Outline: Psychosocial aspects of stress management/compassion fatigue
in the health care workplace. Elizabeth A. Pector, M.D.
I. Four-step model to manage stress
a. Claim it: all organisms have stress. Selye: stress response, stressors b. Name it
i. ABC’s of personal needs
ii. TWERPS: Tasks-Time,Worries, Environment-Expectations-Events,
Roles-Responsibilities, People, Situations (the rest combined) c. Reframe it (III.)
d. Tame it (IV.)
II. Specifics of Job Stress
a. Job stress model
b. Definitions & signs: Burnout and compassion fatigue
1. Withdrawal, emotional exhaustion, low effectiveness
2. 6 elements: Overload, Lack of control, Little reward,
Unfairness, Value conflict, Lost sense of community
3. Gradual loss of idealism, energy, purpose
4. Related to unsupportive work environment
ii. Compassion fatigue= secondary traumatic stress, ―cost of caring‖
1. Exposure to client’s trauma, preoccupation with it
2. Less able to show empathy
3. Symptoms like post-traumatic stress disorder (see chart p. 2)
4. Gradual or rapid, depending on amount & type of trauma
5. Related to client’s traumatic experiences
c. General workplace and worker factors that contribute to job stress d. Occupation-specific stressors in health care workplace & workers
III. Reframe it: Looking at stress in a new way
a. Worker factors that decrease risk
1. Hardiness: commitment, control, challenge
2. Coping styles & strategies: adaptive, maladaptive b. Hardiness, attitude, adjusting expectations, humor
IV. Tame it: Coping with stress
a. Prepare for the expected & the unexpected
b. Self-care:―Balance PIES‖
i. Balance Work/Life
c. Dare to Dream, Decide & Act: stages of change.
d. Share burdens that are overwhelming
i. Cognitive behavioral therapy face-to-face
ii. E-therapy for anxiety & stress
iii. Face-to-face support groups in & outside work
iv. Online support groups: pros & cons
v. Compassion fatigue: trauma-focused CBT, relaxation, EMDR.
e. Be aware: Journaling, mindfulness, ongoing review of coping skills. V. Alternative medicine strategies for self-care: evidence for effectiveness.
a. Includes: Music, yoga, Meditation/relaxation strategies, biofeedback. VI. Communication strategies: interpersonal and corporate
a. Characteristics of effective teams
b. Discussions after crisis; mutual respect and forgiveness.
Books, websites, and scholarly articles on stress & burnout:
1. Figley, Charles R, Ed. Compassion Fatigue: Coping with secondary traumatic stress
disorder in those who treat the traumatized. New York: Brunner/Mazel, 1995.
2. Figley, Charles R, Ed. Treating Compassion Fatigue. New York: Brunner/Mazel, 2002.
3. Kabat-Zinn, Jon. Wherever You Go There You Are: Mindfulness meditation in everyday
life. New York: Hyperion, 1994.
4. Leiter, Michael P. and Maslach, Christina. Banishing burnout: Six strategies for
improving your relationship with work. San Francisco, CA: Jossey-Bass, 2005.
5. Maddi, Salvatore R. and Deborah M. Kohshaba. Resilience at Work: How To Succeed
No Matter What Life Throws At You. New York: Amacom Books, 2005.
6. Maslach, Christina and Leiter, Michael P. How organizations cause personal stress and
what to do about it. San Francisco, CA: Jossey-Bass, 1997.
Alternative medicine: Mind-body practices
Biofeedback: bcia.org, Aapb.org, isnr.org
Counseling, psychology (general)
Metanoia.org/imhs (an older view by an e-therapy client.)
Ismho.org, http://www.ismho.org/suggestions.html suggestions for clients re: therapy online. Onlineclinics.com
Peer support (including online)
allaboutdepression.com/relax/index.html (free, choice of techniques, no music)
healingchronicpain.org/content/relax/default.asp From Beth Israel. Guided Imagery. Choose type of imagery, male, female.
relax-online.com/imageryonline.htm (music, imagery, mind-body (progressive muscle) relaxation, breathing)
Healthjourneys.com: Free 15-min. guided imagery audio
Wilddivine.com Healing Rhythms: biofeedback hardware & sensors, $299.00. Andrew Weil demo wilddivine.com/content/HR_Demo1B_WD_QT384K.mov
Stress at work
Stress at Work. NIOSH Publ. 99-101. http://www.cdc.gov/niosh/stresswk.html
Coping with disaster or traumatic event: http://www.bt.cdc.gov/mentalhealth/. Stress in organizational settings. http://www.cdc.gov/niosh/87-111.html
NIOSH/Health care worker guidelines http://www.cdc.gov/niosh/hcwold5g.html
NIOSH safety & health for health care workers: http://www.cdc.gov/niosh/topics/healthcare/
JCAHO on workplace violence, recognizing & managing angry client http://dev.jcrinc.us/12490/
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Self-assessment tests: These are NOT meant for formal psychological or psychiatric diagnosis. They may help you reflect on how you are currently dealing with work stress, and may help you either alone or in consultation with a counselor or coach determine how to better understand and cope with your stress. Dr.Pector.
