For use with the Oxygen for Caregivers video program

Simon and Karen Fox with Jill Morris

W O R K B O O K

Your personal workbook to build the self-care skills that reduce the

risk of compassion fatigue and vicarious trauma, and lead to greater wellness, resilience, and quality of life

Workbook Printing

This program has both professional and personal value. It is a gift that will improve the quality of your life. However, like anything else, it only works if you do the work. So this workbook is a book to do that work in, not just to read, but to do the exercises, reflective writing, and self-evaluation; to be accountable for doing that work, and to engage in conversations about it with others. This is the work that produces insight, builds commitment, and leads people to make better self-care choices.

Such work is best done with pen on paper. Digital devices (smart phones, tablets, laptops etc.) are not conducive for such reflective work or thoughtful conversations and they introduce many distractions that compromise the quality of focus.

So we recommend that you print out the Workbook. What works well is to print it double-sided, then three-hole punch the pages and put them in a half-inch, three-ring binder. Binders with a clear plastic sleeve on the front make them easy to customize by slipping a printout of the workbook’s front cover into that sleeve.

Viewing in Adobe Reader

For best viewing: Go to the View menu, select Page Display, and choose the option “Show Cover Page During Two-Up” or you can view as single pages.

Simon and Karen Fox with Jill Morris

W O R K B O O K

Adventures in Caring Foundation Santa Barbara, California

www.AdventuresInCaring.com

Oxygen for Caregivers

The Adventures in Caring Foundation is a nonprofit human service organization, dedicated to cultivating the practice of compassion in health care. Under the leadership of Simon and Karen Fox, the Foundation has grown from a small group of local volunteers to an internationally recognized, award-winning program used by thousands of hospitals, hospices, nursing schools, churches, and charities. All proceeds from the sale of this DVD, Workbook, and Leader Guide help to fund the Adventures in Caring service-learning programs in hospitals and skilled nursing facilities. These programs serve a dual purpose: while helping patients and their families cope with the loneliness and emotional distress of illness, injury, and dying, young people entering the health professions develop the emotional intelligence, communication skill, and compassion they will need to succeed in their chosen field. The Oxygen for Caregivers program was produced in response to a simple question that many of these young professionals are asking: How do I not burn out?

The Oxygen for Caregivers program is made possible by funding from Dr. and Mrs. David Chernof, the Rotary Club of Santa Barbara, the St. Francis Foundation of Santa Barbara, and the Wood-Claeyssens Foundation.

Adventures in Caring Foundation

1528 Chapala Street, Suite 202

Santa Barbara, CA 93101

U.S.A.

website: www.AdventuresInCaring.com (educational programs) www.AdventuresInCaring.org (volunteer programs)

e-mail: info@AdventuresInCaring.com

toll-free: (800) 833-5678

telephone: (805) 962-4500

fax: (805) 962-2926

© 2014 Simon and Karen Fox, Adventures in Caring Foundation

All rights reserved.

This Workbook may be reproduced by instructors in the purchasing organization who lead the Oxygen for Caregivers program with this caveat: this permission is limited to internal organizational use only, to making copies without alteration, and to making copies only for those who participate in the Program. It does not grant the right to include the material in any other publication or program. All other uses, including distribution or presentations to other organizations or to the public, are prohibited. No portion of the Oxygen for Caregivers video program contained in the DVD may by reproduced, broadcast, retransmitted, or re-purposed in any manner or by any means, without prior written consent. For more details on the licensing of this program see page 46 of the Leader Guide.

Notice of Liability

The information contained in this book is distributed on an “As Is” basis, without warranty. While every precaution has been taken in the preparation of the book, neither the authors nor the Adventures in Caring Foundation shall have any liability to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the instructions contained in this book, or by the companion DVD described in it.

