Category: Burnout

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Inadequate Training Increases Risk of Compassion Fatigue

70Burnout, Caregiving, Featured news, Health, Stress, Trauma, Work March, 18

Source: Pennsylvania National Guard at flickr, Creative Commons

Every afternoon, personal support worker Susan (name changed) struggled with administering medication to a particular elderly patient in the dementia ward where she worked. On one such occasion, fed up with the patient’s behaviour, Susan became so frustrated that she mumbled a profanity, reached over, and pinched the patient’s arm. With a sharp cry of pain, the patient quickly accepted the medication and Susan was able to move on.

Stories of malpractice or poor patient care like this are not as uncommon as one might imagine. Evident from media reports of negligence in hospital settings, such cases can ignite an outcry in the community and prompt questions about individuals’ suitability for caretaking roles. How could someone with a career revolving around caring for others lack empathy?

Grace, an Ontario care worker who witnessed Susan’s behavior firsthand, believes the demanding nature of the job took a physical and mental toll on her co-worker. Having worked for eight years at a residential center for dementia patients, Grace knows from experience just how mentally exhausting the work can be. In an interview with the Trauma and Mental Health Report, Grace explained:

“There’s so much to take care of with these particular patients. When it’s dinnertime, you have to make sure to clean the patient, take them to the dining room, prepare the area for them, feed them, etc. But the next thing you know, they may have soiled themselves or vomited and you have yet another thing to clean when you already have so much to do… There are times when you need to take dirty clothing or dishes from them and they refuse to give them to you or just start yelling at you.”

When faced with the same situation on a daily basis, Grace explains that it’s hard not to become exasperated:

“It can get annoying and even angering at times. It’s hard to control… I didn’t hear much from Susan when I first started working here, but then she began yelling at the patients. I do believe it’s because the stress finally got to her.”

Mental health professionals support Grace’s theory. Overworked employees who are plagued by such feelings of frustration are showing signs of Compassion Fatigue (CF).

Francoise Mathieu, CF specialist and founder of Compassion Fatigue Solutions in Kingston, Ontario, describes the condition on her organization’s website as a gradual emotional and physical exhaustion of helping professionals. While CF is sometimes used interchangeably with Vicarious Trauma (VT), there is a difference between the two. VT is a secondary form of post-traumatic stress disorder, where a worker becomes preoccupied with a specific event or patient problem. On the other hand, CF is an overall decline in the ability to empathize with others.

The American Institute of Stress also differentiates CF from ‘burnout’. With CF, the constant pressure to show compassion toward patients may wear on mental energy stores, leading workers to become emotionally blunted to people and events. Burnout is less dependent on this loss of compassion.

CF is not limited to mental health professionals. It has been shown to affect teachers, social workers, police officers, prison guards, and even lawyers who work with trauma victims. In Grace’s words:

“At first, the stories you hear and the things you see involving the patients really do follow you home. They used to make me feel depressed. Over time, that sensitivity does lessen. After being exposed to this type of thing day after day, you start to lose those feelings.”

According to CF expert Francois Mathieu, once workers begin to experience this emotional exhaustion, they may be prone to moodiness, irritability, difficulty concentrating, intrusive thoughts, feelings of hopelessness, and apathy in both workplace and personal relationships. Fran McHolm, Director of Continuing Education at the Nurses Christian Fellowship has written about how CF can lead to a decrease in general employee happiness, workplace satisfaction, and quality of patient care.

CF is not a rare condition. Results from a 2012 dissertation study by Shannon Abraham-Cook at Seton Hall University show that, out of 111 urban public school teachers in Newark, New Jersey, 90% were at high-risk for CF. In 2010, Crystal Hooper and colleagues from the AnMed Health Medical Center in South Carolina also found that 86% of emergency department nurses exhibited moderate to high levels of CF.

While CF is common in many workplaces, help for employees who are experiencing symptoms, is not readily available. In an interview with the Trauma and Mental Health Report, Isabella, an assistant teacher working with special needs children at a Toronto daycare, describes her experience:

“When we began training, the instructors only talked about how to care for the children and how to work with the different age groups. Management didn’t provide us with anything else. The only thing we can do when feeling overly stressed is go for a break.”

Grace adds that her center for dementia patients fails to directly address employee needs:

“Recently, they added cameras everywhere to prevent poor patient care, but it’s made things worse. Now we are forced to seem especially compassionate and the littlest mistake can lead to a suspension. The management doesn’t try to understand the worker’s view of things at all.”

