SCALE N = 27 1 2 3 4 5 STRONGLY DISAGREE NEUTRAL AGREE STRONGLY

DISAGREE AGREE

1.You know your strengths, how to use them to help, support colleagues, care for patients.

26 of 27 scored 4 or 5

2.You know your weaknesses, how to deal with them to protect yourself, family, colleagues, and patients.

23 of 27 scored 4 or 5

3.You can say “No!” without feeling guilty, making an excuse why not, or becoming defensive.

15 of 27 scored 4 or 5

2

SCALE N = 27 1 2 3 4 5 STRONGLY DISAGREE NEUTRAL AGREE STRONGLY

DISAGREE AGREE

4.You know how to do good “self-care” , take care of family, be effective co-worker/colleague, perform job at highest level, and be contributing citizen in world.

21 of 27 scored 4 or 5

5.If you experience stressful/disturbing incident at work, you know how to “Self-Debrief” to process event, learn and grow, so you will not experience long-term personal/professional harm.

15 of 27 scored 4 or 5

3

SCALE N = 27In the list below, please check box of any statement that describes how you have felt in the past several months, since the beginning of 2015.

Hypervigilance & exaggerated startle response – being on guard & jumpy.

4 of 27 checked this box

Irritability or angry outbursts. 15 of 27 checked this box

Nightmares & trouble falling or staying asleep. 9 of 27 checked this box

4

SCALE N = 27

In the list below, please check box of any statement that describes how you have felt in the past several months, since the beginning of 2015.

Emotional numbness, lack of interest in activities & difficulty feeling love & joy.

9 of 27 checked this box

Avoiding thoughts & situations that are reminders of a traumatic event. 9 of 27 checked this box

5

SCALE N = 27In the list below, please check box of any statement that describes how you have felt in the past several months, since the beginning of 2015.

5 Common Symptoms of Post-Traumatic Stress Disorder (PTSD)

Important notes: Of the 27 Pre-Evaluations completed May 14th:

6 checked 3 of the 5 Common Symptoms of PTSD

2 checked 4 of the 5 Common Symptoms of PTSD

1 checked all 5 Common Symptoms of PTSD

6

Started today’s Session with same Evaluation questions as 5/14.

DNE and I wanted to see how much progress you each feel you have made in past 8 weeks.

Question (honest answer, please): How many of you have used ANY of the handouts you received on May 14th to help you

address some issues that are most pressing/distressing right now.

If so, which handouts did you find most helpful?

7

Chronic bereavementMultiple losses, anticipatory, unresolved grief

Compassion fatigue“The development of negative professional attitudes and behaviors as a result

of job strain. Work Environments can cause job strain when the worker experiences frustration, powerlessness, and an inability to achieve work goals.”

(Puchalski & Ferrell, 2010)

Burnout“… is a response to the work environment and not to the consequences of caring for people who are suffering.” (Puchalski & Ferrell, 2010)

Particular stressorFeeling inadequate due to inability to alleviate others’ suffering

(Bright, 1996; Hooyman & Kramer, 2006; Vachon, 2000.)

Stress, cumulative loss, and emotional labor can negatively impact those who care for the chronically ill and dying and can diminish their ability to provide effective care;

Therefore, it is imperative to provide staff with self-care education and opportunities to reflect and process grief to ensure their well-being.

(Nevidjon, 2004; Vachon, 2010; Ferrell & Coyle, 2010)

(Pizanti, 2006)

Recognize stress as an occupational hazard of trauma work

Accept your reactions as normal responses to specialized work

Limit exposure to trauma material• Books-conferences-discussions-movies

(Pizanti, 2006)

Develop supportive environment for discussing own reactions to work

Build a network of professional connections

Consider personal counseling to work through issues

Make use of the COH EAP – Employee Assistance Program

(Pizanti, 2006)

Develop supportive environment for discussing own reactions to loss

Work within supportive organization

Set and maintain clear boundaries on therapeutic relationships

Processing a Death ~ Sample Priming Questions How did you find out the person died? Were you there or

did someone call you? If you were present, when he or she died, what was that

experience like? Can you identify ways in which this death brought up

some experiences of loss from your past? How has dealing with losses in the past prepared you to

deal with the losses you face now? In what ways do you feel ill-prepared?

What good memories do you have of the person who died? Think or write a bit about one of those good memories.

(Nichols, 2012)

(Pizanti, 2006)

Spiritual care of Nurses

Identify self-violence, suffering or injury

Empower nurses to care for themselves & others

Promote spiritual, psychological and physical abundance - not scarcity

Explore your own beliefs and values *

Think of a time when you faced a major life transition, change or loss. How did it affect you spiritually? How did your spirituality affect the experience? Did you discover spiritual strength during that time? How did you want to be supported spiritually?