1. Brief COPE
Reference: Carver, C. S. (1997). You want to measure coping but your protocol’s too
long: Consider the Brief COPE.International Journal of Behavioral Medicine, 4, 92-
Downloaded & modified from:
These items deal with ways you've been coping with work stress in your life. There are many ways to try to deal with problems. These items ask what you've been doing to cope with work stress. Obviously, different people deal with things in different ways, but I'm interested in how you've tried to deal with it. Each item says something about a particular way of coping. I want to know to what extent you've been doing what the item says. How much or how frequently. Don't answer on the basis of whether it seems to be working or not—just whether or not you're doing it. Use these response choices. Try to rate each item separately in your mind from the others. Make your answers as true FOR YOU as you can.
1 = I haven't been doing this at all
2 = I've been doing this a little bit
3 = I've been doing this a medium amount
4 = I've been doing this a lot
1. I've been turning to work or other activities to take my mind off things. 2. I've been concentrating my efforts on doing something about the situation I'm in. 3. I've been saying to myself "this isn't real."
4. I've been using alcohol or other drugs to make myself feel better. 5. I've been getting emotional support from others.
6. I've been giving up trying to deal with it.
7. I've been taking action to try to make the situation better.
8. I've been refusing to believe that it has happened.
9. I've been saying things to let my unpleasant feelings escape.
10. I’ve been getting help and advice from other people.
11. I've been using alcohol or other drugs to help me get through it. 12. I've been trying to see it in a different light, to make it seem more positive. 13. I’ve been criticizing myself.
14. I've been trying to come up with a strategy about what to do.
15. I've been getting comfort and understanding from someone.
16. I've been giving up the attempt to cope.
17. I've been looking for something good in what is happening. 18. I've been making jokes about it.
19. I've been doing something to think about it less, such as going to movies,
watching TV, reading, daydreaming, sleeping, or shopping. 20. I've been accepting the reality of the fact that it has happened. 21. I've been expressing my negative feelings.
22. I've been trying to find comfort in my religion or spiritual beliefs.
23. I’ve been trying to get advice or help from other people about what to do.
24. I've been learning to live with it.
25. I've been thinking hard about what steps to take. 26. I’ve been blaming myself for things that happened.
27. I've been praying or meditating.
28. I've been making fun of the situation.
Scales are computed as follows (with no reversals of coding): Self-distraction, items 1 and 19
Active coping, items 2 and 7
Denial, items 3 and 8
Substance use, items 4 and 11
Use of emotional support, items 5 and 15
Use of instrumental support, items 10 and 23
Behavioral disengagement, items 6 and 16
Venting, items 9 and 21
Positive reframing, items 12 and 17
Planning, items 14 and 25
Humor, items 18 and 28
Acceptance, items 20 and 24
Religion, items 22 and 27
Self-blame, items 13 and 26
2. Burnout/Compassion fatigue
? B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV (ProQOL). http://www.isu.edu/~bhstamm. This test may be
freely copied as long as (a) author is credited, (b) no changes are made other than those authorized below, and (c) it is not sold. You may substitute the appropriate target group for [helper] if that is not the best term. For example, if you are working with teachers, replace [helper] with teacher. Word changes may be made to any word in italicized square brackets to make the measure read more smoothly for a particular target group.
PROFESSIONAL QUALITY OF LIFE SCALE
Compassion Satisfaction and Fatigue Subscales—Revision IV
[Helping] people puts you in direct contact with their lives. As you probably have experienced, your compassion for those you [help] has both positive and negative aspects.
We would like to ask you questions about your experiences, both positive and negative, as a [helper]. Consider each of the following questions about you and your current situation. Select the number that honestly reflects how frequently you experienced these characteristics in the last 30 days.
