Understanding Compassion Fatigue & Vicarious Trauma 2018-11-14¢  ¢© Fran£§oise Mathieu 2014 1 Fran£§oise

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  • © Françoise Mathieu 2014 1

    Françoise Mathieu, M.Ed., CCC.

    Compassion Fatigue Solutions Inc.

    Understanding Compassion Fatigue & Vicarious Trauma

    Routledge (2012)

    •Crisis intervention

  • © Françoise Mathieu 2014 2

    ”[…] the patient's suffering ends at the time of death, but that suffering continues in the minds of the care providers, in their hearts and in their memories.”

    Dr David Kuhl “What Dying People Want” (2002)

    Vicarious Trauma Accumulation of indirect trauma exposure

    changes our view of the world

    “An occupational hazard” Saakvitne & Pearlman (1996)

    1995 Dr Charles Figley “The cost of caring”

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    Compassion Fatigue

    •Erosion •Lowered tolerance •Desensitization •Cumulative •Personal & Professional •Caregiver fatigue

    Multiple Exposure: Increased Risk

    Prior Trauma

    Traumatic Grief/Loss

    Direct Exposure

    Secondary Trauma Compassion Fatigue

    Systems Failure


    Image courtesy of Dr L.A. Ross, Children’s Institute, Los Angeles

    How many helping professionals develop CF/VT?

    All studies come to the same conclusions: •  Affects the most caring •  % of traumatic cases on caseload: the more

    traumatic the work = higher incidence of VT •  Full time vs part time •  Availability of social support is protective •  Helper’s own trauma history •  Adequate training is protective

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    •  Emotional exhaustion: 53-69% among oncologists compared to 37.1% among allied health care staff

    •  Low personal accomplishment: 1/3 of gyneco-oncologists. 50% oncologists "reported feelings of low personal accomplishment”

    •  Recent study carried out among Florida hospice nurses found that 79 percent of them had moderate to high rates of compassion fatigue and 83 percent of those who did not have debriefing/support after a patient’s death, had symptoms of CF (Abendroth)

    •  From: Kearney, M.K., et al Self-care of physicians caring for patients at the end of life. JAMA, March 18, 2009 - vol 301, no 11.

    Recent Data •  Physicians with the highest rates of burnout: E.R., internists, Gps, Neurologists then Onco (Shanafelt study) • US Surgeon suicidal ideation: 6.5% in the last 12 months. ¼ sought psychiatric help, 60% of those with SI reluctant to seek help due to fear of repercussions (Shanafelt, 2011) • Nurses: high rates of physical assault, substance use, role overload

    The work that you do •Where do those stories go at the end of your day? •What are your vulnerabilities? •How do you protect yourself? Were you trained to do this work?

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    Are we trained to do the work we do?

    Is Self Care Enough…?

    Bober & Regehr Study, 2006

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    Bober & Regehr (2005)

    •Believing in self care did not equal more engagement •Doing it did not reduce trauma scores

    Kyle Killian, Traumatology, June 2008

    Kyle Killian, Traumatology, June 2008

    What works? “a constructive and supportive


    Organizational changes which offer “better working

    conditions, more control over their schedule, good quality supervision and a

    reduced exposure to trauma.”

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    Burnout, depression and addiction in service providers

    continue to be taboo topics


    John Bradford

    Research started showing that reducing workload was a good place to start…

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    Problem is….

    What works? Identify your warning signs

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    The Warning Signs Continuum

    Symptoms of Chronic Stress •lack of sleep •anxiety •depression •headaches •abdominal pain/GERD/IBS •back pain •eye twitch •bruxing (teeth grinding) •hives •anger, mood swings •poor concentration, forgetfulness •hypertension •cardiovascular disease Image: sixninepixels / FreeDigitalPhotos.net

    Behavioural Signs and Symptoms

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    Behavioural Signs and Symptoms

    Increased use of alcohol and drugs

    Anger and Irritability

    Avoidance of patients/clients

    Absenteeism Impaired ability to make decisions

    Problems in personal relationships

    Attrition Compromised care for patients


    Psychological signs and symptoms Con’t

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    What works?

    Get more training

    What works? Cultivating Resiliency

    Mindfulness Based Meditation

    Randomized trials have shown that

    mindfulness meditation [is]

    effective in reducing Compassion Fatigue

    (Kearney 2009)

    Michael Kearney, MD Santa Barbara Cottage Hospital

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    What works? Organizational and Systemic Changes




    Source: Saakvitne & Pearlman (1996)

    Healthy Organizations What works?

    •Grounded practitioners •Supportive Managers •Well trained managers •Reduced exposure to trauma •Timely debriefing •Good quality supervision •Ability to control schedule

    “Horizontal violence”- a direct result of Compassion fatigue and role overload

    The toxic workplace

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    •  Get more training in trauma- informed care

    •  Develop and enhance your social supports

    •  Identify your warning signs •  Develop a wellness practice and

    grounding skills •  Advocate for change •  Decide what you can control

    What works?


    Apply to present! Deadline January 2015

  • © Françoise Mathieu 2014 14

    Get in touch •  info@compassionfatigue.ca

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