Dan Swayze, vice president of the Center for Emergency Medicine of Western Pennsylvania, discusses several ways management can address employees’ personal needs pertaining to compassion fatigue. In an article in the Journal of Emergency Medical Services, Swayze writes about the importance of implementing policies and developing programs that can help ease the onset of CF. Teaching employees how to set professional boundaries with patients, conducting meetings to solve individual client issues as a team, and offering counselling services to stressed employees are just a few options administration can take.

And a 2015 study by researcher Patricia Potter and colleagues in the Journal of Continuing Education in Nursing argues for resilience training, a program designed to educate personnel about CF and its risk factors. Workers are taught how to employ relaxation techniques and build social support networks to cope with symptoms that arise from working with difficult populations. Staff members from a US medical center who participated in the training self-reported an increase in their empathy and overall emotional health.

Volunteer crisis hotline operator, Anabel, explains the benefits of these resources in her line of work:

“The staff at the distress center are really considerate of their volunteers. In the training they prepare you for compassion fatigue, encourage volunteers to take care of themselves, and to not take the calls home with you. They also make sure to be available to the volunteers 24/7 in case they need to debrief a call with someone. It really helps to know they’re there to talk to—often after a distressing call.”

Training and intervention programs can help safeguard against the development of compassion fatigue in care workers. But many people working in the field, like Grace and Isabella, have been thrown into care-taking roles with no consideration for the risks to their mental wellbeing. Both women have identified various ways of coping as a stopgap until they receive the assistance and support they need.

Isabella suggests taking full advantage of breaks every few hours:

“Whenever you feel overwhelmed, go for a break right away—even if it’s just to the washroom or for a coffee… When you leave and come back, you feel refreshed. I’m lucky that I live so close to my workplace that I can go home during lunch.”

Grace recommends taking a deep breath and focusing on any positive aspect of the job:

“I learn so much from the patients. Hearing their stories, you can end up getting really close to some of them. I try to listen to them when I can and when I see the positive effect that has on them, I feel very fulfilled.”

These coping mechanisms do not work for everyone, which is why early intervention is so important. While camera implementation has prevented some inappropriate conduct like Susan’s from continuing, it doesn’t address the root problem.

“There are times where I get angry,” Grace admits. “I can’t always entertain patients or be friendly. I try… but it’s so hard… I know a lot of people, like myself, are really sensitive, which is why we are so emotionally affected by this job. There’s no stress management or counselling here, but… these training programs could really help.”

For many helping professionals, compassion fatigue may be inevitable. Cases like Susan’s show that the wellbeing of individuals in caretaking roles directly influences the quality of care that patients will receive. Support in the form of training programs and other preventative measures can make a difference in the lives of these workers, and, improve patient care.

–Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report. 

Copyright Robert T. Muller.

This article was originally published on Psychology Today

Robert T Muller - Toronto Psychologist

Firefighters Fight Stress as First Responders

90Burnout, Featured news, Post-Traumatic Stress Disorder, Stress, Trauma, Work February, 18

We tend to think of firefighters saving lives as fires tear through homes or forest land. What many people don’t know is that firefighters are also first responders, arriving at crisis scenes even before paramedics or police officers.

Working in stressful and traumatic situations can take a toll on their mental health. Post Traumatic Stress Disorder (PTSD) and suicide rates are much higher in first responders than in most other professions. Canadian first responders experience twice the rate of PTSD compared to civilians.

Ongoing exposure to stress means that access to support is critical. But cultural and administrative barriers get in the way. Because firefighters are regarded as tough and invulnerable, many feel embarrassed to ask for help, and available programs can be difficult to navigate.

Brian (name changed for anonymity), a 30-year veteran of the fire service and a District Chief in Ontario, Canada has experienced the stressful effects of the job firsthand, and has witnessed the toll it takes on colleagues and family:

“You’re just supposed to deal with the effects of the job. The stigma is that, if you can’t handle it, you’re weak. This idea has been built into the profession.”

When Brian entered his new role as District Chief, he received very little training on how to support the well-being of those working under him. He received only a phone number to an Employee Assistance Program (EAP) to distribute to team members if they had an exceptionally stressful day. The call is left up to individual firefighters rather than to an outreach program that communicates to them directly.

Although Brian believes that firefighters can benefit from the EAP, he knows that stigma exists around making the call. So, the resource doesn’t get used.

“There have always been employee assistance programs. In all my thirty years, I’ve only seen the EAP used once or twice. For the program to work, the agency needs to call the firefighters, because firefighters don’t reach out.”

To fight this stigma, the province of Ontario has launched several initiatives, including a new radio and digital campaign created to raise awareness and reduce the hesitancy of first responders to seek support. A free online toolkit has also been developed that addresses how to cope with PTSD.