0=Never 1=Rarely 2=A Few Times 3=Somewhat Often 4=Often 5=Very Often
1. I am happy.
2. I am preoccupied with more than one person I [help].
3. I get satisfaction from being able to [help] people.
4. I feel connected to others.
5. I jump or am startled by unexpected sounds.
6. I feel invigorated after working with those I [help].
7. I find it difficult to separate my personal life from my life as a [helper].
8. I am losing sleep over traumatic experiences of a person I [help].
9. I think that I might have been ―infected‖ by the traumatic stress of those I
10. I feel trapped by my work as a [helper].
11. Because of my [helping], I have felt ―on edge‖ about various things.
12. I like my work as a [helper].
13. I feel depressed as a result of my work as a [helper].
14. I feel as though I am experiencing the trauma of someone I have [helped].
15. I have beliefs that sustain me.
16. I am pleased with how I am able to keep up with [helping] techniques and
17. I am the person I always wanted to be.
18. My work makes me feel satisfied.
19. Because of my work as a [helper], I feel exhausted.
20. I have happy thoughts and feelings about those I [help] and how I could help
21. I feel overwhelmed by the amount of work or the size of my case[work]load
I have to deal with.
22. I believe I can make a difference through my work.
23. I avoid certain activities or situations because they remind me of frightening
experiences of the people I [help].
24. I am proud of what I can do to [help].
25. As a result of my [helping], I have intrusive, frightening thoughts.
26. I feel ―bogged down‖ by the system.
27. I have thoughts that I am a ―success‖ as a [helper].
28. I can't recall important parts of my work with trauma victims.
29. I am a very sensitive person.
30. I am happy that I chose to do this work.
This information is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a health problem without consulting a qualified health or mental health care provider. If you have concerns, contact your health care provider, mental health professional, or your community health center.
Self-scoring directions, if used as self-test
1. Be certain you respond to all items.
2. On some items the scores need to be reversed. Next to your response write the
reverse of that score (i.e. 0=0, 1=5, 2=4, 3=3). Reverse the scores on these 5 items:
1, 4, 15, 17 and 29. Please note that the value 0 is not reversed, as its value is
3. Mark the items for scoring:
a. Put an X by the 10 items that form the Compassion Satisfaction Scale: 3,
6, 12, 16, 18, 20, 22, 24, 27, 30.
b. Put a check by the 10 items on the Burnout Scale: 1, 4, 8, 10, 15, 17, 19,
21, 26, 29.
c. Circle the 10 items on the Trauma/Compassion Fatigue Scale: 2, 5, 7, 9,
11, 13, 14, 23, 25, 28.
4. Add the numbers you wrote next to the items for each set of items and compare
with the theoretical scores.
COMMUNICATION AT WORK
Rod Ogilvie LCPC, CRADC
Associates in Professional Counseling
708-448-0884 x8 - email@example.com
Self-worth / Self-awareness:
The value of a human life is not directly related to performance or the opinions of others. A healthy self-worth creates more self-confidence and less insecurity and immaturity – but not
A healthy self-worth allows for more freedom for the individual, and is less impacted and driven by fears (failure, rejection, blame, shame).
A healthy self-worth allows a person to accept their part in the overall team: knowing their limits, protects against envy, ensuring healthy responsibility, and enhancing the overall health of the team.
Assertive: Expressing your thoughts, desires, and/or feelings in a direct, respectful manner to another person. Assertive communication takes into account: eye contact, body posture, gestures, facial expression, voice, tone, inflection, volume, timing, and the content of the message. Aggressive: An intense and anxiety provoking manner of communication – acceptable, but
should be utilized infrequently and with great caution.
Passive: A quiet or retreating response to communication – acceptable, but should be utilized
infrequently and with great caution.
Passive-Aggressive: A dishonest manner of communication, which is a communication
killer. Examples include: Procrastinating, leaving things undone, obstructing others, doing things which were not requested, misplacing, ―forgetting‖, purposefully omitting things, being
late or slow, leaking information, withholding information, use of sarcasm.
Tips for increasing self awareness in communication:
; Focus on what you really want
; Focus Feedback on the behavior, not the person
; Focus Feedback on observations rather than inferences
; Focus Feedback on description rather than judgment
; Focus Feedback on specific situations of the here and now
; Focus Feedback on sharing of information, not necessarily giving advice
; Focus Feedback on exploring alternatives instead of telling them the answer or what to
; Focus Feedback on the value it has for the recipient, not the value it has in release
; Focus Feedback on the amount a person can receive, not the amount you can put forth
; Focus Feedback on what is said, not why you think it is said
; Watch out for your ―story‖
; We add meaning
; We add motive
; We add judgement