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How well do you treat yourself?

From the Spring 2013 issue of Scrubs

Answer these questions to find out if you show yourself the same compassion you show your patients and everyone else in your life.

I feel your pain… A little too much?

Empathy is a natural human response. But constant exposure to other people’s suffering without the protection of self-care and self-compassion can lead to empathy overload. Answer yes or no to the five questions below–an affirmative answer is a warning sign of empathy overload. Next, reflect upon the statements under each heading. Answer true or false to each to gauge your level of empathy strain and to recognize the ways it impacts your life at work and at home.

1. Are thoughts of patients intruding into your off-hours?

______ After working with my patients, I’m haunted by what is happening to them.

______ I react to situations the way my patients might (e.g., on edge, anxious, irritable,  startled).

______ My work makes me worry more about the safety of those I hold dear.

______ Because of the intensity of my job, I am reappraising my own beliefs.

2: Have you become detached from patients?

______ While listening to my patients, my thoughts drift elsewhere.

______ I find myself fatigued and drowsy while working with my patients.

______ I feel myself “numbing out” while listening to my patients.

______ I tend to remove myself emotionally from my patients.

3: Do you have a super-nurse complex?

______ I experience protective feelings toward my patients.

______ I have experienced a need to rescue, shelter or save my patients.

______ I am deeply touched by my patients.

______ I have done more for my patients than is required by my professional role.

4: Have you become isolated or alienated from friends and colleagues?

______ I do not feel safe talking to my colleagues or supervisors about my concerns working with challenging patients.

______ I feel alienated from those who do not understand the work that I do.

______ I have felt abandoned by my colleagues and supervisors.

______ I find it difficult to share some of the horrific stories about my patients.

5: Are you disillusioned with your job?

______ It’s hard to maintain firm boundaries with my patients.

______ I have wanted to discontinue working with specific patients because of the intensity of their care.

______ I often wish that I were doing something different in my career.

______ I have a heightened awareness of living or reason for being.

Factors that fuel burnout

Here, the deadly dozen circumstances and characteristics that can lead to burnout and empathy fatigue. Check which statements ring true, and seek support (or at the very least, do a little soul searching).

___ 1. Toxic supervisor and lack of colleague support

___ 2. Little fun at work or in life

___ 3. Only a fuzzy understanding of one’s own needs

___ 4. Lack of a professional  process to turn create more competence and less anxiety

___ 5. Emotionally draining issues in one’s personal life

___ 6. An inability to say no to unreasonable requests

___ 7. Vicarious traumatization that takes an accumulated toll

___ 8. Personal relationships characterized by one-way caring (you give, everyone else takes)

___ 9. Constant perfectionism in work tasks

___ 10. Continual unresolved ambiguous professional losses

___ 11. A strong need to be needed

___ 12. Professional success defined solely by outward recognition or appreciation

Running on Empty … and what to do about it

When emotional resources are depleted, a nurse is no longer able to give of himself or herself. That can lead to burnout, which can contribute to negative and cynical attitudes and a reduced sense of personal accomplishment.

The following interventions can help prevent burnout:

• Avoid blame. Burnout leads to feelings of isolation, and blaming yourself or projecting blame onto others often leads to further withdrawal. Blame is self-perpetuating, and leads to a vicious negative cycle.

• Take action. Start by stepping back and reflecting upon those circumstances that have led to burnout with your job. Self-knowledge can  decrease feelings of helplessness. What action can you take to change your circumstances? Is there someone you can trust to talk to and share your feelings? Do you have colleagues who share the same frustrations? Brainstorm ways to assist and support each other.

• Take control. Identify what you can–and cannot—do to change your work circumstances. Focus on what you can control. Strengthen your own assertiveness skills and learn to say “no” when appropriate. Know your own triggers and find ways to manage them.

• Set goals. Reflect upon your professional and personal goals. If your current job doesn’t nurture those goals, it may be time to take your talents to a new and different setting. Transitioning from inpatient to outpatient care or changing specialty practice can often rekindle enthusiasm and the desire to learn. Think about the good opportunities that are ahead in your work and your life, which may help you feel “unstuck.”

• Practice self-care. Basic self-care includes exercise, adequate rest and sleep, and good nutrition. Other burnout preventive measures may include meditation, guided imagery, yoga, journaling or other activities that lead to personal insight or a higher level of spirituality. Treat yourself to massage therapy or, if needed, interpersonal therapy. Find support from relationships outside of  work, with people who can listen to your concerns objectively and provide feedback. Identify something to look forward to each day, in or out of the work setting. This may be quiet moments in a garden or a walk with a close friend or loved one.

Six strategies for avoiding compassion fatigue

It’s a vicious circle: When you’re suffering from burnout and compassion fatigue, physical and emotional exhaustion make it difficult to improve your self-care strategies. You may also subconsciously feel that self-care is selfish if it takes away from work-related projects or valuable time with family and friends. This represents a different but similar double-edged sword—a personality trait of selfless giving but a vulnerable point of self-starvation. Here, six strategies for avoiding compassion fatigue.

1. Practice responsible selfishness. Engage in activities to recharge and renew personal energy for your own well-being while  remaining responsive to the needs of others.

2. Separate work from home. Develop strategies to leave work at work. Decompress on the commute home or practice meditation or exercise right after work. A healthy barrier can minimize the compounding effect of personal and professional stressors.

3. Develop positive support groups. Surround yourself with people who are willing to listen, empathize and problem solve with mutual understanding. And, don’t be afraid to engage in group or individual psychotherapy.

4. Refuse to be a victim. Feelings of helplessness exacerbate negative feelings. Don’t dwell on what you can’t control… the realities of managed care, for instance.

5. Remember to laugh. Hearty and sustained laughter has been found to relieve stress and boost immune response. Carry out activities that promote laughter, such as social events with friends, movies and, yes, even finding the ability to laugh at our own gaffes.

6. Redefine success. For high achievers, a sense of personal failure is a major contributing factor to compassion fatigue. Learn to reframe expectations and value every little thing you do for patients each day.

Adapted with permission from Self-Healing Through Reflection: A Workbook for Nurses, Hygeia Media Copyright, 2012. Copies of the book may be purchased through the Oncology Nursing Society at ons.org/publications.

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Nancy Jo Bush and Deborah A. Boyle

Nancy Jo Bush, RN, MN, MA, AOCN, is an assistant clinical professor and lecturer at the UCLA School of Nursing. Deborah A. Boyle, RN, MSN, AOCNS, FAAN, is the oncology clinical nurse specialist at the Chao Family Comprehensive Cancer Center at the University of California, Irvine.
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