ISBN: 978-0-9911322-1-8

Table of Contents

Session 1: Real-World Self-CareThe Caregiver’s Dashboard: Program Summary ...........................................................................2Reflections on the Oxygen for Caregivers video .............................................................................. 3Ground Rules for Meaningful Conversations ..............................................................................4Occupational Hazards in the Helping Professions ....................................................................... 5Professional Quality of Life Screening ....................................................................................... 11Quotes for Caregivers .................................................................................................................14

Session 2: Where Wellness BeginsYour Warning Signs of Compassion Fatigue, Vicarious Trauma, Burnout .................................24Patterns of Evasion ..................................................................................................................... 29Four A’s of Self-Awareness .........................................................................................................30Five Lifestyle Strategies: Antidotes to Stress.............................................................................. 35Self-Care Tactics ........................................................................................................................ 37Your Quick-Start Plan ................................................................................................................ 41The Wellness Self-Evaluation Tool .............................................................................................42Effective Choices ........................................................................................................................ 49

Session 3: The Journey into WholenessBalance: The Ebb and Flow of Compassion ...............................................................................52A Map of the Whole Person: Your Healing Connections ..........................................................54Five New Perspectives ................................................................................................................ 57The Edge of Understanding .......................................................................................................58Acknowledgments ......................................................................................................................60Permissions ................................................................................................................................. 61Resources ....................................................................................................................................62Recommended Reading ............................................................................................................. 65

S E S S I O N 1 :

Real-World Self-Care

2 — Oxygen for Caregivers © 2014 Adventures in Caring Foundation

The Caregiver’s Dashboard: Program Summary

The purpose of an aeronautical instrument panel is to allow you to look at your flight from different perspectives so that you can assess your situation, solve problems effectively, and get to where you want to go. It doesn’t tell you what you should do or where you should go. The various parts of this program are like the instruments on a dashboard: they give you different ways to evaluate your situation and choose your direction so that you can arrive safely where you want to be. In this program, you are the one in the pilot’s seat.

Summary of the Program1. Stories and Insights: the view of the real world through the cockpit window, from

experienced pilots – such as the nurses, paramedics, doctors, and social workers – who have safely flown through heavy weather before (Oxygen for Caregivers video).

2. Log Book: reflections on your experience (p. 3).3. Dialogue Ground Rules: etiquette of the air between us, for flying well with others (p. 4).4. Weather Warnings: occupational hazards in the atmosphere you live and work in – client

thunderstorms, downdrafts of disappointment, dense fogs of confusion, high pressure systems, emotional cloudbursts, blizzards of business (pp. 5–9).

5. Fuel Gauge: warning indicators that you are running on empty (pp. 24–28).6. Self-Awareness Compass: four cardinal principles of self-awareness to check your bearings

(pp. 30–34).7. Balanced-Attitude Indicator: to help you monitor the ebb and flow of compassion and not

drift off course due to your wings being out of balance (pp. 52–53).8. Whole-Person Map: four domains where your healing connections and blind spots are

located (pp. 54–56).9. Strategic Maintenance: five lifestyle strategies that protect against burnout (pp. 35–36).10. Tactics Tool Kit: self-care tactics you can use to fix yourself up (pp. 37–41).11. Self-Evaluation Flight Plan: to know where you are starting from and heading to

(pp. 42–48).

Oxygen for Caregivers © 2014 Adventures in Caring Foundation — 3

Reflections on the Oxygen for Caregivers VideoNote: All reflective writing and survey responses in this program are private and confidential.

1. Which moments in the video spoke to you most strongly?

2. How did you feel during those moments? What were you reminded of?

3. Why were those moments meaningful, troubling, or inspiring for you? How do they speak to your own experience?

4. What might you do differently now? What simple habit or ritual could you do regularly that would be a step toward greater wellness?

5. What, or who, will motivate you to protect yourself from burnout, build resilience, and sustain your compassion?

Questions

4 — Oxygen for Caregivers © 2014 Adventures in Caring Foundation

Ground Rules for Meaningful Conversations

Dialogue is a conversation with a center, not sides. This conversation is based on learning rather than winning, personal experience rather than opinions, and cooperation rather than competition. Our goal is to make new discoveries together rather than prove we are right.