*From “Offering Spiritual Support For Family or Friends” http://www.caringinfo.org/UserFiles/File/faith_brochure.pdf

(Pizanti, 2006)

Take time to laugh, have fun, socialize with co-workers

But not about work

Seek spiritual renewal in your life

Worship – prayer – Scripture + + + (Sacred text)

Emphasize self-care and self-nurturing activities

(Pizanti, 2006)

Take sabbaticals from trauma work – if possible

Take mental health breaks purposefully

(Pizanti, 2006)

Develop hobbies, sports and creative interests

Develop restful, meditative activities

Yoga, music, reading, gardening…

Nurture supportive relationships and roles for yourself outside work

(Pizanti, 2006)

Use nature as a healing force in life

Guard against addictive behaviors

Be rested, fit and eat well

Set clear boundaries between home and work• Use clothing/rituals to mark change from work to

leisure

(Pizanti, 2006)

Nurture a sense of joy, grace, beauty, love and connection in life

Seek out experiences which instill comfort and hope

Connect with community and friends +++

Your presence and compassionate, listening ear are the two most important tools you bring to any intervention.

(Stanley, 2002)

Compassionate Presence = A Way of Being (Nichols, 2012)

21

Compassionate presence and follow-up Reflective listening/query about important life

events—spirituality as connection Support patient sources of spiritual strength and

note in chart Connect patient to community resources Referral to chaplain or other spiritual care

professional (Puchalski, 2014)

““My Best Day Ever!”My Best Day Ever!”

“I don’t know what your destiny will be, but

one thing I know. The ones among you who

will be really happy are those who have sought

and found how to serve.”

-- Albert Schweitzer

"The best way to find yourself

is to lose yourself

in the service of others."

-- Mahatma Gandhi

THANK YOUTHANK YOU

Chaplain Terry Irish

tirish@coh.org

626.256.4673 Ext. 85781

Pager 626.423.0023

Anandarajah, Gowri and Hight, Ellen. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. Am Fam Phy 63(1):81-88, 2001.

Bright, R. (1996) Grief and Powerlessness: Helping People Regain Control of Their Lives, (165-167). London: Kingsley.

Ferrell, B. R., & Coyle, N. (Eds.). (2010). Textbook of palliative nursing (3rd ed.). New York, NY: Oxford University Press.

Fitchett, G., & Canada, A. L. (2010). The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention. In J. C. Holland (Ed.). Psycho-oncology, 2nd Edition. New York: Oxford University Press.

Hooyman, N. R., & Kramer, B. J. (2006). Living Through Loss: Interventions Across the Life Span, (347-360). New York: Columbia University Press.

Nevidjon, M. (2006). Managing from the middle: Integrating midlife challenges of children, elder parents, and career. Clinical Journal of Oncology Nursing, 8(1), 72-75.

Nichols, S.W. Mitigating Care Fatigue in Palliative Care Providers: Developing Self-Awareness and Self-Care. Archstone Foundation Grant Teleconference, March 4, 2012.

Osterman, Paulette, and Schwartz-Barcott, Donna. Presence: Four Ways of Being There. Nurs For31(2):23-30, April-June, 1996.

Peery, B. (2009. What’s in a Name? PlainViews, 6(2).

Perez, Jacqueline C. Healing Presence. Care Manage J 5(1):41-46, Spring, 2004.

Puchalski, C., & Romer A.L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3 (1), 129-137. 

Puchalski, CM, Ferrell, B, Virani, R, Otis-Green, S, Baird, P, Bull, J, Chochinov, H, Handzo, G, Nelson-Becker, H, Prince-Paul, M, Pugliese, K, Salmasy, D. Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference. J Palliat Med 2009; 12:885-904.

Puchalski, CM, Ferrell, B. (2010). Making Healthcare Whole – Integrating Spirituality into Health Care. West Conshohocken, PA: Templeton Press.

Puchalski, CM, Handzo, G, Prince-Paul, M, Otis-Green, S. Improving the Spiritual Domain of Palliative Care. American Academy of Hospice and Palliative Medicine, Preconference workshop, San Diego, March, 2014.

Spiritual Care of the Nurse, CH (MAJ) Robin W. Pizanti, RN.

Stanley, Karen J. (2002). The Healing Power of Presence: Respite From the Fear of Abandonment. Onc Nurs For 29(6):935-940 .

Vachon, M. (2010). The experience of the nurse in end-of-life care in the 21st century. In B. R. Ferrell, & N. Coyle (Eds.), Textbook of palliative nursing (3rd ed., pp. 1011-1029). New York: Oxford University Press.

Vachon, M.L.S. (2000) Burnout and Symptoms of Stress in Staff Working in Palliative Care. In H.M. Chochinov & W. Breitbart (Eds.), Handbook of Psychiatry in Palliative Medicine, (303-319). New York: Oxford University Press.

Wolfelt, AD. (2002). Healing A Parent’s Grieving Heart. Fort Collins, CO, Companion Press.