Social support is another essential component of first responders’ wellbeing. In a study published in the Journal of Occupational Health Psychology, Jasmine Huynh of Flinders University and colleagues found that support from family and friends was critical for protecting workers from burnout and for them to cope with the demands of frontline responsibilities.

Brian and his wife Sandra (name changed for anonymity) find support in each other and also through other firefighters and their families. Sandra explains that they often use humour to address the stress:

“When you go into the fire hall, there’s a lot of humour. I think we use humour to deal with the pressure, to keep going. That’s our coping mechanism. It’s also how we manage the stress as a family.”

While some programs exist to help firefighters work through their own issues, there is very little support for families of first responders. Having a loved one who is a firefighter can take a toll on the whole household.

In a study by social work professor Cheryl Regehr and a group of researchers at the University of Toronto, the authors explored how firefighters’ wives coped with the mental distress caused by their husbands’ emotionally taxing jobs. Wives handled partner stress by emotionally distancing themselves when necessary.

After thirty years, Sandra has learned to better read Brian’s emotional states, allowing her to recognize when he needs some space after a bad shift. She explains:

“If he comes home and is quiet, and not himself, I know that something is wrong. But I just let it go and let time pass, and then, eventually, I ask him about it. I can tell when it has been a rough shift. If he wants to be alone, I let him be.”

In an attempt to shield his children from the dangers of his job, Brian doesn’t discuss work much at home:

“When I was initially on the job, I talked to Sandra a lot about it, but when the kids came, I stopped. You don’t want to bring the experiences home; you don’t want the kids to worry. It’s bad enough that Sandra worries.”

Despite being proud of her husband, Sandra can’t help but feel constant fear in the back of her mind:

“I think about Brian’s safety all the time. The fear is always there. When he was first on the job, I tried not to think about it. I didn’t watch the news, and if I did, I prayed it wasn’t his fire truck at an emergency.”

To her relief, it has always been someone else’s fire truck. But that someone usually has a family at home, also worrying.

Brian and Sandra agree that more needs to be done to support frontline workers and families. At least initiatives like the media campaign and online toolkit serve as a starting point for an open dialogue surrounding the stigma of seeking help.

At the end of the day, Brian’s job is just that: a job. He says:

“People want to call us heroes. Most of the time, I don’t classify us as heroes. We do what we’re trained to do, and if we do it well, we all come home.”

–Alyssa Carvajal, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Fast Food Industry Demands ‘Emotional Labour’ from Employees

00Burnout, Depression, Emotion Regulation, Featured news, Health, Stress, Work October, 16

Source: Steffi Reichert on Flickr

Donna Abbott (name changed), a long-time employee at McDonald’s, does more than serve Happy Meals. She smiles politely and greets every single customer. It’s part of the job. She’s even expected to ask the customer about their day. That way, the customer can walk away feeling satisfied.

Emotional labour—strict emotional control and outward enthusiasm—may be a way of earning tips. But in some sectors, including North America’s growing low-wage service industry, emotional labour is a fundamental part of the job. Displaying concern for a customer’s needs, smiling, and making eye contact is critical to a customer’s perception of service quality.

Cheerful presence can be essential to profitability of service providers, particularly in the fast-food industry. But emotional labour may be doing more harm than good to employee emotional and mental wellbeing.

A recent research review by Alicia Grandey and colleagues at Penn State University examined the benefits and costs of emotional labour practices, including those used in fast-food services. According to the study, the self-control and regulation needed to convey a sense of artificial happiness for an extended period of time is taxing, depleting energy and resources that could be dedicated to other tasks.

In an interview with the Trauma and Mental Health Report, Donna said:

“The energy that I spend being overtly happy could be used elsewhere—I know that I’d be able to take orders faster and prepare meals quicker if I didn’t have to take that extra and, in my opinion, forced step to be emotionally friendly with customers that I don’t know.”

Emotional fatigue that detracts from the ability to do other work isn’t the only problem. Unless the employee is naturally a positive person, the act of suppressing true feelings and generating insincere ones leads to what psychologists call dissonance—a tense and uncomfortable state that can lead to high levels of stress, job dissatisfaction, and burnout.

“It’s just stressful and really frustrating,” says Donna. “It creates this push and pull within you that you really want to—but often can’t—resolve. And in trying to cope with these fake feelings, I’ve turned to things I’m not proud of and don’t admit to everyone.”

Donna reports excessive use of cigarettes and marijuana, particularly after a long and emotionally draining 10-hour shift; addictions that are not uncommon among employees in the fast-food industry. According to the Substance Abuse and Mental Health Services Association’s National Survey on Drug Use and Health, food service has the highest rate of drug use, with an estimated 17.4% of workers abusing substances.