1. Extend and receive welcome. People learn best in hospitable spaces. In this room we can support each other’s learning by giving and receiving hospitality.

2. Be present and participate as fully as possible. Be here with your questions, concerns, and failings as well as your convictions, joys, and successes. Please speak up and say what is on your mind and in your heart. And be interested in what others have to say. We are all responsible for the quality of this conversation.

3. No fixing, no saving, no advising, and no setting each other straight. This is often challenging for those of us in the helping professions – but it is vital to reflective conversation.

4. Speak in ways that respect different perspectives. Our views of reality may differ, but speaking one’s truth does not mean interpreting, correcting, or debating what others say. So speak from your own experience, using first person “I” statements, such as “I feel…” “I remember…”

“The way I look at it…” trusting people to do their own sifting and winnowing.

5. Speak about your experience. Discuss your own life or work, such as what you learned, insights gained, feelings you felt, how you changed, what surprised you, and what meant the most and why. Don’t speak about your opinion. And avoid discussing other people’s opinions, theories, beliefs, or dogmas, or what you think other people should do.

6. Listen to learn, connect, or cooperate. Listen for the unknown and unexpected. Listen to understand each other’s needs and goals. Listen to what is not said. But don’t listen to find fault. Or to plan ahead, prove you’re right, compete, or compare yourself with others.

7. Learn to respond to others with honest, open questions. Avoid counsel, corrections, or leading questions.

8. When the going gets rough, turn to wonder. If you feel judgmental, defensive, distracted, or bored, practice being interested in other people’s experiences. Ask yourself, “I wonder what led her to see it that way?” “I wonder what he’s feeling right now?” “I wonder what this means to her?” “I wonder what my reaction teaches me about myself ?” Set aside judgment in order to listen to others – and to yourself – more deeply.

9. Attend to your own inner teacher. We learn from others, of course, but as we explore videos, poems, stories, questions, and silence, we have a special opportunity to learn from within.

10. Trust and learn from the silence. Silence is a gift in our noisy world, and a way of knowing in itself. Treat silence as a member of the group. After someone has spoken, take time to reflect without immediately filling the space with words.

11. Observe deep confidentiality. Nothing said here will ever be repeated to others. Not outside the meeting, not during the meeting, and not even to the person who said it.

Adapted from A Hidden Wholeness by Parker Palmer with Caryl Casbon and Sally Hare.

Oxygen for Caregivers © 2014 Adventures in Caring Foundation — 5

Occupational Hazards in the Helping ProfessionsAdapted with permission from The Compassion Fatigue Workbook by Françoise Mathieu

“Compassion Fatigue is the emotional hazard equivalent to the physical hazards of fishermen working on an arctic fishing boat.”

– Françoise Mathieu

Everyone who cares about patients and clients is at risk of eventually being injured, to a greater or lesser extent, by the hazards of frequent encounters with illness, injury, trauma, and death – not because we did something wrong, but because we care. Ironically, those who are burned out, worn down, fatigued, and traumatized tend to work harder.

Compassion Fatigue (CF)�� Gradual erosion of connectedness with life: loss of empathy, hope, and compassion.�� Profound emotional and physical exhaustion developed over the course of a career.�� The cost of caring for others in emotional pain.�� A disorder that affects those who do their work well. �� Compassion fatigue is far more than simply getting tired of caring – it is becoming

emotionally overwhelmed by encountering suffering on a scale and intensity that your training or imagination did not prepare you for.

Signs of CF include:

�� Feeling dispirited and bitter.�� Being more prone to clinical errors.�� Losing respect for patients or clients and violating boundaries.�� Being short-tempered with loved ones.�� Feeling constant guilt or resentment at never-ending demands.�� Experiencing depression, anxiety, substance abuse, chronic pain, and stress-related illnesses.�� Experiencing suicidal ideation.

Compassion Fatigue

Secondary Trauma

Burnout

Vicarious Trauma

Moral Distress

Primary Trauma