a self care plan that is tailored to you
2. Develop containment exercises for hard stuff.
3. Draw boundaries with professional work and personal life
4. Personal caregivers to communicate needs of others for help and plans for respite.
5. Find a way to stay connected to the meaning of the work, let that be the compass that guides the helping behaviors.
SELF CARE
When developing a plan –include aspects for body, mind, and environment.
Self care is a daily, weekly, monthly practice that is something to recognize as constantly needing evaluation and adjustment based on reality of implementation.
CONTACT
Lacey Sheppard, LCSW Behavioral Health Consultant Summit Medical Group - Bend Memorial ClinicBend, Oregon [email protected]
RESOURCESBerg, Sara. “Physician Burnout: Which Medical Specialties Feel the Most Stress.” American Medical Association, January 24, 2019. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-which-medical-specialties-feel-most-stress.
Excerpt from Bloom, S.L., Caring for the Caregiver: Avoiding and Treating Vicarious Trauma, in Sexual Assault, Victimization Across the LIfeSpace, A. Giardino, et al., Editors. 2003, GW Medical Publishing: Maryland Heights, MO. p. 459-470. .
Collective Authors. “A Trauma Informed Workforce: An Introduction to Workforce Wellness.” Oregon Health Authority, n.d. https://traumainformedoregon.org/wp-content/uploads/2016/01/A-Trauma-Informed-Workforce_An-introduction-to-workforce-wellness.pdf.
Siebert, Al, PhD. “The Resiliency Advantage.” Independent Publisher’s Best, 2006.
Lama, Dalai. Eight Lessons on “Compassion in Health Care,” March 4, 2016. https://sharing.mayoclinic.org/2016/03/04/eight-lessons-on-compassion-in-health-care-from-the-dalai-lama/.
Reith T P (December 04, 2018) Burnout in United States Healthcare Professionals: A Narrative Review. Cureus10(12): e3681. doi:10.7759/cureus.3681
Collective Authors. “What Is Trauma,” n.d. https://traumainformedoregon.org/resources/trauma/.
Resources Professional Quality of Life Scale. Copyright 2019. The Center for Victims of Torture. Hudnall Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version (ProQOL). /www.isu.edu/~bhstamm or www.proqol.org.
https://www.naadac.org/assets/2416/sharon_foley_ac15_militarycultureho2.pdf Secondary Traumatic Stress Scale. Bride, B.E., Robinson, M.R., Yegidis, B., & Figley, C.R. (2004). Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14, 27-35.
Collective Authors. “What Are Vicarious Trauma and Secondary Traumatic Stress.” TEND Academy, n.d. https://www.tendacademy.ca/wp-content/uploads/2018/05/what-is-vicarious-trauma-2018-05-20.pdf.
Bloom, Sandra. “Parallel Process.” Community Works, 2010. http://www.sanctuaryweb.com/Portals/0/2010%20PDFs%20NEW/2010%20Bloom%20Parallel%20Process.pdf.