Individuals vary in their ability to deal with inauthentic emotional expressions. This means that the effects of emotional labour on emotional and mental wellbeing do not apply to all fast-food employees. Some workers may be able to identify with the organization’s values of positive emotional communication, making them better prepared to express appropriate emotions. And people who are generally more cheerful and pleasant may be able to turn off negative emotions more easily than others.

Donna is one of the less cheerful employees:

“When I started working at McDonald’s I would say that I was happy, but still not at the level of putting a smile on randomly for just anyone. I’m not a naturally happy person. And after being there for a long time, I wouldn’t say that I’m the most pleasant employee. I’ve had my fair share of negative attitude and customer complaints, which make it very hard to pretend to be happy or care about the customer—especially since it’s not technically in my job description to do that.”

In their research, Grandey and colleagues note that there are some jobs where emotional labour may be a core requirement. Childcare workers or people who care for those who are mentally or physically ill are a common example. But, the dissonance that a fast-food employee feels is probably more than workers experience in other sectors, like care providers, who typically see the act of helping as part of their identity.

Emotional labour comes at an emotional cost. And employers who require emotional labour should do so in a supportive rather than controlling climate. By training employees to recognize mistreatment, offering down-time to help workers re-charge, and giving employees opportunities to engage in honest interaction, employers might find a positive attitude that comes about on its own.

–Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Mental Healthcare Lacking for Small Business Owners

20Anxiety, Burnout, Depression, Featured news, Health, Stress, Work July, 16

Source: Gary Suaer-Thompson on Flickr

Being your own boss, doing something you love, having control over your own schedule. These are only a few reasons why people choose to start their own business.

But the reality many small business owners face is far less appealing. Financial stress, professional isolation, long hours, and blurred boundaries between work and family life can take a toll on mental health.

Although there is a growing focus on mental health in the workplace, programs often target large companies with thousands of employees, providing fewer options for those running small businesses.

Jeffrey Markus, entrepreneur and founder of Daddyo’s Pasta and Salads restaurant in Toronto, knows firsthand the psychological impact of running a small business. When his restaurant was struggling, he took it personally:

“I was a go-getter and an entrepreneur. But as business slowed I was more and more affected. I couldn’t separate myself from my business. It was the worst experience of my life. It put a strain on my marriage and I missed out on seeing my daughter grow up, which was very difficult for me.”

In Markus’ opinion, small business owners are overlooked when it comes to providing support for people in the workplace.

And he may well be right. While employees in larger organizations often have access to human resource support or programs, business owners and entrepreneurs are left to deal with stress on their own.

Associate professor Angela Martin of the Tasmanian School of Business and Economics in Australia, conducts research on the mental health of small business owners. She believes that while there is some evidence of a growing awareness for providing mentally healthy workplaces among larger businesses, it may not be helping entrepreneurs:

“Small business owners need access to support, but the current workplace mental health programs are missing all of these people. These models don’t work in small business as they do in a larger organization. They don’t translate to a single person.”

Martin’s research has been used to develop a set of preventative guidelines that help small and medium business owners recognize the signs and symptoms of mental health issues in themselves and their employees. But she is working in an under-investigated field:

“There is no big systematically collected data, so we don’t know how many people are affected and what impact it is having on small and medium business.”

Another issue is that while small businesses are often seen as one type of industry, they are actually quite diverse—ranging from building contractors and health professionals to artists and online retailers. These differences mean that the time and cost constraints faced by individual business owners are also different.

In Jeffrey Markus’ experience, the number of small business owners in distress is alarmingly high. But after facing his own share of crises, he has learned to care for himself as well as his business:

“People are borrowing against their homes which can cause marital issues. Many marriages break down when husbands and wives clash within a family business. But I had to reframe my thinking and approach to things. I had to get the entrepreneur life to work for me, not against me.”

Markus has learned a few simple things that go a long way, such as saying no to the prospect of expanding his restaurant to multiple locations, remembering to leave time for relaxation and self-care, and being more present within the lives of his family and close friends.

In considering his experience, he notes that community and peer support were key in helping him get through tough times.

Rebekah Lambert, a good friend of Markus, is an entrepreneur working to help other small business owners connect with each other and find support. Her company, The Freelance Jungle, is an Australian initiative providing community support and helping people manage the stress of running a business:

“I found a lot of people are having a hard time. I saw a lot of them spending money on being a businessperson, but not on getting proper support.”

Markus agrees that small business owners need to support each other due to the absence of government programs. This is particularly important since business owners’ poor mental health will affect not only their lives but also the mental health of their employees.

Potential solutions being examined by Lambert and other entrepreneurs are online associations and support networks, local meetup groups, and mentorship programs. With a current lack of formal mental health programs, it is important that business owners learn to look after themselves in the meantime.

– Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Trauma Workers At Risk for Compassion Fatigue

Trauma Workers At Risk for Compassion Fatigue

00Burnout, Empathy, Featured news, Health, Resilience, Self-Help, Trauma, Work July, 15

Source: Brian Walker/Flickr

The expectation of unending compassion for others is unrealistic. For trauma workers, hearing devastating stories can take its toll. This can be seen in detrimental effects to physical and emotional health; that is, a specific type of burnout called compassion fatigue.

The Trauma & Mental Health Report recently spoke with compassion fatigue specialist and director of Compassion Fatigue Solutions in Kingston, Ontario, Françoise Mathieu, to discuss the symptoms of the condition and how trauma workers can protect themselves from it.

Q: What is compassion fatigue?

A: It is a gradual shift and decline in an individual’s ability to feel empathy and compassion towards others. It is not an illness or disorder. Often, the term compassion fatigue is used interchangeably with vicarious trauma or secondary traumatic stress (STS), but there is a distinction.

STS refers to a traumatic, stressful experience without direct exposure to the trauma. STS results from hearing traumatic stories, like hearing witness testimonies or stories of torture. Over time, those stories can shift your view of the world to a tainted and jaded one, to the point where you lose the ability to experience joy. For example, people who work with victims of sexual trauma may have a hard time trusting babysitters or coaches. Vicarious trauma is the result of the accumulation of several STS experiences.

Q: Who is susceptible to compassion fatigue, vicarious trauma, and STS?

A: Helping professionals are the most susceptible. This typically includes physicians, nurses, mental health care workers, allied health professionals, therapists, clergy, law enforcement, teachers, long term care workers, and personal support workers.

The public can also start internalizing trauma from continuous exposure to graphic images portrayed by the media. Overexposure of the September 11th, 2001 terrorist attacks created a heightened sense of danger and paranoia. The difference is that the relationship helping professionals form with their clients is very unique: You become deeply vulnerable. When you’re opening your heart and listening to someone’s pain, it can be very intense.

Q: Are there any signs and symptoms of compassion fatigue?

A: A major warning sign is workaholism. Many helping professionals are so dedicated to their jobs that they don’t have a balance between their work and home lives. The more caring you are, the more vulnerable you are. We call it a “normal consequence” of doing a good job. Helping professionals may experience a decline in empathy, reduced collegiality, dreading client appointments, and belittling their stories.

Or, someone might be doing a great job at work, but they have nothing left to give at home. Warning signs are irritability, social isolation, emotional and physical exhaustion, or self-medicating with drugs, alcohol, or even excessive shopping.

Q: What can protect trauma workers?

A: With increased budget cuts, many trauma workers do not have adequate training, so Trauma Informed Training can be highly protective. Richard Harrison and Marvin Westwood, researchers from the University of British Columbia (UBC), studied experienced trauma therapists and found that those who connected spiritually or creatively with something outside their work and felt supported by their families and communities managed well with the stress of their jobs.

Establishing a deep therapeutic alliance characterized by a meaningful relationship with clients, based on presence and heartfelt concern, also provided professional satisfaction.

Q: What can a person with compassion fatigue do to alleviate symptoms?

A: We can’t prevent compassion fatigue, but there are strategies and tools for professionals to be able to feel grounded, present in the moment, and well trained. Ask yourself these questions:

–Do I work somewhere where I have control? Control over your schedule can reduce compassion fatigue. Small changes can make a big difference.

–Do I have a debriefing process that might relieve some of the emotional strain?

–Do I have access to supportive people whom I can consult with, when I hear difficult stories?

–Am I trained in trauma-related concepts, so that I have a better understanding of the side effects?

–Do I have a transition ritual, a way to leave work behind and transition into my home life? (e.g., yoga, exercise)

Last, research shows that the most effective strategy is Mindfulness-Based Stress Reduction, which recommends relaxation techniques to reduce stress and improve self-compassion.

Mathieu adds that even if you have your own past history of trauma, it doesn’t mean that you shouldn’t be a helping professional. In this case, it’s important to identify your triggers, ensure you have a support system, and that your caseload doesn’t remind you of your personal trauma.

Mathieu cautions the trauma worker to “pay equal attention to the needs of your client, and yourself.”

– By Shira Yufe, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today